The review into Nottinghamshire Healthcare NHS Foundation Trust (NHFT) and the mental health services provided for Valdo Calocane, a paranoid schizophrenic who killed three people, has occasioned denunciations of the Trust.
In June 2023, Calocane went on a rampage in Nottingham, killing students Barnaby Webber and Grace O’Malley-Kumar, both 19, with a knife as they returned from a night out. He then stabbed to death Ian Coates, 65, near the school where he worked as a caretaker. Calocane attempted the murder of three others, who were injured when he drove a van into them.
Calocane was charged with three counts of murder and three counts of attempted murder and remanded in custody June 17. At his trial Calocane denied the three counts of murder, but admitted three counts of manslaughter, on the grounds of diminished responsibility, and three further counts of attempted murder. On January 25, 2024, he was sentenced at Nottingham Crown Court to be detained indefinitely at a high-security hospital.
Victoria Atkins MP, the then Conservative government Health and Social Care secretary, commissioned the Care Quality Commission (CQC) to carry out a review of NHFT under Section 48 of the Health and Social Care Act 2008. The CQC findings were published in two parts. The first in March this year was an assessment of patient safety and quality of care provided by NHFT, and “progress made at Rampton Hospital [which had not treated Calocane before the killings] since our last inspection in July 2023.”
This week’s second part examined the treatment received by Calocane between May 2020 and September 2022 and found that “the risk he presented to the public was not managed well.” It concluded that “there was no single point of failure but a series of errors, omissions and misjudgments.” It warned there are “systemic issues with community mental health care which, without immediate action, will continue to pose an inherent risk to patient and public safety.”
The family of the victims issued a statement saying of those responsible for Calocane’s care, “there seems to be little or no accountability amongst the senior management team within the mental health trust. We question how and why these people are still in position…
“We were failed by multiple organisations pre and post June 13, 2023. Along with the Leicestershire and Nottinghamshire police forces, these departments and individual professionals have blood on their hands.”
Sections of the right-wing media leapt on the families’ statement, with the Daily Mail plastering “Blood on their Hands” on their front page.
The families are justifiable angry that their loved ones needlessly died in such a horrific way at the hands of a man who should never have been on the streets. But what is not explained anywhere, from the CQC report to sensationalist media headlines, is how this situation has come about.
Calocane was diagnosed with paranoid schizophrenia in 2020 and was sectioned four times in less than two years. In a 300-page summary of his medical records, seen by the BBC, a doctor warned three years before the Nottingham attacks that Calocane's mental illness was so severe he could “end up killing someone.”
Calocane's first admission for mental health treatment came on May 25, 2023 after two incidents when he broke into neighbours’ flats, believing his mother was being raped inside. It was just prior to this that Elias Calocane, Valdo’s brother, said he first became aware that something was wrong: He told the BBC, “He was just crying on the other side of the phone for 40 minutes… Finally, he said to me, ‘I hear voices’.”
The BBC notes that after the first incident of breaking into neighbour’s flats, “He was prescribed medication by doctors for a psychotic episode and released from custody by police. His mother, Celeste, asked the mental health team to keep him until she arrived from Wales, but her pleas were ignored.
“His family said this was the first of the missed opportunities to prevent someone being hurt, because he was not admitted to hospital until after he had carried out another break-in.
“An hour after his release, Calocane tried to get into another flat. The woman inside was so terrified she jumped from a first-floor window to escape and was severely injured.”
Calocane was arrested and sectioned under the section 2 of the Mental Health Act. After being released he again said he heard voices coming from another neighbour’s flat and tried to break in. This time he was detained under section 3 of the Mental Health Act, meaning he could be kept in hospital for up to six months.
The BBC reported, “According to the medical records, at a July 2020 meeting with health and care professionals while Calocane was ill in hospital, a psychiatrist observed that ‘there seems to be no insight or remorse and the danger is that this will happen again and perhaps Valdo will end up killing someone’.”
Yet just two weeks after this warning, Calocane was discharged from Highbury Hospital.
In September 2021, Calocane was sectioned for a third time, but was released less than three weeks later. In January 2022, he was sectioned for a fourth time and final time after assaulting his housemate in their flat. In September 2022, the mental health team discharged him back to his doctor.
How does one account for this history, if systematic incompetence is rejected?
Only by placing events in their proper context.
As far back as 1983, the Thatcher Conservative government adopted a policy of “Care in the Community” as part of an overall cutting of NHS provision within the political project of “rolling back the frontiers of the state.” This policy was maintained by successive Tory and Labour governments over the next four decades, leading to a disastrous situation facing millions suffering mental health problems.
What was pursued was no care in a ruined community rent by unprecedented levels of social inequality.
A report by Parliaments’ Committee of Public Accounts published in July 2023—a month after the Nottingham killings—found that the “number of people accessing NHS-funded mental services has increased, from 3.6 million in 2016-17 to 4.5 million in 2021-22. However, this equates to only around one third of people with mental health needs accessing services, with an estimated eight million still not doing so. The NHSE [NHS England] acknowledged that, under the current planned rates of service expansion, sizable treatment gaps will persist, even if it meets its access targets for 2023-24. There are also 1.2 million people currently waiting to be seen following their referral to community mental health services.”
The cut to funding that was available for mental health care was accelerated during the Tories’ scorched-earth austerity programme from 2010. An October 2018 Trades Union Congress report, “Breaking Point: the crisis in mental health funding,” notes that while “the total amount of income received by mental health trusts in England has risen since 2016-17, once inflation is taken into account it becomes clear that they actually received £105 million less than in 2011-12.”
The report found, “Underfunding in mental health has had a particularly significant impact on staffing, with a 13 percent reduction in full-time equivalent mental health nurses between 2009 and 2017 and a 25 percent reduction in nursing within inpatient care.”
Cuts to mental health services continue apace. Nottinghamshire Integrated Care Board (ICB), which organises healthcare for the county where the deaths took place, plans £55 million in cuts spread over the current financial year and 2025/26. Cuts include care for people who have been sectioned.
Even in the face of warnings of the consequences of Calocane not receiving the correct treatment in a well-funded setting and being allowed to roam the streets with profound mental health issues, Notts TV revealed, “The ICB is proposing reviewing what aftercare is given to people who have been detained in hospital under the Mental Health Act…. The ICB says it wouldn’t remove care where needed but claims £780,000 could be saved over the next two years by ensuring it is provided more appropriately.”
This terrible situation, dangerous to those afflicted with mental illness and the general population, will worsen under a Labour government committed to further attacks on the NHS, with Health Secretary Wes Streeting demanding an end to the “begging bowl culture where the only interaction the Treasury has with the Department of Health is ‘we need more money for X, Y and Z’.”
Labour’s response to the Nottingham tragedy from the outset has been marked by its law-and-order agenda. Following Calocane’s sentencing, then shadow home secretary and now Home Secretary Yvette Cooper said the Crown Prosecution Service accepting Calocane's plea of manslaughter by reason of diminished responsibility should be investigated. A review by His Majesty’s Crown Prosecution Inspectorate (HMCPI) has suggested that new legislation was required, to create a “second degree murder” classification carrying a heavier punishment.