June 13 marked the second anniversary of the tragic killing of Taunton teenager Barnaby Webber, one of three people who was fatally stabbed in Nottingham by Valdo Calocane in 2023.
Following the conclusion of the criminal case against Calocane, NHS England and the Care Quality Commission (CQC) have been reviewing mental health services across the UK, trying to assess how Calocane was failed and what needs to be done to prevent similar events in the future.
The NHS Somerset integrated care board (ICB) has now published an action plan to improve its own mental health provision – though it will require up to £3m of additional government funding to fully implement all the planned changes.
Ian Coates, Grace O’Malley-Kumar and Barnaby Webber were killed in Nottingham on June 13, 2023 by Calocane, who was subsequently sentenced in February 2024 to spend the rest of his life in detention at a high-security hospital.
Calocane had been a patient of Nottinghamshire HealthCare Foundation Trust, having been diagnosed with paranoid schizophrenia in 2020 and been sectioned four times in less than two years.
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The Care Quality Commission (CQC) recently completed a review of the trust’s mental health services, recommending (among other things) that all trusts carry out a similar review and implement any necessary changes.
Subsequently, NHS England asked all trusts and ICBs to review the effectiveness of their intensive and assertive community treatment (IACT) services, focussing on “people with severe mental illness who require treatment but where engagement is a challenge” (i.e. failing to attend appointments, take medication or otherwise accept help).
The issue was discussed when the ICB met at NHS Somerset’s Yeovil headquarters on Thursday morning (June 19).
Neil Jackson, deputy service group director for mental health and learning disabilities, said: “Part of the request [from NHS England] was that we created a ‘high risk of harm list’ for posting, so the team was very clearly aware of all of the patients that are high risk.
“We’ve managed to get that into our governance meetings in the senior leadership team, so on a regular basis we have a member of the team that’s able to discuss with us all of the high risk patients, so that we’re clear about what measures we need to take if necessary.
“When our staff are assessing patients, they’re not only looking for risk to themselves or to the patients themselves, but they’re also looking very clearly at risk to others, which is something that perhaps wasn’t done as much before we implemented new training.”
Mr Jackson said Somerset’s in-patient provision for mental health patients (i.e. dedicated wards where they can receive safe treatment) was in the middle of “a two-year transformation programme”, focusing on providing better continuity between inpatient and community care (to prevent patients slipping through the net).
The action plan also mandates that patients who are discharged from hospital have clear care and support plans in place, in line with Section 117 of the updated Mental Health Act 1983.
Mr Jackson said: “We’ve done a very good update on the policy recently, which means we’ve got a really clear check-list, with really clear guidance for the inpatient wards, social services, the local authority and the community services that we manage.
“One of the main benefits for us with this is we’ve got clear templates, so that we can be clear when people have been discharged from hospital.
“We’re really monitoring them very closely, especially within the first few weeks, and then being able to have a clear review pattern over the next the following years and months to come.”
One of the main problem with severe mental health patients is their failure to attend regular appointments or reviews – something which could lead to them being missed if their condition deteriorates at a later stage and they cause harm to themselves or others.
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Mr Jackson said: “There’s now a really clear procedure to make sure that patient is contacted, monitored, and if they’re not able to be contacted, staff continue to try.
“If we get patients where we eventually can’t get hold of them, we’re having very regular disengagement meetings to make sure that everything’s been done that could be done to ensure that we haven’t lost that patient.”
Mr Jackson said work was also ongoing to ensure the different branches of healthcare could access a patient’s medical notes seamlessly, with the creation of the Somerset integrated digital electronic record (SIDER).
He said: “This means that we’re not asking the patients to give their story over and over again.
” It also means that we’ve got access to really good safety plan management, so that we can share those safety plans with GPs and the local authority so they can respond quickly to patients.”
Treatment in county pledge
The plan also includes a commitment to treating more patients within Somerset (rather than sending them outside of the county to access specialist services, at a potentially higher cost) and to improve the liaison between staff and patients’ families to ensure they are properly supported.
William Barnwell, associate director for mental health, autism and learning disability, said that implementing all these improvements to the fullest extent would cost around £3m – funding that was not currently being provided by the Department for Health and Social Care (DHSC).
He said: “The issue is that no national funding has been allocated to this programme for delivery, and NHS England has asked us to prioritize actions that have no cost implications.
“The autumn statement did mention some allocations for crisis care, which which might help in related areas to this work, but it’s not a direct funding pot for intensive and assertive outreach.”
NHS England will now review the ICB’s action plan, with an update expected to come back before the board in September.