Suicide Risk Assessment Tools in the NHS

Debate between Hugh Gaffney and Kevin Hollinrake

Wednesday 4th September 2019 Westminster Hall

[Kevin Hollinrake]

I entirely agree with the hon. Lady. I know that the Bellerby family would very much like to meet the Minister here today—the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries)—to see what can be done to make sure these situations do not happen again, and I think they would be very pleased to meet the hon. Lady, too, because I know that she does tremendous work in the all-party parliamentary group.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

Will the hon. Gentleman give way?

[Kevin Hollinrake]

I am happy to give way again and then I will make some progress.

[Hugh Gaffney]

I will just add my point, from Scotland. In emergency departments, the staff have not been trained up to the level that we are hearing about today. Suicide is a big risk, especially among young people, and all we are asking for is that people look at this situation and give emergency staff the proper tools and training. If that had happened before, Andrew would be with us today.

[Kevin Hollinrake]

The hon. Gentleman is absolutely right and I am grateful to him for his very kind contribution. I know that Andrew’s family will also be grateful to him.

The fact is that the Sheffield trust had been treating Andrew for many years; it knew him well and knew that he was a serious suicide risk, yet none of this was taken into account when he was admitted to hospital for that fateful final time. The untrained nurses carried out the assessment using a crisis triage rating scale, CTRS, and deemed Andrew fit to be discharged. They rated Andrew 14 on a scale of zero to 15, where 15 means that there is no serious or immediate risk of suicide, despite the fact that Andrew had a history of suicide attempts and also threatened to jump out of a fifth floor window while he was being assessed.

The insult to fatal injury in this case is that Mr Richard Bellerby has had to fight for justice and answers for years. He describes the trust’s role in this process as a campaign of dirty tricks—dirty tricks, denial and deceit. In February 2018, the trust finally admitted its wrongdoing, apologised and agreed to settle out of court, but before doing so it had persistently and gratuitously maintained that it was not at fault. For instance, the trust had said that it had an expert witness whose opinion was that whatever the trust would or could have done, Andrew would still have taken his own life. However, the trust refused to supply that expert witness’s evidence and it appears that such an expert never even existed.

The inquest established that the trust was guilty of missing numerous opportunities to provide help. The trust’s own internal investigation revealed that the nurses who had seen Andrew had no training in this area, which directly contravenes national guidelines. At the inquest, there was an embarrassing blame game between Andrew’s GP and the trust, with each pointing the finger at the other. As Mr Bellerby has said, it was like musicians in an orchestra playing from a different sheet of music, with no conductor.

There appears to be a complete lack of accountability; nobody has been properly held to account for these errors. The trust admitted in its internal investigation that it had failed to carry out adequate risk assessments. In Richard Bellerby’s profession, which is construction, failure to carry out proper risk assessment or failure to train people properly can lead to a charge of criminal responsibility for manslaughter in the event of a fatality.

Instead of being open and honest about the circumstances surrounding Andrew’s death, the trust only corresponded when it was forced do so. There were no responses to Mr Bellerby’s letters unless they were sent by recorded delivery, and even then the only responses came from corporate affairs managers rather than from clinicians, and they still failed to provide answers. The trust has not even responded to my letters, other than to send a holding response. I wrote to the trust on 28 January asking for answers to questions and I chased things up on 6 March, but there was still no full response. When the trust finally agreed to meet Andrew’s father, Mr Bellerby, it was of course a meeting with the corporate affairs director. When Mr Bellerby insisted on a clinician being present, the meeting was cancelled.

The trust refused simple requests for information, such as how long the nurses who saw Andrew had worked at the trust and what their qualifications were. The two-year battle cost the NHS around £40,000 just to reimburse the Bellerby family’s legal costs, in addition to any costs that the trust itself and NHS Resolution would have incurred. The total bill is likely to be in excess of £100,000—all for £9,000 in compensation. Critically, there was no compassion, no condolences and no remorse. Instead, there was contempt, denial and disregard.

To say the Bellerby family won is a travesty. They lost their son, a grandson, a brother, but they did defeat the trust. With the help of their solicitors, Irwin Mitchell, whose efforts were instrumental to their success, they won their case, they received their grudging apology and the trust has now stopped using the CTRS. All the family wanted was recognition of the failures and an apology. Given that, everything could have been sorted on day one. Instead the family had to fight against our own bureaucracy. It beggars belief that we tolerate a system that behaves in this manner.

Surprisingly, given the facts of the case and its role in the two-year cover-up of the truth, NHS Resolutions agrees with having a position of openness. In its 2018 report, “Learning from suicide-related claims”, it states:

“Where compensation is due it should be given willingly and in a timely manner to prevent further distress and suffering to distraught families.”

It is time we lived up to those fine words.

The Bellerby family have worked closely with Manchester University on the inquiry I mentioned earlier, which is called, “The assessment of clinical risk in mental health services”. It has helped to establish the extent of the problem of inappropriate use of suicide risk assessment tools in the NHS and the figure of 636 deaths per annum. It has also established that today, 33 out of 85 trusts use a tool that has not been independently validated and 29% of trusts use it with untrained staff. The national inquiry into safety in mental health recently raised issues of the

“inconsistency across mental health trusts in the length and content of risk assessment tools”

and a

“variation in how tools are used and examples of use contrary to national guidelines”.

Everyone seems to agree that the incorrect use of such tools is wholly wrong. Mental health charity Mind is clear that the Government should standardise tools across the service, improve training and support in their usage and follow-up within 48 hours with those who have received assessments. The Royal College of Psychiatrists said that we should

“move away from a risk assessment model to a risk reduction model”.

I know the Minister will be appalled by the full details of the case and will be determined to help drive change in the system, and I have some questions for her. What has changed since Andrew’s death? Specifically, what action will she take to ensure that mental health trusts are only using risk assessment tools that have been independently validated as safe? What action is she taking to ensure that staff in mental health services receive training in risk assessment? What action is being taken to support staff to be able to talk to people about suicidal thoughts? Will she implement a process so that the Care Quality Commission or another body can check that best practice is adopted? Will she commit to an ambition for zero suicides among all those under the care of mental health services? Will she look at the behaviour of the trust and drive through a new policy of openness and honesty in our health services? Finally, will she meet me and my constituents to hear Andrew’s story and possible solutions at first hand, to ensure that Andrew did not die in vain?