The final defendant, who faces one charge, Count 27, was called to give her evidence by her counsel, Mr Rooney. In response to questions she told the court that she was 27, had never been charged with any criminal offence before this one, had never been cautioned by the police and was a person of good character.
MrR: I want go through your upbringing and personal information that may be difficult for you, for the jury to understand what kind of person you are. Is it fair to say you had a difficult childhood?
MrR: Were your parents very strict?
MrR: Were you the eldest child?
SM: I was yes
MrR: Were you allowed to go to school on your own?
SM: No my mam used to take me in the car to school and bring me home from school
MrR: When at home, after being to school, were you allowed to play out?
SM: No, I had to stay in the house
MrR: Up to the age of leaving school?
MrR: Please tell me what happened when you attended your school prom when you were 16 years of age?
SM: I thought I was going to prom, turned out I wasn’t going to prom, me mum had arranged a marriage for me, I was 16 at the time. What I thought was on way to prom, I was on the way to a mosque to get married
MrR: You were 16?
Ms Mahmood told the court that she was forced to marry a man who was ten years older than her. Asked questions by Mr Rooney she told the court that her marriage was not a happy one, that she suffered domestic violence and that she walked out and ended her marriage when she was 18.
MrR: Did you go back to your parents address?
MrR: Why not?
SM: Umm, according to my parents I put shame on the family for walking out and due to that I was shunned from the family
MrR: Were you allowed to move back into the family home?
MrR: Are you alright?
Asked where she lived after leaving her husband, Ms Mahmood said that she was “on the streets” for two weeks before she got taken to a women’s refuge. Whilst staying there she found a lump under her arm, attended hospital and was diagnosed with Stage 4 Cancer, a mix of Hodgkin and Non-Hodgkin Lymphoma. Ms Mahmood told the court that she was an inpatient in hospital for a year, receiving chemotherapy and radiotherapy. As a consequence of her cancer treatment Ms Mahmood told the court that she had developed a condition called avascular necrosis, restricted blood flow to her hips and knees and that she is on the waiting list for a full hip and knee replacement. Ms Mahmood also told the court that she was at high risk of heart attacks as a result of the radiotherapy treatment she received.
In response to questions from Mr Rooney, Ms Mahmood told the court that she was suspended from Whorlton Hall when the Panorama programme was aired and at the time she was living in a town near Bishop Auckland.
MrR: Did you receive any warning from BBC that the programme was to be aired prior to it being shown on the TV?
MrR: The day after the programme was shown on TV the police arrested you and interviewed you didn’t they?
MrR: And we know you were interviewed for a second time a year later … between the first and second interview was your house targeted?
MrR: I don’t think it is in dispute, the police came and had to help escort you away?
MrR: And they also had to escort you back to get your belongings?
Mr Rooney asked Ms Mahmood about her career prior to working at Whorlton Hall, asking her if in 2015 she began to work in the elderly care sector, she did. Ms Mahmood told the court that she worked in elderly care on and off until starting at Whorlton Hall.
MrR: Was there a period when you were working in the elderly care sector you had to take some time off for further cancer treatment?
MrR: During your time in the elderly care sector, were you subject to any complaints?
MrR: We know you started work at Whorlton Hall in March 2018, was that through an employment agency?
SM: It was yes
Mr Rooney asked Ms Mahmood if she received any training prior to starting work with the agency, at Whorlton Hall. She told the court that she had MAYBO training, safeguarding, DOLS and COSHH.
MrR: Pause there, DOLS means deprivation of liberty?
HHJ: What does that mean?
SM: It’s to do with the Mental Health Act, to deprive service users from going out on their own
MrR: And COSHH, control of substances hazardous to health?
Mr Rooney asked Ms Mahmood about any other training she’d undertaken and she told the court that the other training courses were all online and that there were no examinations.
MrR: So help me, what was the training then?
SM: Reading a document online, that’s it
MrR: Were you ever trained in how to approach individual service users?
MrR: Were you given any training in psychology?
MrR: Other than Deprivation of Liberty were you given any training in the Mental Health Act?
Mr Rooney asked Ms Mahmood when she worked at Whorlton Hall through the agency what her shift patterns were and she said that she’d be expected to work from 8am to 8pm and that staff had to be there half an hour early for handover.
In response to Mr Rooney’s questions Ms Mahmood told the court that as an agency worker she was paid approximately £8.60 an hour, and that when she became a full time employee at Whorlton Hall she took a pay cut.
MrR: Why did you take a pay cut?
SM: I needed the perks, I wasn’t getting any holiday pay, any sick pay. With my health the way it was I needed those sorts of perks and I needed stability, so I knew I was getting shifts, not just as and when
MrR: Were you ever given additional training?
MrR: Were you ever given any training on dealing with individual service user’s complex needs?
Mr Rooney then discussed careplans with Ms Mahmood, asking whether the court had seen 37 pages of Patient 1’s careplan, 32 pages of Patient 4’s careplan and only 6 pages of Patient 7’s, which she agreed.
HHJ Smith interjected to check whether the six pages relating to Patient 7 were the entirety of the pages that the defence team had been provided with.
MrR: That’s correct, yes, and we’ve heard evidence from Ms McGhee there were at least two folders worth of notes. Was that your recollection?
SM: Yes that’s right
Mr Rooney then turned to the allegation that Ms Mahmood faces.
MrR: The last count, Count 27, you’re accused on 4 January 2019 you did ill-treat Patient 7 by shouting aggressively at her, swearing and making derogatory comments about her family.
MrR: Do you understand?
MrR: Do you understand the word derogatory?
SM: I don’t know
MrR: It means expressing criticism or being insulting
Mr Rooney said that he’d not play the video as Ms Mahmood had seen it several times, unless it would help her, she said she was ok without seeing it. When asked by Mr Rooney what she was seen trying to do in the video, she responded “de-escalate the situation”.
In response to Mr Rooney’s questions, Ms Mahmood told the court that she was on a day shift that day, and when she arrived for work she had to walk through the lounge to get to the handover room, and she could see Patient 7 was a bit anxious, she stopped and asked her how she was and she began to explain that she’d received a message from a family member.
MrR: Tell us about that message please
SM: She received a message from a family member to say to her she should have died instead of her mother
MrR: Was this the first time you knew of her family sending such a message?
MrR: When she told you about the message from her family, how did that make you feel?
SM: Frustrated, I felt sorry for her
MrR: Were you assigned that day as one of the dedicated support workers for Patient 7?
SM: I was yes
MrR: In the morning or afternoon?
SM: The afternoon
Mr Rooney asked Ms Mahmood if she knew what time the incident had taken place, explaining that the footage is time recorded. Ms Mahmood told the court she thought it was at approximately 10:30am, that she was assigned to Patient 6 that morning when the nurse in charge, Wendy, had come up to Patient 6’s breakout area and asked Ms Mahmood to goto Patient 7’s room and try and de-escalate the situation.
Mr Rooney took the jury and Ms Mahmood to the transcript and said he wanted to go through it. Mr Rooney started by telling the court that in that 12 hour shift that Ms Mahmood was working, the footage lasted 6mins and 17 seconds.
In response to questions from Mr Rooney, Ms Mahmood told the court that she’d asked Patient 7 to take her shoes off because they were muddy, and that they were muddy because she’d been in the garden prior to this incident. One of the other staff members told the room that Patient 7 had something in her hand and as a result she was held and the wire she had, which Ms Mahmood thought was from a fence at the end of the garden, was removed from Patient 7.
MrR: Did she often take pieces of wire and conceal them about her person?
MrR: When you took the item from her, you then sat on her bed, why did you do that please?
SM: So I could get down to her level… to show her I was ready to listen to what she had to say.
MrR: She kept putting a blanket over her head. Why did you want her to stop doing this?
SM: She was a known self-harmer, I didn’t know if she had anything else on her and I wanted to make sure she was safe.
MrR: She says to you “you’ve caused this now” and you say “go on, keep going”. What did you mean by “go on, keep going”?
SM: Looking back now I don’t know, can’t remember
MrR: You then tell her if she keeps going she’ll end up on the floor
SM: Yes that’s right
MrR: Why would you put her on the floor?
SM: You could see she was escalating. Any further escalation would result in self harm or attacking staff
Ms Mahmood told the court that Patient 7 would need to be put on the floor because it wouldn’t be safe to restrain her on her bed.
MrR: Then you say to her “just talk, what’s the matter?” Why did you ask her that please?
SM: Because I needed to know from her what was in her head
MrR: You ask her for a reason before asking for PRN?
MrR: You couldn’t administer PRN could you?
MrR: Could only be administered by a nurse?
MrR: She says she wanted “everyone to fucking leave her alone” and you say “that’s not going to happen”. Why’s that?
SM: Because Patient 7 was eyes on at all times
Mr Rooney asked Ms Mahmood to pause there and explain what eyes on at all times meant. Ms Mahmood told the court that it meant one of her staff members had to have eyes on her at all times, due to her risk of self-harm.
MrR: You ask her three times “do you want PRN or not” and she replies “I don’t fucking know”. You then say “so is that yes or no, I need a yes or no answer please”, “do you want it?” and she says she wants to “go for a fucking walk” and you keep asking her if she wants PRN or not.
Were you ever trained in the correct way of asking a patient whether they wanted PRN?
MrR: Why were you asking her in the way we heard on the video and see in the transcript?
SM: Because around that time Patient 7 was known to ask for PRN willy nilly, whenever she wanted to, she’d take it because she liked the buzz of the high. We were told by Wendy on that shift if she wanted it, she had to state a reason.
Mr Rooney asks further questions, including what answer Ms Mahmood was looking for to the question about why Patient 7 wanted PRN and she told the court that she needed her to give some justification, that if she didn’t receive PRN she would escalate to self-harm or to harm a staff member.
MrR: So you wanted her to give some justification?
MrR: Then she says she “wants to go for a fucking walk” and Alex says “that can’t happen while you’re unsettled so what are we going to do?”. You say if she wants to go out in the afternoon, play with drums or electronics she has to sort herself out… does want PRN yes or no? Why do you say that?
Ms Mahmood told the court that if Patient 7 had not de-escalated she wouldn’t be allowed to go out, or have access to her belongings for her own safety.
MrR: She shouts “yes” in answer to your question and you say “what’s the reason” and she says she didn’t want two staff members on her obs and wanted to go out on her own. Is wanting go out without staff members an acceptable reason to give someone PRN?
MrR: She then calls you a dickhead and Alex says she’s just said she’s going to punch you in the face and advises you to step back, and you say “how many times have you said that before, how many times have you caught me? Once or twice and you’ve said it a shit load of times because you think you’re clever and hard”. Why did you say that to her?
SM: Was factual, she did only catch me one or two times, she was slow so did have time to move out the way.
MrR: Why did you say “because you think you’re clever and hard”?
SM: That was my mistake, shouldn’t have said that, I was frustrated at the time
Mr Rooney then asks Ms Mahmood if she’s ever received any injuries from and she says broken fingers, he clarifies that they were from an interaction with Patient 7, they were, and asks if she was “known to assault other staff” and Ms Mahmood says yes.
MrR: Then you say are you going to give me the actual reasons so I can help you. Why?
SM: Wanted her to go back to baseline, she was already feeling anxious because [I’m going to withhold this for concern of possible jigsaw identification of Patient 7]
MrR: You go on to say “right, you won’t get any PRN then… if this is about your family Patient 7 I’ve already told you before they’re fucking poison, I’m sick of telling you”. Why did you say her family were fucking poison?
SM: In my opinion it’s factual
MrR: Why do you say it’s factual?
SM: Because first hand it’s happened before… if a family member is messaging another family member telling them to die instead of their mother, in my eyes that’s toxic and poisonous
MrR: Were you frustrated?
SM: I was
MrR: Do you agree in isolation those comments sound awful?
MrR: And do you also agree could be viewed as unprofessional?
MrR: Why did you speak to Patient 7 like that please?
Ms Mahmood told the court that Patient 7 preferred you to get down to her level and speak like she did. Mr Rooney checked with Ms Mahmood that she wasn’t suggesting that Patient 7’s careplan said you swear at her, she wasn’t.
MrR: When you say get down to her level, what do you mean by that please?
SM: Like a young lass does, she spoke using swear words, all the time, so she’d expect, for me anyway she told me she wanted me to speak to her the way she spoke to me. I was able to understand her more, build more rapport with her that way.
MrR: She then screams “shut the fuck up” and you respond by saying to the undercover reporter “she’s just being a dick”. What did you mean by saying she was being a dick?
SM: It was a reflection of her behaviour
MrR: Help me a bit more
SM: The way she was acting at the time
Mrr: Did it have any effect on Patient 7 when you said that?
MrR: And what happened, the video is stopped at that point
MrR: What happened after the video?
SM: I sat on Patient 7’s bed with her. One of her techniques to get back down to baseline was to tap your hand so I gave her my hand, to tap my hand, and from there on she started to talk to me. We managed to de-escalate the situation approximately 20mins after the clip ended
MrR: Having de-escalated was she calm?
SM: She was yes
Asked by Mr Rooney what happened once Patient 7 had calmed down Ms Mahmood said that they went to the lounge for a few games of pool.
Mr Rooney then moved on to talk about Ms Mahmood’s police interviews. Ms Mahmood told the court that she was advised to answer no comment in the first interview. Ms Mahmood told the court in her second interview on 4 July 2020, she had told the police that Patient 7 had received a message from her family telling her they wish she’d died instead of her mum.
MrR: And you were asked specifically if anyone else was present and you told them Alex Hall and the undercover reporter was?
MrR: And you told police she wasn’t allowed to contact her family, who told you that please?
SM: The nurse in charge, Wendy
MrR: According to your interview, when de-escalated Patient 7 said to you she knew her family was poison and she was glad you said that to her because it allowed her to think. Is that true?
MrR: You told Police in your interview when you watched the video it looked awful?
SM: Without context yes
MrR: During your time at Whorlton Hall have you ever reported any one for behaving in what you view to be an unacceptable way?
SM: I have yes
Asked by Mr Rooney if she’d ever heard other staff members swearing at Patient 7 Ms Mahmood told the court that she had, a senior staff member called Lyndsey Hodgson.
MrR: Did anyone tell you that you shouldn’t be swearing at Patient 7?
MrR: Did you say those things to Patient 7 to upset her?
Mr Rooney asked Ms Mahmood if she was saying those things to Patient 7 to be cruel, she said no. Mr Rooney then asked her if she was trying to de-escalate the situation and did it work and Ms Mahmood said that she was, and it did.
Mr Rooney finished by turning to training.
MrR: Were you ever given any training in how to deal with your own emotions?
MrR: Any training in how to deal with your emptions when dealing with service uers with complex needs?
MrR: Did anyone ever explain to you how dealing with someone with complex neds could affect you as a person?
MrR: When you started as agency staff, and later full time employment, did you ever shadow anyone?
MrR: Did you receive any training from resident psychiatrist on how to deal with these patients?
MrR: Any training from a psychologist?
MrR: From March 2018 to January 2019, 10 months, other than the 6 minutes we see on the video clip, have you ever been told your behaviour was ever inappropriate?
MrR: Have you ever been told you need to undergo training to modify your behaviour in any way?
Mr Rooney finished by turning to the agreed facts document in the bundle. Mr Rooney told the court that the agreed facts state that Ms Mahmood’s training record provided to the police whilst she was employed at Whorlton Hall is blank. His final question was whether Ms Mahmood received any training when she was employed full time at Whorlton Hall, she replied no.
No questions from Mr Rutter for Peter Bennett or from Mr Constantine for Matthew Banner.
Mr Walker for Sarah Banner wanted to ask Ms Mahmood a question about de-escalation techniques.
MrW: Just want to ask you a little about techniques you’d use to bring situation down. You were asked about a phrase “go on, keep going” and later “just keep going the way you are Patient 7”. That’s just before a comment is made, you’re obviously not encouraging her to go on the way she is are you?
MrW: Olivia Davies in fact used the phrase during her evidence of “calm opposite”
MrW: Are those two phrases “go on, keep going” and “just keep going the way you are Patient 7”. They’re graphic illustrations of calm opposite aren’t they?
SM: They are yes
MrW: You’re saying to a patient something you’re intending them to do the very opposite of, in a calm manner to de-escalate the situation?
SM: That’s right
MrW: You weren’t unique in using that soft power were you?
MrW: Was used by other members of the team wasn’t it, including Sarah Banner?
No questions from Mr Normanton for Karen McGhee or Mr Knox for Ryan Fuller.
Mr Patton for Niall Mellor then asked Ms Mahmood a number of questions, taking her to Patient 7’s careplan.
MrP: OK, this is part of her careplan. Is quite detailed isn’t it?
MrP: Do you agree with Niall Mellor she could be good fun?
MrP: She was a patient you could go to the cinema with?
MrP: And she liked what they call good craic?
MrP: She was someone who engaged with staff?
SM: She did yes
MrP: Whatever difficulties others had she was able to express herself?
Mr Patton asked Ms Mahmood if Patient 7’s careplan stated that Patient 7 had requested a set period specifically identified as a daily time to talk to staff. Ms Mahmood agreed that was right.
MrP: Did she have that?
SM: When she felt she needed to
MrP: Specific time where someone would talk to her, and what she’d have to say about life?
MrP: Would any notes be made of that
SM: When the notes came around
HHJ: Do you mean observation notes?
HHJ: Slightly crossed wires maybe
SM: If was safeguarding, then notes would be taken at the time
MrP: If something happened she didn’t like, could she ventilate that?
MrP: It says Patient 7 has therapy appointments weekly with a psychologist and OT, might have been like unicorns there, did you ever see the psychologist or the OT?
MrP: Do you remember if she ever did see them?
SM: Not to my knowledge
Mr Patton then read another section from the careplan that stated that Patient 7 thinks the staff supporting her would benefit from personality disorder training, attachment disorder training and sensory awareness training. In response to a question from Mr Patton, Ms Mahmood said that she’d never received any training like that, and no-one else had to her knowledge.
MrP: Its said she had a meaningful activity careplan. Do you know what that was?
MrP: Did you ever see meaningful activities for Patient 7? Apart from going to the cinema?
MrP: Says staff supporting her on daily basis were to provide her with access to easy to read hospital complaint forms. Did you do that?
SM: No. She never asked.
MrP: Did anyone ever give you forms and ask you to hand them out when you sit with her?
MrP: Would she be capable of making complaints if she had any?
SM: Oh yes, definitely
MrP: Did she ever make complaints as far as you’re aware?
SM: As far as I’m aware no.
No questions from Ms Brown for Darren Lawton or Mr Dryden for John Sanderson.
At that point court was adjourned for lunch and it was over to Ms Richardson, the Crown Prosecutor, when we returned.
MsR: As I understand your evidence Ms Mahmood, you were someone who spent quite a bit of time with Patient 7?
SM: I did yes
MsR: And you knew she was someone who could be emotionally labile?
SM: What do you mean by that? Sorry
Ms Richardson suggested that Patient 7 could be up, down, sideways, depending on mood and Ms Mahmood agreed.
MsR: And on that particular day you knew [withheld]
SM: Yes that’s right
MsR: Had she talked to you in detail about the difficulties with her family?
SM: Not in extensive detail
MsR: But you knew her family was something she had extensive feelings about?
MsR: And did you know there was unresolved trauma surrounding her and her family?
MsR: And did you know sometimes she wanted to self-harm because of that?
MsR: When she told you about the message how did she appear when she told you?
SM: Anxious and sullen
Ms Richardson asked Ms Mahmood whether part of her duties if she were on observations were to ensure a patient returned to baseline. Ms Mahmood said that was the case but that she wasn’t on Patient 7’s observations that day, but had been pulled off Patient 6’s observations to attend.
MsR: Once you were there you’d have done everything in your power not to escalate her anxiety?
MsR: To bring her back to a calm level?
Ms Richardson said that she would play about one minute of the clip relating to the count that Ms Mahmood is charged with.
MsR: When we first see you come to that situation, you’re trying to calm her down and ask her whether or not she wants PRN aren’t you?
Then if we look at p124 behind Divider 7 she says “I want you to leave me to it”, you ask “do you want PRN or not” … you say ”I’ll ask you one more time, this is the last time I’ll ask you, do you want PRN or not” and she says she doesn’t know. You go on to continue to ask her don’t you?
SM: I do yes
MsR: Why when this woman is getting increasingly agitated do you continue to insist she give you an answer to that Ms Mahmood?
SM: Because I knew she needed the PRN, but the direction given by Wendy at the time was I needed a straight answer and a reason why.
MsR: But you weren’t getting an answer
SM: I did in the end
MsR: But in that clip… that wasn’t de-escalating that anxiety for her did it?
SM: It did in the end, yes
MsR: But the part we’re seeing that the jury have to decide upon, she’s not de-escalating is she?
SM: No, but it’s always slow to de-escalate, it isn’t instant.
Ms Richardson asked Ms Mahmood if this were the first time that she’d told Patient 7 her family were poison and she said it was not. Ms Richardson asked whether Ms Mahmood accepted that Patient 7’s anxieties might have been higher for her about her family on that day and she agreed.
Ms Richardson then took Ms Mahmood to her police interview transcript and asked her what she meant when she said that Patient 7 wasn’t able to pull the wool over her eyes.
MsR: You’re being asked about the message that Patient 7 told you, you hadn’t seen the message, and you don’t know how she got it, but you’re telling the police “I don’t have a clue because I didn’t see it”. Then you say “I don’t like to make out she’s lying to me simply because she’s a 19 year old kid… just went with flow… told her how it was, and she de-escalated straight away, she knew she wouldn’t be able to get there, she wasn’t able to pull the wool over my eyes”. What do you mean by pull the wool over my eyes?
SM: When new members of staff worked with her, she’d work out whether they’d be able to see past her behaviours. She knew I knew her very well, we had a very good rapport.
MsR: Yes. Did you think Patient 7 thought she was clever and hard?
SM: No that was something I said out of frustration. I shouldn’t have said.
MsR: It started off with you trying to calm her, but then you lost your temper didn’t you?
SM: I was frustrated for Patient 7
MsR: How was saying her “family were fucking poison” the only way to de-escalate her?
SM: I needed to know that Patient 7 knew why I was there, why she was escalating basically, that was a way to, I don’t know what the word is
MsR: What I’ll suggest to you is it wasn’t the only way you could de-escalate the situation, in fact it was upping the ante wasn’t it?
Ms Mahmood asked Ms Richardson what she meant and she explained. Ms Mahmood told the court that Patient 7 was already escalated at that point. Ms Richardson pointed out that Ms Mahmood’s job was to “bring her back down’ but at the time she was standing over her, pointing at her and that wasn’t the only way she could de-escalate the situation.
Ms Richardson took her to another extract from her police interview.
MsR: She was screaming, screaming and screaming the only way I could de-escalate her was to overpower her. Do you have that? The officer says uh hu, so I had to overpower her and say to her, her family were poison, it was the only way to de-escalate her. But it wasn’t the only way was it?
SM: In that moment she was screaming, I had to assert myself
MsR: Do you accept from being patient your mood escalated?
SM: I was frustrated for her
MsR: You lost your temper with her didn’t you?
MsR: Rather than de-escalate, you said what you said because in that moment you wanted to be deliberately cruel to her didn’t you?
MsR: Thank you
No further questions from Ms Richardson. No re-examination from Mr Rooney and he closed the case for Ms Sabah Mahmood.
HHJ Smith explained to the jury that the defence had now completed their case, that all the evidence in the case had been heard, there would be no more.
He told the jury that the next stages was the speeches, the addresses, or arguments from the lawyers, by which he said he meant what they were seeking to persuade them to adopt. HHJ Smith said that this was not evidence, it was bringing the evidence together in support of their particular position. He said that the prosecution will go first and then each defence counsel would address them in order.
HHJ Smith told the jury that then there would be his summary of the evidence, that there would likely be one or two additional legal directions he’d need to give them, in addition to the ones he gave earlier in the case. He said that the first part of his summing up would come before the speeches and in that he would give a route to verdict questionnaire that the jury will look at each time they are considering an allegation, and one or two other directions at that preliminary stage before the speeches.
HHJ Smith explained that he needed to settle that and agree it with counsel, that they would do some work on it this afternoon and early tomorrow morning. Then he anticipated that Ms Richardson would address the jury, and that after that he suspected we’d start the defence speeches tomorrow.
HHJ Smith told the jury that we’re at a really critical stage and he asked them not to conduct their own research and not to discuss things outside their number. He then sent them off to enjoy the sunshine at 14:25.