Whorlton Hall Prosecution – 21 March 2023 Read Evidence

After the two live witnesses had given their evidence today, Olivia Davies and Joe Plomin, it was explained to the jury that there is some evidence that is agreed by all parties, and as such witnesses are not called to give their evidence, instead it is read onto the record because it is not in dispute. There were two statements read to the jury.

Statement 1 [I’ll not report her name] dated 14 October 2020

The first was from Patient 1’s mother. In it she explained that her daughter had been diagnosed with autism when she was 2.5 and had attended special educational needs schools from that point onwards, until she was 15 years old. Roughly around that time she was sectioned for the first time under the Mental Health Act and admitted to a hospital in Norfolk.

Her mother told the court “she was suspected to have a psychotic illness but this was not proven, she was diagnosed with classic but severe autism. During this time she was also diagnosed with Tourettes Syndrome, but different doctors at the next hospital said there was no evidence of this”.

She explained to the court that Patient 1 was then placed into Assisted Living in Nottingham, at a hospital but as her behaviours worsened she was sectioned and sent to Whorlton Hall. Her mother said there had always been argument amongst clinicians about whether her daughter had a learning disability or whether everything was due to her autism. She said “as a family we still don’t know the answer to this”.

She described the purpose of her daughter’s stay in Whorlton Hall was to help change her behaviour, with the ultimate goal to go back to Supported Living. They were to deal with this by teaching her de-escalation techniques, such as breathing techniques, to help her daughter deal with what she describes as “brain shocks”.

In her statement, Patient 1’s mother described her daughter’s difficulty with triggers for her behaviour. She explained how the list of triggers gets bigger every week, some can stay for a few days, but some are with her for years. She was able to list for the Court over 20 triggers which she referred to as “the main ones” that were well known to her family, and documented with medical professionals. These included balloons, but specifically them popping or bursting, songs coming to an end, talking about the weather, singing and clapping.

Her mum said balloons fell into the “breaking category” for her daughter as she’s petrified of them going pop and bang. She told the court that “men is a tricky one to explain as to why she becomes upset” when they’re on her observations. She said they “still do not know why she did not like men looking after her” but that it was well known when she moved to Whorlton Hall, and had been apparent before she left St Andrews Wilmslow Hospital in Nottingham.

Her mother described how her daughter could find repeating of words soothing, and had done since she was a toddler. She said that she will sometimes repeat words again and again and if you don’t do or say what she requires it can lead to her having a massive meltdown, which could result in her causing harm to others and herself, and destruction of whatever is around her. She finished by explaining that although her daughter had a long history of triggers, if she were anxious or upset, or going into a meltdown, she would sometimes requests some of her known triggers for example she would ask her mum to message her about things that she knows will make her worse. She explained that “if my daughter asks anyone for a balloon it will already be when she’s already upset” she explained that she believed that she did this as she knows it will make her more upset, and with that comes an adrenaline high which she believed to be similar to a “brain shock”.

Statement 2 – Dr Tom Jackson dated 19 March 2023

This statement was given by Dr Tom Jackson who was currently employed as the Trust Lead and Clinical Lead and Consultant Clinical Psychologist for Learning Disability at South West Yorkshire Partnership NHS Foundation Trust in Wakefield.

He said that following the BBC Panorama broadcast on 22 May 2019, Durham Constabulary had undertaken an investigation into the care provided to residents at Whorlton Hall.

The Crown Prosecution Service sought expert clinical opinion on the type of patients accommodated at Whorlton Hall and the underlying principles of providing care in this sort of establishment.

He lists the sources of information that he had for compiling his report which included the film clips already shown to the jury and a description of them provided by the Officer in Charge, and also documents from patient’s care plans.

He specialises in the support of people with complex intellectual disabilities, emotional and psychological disorders which challenge others, typical of those residing at Whorlton Hall hospital.

He confirmed that the patients at Whorlton Hall were all adults with learning disabilities who had significant additional psychological and behavioural needs and who were in that hospital because they required a level of specialist care not readily available in community settings.

He explained that many were displaced from their families and places that they called home in order to get the specialist care they were deemed to require. All patients needed that care as a result of significant impairments in their intellectual functioning, social and adaptive functioning. He said their deficits were present throughout their lives and were longstanding, originating in childhood.

He said all patients frequently experienced high levels of distress and these were overwhelming, leaving them vulnerable to harming themselves and other people. He said that they found all aspects of life much harder than non-disabled people.

He told the court that patients had all sacrificed the usual level of control and autonomy enjoyed by most non-disabled people, leaving them reliant on support provided by caregivers. For many they were further restricted due to being detained under the Mental Health Act 1983. Many decisions were made by those who were legally responsible for their care, consultant psychiatrist and wider care team.

Subsequently, he told the court, patients would have to trust that they were safe in the care of their caregivers, that their caregivers had good intentions towards them and had their best interests at heart.

Although he had not assessed the patients himself, he told the court that it was reasonable to assume that many of the patients would have found the world and people in it, to be an unpredictable and frightening place, and suffered with high levels of anxiety.

He said that this typically manifests in people with learning disabilities as heightened arousal, fight or flight response, and a desire for predictability in their routines. He told the court that Whorlton Hall were hospital wards for people with learning disabilities, people who find life harder than other people because of significant intellectual and functional impairments.

He said that people were typically admitted to these types of facilities due to their behaviour, which is deemed to present significant risk of harm to themselves, or others, and is of a degree and nature that can not be met in community settings.

He told the court that almost everyone admitted to these services will have experienced hardship, disadvantage and [my note is unclear here, apologies, he may have said deprivation, or trauma, or both]. He said that about 80% of those people will have comorbid mental illness or neurodivergence, such as autism or ADHD.

He told the court that the aim of such facilities should be to help people admitted to live well, develop independence, show less challenging behaviour and better cope with difficult life events by providing specialist care and treatment, which is not available or could not safely be provided in community settings.

He told the court that there were a variety of methods that could be used, but that there are aspects of care which are consistently and commonly advised and recommended in the Western World over the past twenty years including that described in the National Service Model for Acute Learning Disability Inpatient Services in the NHS published in January 2017.

He said that typically services would be expected to apply the principles of active support, to enable people to live well and as independently as possible. They should employ positive behavioural support strategies to reduce the frequency of behaviour that challenges, and they should apply the principles of trauma informed care to help people better cope with difficult life experiences.

He told the court a little more about each of these approaches, pointing out while doing so that active support can often be harder and take longer than staff doing things themselves, but that it was an essential and important part of recovery.

He said that positive behaviour support is based on the notion that challenging behaviour is a sign of a person’s distress and unhappiness and that this will reduce if people are less distressed and unhappy. He said that it aims to understand why people are distressed and unhappy and support them with things they find difficult, and help them to lead happy, fulfilling lives, engage in leisure, hobbies and meaningful activity.

He said that trauma informed care is a way of providing support which formally acknowledges people being cared for almost certainly experienced some sort of abuse, trauma or loss in their life. He described that it changes the narrative from what’s wrong with you, to what has happened to you. He outlined the 4 Rs which were essential to trauma informed care: reassurance, relationships, regulation and routines, describing each in outline.

He told the court that the key functions of acute learning disability hospitals such as Whorlton Hall, were to conduct a comprehensive assessment of each patient’s underlying mental health, behaviour or disturbance. To then in turn develop a formulation and diagnosis, and to provide treatment and therapeutic, developmental intervention to allow each person to be discharged as quickly as possible.

He said that the contribution of care workers typically falls into three categories:

  1. providing direct support to patients and meeting their care needs
  2. managing the ward environment to ensure the effective running of the ward and the safety and wellbeing of patients and others; and
  3. contributing to the clinical team’s assessment and treatment of patients helping the clinical team to understand patient’s behaviour and implement appropriate strategies which reduce the likelihood of future challenging behaviour and increase the likelihood of future prosocial behaviour.

He told the court that one of the underlying principles of caring professions is that care workers are in service to the patients in their care. He described behaviours he’d expect to see, including pro social modelling, active support and engaging in activities, empathy, compassion and kindness for patients in their care.

Dr Jackson said it was reasonably expected that carers at Whorlton Hall would have sufficient knowledge to enable them to work with each patient on an individual basis. The specifics of these interactions should be carried out as directed in each patient’s care plans. In general terms this was positive encouragement in activity, through compassionate, and enabling facilitative support. Lots of encouragement, affirmations, reassurance and positive praise.

He told the court given people’s presenting difficulties, common aspects of support that he’d expect to see provided to people would include proactive engagement in activities, predictable routines, reassurance and avoidance of further trauma, support with difficulties and communication, and staff promoting positive relationships between patients’ families, friends and staff, and assisting them with regulating difficult emotions.

He told the court that approved clinicians are responsible clinicians, typically consultant psychiatrists, or very experienced or qualified clinicians from other professions.

He said that restrictive physical interventions, also described as physical restraints, were direct force used to limit or restrict someone’s movement. To be considered lawful they should be deemed necessary, proportionate and justifiable and only used to prevent serious harm. He told the court that any use should be carried out using the least restrictive interventions possible and for the minimum amount of time possible.

Finally, with regards to care plans he told the court that the care, support and treatment provided to patient detained under the Mental Health Act are the responsibility of the patient’s responsible clinician, along with the clinical team, and that they should be adequately described. He said that hospital care plans should be approved by the clinical team responsible for patient care, usually the MDT.

He told the court that care workers in hospitals such as Whorlton Hall are not autonomous practitioners, and they are not broadly free to determine how and when care is provided to patients. Care plans are not guidance or advice that they can choose to follow, they are directives that must be followed consistently. He told the court that adherence to care plans by care workers is typically the responsibility of the nurse in charge of each shift, and that’s a requirement for all regulated activity such as hospital care for people detained under the Mental Health Act 1983.

That was the end of the evidence today. Ms Richardson, the Crown Prosecutor advised HHJ Smith that the crown envisaged safely closing their case by Friday. The case will continue tomorrow morning.

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