Tom Hayward
A year on from the sentencing of Valdo Calocane, the perpetrator of the 2023 Nottingham attacks, a debate over accountability continues to rage. Yet despite a push to identify specific individuals at fault, a picture has emerged of deeper flaws in our public services. With the recent announcement of a judge-led inquiry into the attacks, investigations into the events of June 2023 have also prompted a societal discussion about the broader failures in our mental health services.
Barnaby Webber and Grace O’Malley-Kumar, first-year students at the University of Nottingham, and Ian Coates, 65, were murdered by Calocane in the early hours of 13 June 2023. For members of this University, the loss of Barnaby and Grace was especially painful – both were bright and vibrant members of our community. In the following days and weeks, a wave of community support emerged, with grief and condolences shared by students, faculty, and alumni worldwide.
The sentencing judge cited Calocane’s “severe symptoms of mental disorder” as justification for the sentence.
In January 2024, Calocane was found responsible of three counts of manslaughter on the basis of diminished responsibility, and sentenced to be detained indefinitely at a high-security hospital. This sentencing was to the shock and disappointment of the victims’ families, who were anticipating a murder conviction and prison sentence. The sentencing judge cited Calocane’s “severe symptoms of mental disorder” as justification for the sentence.
The bereaved families have called for individual clinicians to be named and held responsible for failings in Calocane’s treatment, seeking individual accountability for the tragedy.
Calocane had spent two years being passed between different health services, all of which were unwilling or unable to administer effective and sustainable treatment for his mental illness.
At first glance, such calls appear to be justified given the litany of failures in the weeks and months before the horrific events of June 2023. Calocane had spent two years being passed between different health services, all of which were unwilling or unable to administer effective and sustainable treatment for his mental illness. The NHS Nottinghamshire mental health team had discharged Calocane in September 2022 back to his GP because of a ‘lack of engagement’ in his treatment. Calocane was known to the authorities and had been previously detained under the Mental Health Act, yet for the nine months in the lead-up to the killings, there was no contact at all between Calocane and mental health services.
Yet a mounting body of evidence suggests that systemic failings, rather than isolated individual errors, lie at the heart of this case.
As a result of unprecedented pressure, an approach has become ingrained in NHS practices to prioritise speedy treatment and discharge
A recent CQC inquiry into Nottinghamshire mental health services highlighted several longstanding concerns including soaring demand for services, chronic understaffing, and fragmented leadership. This is not a unique position – mental health services across the country suffer from these very issues. As a result of unprecedented pressure, an approach has become ingrained in NHS practices to prioritise speedy treatment and discharge: treating symptoms rather than root causes of mental health concerns.
Who could blame clinicians for this approach? In 2023, mental health services in England received an unprecedented 5 million referrals, an increase of 33% from 2019. This is not a problem which will dissipate in the coming years, either. The prevalence of common mental disorders has been rising since the pandemic, and rates of mental illness are growing at a faster rate among children and young people.
In healthcare, the fear of professional repercussions and the prevalence of blame culture prevents open discussion about mistakes.
In Matthew Syed’s Black Box Thinking, the author outlines the ‘black box’ culture of the aviation industry. After plane crashes, investigators treat the incident as an opportunity to prevent future tragedies by methodically examining errors without blaming individuals in isolation. Emphasis on a developmental approach enables individuals to speak up when things are going wrong, rather than being fearful of the potential consequences. Meanwhile, in healthcare, the fear of professional repercussions and the prevalence of blame culture prevents open discussion about mistakes. Rather than errors being seen as opportunities for improvement in patient treatment, they are perceived as failures to be punished and as black marks on the reputation of doctors and nurses.
What’s needed is an acceptance of institutional problems in the NHS, and not least more resources to community mental health provision.
A campaign for individual accountability will do little to solve the systemic problems in NHS mental health treatment, or to ease the growing burden on the UK’s mental health services. It is understandable to feel that naming clinicians who have made errors is a way to achieve justice or closure – families and friends feel betrayed by the very services that were meant to protect their loved ones. But it also runs the risk of obscuring deeper structural issues – underfunding, staff shortages, disjointed leadership – that are really to blame. Jeremy Walker, a former NHS mental health manager and CQC inspector, wrote recently that further inquiries and commissions will “demoralise staff, sap clinical energy and ensure that the most able staff spend their time managing change when they should be managing illness and treatment”. Rather than devoting millions more of taxpayer money to blame games, what’s needed is an acceptance of institutional problems in the NHS, and not least more resources to community mental health provision.
Health Secretary Wes Streeting has embraced the notion that “sunlight is the best disinfectant” in his quest to fix a broken NHS. He should start by shining that sunlight on the system’s flaws, not scapegoats.
Tom Hayward
Featured image courtesy of Number 10 via Flickr. Image license found here. No changes were made to this image.
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