13 April 2023
The fourth defendant to give evidence was the Senior Staff Nurse Karen McGhee. Her counsel, Mr Normanton, started by providing additional transcripts for additional video clips he would show, and one page of additional agreed facts.
In response to questions from Mr Normanton the court heard that Mrs McGhee was 54 and she’d lived in a village outside Darlington all her life. She had first worked as a care assistant in 1993 before working for a crane hire company and as a sales advisor. She told the court that she was divorced and had been a single parent to her two, now adult, children. She had worked as an NHS bank healthcare assistant between 2011 and 2014 mostly working on an eating disorder ward in Darlington. Mr Normanton asked Mrs McGhee why she had returned to working as a care assistant and she told the court that she’d always wanted to be a nurse, since she was a young girl, adding “that was always my passion, helping people”.
Asked by Mr Normanton why she’d not become a nurse in the 90s Mrs McGhee explained that she now knows she is dyslexic but back then “you were just classed as thick” and she left school without qualifications and her confidence was shattered. After returning to study in 2012, and completing a foundation access course into health, she started a learning disability nursing degree at Teesside University, graduating in 2017 with a third class degree. Mrs McGhee told the court that she found the practical side of study to be “brilliant” but the academic side was challenging. After she passed her course and graduated, Ms McGhee worked as a community nurse at TEWV between March and November 2017. Mr Normanton asked what that role involved, she said lots of assessments.
MrN: What kind of people were you visiting? What problems did they have?
KMcG: People with behaviour at home, showing aggression to either their parents or the services they were using. I’d try to implement strategies to try and help them.
MrN: OK. Your training at Teesside University, your degree in Nursing Studies, did you have any particular specialism when you qualified?
KMcG: I was a learning disability nurse, then. Now with mental health, learning disabilities is what I passed at but I’ve done a lot of mental health as well.
MrN: Were you trained in mental health?
MrN: Trained in learning disability but not in mental health?
KMcG: I was a learning disability nurse but the mental health side was just what I gained with courses and how I picked it up.
MrN: Ok. Did you enjoy being a nurse?
KMcG: I loved being a nurse
MrN: Why did you like it?
KMcG: It was a pleasure seeing, especially people with learning disabilities out in the community, having a full lifestyle.
Mr Normanton then asked Ms McGhee questions about whether everyone was fit and well in her family and she discussed her daughter’s health. Mr Normanton then asked Ms McGhee about her current employment situation.
MrN: Are you working as a nurse now?
KMcG: No, I’m suspended
MrN: You were suspended when?
KMcG: After the programme
MrN: And you haven’t worked as a nurse since?
MrN: What have you been doing for work?
KMcG: After the programme came out I couldn’t work for about 9 months, because I couldn’t face society.
KMcG: Now I work as a barmaid, a bar person.
Asked by Mr Normanton why she’d moved to Whorlton Hall to work, Ms McGhee told the court that she’d not enjoyed lone working as a community nurse.
KMcG: I recognised I wasn’t happy doing community nurse work and one of the other nurses in my team went to work at Whorlton Hall, and she told me about the job
MrN: Wheat were you told?
KMcG: Was a unit for people with challenging behaviour, learning disabilities and autism
MrN: Right. What level of challenging behaviour, did you understand the level of challenging behaviour you’d face?
KMcG: I thought I did
MrN: Right. When you went to Whorlton Hall, you say you thought you did, what do you mean by that?
KMcG: There’s behaviour that challenges and there’s Whorlton Hall behaviour.
Mr Normanton then asked Ms McGhee about the application process to secure her role at Whorlton Hall. She told the court that she applied for the position, had an interview that she believed was with Christopher Shield and Stephen Robdrup, and provided references.
Mr Normanton read an agreed fact which was an extract from a document provided to the police by Cygnet, which was a confidential reference form for Mrs McGhee. He read that to the court, it was from her nursing mentor when she first qualified and discussed her requirements for support with communication at handovers and it also discussed her confidence issues as a student. Mrs McGhee told the court “I do lack confidence but its a thing I’m building on all the time”.
Mr Normanton told the court, and Mrs McGhee confirmed, that she completed her probation at Whorlton Hall after 8 months in the role in August 2018. She told the court she had a mentor, who was one of the senior staff nurses. In response to a question from Mr Normanton, Ms McGhee told the court that she “didn’t think” there was a charge nurse when Olivia Davies was working at Whorlton Hall, and she was promoted to Senior Staff Nurse in February 2019.
Mr Normanton then goes on to ask about training. Mrs McGhee agrees she’d not been a nurse for very long when she joined Whorlton Hall in 2017, and she had the same 5 day MAYBO course as other staff. She said there was no training on the policies, staff were just shown.
Mr N: You sigh, why do you sigh?
KMcG: Because there was no training
MrN: You were shown those policies though?
KMcG: You were shown, yes
MrN: What about, we’ve heard a lot about ad complex conditions, was there training specific to a service user and their conditions?
KMcG: No, but you’d get training with regarding autism but autism is huge, you didn’t get training for one individual person
Asked by Mr Normanton if she’d received any training in managing staff on shift, Mrs McGhee said she only had what she’d received at university, and that Danshell and Cygnet had not provided any. Mrs McGhee said that she “definitely worked 40 hours per week and it could be more”, her contracted hours were 40 per week. Mr Normanton then moved on to asking about some of Mrs McGhee’s responsibilities during her time at Whorlton Hall.
Mrs McGhee answered Mr Normanton’s questions describing the role of named nurse, as the person responsible for the patient in multi disciplinary team meetings and responsible for their careplans, although she said that all nurses could still have input into those relating to all patients, not just the ones for whom they were named nurse. Mrs McGhee told the court about the practice for medication rounds, that in the mornings service users would come to the ‘clinic’, an office on the ground floor with lockable medicine cabinets, to collect their medication. Mrs McGhee told the court that only one resident was not on prescribed medication.
MrN: There have been references to treatment, either was no treatment, can you help us with were service users treated? As in therapy, things like that?
KMcG: Um, well, taking them out and doing their own shopping
KMcG: We did have an OT, an occupational therapist, you could go upstairs and do activities.
MrN: Was treatment of that kind, say occupational therapy, was that a regular thing?
KMcG: They were upstairs but there was nothing, apart from them type of therapies, there wasn’t like a wellbeing session. Was no sessions, no therapy sessions.
MrN: Was there a doctor there?
KMcG: The doctor would be there for the MDT meetings, once a week, unless required
MrN: Was the doctor there any more frequently than that?
MrN: In terms of medical staff then on shift, was just two nurses then?
MrN: What did you think about doctors only being there once a week?
KMcG: Sometimes we did need them, but we could phone them up and ask for advice and raise it in the next meeting, but a lot of the time was no need for doctor to be on site for medication.
MrN: What sort of occasions would be desirable for doctor to be there?
KMcG: If one of the service users was physically, seriously ill and we had to care for them, then that would be a massive help.
MrN: What about for example in response to violence from service users?
KMcG: Would have been very good they could witness the severity of some of the violence
MrN: But they weren’t there?
KMcG: They weren’t there
MrN: In terms of treating, you mentioned trips out, why was that treatment?
KMcG: It’s not treatments, it’s therapeutic
MrN: Why is it therapeutic?
KMcG: Because they’re living a normal life, going out shopping, giving purpose in life.
In response to a question from Mr Normanton, Mrs McGhee explained the nurses’ responsibilities for conducting and recording risk assessments before patients went on trip’s out. She then talked through the nurses’ responsibilities for record keeping, telling the court that healthcare assistants would fill out observation sheets and the nurses had to read them, and if anything were highlighted in them they’d be responsible for addressing it. Mrs McGhee told the court that if there had been a restraint incident then it was expected that the healthcare assistants would record what happened, and the nurses would then read them and sign it off, entering information onto the Ulysses computer system. Asked how long that could take in a day, Mrs McGhee responded “that could take a long time”.
Mr Normanton then asked Mrs McGhee about multidisciplinary team meetings and she responded that a patient’s named nurse, or one of the nurses, would go into the meeting and in it “would be any medical highlights of all the incidents” and then they’d discuss the patient in that meeting. She said the meeting would also involve the occupational therapist and doctor. Mrs McGhee told the court that each person would have an MDT meeting every month to six weeks, depending on how many people were resident at Whorlton Hall. Mr Normanton asked Mrs McGhee what was involved in setting up those meetings.
KMcG: You’d go in, have document, you’d gather, would take a very long time, would say Patient 1, how many times out in the community, how many incidents, good things about Patient 1, that could take a long time but on a night you’d get them done
MrN: What about behavioural changes, would that be reflected in the notes?
Asked by Mr Normanton who was in attendance at those meetings, Mrs McGhee said the doctor and OT. That an advocate might be there, or could be patient’s family members, and that the MDT meeting was a place where changes could be discussed.
At this stage the court adjourned for lunch.
After lunch Mr Normanton asked Mrs McGhee about handover meetings. She told the court that these took place at the start of every shift.
MrN: What was the purpose of a handover meeting?
KMcG: Allocation of the staff, also we went through 24hrs of each service users to see if there was anything that needed highlighting, or how the days went, positive things as well
MrN: What kind of things would need highlighted?
KMcG: Their behaviour, if they’d gone out in the community and an incident, any incident, also positive things highlighted.
MrN: What sort of positive things?
KMcG: Going out in the community, having a fantastic day
MrN: What specifically was the role of the nurse at a handover meeting?
KMcG: They’d take the lead, we’d allocate and tell staff about the events of the day.
Mr Normanton then showed the court a clip from a handover meeting that Olivia Davies had recorded on 29 January 2019.
MrN: What’s happening in this meeting, what’s going on?
KMcG: This is the morning handover, I was on night shift, during the night and had major incidents with Patient 6. He kept repeating about going to Manchester and when he goes to Manchester he’s going to have a party.
MrN: Is that something he said?
KMcG: He must have said it to someone
MrN: Why was it a problem?
KMcG: Because he wasn’t going to Manchester and wasn’t having a party and it would cause issues.
MrN: What sort of issues?
KMcG: Would be up all night, Patient 6 could be hitting his head, he had a deep scar down his head, would regularly hit the corner of the doorframe and open up or punch walls, throw faeces at staff
MrN: Ok focusing on what’s happening here, piece of paper had appeared, what piece of paper was it, where had it come from?
KMcG: Someone must have done something, when he’s been with staff members
KMcG: And Patient 6 was quite manipulative, he must have tricked someone into saying about Manchester and having a party.
MrN: You’re saying he can’t spell party like that and everyone knows don’t they he can’t do anything like this, is Patient 6. What’s the purpose of saying these things?
KMcG: To highlight it, was a lot of agency, no doubt Patient 6 would have tricked an agency staff into doing that
MrN: Were these meetings an opportunity to raise issues with staff and say stop behaving in particular way after this point?
KMcG: Yes, and to highlight it
HHJ: to highlight it
MrN: How would you have discovered this piece of paper, found out about it?
KMcG: Because I’d have been up all night with Patient 6 because of his behaviours and get to the bottom of it
HHJ: What was the piece of paper?
KMcG: I don’t know, if you know what I mean.
MrN: It’s saying Patient 6 is moving to Manchester and he’s having a party, that’s what you said in the recording?
Mr Normanton questioned whether the handover meetings were only for the nursing staff to say things and Mrs McGhee said that “anyone was free to say anything, highlight things from shift, ask questions”. She told the court that she would personally address it if anything were raised, by solving the problem or issue.
Mr Normanton then moved to ask Mrs McGhee about staffing issues. She told the court “we had major staffing issues” and there was a reliance on agency staff. In response to questions she said that the staff team was majority male and that it was not possible to put female care staff with female patients. Mrs McGhee told the court that Steve Robdrup, the Deputy Manager, was responsible for recruiting staff and that the nurse on shift would allocate staff to patients when they first arrived for the shift.
She told the court that if they didn’t have enough staff then “we’d have to phone around the agencies, different agencies and phone our staff to see if they could come in”. Asked how frequently that would need to happen Mrs McGhee replied “quite often” and agreed that it would take a long time to phone everyone.
Asked if there were any other duties in her role that had been missed Mrs McGhee replied allegations.
MrN: What would you have to do as nurse? We heard Patient 4 made them [allegations]?
KMcG: I’d go see Patient 4, ask him what it was all about. I’d come away, then return a bit later and ask him about the allegation and most of the time he’d retract it, but if he went along with it we’d have to go record it.
MrN: Did you do that?
MrN: Doing all those things, how busy was your role?
KMcG: Very busy
MrN: How would you describe the level of responsibility you were given?
In response to a question from Mr Normanton, Mrs McGhee told the court that she felt she could handle the role because she had a lot of support, from her colleagues who’d be on that day, other nurses and healthcare assistants.
Mr Normanton then asked Mrs McGhee a number of questions about the managers at Whorlton Hall.
MrN: There are two managers?
MrN: What did they do?
KMcG: Chris was the Manager, Chris Shield. He was in his office, 9 till 4 or 5pm, I can’t remember, he was in his office. Steve was the Deputy Manager, he was in his office doing the rotas.
MrN: We heard they were trained as nurses is that right?
KMcG: Yes, they’re both learning disability nurses.
Mrs McGhee told the court that Christopher Shield did not work overtime and spent his time in his office.
MrN: Was he present on the shop floor?
MrN: What about Mr Robdrup. He was in his office as well?
KMcG: He was in his office, he’d sometimes come out
MrN: Was he out frequently, observing things?
MrN: How did you feel about that, if anything?
KMcG: You just did your job, don’t think I recognised it until now looking back at it.
MrN: Now, looking back, how do you feel about it?
KMcG: Cross. Angry.
MrN: Why are you angry?
KMcG: Because I think we could have had more support
MrN: What did you think of the attitude of these managers? Did you have a view on their attitude at the time?
KMcG: No. We just got on with our work.
MrN: Looking back, what do you think?
KMcG: I think we could have had more leadership. They could have been more aware of what was going on, so we could have had more training.
Mr Normanton then discussed the other staff’s roles and responsibilities with Mrs McGhee. She told the court that healthcare assistants [interchangeably called support workers] would do a lot of the observations and that the senior healthcare assistants would be responders. Mrs McGhee told the court that most of the senior healthcare assistants, and therefore responders, were men. Asked by Mr Normanton if, as a nurse, she got to spend extensive amounts of time with service users, like healthcare assistants would, Mrs McGhee said that she could if they were short staffed, or if an incident occurred or someone was injured.
When Mr Normanton asked about record keeping Mrs McGhee told the court that she’d read everything recorded in observations notes and that she’d expect any changes in behaviour or any new triggers to be recorded, telling the court that if it were not recorded the nurses would not know about it. Mr Normanton then moved on to discuss careplans.
MrN: What really is the point of a careplan?
KMcG: In your careplan is a lot of things, a lot of, it helps healthcare assistants to look after the service users. There’s risk factors in there in a different assessment, they’d be all different assessments, not just careplan, loads, lots and lots of different assessments in there
MrN: As in?
KMcG: Even going out, there would be a risk assessment
MrN: So for the service users in the counts you face
MrN: Patients 1 and 4
MrN: How large were their careplans?
KMcG: Everyone’s was big, was probably only Patient 11’s who had a small one, he wasn’t on medication or anything
MrN: Were you their named nurse, Patient 1 or Patient 4?
MrN: What did you have to do, if anything, in relation to their careplans, did you have to read them?
MrN: Had you done that?
KMcG: I had
HHJ: Just so I understand. Everyone has talked about the size of these things, they’re enormous. Am I right in assuming, if there’s an update to this, that would be added to the file?
HHJ: But the old one would still be in there?
KMcG: It could be for a limited time, until the MDT meeting, then it could be taken out and filed.
HHJ: And presumably these folders had some sort of organisation?
KMcG: Yeh they did, they had a structure.
Asked by Mr Normanton how people would know about a change to someone’s careplan, Mrs McGhee told the court that if a nurse who wasn’t a named nurse made a change they’d make sure their colleague was aware, and for all other staff it would be relayed in handover meetings in the morning or at night.
Mr Normanton then moved on to discuss in detail another of Mrs McGhee’s responsibilities, restraint, including a discussion about MAYBO and primary, secondary and tertiary. He asked questions and HHJ Smith interjected to sense check the answers at times and the court heard that you had baseline level, which Mrs McGhee said depended on “the personality of that individual” and that was also known as primary. Mrs McGhee said that slight changes in a person’s level would still be in primary and it might be possible to calm a person down by suggesting a cup of tea or to go outside. She said that if a person continued to escalate then you’d go into secondary and she told the court that you “can still stop it then”, and if it were not possible to stop a person escalating then you would “go to tertiary, either open supine on the floor, or holds”.
In response to questions from Mr Normanton, Mrs McGhee told the court that a nurse would attend every restraint and when he asked her why, she replied:
We were supervising service users and healthcare assistants, making sure everyone is fine in the restraint, no one is injured and there’s no physical [issues]. With someone on the floor could be physical, not able to breathe, so we’d look at how they are.
Asked if nurses were required to say anything to the person being restrained Mrs McGhee told the court that “it’s usually the person on the head that is [talking to the patient] but sometimes they need a different voice, a lot of them respond better to a nurse”. She described her responsibility to healthcare assistants as making sure that the holds were correct and checking that they weren’t injured, because if they were she’d need to swop them out with someone else.
MrN: How often did restraints occur at Whorlton Hall?
HHJ: What does that mean?
KMcG: Very, very frequent
HHJ: Give us an idea. During a 12 hour shift, how many might there be?
KMcG: Depends. Some days might be three, or five, or six. Every day was different.
MrN: Can we look at statistics to guide us a little bit, table at front of tab 12
Mr Normanton directed the jury to an extract of incident data provided to the police by Cygnet where Mrs McGhee was recorded as attending a restraint, adding that we “don’t know if it’s a full list, was the evidence given”.
MrN: Shows repeated restraints on certain days and your attendance at it?
MrN: We can see not infrequently you are injured as attend these restraints?
KMcG: I am
MrN: Scratch to your hand, you have water thrown at you, you are kicked in the stomach
MrN: When you’re restraining someone would violence occur to you and others?
MrN: Violence having occurred, what did you learn about the risk some service users presented?
KMcG: What do you mean?
MrN: Were people at risk of violence frequently from service users?
KMcG: Yes, yes
MrN: That violence having occurred, did it make any difference to the way in which you view service users as people?
KMcG: No because I wouldn’t do my job if it did.
Asked if working with service users only involved restraint, Mrs McGhee said no and that there were good times.
MrN: What were the good times?
KMcG: A lot of them had fantastic personalities. You see them when they first came in, to changes we all made to that service user, and then eventually moving on, it was just…
MrN: Patient 1?
KMcG: When she first came was horrendous for staff, screaming and attacking was constant. That’s why she came to us, was a break down of her last placement, we got her, and she was going out doing her shopping, but Patient 1 a lot of the time chose not to go out.
MrN: In your time there before Panorama was released and you had to stop working, was she there until you left?
KMcG: No. Myself and Peter Bennett and another member of staff took her to a placement.
MrN: Took her to a placement?
KMcG: Where she wanted to live. Patient 1 was a very intelligent girl, she wanted to move closer to her mum. She looked some places up, she found a placement and managed to get there.
MrN: She left Whorlton Hall?
MrN: In your time there?
MrN: How did that happen?
KMcG: Because we got her in a good place
MrN: All that happened before the Panorama came out?
KMcG: Before it came out yes.
Mr Normanton told the court, and Mrs McGhee agreed, that all the counts against her involved a restraint that she attended, and were focused on things that she said during a restraint. Mrs McGhee told the court that she’d vary how she talked to service users, and had different approaches for different service users. She described her approach to Patient 1 as “firm but fair” and when she was asked why that was necessary she told the court that Patient 1 would attack you if you were weak, adding “when I say firm I just mean confident to work with Patient 1”.
MrN: Yeh, you say when she perceives someone is weak, how would she perceive someone was weak in your view?
KMcG: Because she knew, she was an intelligent girl.
HHJ: I think Mr Normanton means what would she mean by weakness?
KMcG: Confidence I mean, not weakness
MrN: If you were lacking in confidence in your style what might she do?
KMcG: Very easily attack you
MrN: What about Patient 4? What was your style like with him?
MrN: Let me be clear, when he had a behavioural incident?
KMcG: That’s better, you’d have to be firm
KMcG: Because he was a bit like Patient 1, very manipulative.
HHJ: You’d have to be firm with him too?
KMcG: And confident
MrN: You used the word there “manipulative”, I’d like you to explain that.
KMcG: Yes he was very manipulative, and Patient 1 was very manipulative as well.
MrN: I want to ask you about that. Focus on Patient 1 first, what do you mean?
KMcG: I don’t mean this in a bad way, being manipulative. I think a lot of Patient 1’s behaviours were learnt behaviours from when she was younger.
Mrs McGhee then told Mr Normanton that Patient 1 used behaviours to get what she wanted.
MrN: What do you say the learnt behaviours were?
KMcG: Attacking to get what she wanted from people, because she was going to attack you’d give into her, that’s what happened and that’s her learnt behaviour, if she went to attack you’d give in because she was strong, powerful and quick. People would give in to her, it’s all over, learnt behaviour before she came to us.
MrN: Was anything being done to try to address that aspect of her behaviour?
KMcG: It was already learnt and we just had to manage it
MrN: Was there any treatment?
KMcG: There was no treatment, it was just management. Unfortunately the attention wasn’t there earlier on in her life, she was let down.
MrN: You then described her going to placement, when she left did she still have that problem?
KMcG: From when she first came, to when she did go, she was a lot, lot better
MrN: Had she got rid of that?
KMcG: No, no. She still had to have staff to support her.
Mr Normanton moved on to discuss Patient 4 with Mrs McGhee.
MrN: Explain what you mean by manipulative in relation to Patient 4?
KMcG: Patient 4 is the same, his behaviour a lot of it was to get what he wanted, not all but a lot of it. He learnt that by being aggressive people always give in to him, that’s his learnt behaviours to be aggressive.
MrN: Be aggressive to get what he wanted?
KMcG: Yes, but not all the time.
MrN: When he wasn’t like that, what was he like?
KMcG: Good, funny. We had a good laugh.
MrN: What do you mean?
KMcG: He was actually quite witty, you could be witty back to him, jokey.
Mr Normanton went on to discuss an occasion where Patient 4 had given Mrs McGhee a black eye and asked her if it changed how she felt about him as a person, she told the court that it “didn’t change anything, that was part of what I went into, if I’d started to resent someone I wouldn’t be in that job”.
Mrs McGhee told the court that she’d spent time getting to know Patient 1, would “go talk to Patient 1, sit with Patient 1, have a chat”. Asked to describe their relationship she told the court it was “fine, a good relationship, positive relationship with Patient 1”.
MrN: Was there trust in that relationship?
KMcG: There was
MrN: You described her as being manipulative, you’ve explained what that means. She behaved in certain ways, what was your view of any sense she had about the way in which she’d behave?
KMcG: Not all the time, but Patient 1 would know what she was doing. Like if she was going shopping she’d say she was going to attack a pregnant lady or a young child
MrN: She’d say that?
KMcG: She’d say that before she went shopping, so then the risk factor was she wouldn’t be allowed out.
MrN: Why do you say she knew? Using that example.
KMcG: Sometimes she’d say to a staff member “I’m going to grab you”, which she did with me, grabbed my breasts and caused a lot of damage. She told me, but I couldn’t move out of the way.
MrN: Was she conscious of the consequences of some of the actions?
KMcG: Some of them, not all of them. She was autistic.
MrN: In your view was she able to be told off, and told not to do things?
KMcG: Absolutely she could. Not told off, but explained to.
Mr Normanton then went through some of the documentation relating to Patient 1 with Mrs McGhee. When Mr Normanton described Patient 1’s Positive Behaviour Support plan as a blueprint, Mrs McGhee said it was a guideline. He talked through some of the contents of it, with Mrs McGhee confirming them, detailing different secondary and tertiary strategies such as using a calm voice, and encouraging deep breaths.
MrN: At the point of the violence, at the point the restraint is taking place, is one supposed to be, at that point, speaking to her in a calm manner?
KMcG: It all happens that fast, because it’s an attack
HHJ: Depends what is meant by the point of attack
MrN: Patient 1 lashes out as seen in videos
KMcG: It’s a split second, you’re thinking safety on the floor, holds
HHJ: Restraint is in fact a longer process than that initial point
Mr Normanton thanks HHJ Smith for clarifying and says he could have been clearer there.
MrN: This document, was it intended to be comprehensive? Or something other than that?
KMcG: So everyone can read and understand
MrN: In terms of triggers, p35 if you see Patient 1 does this, you should do this. In preparation of a document like this, is that intended to be a comprehensive account of things Patient 1 does as much as possible?
KMcG: As much as possible, then ongoing things, changes and things can be put in.
Mr Normanton then looked at some of the other documents including a psychology report dated August 2018. Mrs McGhee confirmed that she had read it, but not everyone would have “a lot of the healthcare assistants would concentrate on PBS and all the other ones, but they could read that, but they had that much to read”. Mrs McGhee said that the person centred statements were a “work in progress” and were kept in a different filing cabinet to the careplans.
When asked about Patient 1’s preference to be supported by female staff Mrs McGhee told the court that “she was a female, and preferred female staff, but that was not always, we couldn’t do that”.
MrN: Preference, but was it anything to your mind more than that?
KMcG: No, was nothing in her report. Nothing highlighted to us that she was afraid of men or anything had happened to Patient 1, so she was afraid of men, was just a preference
Mrs McGhee told the court that the only reason Patient 1 would be supported by men was “staffing issues”. Asked if Patient 1 requiring restraint would change anything, she said that “very few” female staff could deal with Patient 1 on all occasions, because they used a lot of agency staff, and the female staff in Whorlton Hall were often relatively new and lacked confidence. Mrs McGhee told the court that she’d address this by putting a “confident staff member, could be male or female, with that female” [new staff member]. When Mr Normanton asked whether Mrs McGhee was aware of a change in early 2019 to Patient 1 requiring being supported by female staff [as referenced by Olivia Davies] she replied “not really” and when Mr Normanton asked a clarifying question she replied “I can’t remember, not really aware that he was”.
Mr Normanton then took Mrs McGhee through the information that would be recorded in observation notes and was required to be entered onto the Ulysses system following a restraint.
MrN: If there was a change of behaviour recorded in care progress notes that led to an incident, would you expect that to be recorded in the notes?
HHJ: The whole point is to try and spot triggers and reduce it occurring in the future, and give guidance in the future?
MrN: If someone wasn’t recording what would the effect be?
KMcG: Well I wouldn’t know, and things couldn’t be implemented then.
After the afternoon break Mr Normanton played a number of video clips to Mrs McGhee.
Firstly he read the particulars of Count 8 and played the clip from the start, stopping and asking Mrs McGhee what was happening, at several points. Mrs McGhee told the court when Patient 1 was waving her arms around she is self-regulating. Asked why she was telling Patient 1 that the situation was bad, she said because it was and Patient 1 was asking her. When Mr Normanton asked Mrs McGhee if the video was an example of her being firm she said “not being firm, just saying to Patient 1 stop”. In response to a question from Mr Normanton, Mrs McGhee told the court she had no independent recollection of this, or any of the incidents in the counts she is charged with.
Asked by Mr Normanton why she is seen on the video mentioning two males to Patient 1, she said she had to risk assess the situation and the female staff members supervising Patient 1 were not confident enough. Asked why she mentioned Matthew Banner and Ryan Fuller by name, Mrs McGhee said “they were my responders and not on direct observations so I knew they were floating”.
MrN: There’s some reference in this case to perhaps Patient 1 didn’t like Matthew Banner, is that something you knew about?
KMcG: No I didn’t
MrN: Why communicate this to Patient 1?
KMcG: She’s an intelligent young lady, why would I not explain to her that she would have males?
MrN: If the situation was you didn’t explain to her and then males were on suddenly supporting her, walked into the room, would that be a good situation?
KMcG: Obviously not
MrN: Why was it important to communicate with her?
KMcG: Because she understood what I meant and she’s a right to know I was going to put two males on with her.
MrN: The allegation against you is you said that to threaten her and illtreat her. What do you say about that?
KMcG: Why would I? Absolutely not.
Mr Normanton then moved to the next count that Mrs McGhee faced, Count 9. He asked Mrs McGhee what was happening on a couple of occasions, she explained she had cramp in her feet, said that she was asking Patient 1 to speak nicely to her “because Patient 1 understood, I’m not speaking to her like that, she shouldn’t”.
MrN: What’s the purpose of saying it?
KMcG: Because she understood what I was saying to her wasn’t in a nasty way
MrN: What was your aim in saying that?
KMcG: To calm her down
Mr Normanton then highlighted Mrs McGhee releasing Mr Fuller’s hand when Patient 1 was scratching it, before continuing.
MrN: I want to ask you about the statement you make towards the bottom of p37 you say “it’s like she’s possessed”. Why did you say that?
KMcG: I was wrong. I shouldn’t have said that in front of Patient 1.
MrN: I know you don’t have independent recollection, but do you remember why you said it?
Mrs McGhee then explained to the court that she was asking Patient 1 for ten deep breaths in an attempt to calm her down, and that she commented on Patient 1’s nails because they were pretty and she was trying to take her mind off things and calm her down. The purpose of which she described as to calm Patient 1 down so they “would all be able to get out of the hold as soon as possible”.
Mr Normanton said the conversation then moved onto shoes and asked Mrs McGhee what she’d be doing at this stage. She told the court she’d be concentrating on Patient 1.
MrN: In terms of conversations happening during restraint, what if anything are you conscious of?
KMcG: In a restraint, it’s all about risk and quick thinking, diffusion, things happen so quickly. You use all different tactics.
MrN: A conversation like this, is that in tactics or something else?
KMcG: Was just something we’d just use… Patient 1 was a female, shoes. Someone was on about my wedgie shoes.
MrN: When you say Patient 1 was female and shoes, what did you mean by that?
KMcG: Patient 1 liked to dress up, made balloons with wings, tutus.
MrN: You say “think will put two males in, two males tonight with this carry on”. Why do you say that?
KMcG: On a night shift you were very limited with females, would have to be two, probably agency staff.
MrN: Why did it have to be two males?
KMcG: If you put female on and they weren’t confident with Patient 1 she’d continued to do this behaviour
MrN: Why does Patient 1 have to know about this?
KMcG: So she knows and understands. She had the capacity to understand.
Asked why she mentioned Mr Banner by name, she said because she knew he was working. She also told the court from her perspective “it was for the safety of the staff that were coming on”. She said if she’d a strong female responder that she knew was on that night, she’d have said their name.
Mr Normanton said that in a slightly less voice, something of a whisper, Mrs McGhee comments while Patient 1 is being restrained “she’s got bigger hasn’t she”. She could not recall what that was about.
MrN: It was put earlier to Ms Banner what was said there was Patient 1 had got bigger in size, was said when Patient 1 was there. Was this something that was appropriate?
KMcG: Not while Patient 1 was on the floor.
HHJ Smith checked what had been said as Mrs McGhee had lowered her voice, and asked Mr Normanton to repeat the question.
MrN: Why was this being said?
KMcG: When I look at this it’s Patient 1 must have put on some weight
MrN: What do you say about the appropriateness of that, even if whispered, while Patient 1 was there?
KMcG: Looking back I shouldn’t have said it, reflecting on it.
Asked her purpose in that restraint Mrs McGhee told the court she was concerned with “safeguarding everyone”.
MrN: When making comments, couple of comments I’ve raised with you and asked you to explain the appropriateness of, the possessed comment, and the bigger comment.
MrN: What was your attitude towards Patient 1?
KMcG: I had a good attitude with Patient 1
MrN: Do those comments say anything about your attitude at all?
KMcG: No, but things happened that quickly. It was a lapse of me being professional and within nursing you do a lot of reflective practice, if things are highlighted to you, positive and negative you’d reflect on that, that was one of my moments of lapse.
14 April 2023
Mr Normanton started this morning by asking questions of Mrs McGhee about Patient 4. She told the court that he arrived at Whorlton Hall in August 2018 and that she “got to know [Patient 4] well”. Asked what he was like Mrs McGhee told the court he was “very unpredictable” and when Mr Normanton asked what risks he presented she responded “attacking staff, throwing things, even service users he’d attacked other service users as well”. In response to a further question from Mr Normanton, Mrs McGhee told the court that Patient 4 had made sexual comments towards her, when asked what they were she replied “he told me that he was going to rape me three times”.
Mr Normanton turned to the table of incident data provided to the police by Cygnet, where Mrs McGhee was recorded as attending a restraint. Mr Normanton read out “some things that have occurred between you and him” which included Patient 4 making threats of violence, kicking Mrs McGhee in the leg three times, and punching her in the face which gave her a black eye. She told the court that she had to go to hospital to be checked over and was back at work at Whorlton Hall at 07:30 the following day.
In response to questions from Mr Normanton, the court heard from Mrs McGhee that Patient 4 was very food orientated and that he could throw things. Mr Normanton then turned to a number of specific incidents in the agreed facts, asking why Patient 4’s CD player was removed from him until he “returned to baseline” and Mrs McGhee said that it was removed because it could be used as a weapon. She told the court that as soon as he calmed down his CD player would be returned to him, which could be as soon as after 5 minutes.
We heard from Mr Normanton that Patient 4’s one page profile recorded in response to the question what is important to me, “my CD player and Tears for Fears CDs”. On the front page of his person centred statement was the album art work for the Tears for Fears album Rule the World.
MrN: He’s a big Tears for Fears fan, who can blame him, his love of Tears for Fears, and his love of music, what bearing did that have, if any, on the need to remove CD players and CDs and things like that?
KMcG: Reason is he can use that, unfortunately. We know he loves the music, but that CD player could be used as a weapon to hurt someone.
Mr Normanton then asked about the background to 25 January, where Mrs McGhee is charged with Count 20, telling the jury that in the agreed facts Cygnet records recorded 14 episodes of violence between 21 and 25 January, and in January 2019 Cygnet recorded 40 incidents of violent behaviour for Patient 4, with 15 of those taking place in the corridors.
MrN: That’s the evidence we’ve had. What was he like at that time, do you remember?
KMcG: He could be very violent
MrN: In the video you’re heard to say you’re glad he’s down in room 11 now. What’s the relevance of that?
Mrs McGhee started explaining the layout of the bedrooms and Mr Normanton suggested that the jury follow on the map.
KMcG: When Patient 4 first came, if you see bedrooms in yellow, three bedrooms?
MrN: The bottom floor, where it says ISS intensive support suite?
MrN: What was the ISS intensive support suite?
KMcG: When people first came, the males first came to Whorlton Hall, that’s where they tended to go.
MrN: Why did they go there?
KMcG: Because we don’t know their behaviours as such, that was to monitor them.
MrN: Why was monitoring them there better than anywhere else?
KMcG: If you knew what Whorlton Hall was like, it’s a massive building, lots of stairs, that was right near the office. Where the nurses and managers were.
MrN: So, he was there when he first came?
KMcG: He was, but then we had to move Patient 4 because he had to walk past the offices all the time and it was causing major issues.
MrN: What type of issues was it causing?
KMcG: He was shouting, possibly risk of and having to go and get restrained
MrN: To decrease that risk what did you do?
KMcG: A bedroom became available upstairs on the top, second floor
MrN: Second floor or first floor?
KMcG: Second floor
MrN: Layout we’ve got of 2nd floor I can’t see any bedrooms there?
KMcG: No, there’s one called office, and I think it was that one we made into a bedroom.
Mr Normanton and HHJ Smith check the location
MrN: OK, so he was moved there
KMcG: Then there was lots of major issues up there as well
MrN: What issues were up there?
KMcG: Patient 4 had his own telephone and he would phone up sex lines and abuse females and then would phone the police and he’d abused the police, who sometimes would come to Whorlton Hall, and when we tried to stop it we’d have major issues and as you can see is the very top floor and we’d have to run from the office to go help in a restraint and it was too risky.
MrN: OK, to decrease that risk, what did you do?
KMcG: We managed to move Patient 4 to the first floor
MrN: So second page, think said he was in the room at the very top of that with the lounge?
KMcG: Yes it is, that says bedroom and Patient 4 was lucky, he had a bedroom and a lounge as well
MrN: So he went here?
KMcG: Yes and that was good for Patient 4 because when a behaviour occurred we could take Patient 4 up to his bedroom because he had a lounge, that’s where he could regulate himself.
MrN: Regulate himself. How would he regulate himself?
KMcG: Talk to staff, listen to his music.
Mr Normanton then read the particulars of the charge of Count 20, before playing the video relating to it. In response to his questions, Mrs McGhee tells the court that she does not know why Patient 4 is in a heightened state, that he is being restrained by the time she responds to the attack alarm. Asked what she is doing at the start of the video when she comes into the picture and leans over Patient 4 she says she doesn’t know but she may have been pulling his top down. Asked why she’d be doing that she says “dignity”. She tells the court that she has medication under her arm and she was likely on medication rounds. She described her tone of voice as firm and said that Patient 4 could cope with that.
Mr Normanton played more of the clip and said that he wanted to ask Mrs McGhee about two things, the first of which was laughing over Patient 4 whilst he’s being restrained.
MrN: I don’t know if you’re part of the laughing. What’s going on there?
KMcG: Patient 4 was very nosey. He liked to listen to people, so if you were talking he’d stop to listen to you, so could be used as a distraction.
MrN: Was that what was happening?
KMcG: It did work
MrN: Then we have the chewing gum situation. In one point in an interview you described it as unprofessional, you’d reflected on that?
KMcG: I did
MrN: What are your reflections on that?
KMcG: In nursing, as newly qualified, you’re always taught to reflect on good practice and bad practice. After all good things you do and bad things you do, you know you’ve done it, the little things you do like smile at someone you don’t know they’ve made their day, the bad things aren’t bad things they’re just little things, its learning if they’re not pointed out you don’t learn.
MrN: So a lapse of professionalism?
KMcG: A lapse yes
MrN: Looking back at the video what do you think about that?
KMcG: I used a spider dump, so you get what you’ve done wrong and then put all your good and bad things, that’s something I do, lessons learned.
MrN: The moment of asking for chewing gum and receiving chewing gum does that say anything about your attitude to Patient 4 as a person?
KMcG: No, because in that moment everything is so intense, sometimes you don’t realise what you’re doing.
MrN: Do you have an independent recollection of this?
KMcG: No, no.
Mr Normanton asked what Mrs McGhee’s intention was for mentioning the removal of his CD player to Patient 4 and she told the court that it could “diffuse Patient 4, and lessen distracting, or diffuse the situation and Patient 4 would then be able to released from the hold as soon as possible”.
MrN: It will be suggested I imagine that you’ve been saying this “yeh, yeh, music, everything” to punish him.
KMcG: No. Why would I do that?
MrN: Or to antagonise him?
KMcG: No. Why would I do that?
Mr Normanton then asked what she did when Mrs Banner came downstairs with Patient 4’s belongings.
MrN: What do you do at this point, do you know?
KMcG: Sarah needed leadership and I led her, and redirected her back upstairs
MrN: Why did you redirect her back upstairs?
KMcG: Because she would have had to walk past, because it was in the corridor and it’s a very small corridor, she would have actually had to walk past Patient 4
MrN: What would be the problem with that?
KMcG: Don’t know, but it could have caused Patient 4 to be aggressive, or antagonised him.
Mr Normanton then moved on to discuss what Mrs McGhee said to Patient 4 in the video clip.
MrN: “You’re not getting your things back yet, there’s absolutely no chance, you have to earn them back”. Why were you doing that?
KMcG: Must have been a lot of restraints that day and I’m human.
MrN: What does that mean?
KMcG: I’ve told Patient 4 he’d get this. Could you ask the question again please?
MrN: You’ve provided an explanation and said I’m human
KMcG: Yes, they’d been a lot of restraints
MrN: What did the number of restraints impact have on your decision to say this do you think?
KMcG: It’s not just me, it’s other staff having to restrain Patient 4 or get injuries off Patient 4. It is tough going.
MrN: So what did you, appreciate you have no independent recollection so it’s hard, but looking back at it, what do you think you were trying to achieve by saying this?
KMcG: For Patient 4 to take some responsibility for his actions
Mr Normanton played the rest of the video clip and commented that the transcript hadn’t picked up Mrs McGhee saying 5 minutes, 10 minutes. Asked what that meant Mrs McGhee told the court it was a reference to how long Patient 4 would need to remain calm before his belongings were returned to him “to show Patient 4 once everything was ok and safe, that he would get his stuff back, as soon as possible”.
Mrs McGhee told the court that at first in the restraint she’d not seen Mr Fuller had Patient 4’s glasses on and that “he might have had them on for safety, so they don’t get broken, as you can see it’s a very small corridor”.
Mr Normanton says that later Mrs McGhee is engaging in a conversation about who Mr Fuller looks like wearing the glasses.
MrN: Then you say “Superman, are you having a laugh?”. That appears to be a reference to the glasses
KMcG: It does
MrN: So had you noticed the glasses?
KMcG: Things happen that quickly
MrN: Do you remember thinking it was inappropriate?
KMcG: No, because it was split seconds.
Asked what would normally happen if someone was wearing glasses and needed to be restrained, Mrs McGhee told the court that they would be given to someone, or they could be put out of arm’s reach.
MrN: Was there any aspect of your conduct there with Patient 4 designed to antagonise him?
KMcG: No. I was just being firm with Patient 4, and he had capacity to understand most of his actions
MrN: Would it have helped what you wanted to achieve here by antagonising him?
KMcG: No. As you can see everyone left the restraints and Patient 4 went upstairs and carried on with his day
MrN: Those are all my questions for now. Just remain where you are.
There were no questions for Mrs McGhee from Mr Rutter for Peter Bennett and none from Mr Constantine for Matthew Banner.
Mr Walker for Sarah Banner wanted to ask Mrs McGhee about her experiences of working alongside Mrs Banner. He asked if the paragraph in agreed facts that he’d read out about Mrs Banner when she gave her evidence, describing her as “demonstrating excellent support skills to service users and staff” and “acting confidently and in a calm manner” accorded with Mrs McGhee’s experience of dealing with her.
KMcG: Certainly did. She was a very valued member of the team
MrW: She could be firm, we can see that from footage?
KMcG: She could
MrW: She was confident in her own views?
KMcG: She was
MrW: And confident to express them even when they didn’t accord with all her colleagues views?
KMcG: Sarah would go out of her way to help when she could.
In response to questions from Mr Walker, the court heard from Mrs McGhee that every restraint was unique in it’s own way, that staff at Whorlton Hall were having to adapt all the time, and they had to learn on their feet and risk assess.
Mr Walker then asked about Patient 1’s mobile phone.
MrW: the mobile phone for Patient 1 was a positive and a negative thing, is that right?
MrW: On the positive side she’d write stories?
KMcG: She’d write stories and phone her mum
MrW: She’d spend an an enormous amount of time on her mobile phone?
KMcG: Yes she would
MrW: On the negative side she’d sometimes google or search for issues which caused her emotional turmoil, would that be right?
KMcG: Yes, and some of her stories were nice stories and some of her stories were pretty horrendous which would escalate her and she’d phone her mum as well and be quite verbally abusive to her mum
MrW: I guess on her positive and negative side, her preference would be to have mobile phone at all times?
Mr Walker discussed how staff would remove Patient 1’s phone, and how they’d risk assess something contrary to her preference.
MrW: The video yesterday, Debbie James is heard to say “I don’t care who you hit, I want that phone back”. Is that an exemplar of phone being removed from Patient 1 for her own good, to calm the situation perhaps?
KMcG: By looking at it, staff members do it the best of their abilities, to get the phone off Patient 1
MrW: On the hoof effectively?
KMcG: Yes, yes
Mr Walker then wanted to ask Mrs McGhee about Mrs Banner returning from Patient 4’s room with his belongings.
MrW: Your words were she needed leadership at this point?
MrW: Because she was presenting and asking what to do next?
KMcG: Yes. She asked me what to do and I didn’t do it in front of Patient 4 and I redirected her up the stairs
MrW: No further questions.
Mr Knox, for Ryan Fuller, had one brief matter for Mrs McGhee.
MrK: Very briefly you’ve mentioned about care records. What we’ve been told is this, obviously there were care files and staff read them, were required to read them. What we have got in this case represents documents which may or may not have been in the care files is that your understanding?
KMcG: The relevant documents would be in the careplans
MrK: What we’ve got doesn’t reconstruct the careplans the staff had? We’ve got documents that have been supplied, but we haven’t got a reconstruction of the care files have we?
MrK: Thank you very much indeed.
Mr Patton, for Niall Mellor, asked to continue with questions about records. Mrs McGhee confirmed that she’d have had access to patients medical records, records of consultations with consultant psychiatrists and records from MDT meetings, but that the court didn’t have them. Mr Patton stated that the police had not sought access to them.
Mr Patton checked with Mrs McGhee that MDT meetings took place on a Tuesday. She told the court that she thought it was Tuesday.
MrP: Was it the same day every week?
MrP: Attended by the psychiatrist?
MrP: Or one of his assistants
KMcG: Usually one of the doctors yes, the named nurse if possible, OT
MrP: Where would he come from?
KMcG: Another unit, they’d be going around all the units
MrP: So he’s employed by Cygnet?
KMcG: Danshell at the time, yes.
MrP: Is he working within the NHS or is this separate?
KMcG: No I think he worked for Danshell
MrP: So he’s working for Danshell, going around different units?
KMcG: Yes. There’s a lot.
MrP: Does he have assistants who come?
KMcG: No there was two doctors
HHJ [Didn’t catch]
MrP: I’m trying to think of the usual process.
Mrs McGhee said that the psychiatrist didn’t have junior doctors working with them.
DrP: Dr Joyce?
MrP: And a Dr Perini?
MrP: Do you ever remember Patient 4 meeting Dr Joyce?
KMcG: Patient 4 was always welcomed to MDT meetings. Was his choice if he wanted to go or not, with and with his diabetes
MrP: You know what I’m going to ask you about. His interaction with Dr Joyce. When he met Dr Joyce for the first time he told him to fuck off and he wasn’t a doctor.
KMcG: Yes that sounds like Patient 4
Mr Patton then listed other professionals that Patient 4 had “attacked”. In response to his questions Mrs McGhee told the court that Patient 4 was welcome to attend MDT meetings, and he was able to say what he wanted within them. Mr Patton asked if what he said would be recorded, if he had “a beef about the way people spoke to him” or if “he thought some staff were fantastic” would it be recorded in the notes from the meeting and Mrs McGhee said it would be.
Mr Patton then checked that Patient 4 was subject to the Mental Health Act order detaining him against his will.
KMcG: A section yes
MrP: Notionally for treatment?
KMcG: Yes, when Patient 4 came to us, his health as well as his behaviour, his physical health, his legs were because of his diabetes, were horrendous
MrP: Yes were a number of comorbidities, but he’s not at Whorlton Hall for his diabetes is he?
KMcG: No for behaviour breakdown
MrP: He was there because he was so dysregulated in his behaviour he posed a risk to himself or other people or both?
MrP: He could not be left in the community
MrP: Presumably someone had worked out what they’d do with Patient 4 to get him to a state, or state of health, where he didn’t stay at Whorlton Hall?
MrP: Was it medication plan or therapeutic plan, what was it?
KMcG: It was medication, managing his risk factors
KMcG: Because Patient 4 was diabetic, he sometimes refused to take his medication and that would heighten Patient 4’s state of mind. We had a lot of issues then but we couldn’t force Patient 4 to take his medication.
MrP: Part of the complication for him was his mood?
MrP: And presumably doctors tweaked his medication to improve his mood?
KMcG: I cant remember Patient 4’s medication
Mr Patton then moved on to ask more about the “treatment” provided to patients from the psychiatrists and medical professionals.
MrP: To try give us an idea of how it worked for and, the psychiatrist came on a Tuesday, when would he actually see Patient 4?
KMcG: In the MDT meeting
MrP: What about consultation on a 1-1 basis to speak to Patient 4 and find out how he was?
KMcG: That wouldn’t happen that often
MrP: Did it ever happen as far as you’re aware?
KMcG: Would all happen in the MDT meeting, unless Patient was at risk of harm to himself, as his physical harm
MrP: What about a psychologist. Would a psychologist have come in?
KMcG: I don’t think Patient 4 would have engaged with the psychologist
MrP: What about the OT?
KMcG: When Patient 4 did that was upstairs and he had a lot of issues so I don’t think Patient 4 engaged in any occupational therapy
Mr Patton then asked Mrs McGhee about Patient 4’s relationship with food, describing his problem being he liked food very much, and Mrs McGhee responded “very food orientated”. Mr Patton then suggested that it was a “large part of the day for him” which Mrs McGhee agreed with, whilst mentioning the responsibility to give him a healthy balanced diet.
MrP: Would the doctors say to him he had diabetes?
KMcG: No, because he’d probably attack them
MrP: Would they say he needed to regulate his food?
KMcG: We’d have told Patient 4
MrP: Did you ever hear them say anything to him about his diet?
KMcG: No but there was a plan in his file
MrP: Someone has to take responsibility, it can’t just be the care workers can it?
Mr Patton asked Mrs McGhee how Patient 4 would spend his days, she mentioned he’d go out into the community to do his shopping.
MrP: So part of the routine would be to go shopping, but that’s not every day of the week is it?
MrP: What would staff be doing rest of time?
KMcG: Sitting with Patient 4 making sure he’s safe
MrP: So he didn’t see a psychologist, occupational therapist. Had no interests apart from music and food. How was he going to get better?
KMcG: With Patient 4 it’s management
KMcG: Patient 4’s behaviours
MrP: And his diet?
KMcG: Yes, yes, which is all knock on effect
MrP: Would you forgive me for saying it rather looks from a distance to someone not working there, it’s more containment than therapeutic
KMcG: It is containment, yes, with Patient 4
Mr Patton asked Mrs McGhee if she remembered that the organisation used to provide food for staff, so that they could breakfast with the patients, that there used to be bingo activities in the afternoon and that staff would join patients for themed food evenings, Chinese, Indian, and so on. Mrs McGhee did remember, and agreed that it was a way of integrating staff to make them more friendly with patients. Mr Patton suggested that all stopped as a cost saving measure, but Mrs McGhee could not recall.
In response to another of Mr Patton’s questions Mrs McGhee said that she wasn’t aware of what Mr Patton described as “whistleblowing incidents” reported to the CQC. She said she had worked alongside X and Y, and was aware that they had been suspended. She had no recollection that CQC were involved.
Mr Patton’s final question for Mrs McGhee was how staff would know if patient’s medication was changed, Mrs McGhee said that medication was the nurses responsibility but “if there was a big change with medication you would say and tell staff, but was mainly the nurses responsibility”.
Court was then adjourned for a short break.
Ms Brown, for Darren Lawton, adopted her learned friend’s cross examination about careplans. She then asked Mrs McGhee about a segregation reduction care plan for Patient 6. Mrs McGhee confirmed that Patient 6’s care plan was greater than this plan alone “think because of segregation and risk he might have had two files”.
Ms Brown asked whether the risk screening tool would have been in the careplan and Mrs McGhee said it would have been. Asked if she knew who Dr Roberts was, Mrs McGhee responded “I think it was a student psychologist, if I remember”. She told the court that they worked with all the service users at Whorlton Hall.
MsB: Then very briefly, were you in charge of deciding which staff member would be allocated to which patients?
KMcG: Yes I would be
MsB: Can you confirm Darren Lawton was very often placed with Patient 6?
KMcG: Yes he was
MsB: No further questions.
Mr Rooney, for Sabah Mahmood, asked Mrs McGhee to look at the positive behaviour support plan for Patient 7. He checked that the 6 pages of the PBS plan was not the entirety of the careplan and Mrs McGhee agreed.
MrR: Do you have any recollection of how voluminous Patient 7’s careplan was?
KMcG: She had a lot of risk factors so hers was. All were really big files.
MrR: Thank you
Then it was the turn of Ms Richardson, the Crown prosecutor. She checked that Mrs McGhee could hear her, she could.
MsR: You’ve had extensive training as a nurse haven’t you Mrs McGhee?
KMcG: No I only just qualified in 2017
MsR: But throughout your qualification period you’ve been training?
MsR: You’ve told us little of your previous experience and am I right in saying your joy at working with people with mental health difficulties?
KMcG: Yes, great pleasure
MsR: In your position did you understand the very real problems there were for people caring for those with mental health difficulties? It’s not an easy task is it?
KMcG: No and it’s a learning curve. You learn every day.
Ms Richardson then discussed with Mrs McGhee what she’d meant when she stated some of the patients, such as Patient 1, were intelligent. She asked her whether she remembered the film Rain Man, where Dustin Hoffman played a man who was able to do lots of mathematical equations in his mind, but wasn’t able to do the day to day tasks that his brother, played by Tom Cruise. Mrs McGhee did recall and said that Patient 1 wouldn’t be able to do her finances, she “wouldn’t have any sense of money”.
MsR: So, a particular type of intelligence. Would you agree sometimes… although the patients would know what they were doing and what was happening to them, sometimes they’d have no clue as to their behaviour?
KMcG: Sometimes, yes
MsR: In Whorlton Hall whilst accepting was hierarchy, no criticisms whatsoever meant by this, going from support worker right up to senior management. When it came to care and management of patients, who was in charge? Was it you or seniors such as Mr Bennett and Mr Banner?
KMcG: We’d have two types of responsibility, mine would be as a nurse the full shift, with everything.
MsR: Christopher Shield and Stephen Robdrup, you said although they were office bound, were both trained nurses?
KMcG: They were trained learning disability nurses, yes.
In response to questions from Ms Richardson, Mrs McGhee said that whoever arrived on the scene first would take part in a restraint, and whether or not the nurse would be hands on, or taking responsibility for the patient’s head, would depend on the situation and how quickly they were able to get there.
MsR: Supervisory role extends to making sure a patient doesn’t choke or hit their head?
KMcG: It would be
MsR: Would you ever describe restraint as a rugby tackle, or decking a patient?
KMcG: I wouldn’t
MsR: Would it be something you’d consider to be highly inappropriate?
KMcG: I wouldn’t use it.
Ms Richardson asked Mrs McGhee about Patient 1, commenting that she’d told the court that Patient 1 has extreme difficulties, but she was also someone who could be bright and lively. Mrs McGhee agreed that she could be.
MsR: Yesterday when you gave evidence your face lit up when you spoke about Patient 1 at times. As a nurse did you make it your business to know what was in her care plan?
KMcG: I did
MsR: And as a nurse did you make it your business to know what her preferences were?
KMcG: I did
MsR: Although you couldn’t always accommodate them, did you do your best to meet them?
KMcG: Yes absolutely.
Ms Richardson then asked Mrs McGhee about careplans and their importance, before moving on to discussing how Mrs McGhee was engaging with Patient 1 in a restraint.
MsR: In various clips you hear you saying your own name, not I want, but Karen wants, can you help us why you did that please?
KMcG: In a restraint there’s that many people, to get Patient 1 focused on me so I can deliver deep breaths, so she can focus on Karen
MsR: That need for you to get her to focus on you, would that have something to do with her autism?
KMcG: That’s hard to say
MsR: Did it assist her understanding when you did that?
KMcG: It worked well with me
MsR: Again Mrs McGhee, we see and hear you repeating words to Patient 1. Same questions, why were you doing that? You were repeating to her.
KMcG: Patient 1 has an understanding and I was repeating
MsR: Was this a de-escalation strategy you were using to try and calm her?
KMcG: It could be
MsR: If it could be, from where did you get that knowledge?
When Ms Richardson asked Mrs McGhee whether she thought Patient 1 had a genuine preference for female carers, or whether it was a deliberate manipulation strategy, Mrs McGhee said that “nothing was said that Patient 1 couldn’t have men”, when asked again whether she thought it was a genuine preference she told the court “as a female who wouldn’t want female staff to look after you?”.
Ms Richardson moved onto Count 8, saying that she’d not play the clips as Mr Normanton and Mr Jenkins had already done so.
MsR: We know your first thought after that restraint, quite properly was to ensure staff were OK, you say “is everyone OK’?
KMcG: I do
MsR: Is that something you’d do for most restraints? Check your staff are OK?
MsR: We also hear you repeating and saying please and thank you to Patient 1. You’re not shouting to her, but firmly telling her to stop.
KMcG: I am
MsR: Using please and thank you in that way, why were you doing that?
MsR: I’m not criticising you.
KMcG: It’s just a natural thing for me to say
MsR: Perfectly proper and appropriate behaviour for a nurse towards a patient?
MsR: But unfortunately despite your best efforts Patient 1 doesn’t stop screaming does she? We can hear that on the clip?
KMcG: Sometimes it works, sometimes it doesn’t.
MsR: I’m not suggesting you do this, would simply shouting at her, have calmed her down?
KMcG: A firm voice could have
MsR: But shouting?
KMcG: No but a firm voice could
Ms Richardson then asked Mrs McGhee whether her aim was to calm Patient 1 down and stop her screaming, which she agreed it was. Asked by Ms Richardson how she thought saying she had two males would calm down Patient 1 and stop her screaming, Mrs McGhee told the court that she was explaining to Patient 1 that two males would have to come on her observations because of a lack of females.
Mr Normanton said that he had a different recollection of the clip so Ms Richardson agreed to play it to Mrs McGhee. Ms Richardson asks Mrs McGhee what Patient 1 is doing in the still before the clip starts and she tells the court that Patient 1 is making a hand movement to regulate herself.
MsR: On arm regulating gestures, is your evidence could be de-escalation signal for Patient 1 internally?
KMcG: It could
MsR: But equally it could be the start of an escalation?
HHJ: is it called stimming?
KMcG: People with autism have all sorts of regulation, I don’t recall, it could be.
Ms Richardson moved onto discussing the restraint in Count 9 with Mrs McGhee and she agreed that when she arrived on the scene of a restraint the focus was where things were going, not how they got there.
MsR: Very fairly you’ve said looking back, with the benefit of hindsight, saying words like possessed was wrong?
MsR: Would it be appropriate to speak about how Patient 1 had got bigger in front of her?
KMcG: It was, once pointed out to me, I’ve reflected on it, but when it’s not pointed out, sometimes these things happen, it’s a lapse.
MsR: I’m not for one moment suggesting you have said these words, would you as nurse on duty condone staff talking about “todger dodgers” or lesbian activity in front of a patient, even if that patient couldn’t hear?
Ms Richardson then moved on to discuss Patient 4 with Mrs McGhee.
MsR: You’ve already said he was incredibly volatile and you’ve explained how he could change and continually swear at staff, and other patients, did he swear at other patients?
KMcG: Yes. And he wasn’t very nice to agency staff
MsR: But he loved his music didn’t he?
KMcG: Yes and he loved going out
MsR: His CD player was very important to him?
KMcG: Patient 4 had very little items, his CD, his telephone when he had his telephone
Ms Richardson said that his one page profile clearly stated that he liked music and loved speaking to his sister on the phone.
KMcG: Yes every Sunday
MsR: Would you agree, generally he didn’t have much to look forward to did he?
KMcG: No, but we tried as much as possible to give him a life, we do as much as we could
MsR: Within a secure setting
KMcG: In hospital yes
Ms Richardson asked Mrs McGhee about MDT meetings and she told the court that “every Tuesday a certain number of patients were discussed at MDT meetings, and service users were always asked if they’d like to go”. Ms Richardson said that the agreed facts document stated every patient was seen at least monthly, Mrs McGhee told the court that it depended how many service users they had “monthly or every six weeks”, and HHJ pointed out that this policy was dated 2016.
In response to questions Mrs McGhee said that she thought Patient 4 was one of the patients who always went to his MDT meetings. She said that she had been present at MDT meetings where there were difficulties with Patient 4’s safety and escalation in the meeting.
MsR: Were you present at any meetings when there weren’t difficulties with Patient 4? Not sure how many times you were present?
KMcG: I don’t remember, unfortunately you remember the behaviour side, that’s when you respond, more likely to remember a meeting when there’s been an incident than when there hasn’t been an incident.
Ms Richardson moved on to Count 20. Mrs McGhee confirmed that when she arrived on the scene of Patient 4 being restrained she didn’t know what had happened that meant a restraint was needed. Mrs McGhee told the court that a restraint could last seconds, 5 minutes or 10 minutes “it depends”.
Asked why she said to remove Patient 4’s “music and everything”, she said that music to her meant his CD player, which need removed for safety reasons.
MsR: If it’s purely for safety reasons why say it in front of Patient 4? Why not say quietly so as not to antagonise or escalate?
KMcG: Because it could be a de-escalation technique
HHJ: Sorry, are you saying that saying things in front of him could be de-escalation?
KMcG: It could be yes. When you’re in a hold you have to improvise, think on your feet, sometimes you say things.
MsR: Were you using it as a punishment against him?
KMcG: Why would I? No.
MsR: Telling him he had to earn the right to get his things back?
KMcG: I have great difficulty expressing myself, when I say earn it, it means you have to have good behaviour before you get items back, simple as that.
When asked by Ms Richardson, Mrs McGhee agreed that it wouldn’t have been appropriate for Mrs Banner to walk past Patient 4 with his belongings and that was why she redirected her elsewhere with them.
KMcG: As a nurse I have to show leadership and Whorlton Hall there was a lack of training for everyone
MsR: Would you agree it would not be appropriate to walk past him with those things?
KMcG: Yes, that’s why I redirected.
Asked by Ms Richardson why Patient 4’s glasses weren’t passed to a member of staff not part of the restraint for safety, Mrs McGhee responded that “everything happens so quickly” and “as long as his glasses were safe”. Asked why she’d said in the police interview “you don’t want to put other people’s glasses on, did he put them on so they don’t break, I don’t know” Mrs McGhee told the court that she’d not seen the full clip when interviewed by the police.
MsR: Now having seen the clip, no doubt you’ve looked at it many times with you legal advisors, do you think it was an appropriate thing in the circumstances?
KMcG: I hold my hands up, have said it was unprofessional and a lapse.
Mrs Richardson suggests to Mrs McGhee that Mr Fuller wearing Patient 4’s glasses must have been discussed given the conversation turned to Clark Kent and Superman and everyone laughs.
MsR: Is that usually what happens, humour used during a restraint?
KMcG: No, someone said something. It’s a very intense moment for all the staff and people do, probably a coping strategy, coping mechanisms of all of them, it’s that intense, days working in Whorlton Hall.
MsR: Mrs McGhee at the time when Patient 4 is on the floor and you’re part of that restraint, where was your focus?
KMcG: All over
MsR: Who were you focused on?
KMcG: Patient 4
MsR: Thank you very much
KMcG: And staff
MsR: Thank you.
HHJ Smith had a couple of questions about baselines and strategies to support patients to calm down.
There was no re-examination for Mrs McGhee. There were two further pieces of evidence in the form of character references which Mr Jenkins, Mr Normanton’s junior, read onto the record. [I’ve tried to provide a skeleton of what they said, as much as I’m able]
In her character reference she told the court that she was a Community Midwife and had known Mrs McGhee since she was 16, almost 40 years. They had met in sixth form and had a close group of friends who often go away together and see each other. She said that Mrs McGhee had always had an interest in healthcare but when her children were young she’d put them first, and as soon as a chance in life became available she began working towards her nursing qualification.
Ms Campbell said that in her opinion Mrs McGhee was the perfect candidate for a nursing job. And as a healthcare professional herself she understood that it was a vocation and becomes your life.
She said that all Mrs McGhee had ever wanted to do was make a difference and look after patients and she knew Karen was devastated that she is not doing that any more. She said that Mrs McGhee was a friend you could ring any time of the day and that she’d always be there for you, she’d assess a situation and will be there with the correct advice you need.
Ms Campbell said that she was close to Mrs McGhee’s family and that Karen was devoted to her children, and that the whole family are very close.
She said that she is aware of the court case against Karen and she could not believe it, that it does not fit with the Karen I know. She said that she found it very emotional and could cry at the fact Karen is not doing what she loved and worked so hard for. She described her as the most reliable and faithful friend she could ask for, and she wants everyone to know how lovely she is.
She told the court that she is an advanced practitioner sonographer, having qualified as a radiographer in 1987 and studying further qualifications in 1993. She said she had known Mrs McGhee for about 20 years, having met through Karen’s sister Deborah.
She told the court that she saw a lot of her socially throughout the years, including seeing each other at their book group and attending concerts together. She said that she remembered it was a big deal for Mrs McGhee to get onto her nursing course due to her dyslexia, and she knew she had to work very hard. She was delighted for her when she achieved her qualification.
She said that she thought Karen was well suited to a nursing job and she knows she loved the mental health side of things. She said that Mrs McGhee has always been enthusiastic about helping others. She said Mrs McGhee has great interpersonal skills, was very aware of how others are feeling and is socially tuned in. “You just know Karen understands and gets you”.
She said that Mrs McGhee is also very resilient. She said that she’d seen a change in Karen during proceedings, although she was always warm and bubbly, can see it has deeply affected her. She said she hasn’t been as present and hasn’t been attending book group, also partly due to her working pattern, but also because she is under strain.
She said that Mrs McGhee always knows the right thing to say and do and that she was very kind to Mrs King during her separation and subsequent divorce.
That was the end of the defence case for Mrs Karen McGhee. Shortly before 3pm Mr Fuller was called to give evidence. I’ll report that next week when it’s complete.