Day 6 Jessie’s Inquest: Ruth Nathan, Lead Practitioner

The final witness before lunch on Day 6 was Ruth Nathan.

Asked to give her full name and professional status, she did so and told the court that she’s a senior social worker.

Coroner: OK, you indicated that you’re a Senior Social Worker, how long have you been in that role?

RN: Just a couple of months, it’s a new post.

Coroner: Before that, how long were you a social worker?

RN: Since 2006

Coroner: I wanted to ask you specific questions relating to your involvement with Jessie

Counsel for Sussex Partnership asked if the coroner could clarify who Ms Nathan worked for, saying that she was really mindful that social worker could be misleading for the jury

Coroner: I’ll come onto that. Your care with Jessie started on 21 June 2021, when you were appointed her Lead Practitioner. Wonder if you could tell the jury what a Lead Practitioner is, and who you were working for in that role.

RN: Just to make that point clear, although officially on paperwork I was Lead Practitioner on 21 June 2021, I was asked to step back as my Service Manager and one of the Lead Nurses was doing all work with family and the first time I met Jessie was 21 September 2021.

Coroner: OK, so although you held the role, your actual involvement with Jessie wasn’t until September. So tell us what a Lead Practitioner does, and who employs you?

RN: I’m employed by the NHS, Sussex Partnership, and work in mental health services. Lead Practitioners is open to several professionals, mental health nurses, OTs and social workers, social workers are quite recent thing in last few years.

My role was very much like the old Care Co-ordinator [can’t hear] and I have lots of threads with Jessie, I had oversight, but for me as a social worker I felt big part of the job was to really know about Jessie. So I spent considerable amount of time going through all the notes, right back to when she was in Chalkhill, so I could know her as a person, and take a trauma informed approach.

Coroner: OK, as her Lead Practitioner, you were working with her in the community?

RN: [can’t hear] in community with emphasis on mental health, so I wasn’t involved in commissioning and actually have very little responsibility, other than oversight of the case… [can’t hear] …checking in on Jessie on a weekly basis

Coroner: OK, so would it be fair to say you’d be the go to person from different agencies, come to you as Lead Practitioner?

RN: Yes I was the go to person but I, there was a lot of things I didn’t have information about, such as placements for instance, I didn’t have information about, I’d feed in information in, about what her needs might be, what might be best type of placement for Jessie to meet her needs

Coroner: So the jury have got within their folders the chronology, they’re aware of the various admissions that Jessie had had. But after, or when you were appointed, had she had a spell in Langley Green Hospital?

RN: [can’t hear]

Coroner: Before you were appointed?

RN: yes, was before that, was 11 February 2020, sorry I’m not very good with dates, will refer to my chronology

Coroner: In your statement you refer to dates 15 March to 5 August. You were appointed 21 June, so was she in Langley Green at the time you were appointed?

RN: Must have been

Coroner: You said you didn’t get involved until September because there were others involved in her care, in September 2021 I assume she must have been out in the community

RN: [can’t hear]

Coroner: So what did you understand Jessie’s diagnosis to be?

RN: First of all autistic spectrum condition, ADHD, post traumatic stress disorder, and also notes about emotionally unstable personality disorder, but that was always disputed by Jessie. Was also a conduct disorder but I can’t remember the name.

Coroner: You mention autism spectrum condition, what’s your experience of people with autism?

RN: I am 100% up to date with my training I’m proud to say, and I’ve done autistic spectrum and psychosis twice and Oliver McGowan training and I’m a parent of an autistic child … when I was working for BHCC I was in the disability team [can’t hear] I campaigned for training for managers to get the best out of staff with neurodiversity, I’m dyslexic myself, hence my difficulties with dates. I think that’s and yeh I was also [can’t hear] representative for disability at BHCC at conferences [can’t hear].

I’ve read a lot of books.

Coroner: OK, so you were asked to be Jessie’s Lead Practitioner, you’d researched, or rather you’d read all her notes, you didn’t get to see her until 20 September, and you told us why. Can you talk to that first meeting, your statement says you met her on 20 September?

RN: [can’t hear]

Coroner: Paragraph seven of your statement if that assists you

RN: What page is that?

Coroner: My pages are different, its paragraph seven of your statement

RN: Yes so to start with I don’t think she liked me very much, and so it was quite a slow process and Andy came in, I was quite grateful for that initially, I found out she really liked art [can’t hear] brought in things to do [can’t hear] was a breakthrough moment [can’t hear] broke the ice a bit, the sessions were mostly taken up, right from the beginning about complaints about [can’t hear]

Coroner: I’ll come onto that, you had this first meeting, how often did you meet Jessie?

RN: The offer was weekly, it didn’t always happen, up until the incident I’ll talk about on 17 February, then it was [can’t hear] it was offered on a weekly basis while Jessie was in the community. Quite a high level of support for a Lead Practitioner, wouldn’t be an expectation to do, but yeh, to start with we were just focusing on goals really and establishing rapport, can take some time.

Coroner: OK, and you met with Mr Seares, Andy, at that first meeting, was he present on all your meetings?

RN: There was only one occasion when Andy wasn’t there.

Coroner: Was it your preference to have Andy there?

RN: It wasn’t about me, it was about what Jessie wanted. I suppose it was good to see Jessie independent of her Dad, the one occasion we did have a session on our own it was great, really saw her relaxed, we were laughing and joking, she did a lovely piece of art, we didn’t talk so much about complaints we were talking about strategies for grounding and stabilising. That session as well I had a big bag of clothes donated to me by one of my other patients going to the charity shop, and she looked through them and picked some out and a weighted blanket. After that she said [can’t hear].

Coroner: You said that was your one opportunity when the complaints were not discussed, I assume these are complaints about IMC Locums?

RN: Yes

Coroner: I don’t want to put words into your mouth, did they dominate your sessions?

RN: Yes, thing is they needed to be said. I don’t think Andy felt very heard. I did offer a safe space to discuss those, and always took them back to the agency, I wanted to do that, they were going everywhere [can’t hear].

Coroner: So we understand, Andy and Jessie were raising the complaints with you, you then took them back directly to the agency, but copied in others?

RN: Yes, everyone got copied in

Coroner: Did you speak with the carers yourself at all, or offer any assistance at all?

RN: Yeh [witness becomes upset]

Coroner: Its ok, take your time

RN: I wish I could have done more.

Coroner: Why do you say you wish you could have done more?

RN: Because the carers weren’t very experienced with autism, one of them even said to me “will she get better, is she doing to grow out of it?” and I realised the absolute depth of the ignorance with some of them, not all of them. Will be such a big job to educate them.

Coroner: You mention in your statement you offered some supervision to the carers, explain that

RN: Yes.. I suggested, what was brought to our attention was Jessie said a lot of the carers were cooking fish, I know from my experience that’s a big no no in the house. Just really wanted to get information, so I said how about I offer, this is completely out normal way of what Lead Practitioners normally do, I will offer supervision to the carers, there was quite a lot of different carers. I was given the phone number of the house phone. I put a date together and said, right, will have online supervision, I’ll explain about Jess, go through some of the plans we had, previous assts been done, the TCAT ones particularly, and I was going to make some suggestions about the best way forward and getting the best out of the placement.

The day came, the first supervision was going to take place, I turn up on the call, there’s only one person there from IMC. He was trying to phone around staff saying you need to prioritise this, he did try. In the end I just had two people, we had an hour talking about Jessie and how best to care for her [can’t hear].

Said we’d try to make this a regular thing and no-one ever came to the sessions. Was limited time [can’t hear] but I did try.

Coroner: We’ll go through some of detail as to concerns Andy had, but also concerns raised by the carers in respect of Andy’s involvement with his daughter

RN: Yes

Coroner: Did you speak to Andy about that, and Jessie?

RN: Twice

Coroner: Tell us a little about that

RN: When you’re a social worker there’s a lot put on you, you have to have difficult conversations, previously worked in child protection had a lot of difficult conversations. Had a conversation with Andy, don’t remember the date.

Coroner: Don’t worry we’ll go through in a moment

RN: First one, I was told we’ve had series of complaints, we need to bring this up with Andy, are you comfortable doing it. I said who is going to do it, there’s a safeguarding ongoing, I said needed to have conversation.

The way it was brought up, I remember the conversation, we were doing some art and talking about appropriateness of bathing your daughter, and how it might seem, how other people might interpret that and how do you feel about it Jessie. She said alright, why wouldn’t I be? I said when I was your age… [can’t hear] when I get to 15, and she said well he’s always done that, there was no question was anything strange.

Andy also said what if she has a seizure, but [can’t hear] then there was also Jessie quite likes a bath rather than a shower or whatever, and because one of her conditions holding her arms up is quite difficult for her and you can’t wash your hair without holding your arms up

Coroner: the minutiae of it we’ll move around, you brought it up?

RN: I brought it up, took explanations back to the group.

Coroner: Before that, how did Jessie and Andy react?

RN: It was OK really, it wasn’t a big deal really.

Coroner: Was there any plan at that point for Mr Seares to stop bathing Jessie or did you leave it at that?

RN: [can’t hear]

Coroner: You raised it again, how was it on this occasion?

RN: Second time didn’t go down as well, was still complaints coming in from the carers, had had email this particular morning from IMC Locums to say, one of carers who was trusted carer who Jessie liked and Andy liked had said, I don’t even want to say was inappropriate, what was alleged.

Coroner: I think you’ll have to say

RN: Was that Jessie was naked and Dad had kissed her on the lips, and taken her into the bathroom. This was seen by Linda.

We had a team check-in in the morning and I had my appointment with Jessie and Andy at 11am and the allegation was spoken about in the team meeting, I said I’ve had this conversation before what do you want me to do and my manager said please can you raise it.

I had an OT meeting with me, at that point been quite a lot of safeguardings and I was told better not to have one to one with Jessie. In preparation for this I sent the OT some [can’t hear]

We had such a positive session, at which I went to [can’t hear]

Coroner: I’m afraid I’m going to have to stop you, a lot to get through

RN: At the end I knew I was going to have to raise it. I said I just want quick chat with your Dad and Jessie said anything you’ve got to say can say in front of me, I remembered in her care plan she likes included in everything. I should not have done it like that, at that point whatever we were going to discuss Jessie had started to become deregulated [can’t hear]

Coroner: So I understand that’s the outcome, in Jessie hearing you mention?

RN: Jess was sitting there, I said are you sure you want to hear, is a bit awkward, will only take a couple of minutes. She said no, I want to hear it, so I said this was the allegation.

Coroner: How was that left then? Obviously she came dysregulated

RN: [Can’t hear]

Coroner: And what about Mr Seares?

RN: He was very upset, wanted to know who made the allegation, he didn’t know at the time was Linda, he then called Linda who denied everything.

Coroner: I can only take evidence from you that you directly know about. That incident was 17 January, what was your last contact you had with Jessie before she was admitted to hospital?

RN: After that one Jessie said she didn’t want to see me anymore, she’s quite black and white in her thinking, you’re either in or you’re out. At that stage I was out. I did manage to get back in, went to a few ward reviews, and I [can’t hear, witness becomes uspet]

Coroner:  OK, take it slowly, when you say ward review, was this virtual or were you there in person?

RN: It was virtual

Coroner: Other professionals were there as well?

RN: Yes, was a ward review, Andy was there

Coroner: How was jessie that day?

RN: She was alright, she was talking about her behaviour chart, she showed me it with stars on, she’d done quite well. She was talking about the summer, maybe a trip to Disney [can’t hear] was quite big conversation about money, Jessie likes treating people to things, buying art material. We talking about her money, she agreed she’d put some of her money into a savings account that she couldn’t touch and she downloaded an app for that. Such a lot of positive things in the meeting and also forward planning. She seemed in quite good spirits really.

Coroner: What’s forward planning saying to you as a social worker?

RN: I was thinking she was looking forward, to living her life

Coroner: Did she give you any concern at all at that meeting?

RN checks statement

RN: Oh there was some talk about, she was on a diet and talking about her weight and restricting herself to 500 calories, that wasn’t uncommon, Jessie had a complex relationship with food

Coroner: What about coming out of hospital, did she talk about that?

RN: Yeh the summer, trips and things she wanted to do, and go out with her Dad on car rides.

Coroner: Where was she hoping to go?

RN: For placement?

Coroner: Yes

RN: I did feed into quite a lot of that, what was it Jessie wanted. Jessie had impressed on me she really wanted a bungalow, she didn’t manage stairs very well, close to hydrotherapy pool, where she could be independent with people to support her. She wanted a therapy dog [witness becomes upset].

Coroner: OK, can I ask you what you had hoped for Jessie’s future, as her social worker, what had you?

RN: Lead Practitioner

Coroner: Sorry yes, as Lead Practitioner, what had you hoped?

RN: My vision for Jessie was for her to get one of those bungalows in Eastbourne, or situation, even though family were really against EUPD diagnosis, I’ve worked really closely with people with similar diagnosis with Jessie and benefited from the Thinking Well programme, and I was working closely with them, thought she’d really enjoy that, art groups and drama and forming relationships with them, and other people with autism, that’s what I was hoping for for Jess

Coroner: You said you weren’t responsible for her placements, that was for others to do. Were you aware of the difficulties the local authority were having in finding suitable placements?

RN: Yes I kept asking, knew there had been about twenty approaches, hadn’t seen them, but had filled out one referral right at beginning of my relationship with Jessie. Knew had been multiple approaches, but unfortunately the risk assessment was such it wasn’t going to happen, but my hope was incidents would get less and less, risk is a changeable thing, it was going in the right direction.

Coroner: Can I take you back, I was going to take you through your chronology, may leave that now to others. This ongoing situation with Jessie in the community with IMC Locums, just focus on that for a moment. When a complaint was raised with you, are you satisfied it was dealt with?

RN: I don’t want to point fingers, but it was taking an inordinate amount of time.

Coroner: Your time?

RN: No. I had to keep chasing up, people were off sick, was no one sitting there twiddling their thumbs, just there wasn’t people to do it

Coroner: We heard evidence from IMC Locums, when complaints were made they were dealt with, staff were removed and dismissed for example, are you saying that didn’t happen?

RN: No they were. Jess wasn’t really spoken to, maybe once or twice, by a social worker in a way I would have expected in a timely manner. But again no one’s fault, I think everyone was doing their best.

Coroner: There was communication between Jessie’s parents and yourself?

RN: Yes with Andy. My manager was very keen for that to be contained. So I did always answer Andy’s email and Jess’s as soon as I could. I didn’t have any communication [can’t hear]

Coroner: What I’m trying to understand was, you were aware of these problems, did you see your role as trying to contain it, in as much as try to maintain this support for Jessie in the community to stop her going to hospital?

RN: It wasn’t my job to contain anything, I passed it on. Safeguarding was raised, I had a duty to pass it on, in the end there was no choice, it wasn’t my choice Jessie was in hospital … [can’t hear]… the things that were happening started to escalate, that’s why.

Coroner: So allegations by family against IMC, and going back the other way, in your view did it become impossible for that relationship to continue?

RN: I think it did make it difficult

Coroner: Did you see the impact that caused for Jessie?

RN: [Can’t hear]

Coroner: OK. Thank you, if you’d just like to remain there. Counsel, I was going to take this witness through her exhibit RN1 but think we’ve touched on the surface of chronology, maybe individual aspects explored further.

Then it was over to the family for their questions. Counsel for the family checked if Ms Nathan wanted a break first, she didn’t.

Counsel: Your interactions with Jessie at Viaduct Road, didn’t take place in the property, they were in a separate office that Jessie was taken to by her dad, Andy?

RN: Yes I did offer to go out there but my manager said no. Was Brighton placement, some distance and I had 30 other patients.

Family: So a time management issue. Does that mean you never saw what her living arrangements were at Viaduct Road?

RN: Yeh, I never saw it [fuller answer – missed]

Counsel: Just in respect of the impact this placement seemed to be having on Jessie. I’ve got some text messages Jessie sent to her Dad in September 2021. I’m not suggesting you’ve seen them, g298 and g297. Jessie explains to her Dad she has [self-harm, withheld] and can’t cope, with the words she used “these fucking carers”. She says “the carers are so horrid, I can’t be doing it much longer, I do feel really low and suicidal, just because of how bloody useless they are”. She said she felt suicidal. Did you understand the impact on Jessie?

RN: Yes, she was not happy with the accommodation, knew why, stairs unmanageable, toilet situation unmanageable, kitchen, was lots of things weren’t ok.

Counsel: What was your understanding of the toilet not being manageable?

RN: Don’t think it was right she had to carry a bucket down the stairs.

Counsel: Were you aware of Jessie’s interaction with her carers?

RN: [can’t hear] knew it wasn’t good

Counsel: She goes on to say in this message “I can’t even have a conversation with them, I need people who I can speak to and do stuff with. That’s why I’m always fine when I’m with you or mum because you are the best parents ever and you actually care about me. But as soon as you leave I’m left in my own world full of sadness and loneliness with nobody to speak to when I feel like doing something destructive”.

Did you have an understanding of Jessie’s general wellbeing and how occupied she was when her parents were not there?

RN: Yes and I brought it up with IMC Locums, said Jessie said bored and nothing to do and I was told it wasn’t true, was told were offers of activities and things.

Counsel: Did it go any further?

RN: I always recorded it when she said things weren’t.

Counsel: Were any steps taken as part of the supervision you offered, to try put to something more concrete in place?

RN: Yeh I did say, would it be possible for the carers to take her to the Sea Life Centre, anything like that and they said they were always offering things like that.

Counsel: As far as you’re aware did any of that ever take place?

RN: No

Counsel: You’ve spoken of supervision session you tried to put in place and only two staff members joined the call. We heard from Mr Brown that staff were emailed bullet points of how to communicate Jessie towards the end of her time there, in February 2022. Were you involved with putting together that list?

RN: I can’t remember, I know I sent them the TCAT report and various things to help them.

Counsel: I won’t ask more then, if we can move to safeguarding issue. We’ve heard about reports and conversations you’ve had. You refer to Andy’s explanation at the time, when you first raised, when both he and Jessie didn’t think was problem and Andy referred to seizures, is that right?

RN: Yes

Counsel: You knew Jessie was suffering seizures, and he provided you with that information?

RN: Yes

Counsel: Do you agree that’s important contextual information for safeguarding enquiry?

RN: Yes, but also information from previous hospital was she was able to bathe without support, so that was confusing.

Counsel: But you heard evidence from Andy seizures was concerning, could you understand where he was coming from about potential risk?

RN: [Can’t hear]

Counsel: When these conversations started happening, did you have any conversations with Jessie’s mother Kate about this?

RN: No, I was asked not to contact Kate

Counsel: Who asked?

RN: Simon Hellyer

Counsel: Can we take [can’t hear]

RN: I knew that was the case, talk about Jessie being in a bathing costume at the time

Counsel: So you knew Kate undertook bathing with Jessie?

RN: Yes

Counsel: But not having a conversation with Kate, you weren’t able to get other contextual information about her needs?

RN: Got a lot of contextual information from the reports, but yes

Counsel: I think in your chronology, at g142, you refer to a professionals’ catch up meeting 9 November 2021.

You’re there, as well as Simon Hellyer, Lauren Bernard and some others. Note there saying positive feedback from IMC following introduction of female nursing staff. Reported Jessie begun to engage with female nursing staff around personal care. What was your understanding of what provided at that stage?

RN: [Can’t hear]

Counsel: You’ve spoken about your experience in January with Jessie when you tried to broach the subject but said it didn’t go well. You accepted, reflecting on it, may have been better approach to deal with matter separately with Andy. You referred to it effectively as a mistake having not done that?

RN: Yeh, I mean it didn’t go well did it. If I’d had more time to reflect on it, I think I might have challenged my manager’s decision about bringing it up.

Counsel: Bringing it up with Jessie there?

RN: Yes, but previously we brought it up and she was ok

Counsel: Previously issues were about bathing, January much more pointed allegation, do you accept that?

RN: Yes

Counsel: Possibly much more distressing for Jessie to hear?

RN: Yes

Counsel: And you said the impact was increasing dysregulation?

RN: Yes

Counsel: The police were called in respect of that incident weren’t they?

RN: Yes

Counsel: We have the police report detailing that incident, refers to having attended and spoken to you and spoken to Andy about that allegation. One of the parts of this report says “officers spoken Ruth Nathan who informed allegation and then bizarrely said allegation of father kissing Jessie on the lips had been withdrawn by the care home”.

RN: Yeh it had

Counsel: So that’s what you provided to officers at time. Officer says “I am also concerned is no clear guidance for Andrew or carers as to how much care Jessie requires, Andy is of opinion Jessie suffers regular seizures and therefore needs 24/7 care, Ruth says not required to support Jessie at all times”. Does that reflect the conversation as you recall it?

RN: I can’t remember the conversation, it was very stressful, the whole thing was very upsetting

Counsel: Then says “in attempt to clear air between Ruth and Andrew, impromptu meeting held, but then unfortunately when sat together Ruth said not medically trained so can’t say whether Jessie required any assistance with bathing”

RN: I’m not an OT, wouldn’t be for me to say.

Counsel: At this time, in lead up to January, had you taken any steps to secure an updated OT assessment?

RN: Yeh there was one in progress

Counsel: Did you seek any information from the people carrying out Jessie’s care at Viaduct Road?

RN: I was given regular updates, was email coming in every day

Counsel: We see update at G301, I’ll read to you, text message between a member of staff at IMC called Tracy and Jessie’s Dad, from February 2022

Begins with Andy asking if this woman Tracy can do more shifts for Jessie as Jessie really likes her. Response from Tracy says “If I’m with Jessie don’t worry too much, she’s also much calmer if I’m with her, although sometimes if not too well she can’t help it”. She says “I find Jessie is more incontinent now, she needs changing 3 to 4 times a night”…[missed]

Were you aware Jessie was becoming more incontinent at that time?

RN: Yeh I knew about the enuresis, was an ongoing issue

Counsel: We see at g300 there’s in March 2022, message from Andy to Tracy to let her know Jessie has been moved to Mill View. They speak about the seizures, and then Tracy says, I still blame IMC, they should have left her with the good carers she was getting used to, especially if needing incontinent personal care. If there’s any opportunity to support Jess I’d be happy to [missed section]

Were you aware of Tracy’s involvement in February and March and the support she was giving Jessie?

RN: No

Counsel: So at the point you made the safeguarding referral, does appear you had any information about that nature to pass on to the safeguarding referral?

RN: Would have been included, her night time needs

Counsel: Were you satisfied whoever carried out the safeguarding referral had enough information about how to approach Jessie about these allegations?

RN: Can’t speak to someone else’s experience, just know as social worker get training

Counsel: Sorry, not with respect someone’s training, but information you provided about Jessie. Do you accept might have bene useful to provide, as has key information about how to approach Jessie?

RN: Yes

Counsel: You’ve given evidence about impact this January meeting had on your relationship with Jessie, did you make any attempts to re-establish rapport by visiting her on the ward?

RN: What you have to understand about Jessie is if she’s made up her mind about something, there’s no changing it. I made it consistently clear I was available to do video call or phone call and she didn’t want that, she did say about Christmas she might … it was alright, we made up in the end.

Counsel: We see skype assessment for [missed], said Jessie didn’t want take part video [missed] did take any steps to discuss?

RN: No

Counsel: Did you at this point take any steps to contact Jessie’s mum Kate

RN: Said earlier, didn’t at any point, that’s what I was told, talk to Andy

Counsel: You’ve given evidence about ward reviews you attended, attended one 9 May 2022, in our records at xxx. There’s reference in this ward review to Jessie speaking with you and expressing anger about allegations, it says “she asked Ruth what the fuck she’d been doing over the last few months, boundaries were set around engagement and Jessie rephrased it. Ruth explained ongoing [can’t hear] Jessie said she felt allegations was made because the carers were being fired”. Does that accord with your recollection?

RN: I don’t remember that

Counsel: Do you remember Jessie’s comments about allegations being made because carers were being fired?

RN: No

Counsel: Records says “Ruth says pleased discussed today, and want move on to placement”

RN: I would have been pleased, I did have a really good relationship with her [witness gets upset]

Counsel: If it helps Ms Nathan I’m very close to the end of my questions?

Coroner: Are you ok, would you like to take a break? Members of jury, we’re very close to lunch actually.

Counsel for Sussex Partnership: I don’t think it’s a good idea if witness is upset

Coroner: If close to the end

Counsel for Jessie’s family: Yes

RN: Keep going

Counsel for Jessie’s family: When you said moving forward, doesn’t appear anyone talked to Jessie about safeguarding referral still being open, do you know Jessie’s understanding about the safeguarding?

RN: I can’t remember

Counsel: With understanding you’d like to move forward, tell me if I’m wrong, but doesn’t appear Jessie would still know was a live issue when contacted about them.

RN: I don’t think we can say what it appears or doesn’t appear.

Counsel: In Ward Review 9 May do you think Jessie’s expectations were adequately managed by ongoing safeguarding referral?

RN: At the time I was thinking more about my professional relationship with Jessie

Counsel: Did you have any further discussion with anyone at Brighton and Hove City Council about these comments in Ward Review on 9 May?

RN: I can’t remember

Counsel: You said as part of safeguarding enquiry you would have provided Jessie’s care act assessment, have I got that right?

RN: No

Counsel: You wouldn’t have. We can see in Jessie’s Care Act Assessment in March 2022, as part of her support needs says requires supervision in bath due to frequency of seizures and requested assistance with hair washing due to pain in her arms… [reads more] so I think that information wasn’t passed onto Alison Woolfenden as part of her enquiry?

RN: I don’t know

Coroner: Not by you

Family: Not by you

RN: I don’t know

Counsel: In terms of therapeutic support Jessie was getting whilst on the ward, we asked Dr Cuthbert last week what support Jessie was receiving for trauma whilst on ward, part of her answer was before sessions it was important she was prepared in emotional regulation, that was work you’d started with her, is that right?

RN: Yes

Counsel: What work was that?

RN: Stabilising work [can’t hear] thinking about breathing, about distraction, about two things can see, two things can hear, what’s worked before. Quite small in chunks of information, Jessie had quite short attention span, had to be quite small.

Counsel: In terms of period of time March to May when Jessie was on the ward, was any of that work being done by you?

RN: No, no, my remit is to work in the community. Starts muddying the waters if I work on the ward.

Counsel: So in your view any therapeutic support relating to trauma would be something Dr Cuthbert and the ward provided?

RN: I couldn’t have provided that

Counsel: Just final questions of Jessie’s presentation on 16th, were you familiar with her Autism, Crisis and Wellbeing Plan.

RN: Yes

Counsel: Were you familiar with Jessie having body image issues indicating she was entering amber zone in terms of her distress

RN: Yes

Counsel: And I think you said in the morning she discusses restricting her calorie intake. The record we’ve seen refers to h22263, record of ward review, when asked how she as doing Jessie said she’s doing alright at moment, Ruth asks if purging after meals new, Jessie said doing it since 18 but hadn’t been doing it for a few years. You were told Jessie was purging after meals, what did you understand that to mean?

RN: Eating and then being sick

Counsel: Jessie’s said she’s triggered by Anna, voice in her head. Were you aware this comes up after few years?

RN: Don’t remember much of that discussion, remember 500 calories, don’t remember the purging.

Counsel: So you don’t have any independent recollection of what’s in this record

RN: No

Counsel: Were you also aware the Autism, Crisis and Wellbeing Plan referred to discussion of money being triggering topic for Jessie?

RN: No

Counsel: So does it follow the conversations you were having about money on 16th, weren’t ringing alarm bells for you. You referred earlier to it being positive.

RN: No, she knew was last of her money, but she wanted to be independent and so [can’t hear]

Counsel: It’s clear you weren’t aware of this as a trigger?

RN: No I can’t remember that in this particular plan

Counsel for the family asked if she could turn her back, the coroner responded of course and she then had a further question.

Counsel: I’m asked to ask you whether you were aware of any issues with Linda from IMC Locums having been suspended at any point during time of caring for Jessie.

RN: No I didn’t know that

There was a further discussion around timetabling and it was agreed that questions would continue.

Next was counsel for Brighton and Hove City Council who requested a record, the safeguarding enquiry, was provided to the witness.

Counsel: Ms Nathan I wonder, you see there, looks to me to be a cut and paste email sent by you on xx October [can’t hear]

RN: Sorry what are you asking me to do?

Counsel: Is that a cut and paste of an email sent from you?

RN: I don’t know if its cut and paste

Counsel: But it looks like its sent by you

RN: Yes

Counsel: In that email, that’s your email making safeguarding referral, is that right?

RN: Looks like it

Counsel: You tell the Safeguarding Team you’re Jessie’s Lead Practitioner?

RN: Uh hum

Counsel: And where she’s living, in a high needs placement. And you tell them she’s 18 years of age with ASC and EUPD, hypermobility, also has seizures with no medical explanation, you’re providing relevant background there. You say professionals concerned about the following, is that correct?

RN: [Can’t hear]

Counsel: When Jessie’s father and Jessie come in for support session on Monday 11 October, concerned when discussing Jessie’s personal care, you said wasn’t appropriate for male carers to provide this but asked if they were helping with soiled bedsheets and Andy said happened some times, he said wasn’t appropriate carers help Jessie with personal care and he was doing that, is that correct?

RN: Yes

Counsel: I told Andy wasn’t appropriate to bathe his daughter, was still happening… don’t want to over sensationalise this, this is sort of thing can crop up when you’ve got parents looking after children with complex needs for many years, and as become older is difficult to adjust, various explanations, one of them is you’re raising issues of boundaries is that correct? You’re nodding, thank you very much.

Today 21 October, ten days later Andy said he’d email me after he’d finished giving Jessie a bath… when spoke to carers on 11 October I asked if Andy was washing Jessie and they said no comment, I said would like to comment and they said he’s in her room for hours most days and don’t know what goes on

RN: That’s not on my document

Coroner: My officer will come and assist

Counsel: So discussed in supervision today, concluded safeguarding needs to be raised with regards to this [missed section] you refer to conversation you had with Jessie on Monday 18 October when she became distressed [self-harm] asked if she was frustrated, wanted to tell me something but could not [missed] Jessie is unable to be engaged after this, session ended 10 minutes early. Andy then told me he was watching tv in bed with Jessie when Jessie had a seizure, then you address a different topic about mental capacity. You say observe Jessie as having mental capacity, able to make decisions based on information, able to retain and weigh up against potential outcomes. She sometimes makes unwise decisions such as jumping off a 15ft wall the other weekend… there you are giving your professional view about her capacity to assist anyone doing assessment, and noting rightly someone can make bad decisions but still have capacity?

That’s referral you made, our understanding is its accepted in November, goes through a filtration system, then allocated to Ms Woolfenden in December, and she starts work and sees Jessie in January. Does that sound about right?

RN: I can’t remember the timeline, I know it took a long time

Counsel: Were you involved in any multidisciplinary meeting about the safeguarding enquiry?

RN: I believe so but I can’t remember the date

Counsel: That took place after Ms Woolfenden had seen jessie

RN: I don’t know, I don’t remember. When I went to meeting was about sharing lots of information about Jessie, went over her profile and difficulties.

Counsel: OK, and then there is a parallel safeguarding which was about the care team at Viaduct Road. When I say care team, they were engaged from an approved employment agency is that right?

RN: I don’t know

Counsel: IMC Care. You’re aware?

RN: I knew they were agency, but I don’t know how they’re commissioned.

Counsel: Even at the beginning of this, first of all would be right to say initially issue had been Jessie’s wish had been for male carers is that right?

RN: Yeh she preferred to work with males, but occasionally she got on with females, she liked me at one stage and other female carers

Counsel: One of feedback aspects, one of early interventions was introduction of female carers, slowly, so Jessie got used to it?

RN: Yes

Counsel: Were you aware also agency terminated contracts of series of workers?

RN: I know about some of them

Counsel: So is it fair to say the work being done at Viaduct Road was of high quality as time went on, in response to complaints, feedback?

RN: [can’t hear]

Counsel: Yes, I think that’s a proportionate number of questions

It was then over to counsel for East Kent County Council to ask questions.

Counsel: Thank you Ms Nathan, we’ve already heard placement provided at Viaduct Road was a temporary placement, so extent to which it was not physically ideally environment, did you understand that was aspect of temporary?

RN: I kept saying

Counsel: You understood attempts were made to find somewhere else?

RN: Yes, was just so unfortunate [missed]

Counsel: Accepting is a temporary placement, not ideal, but offer made for Jessie to move downstairs so nearer to the bathroom

RN: I don’t think she liked the cooking smells, there was a reason

Counsel: Of course. Coming back to the question of, I think you’ve said you weren’t aware of the level of personal care being required, or being done at Viaduct Road, except

RN: I knew what level of care was required

Counsel: And your understanding was at Viaduct Road she didn’t require hands on personal care?

RN: Andy was doing it all

Counsel: Had you seen OT assessment at the time that said that was what she required?

RN: I can’t remember

Counsel: Did you see any evidence of any medical professionals to suggest had been a deterioration of Jessie’s physical or mental health as a result of the care she was receiving at Viaduct Road?

RN: Difficult to say, it was deteriorating, whether it was about care or not, no-one knows.

Counsel: Did you see any medical evidence to suggest that was happening?

RN: I can’t remember, there were reports coming in on a daily basis

Counsel: If you had seen something like that, would it not stick in your mind?

RN: Were so many reports, what did stick in my mind, was when she needed to be taken out of the house by a cherry picker, when she had a seizure, because they couldn’t get her down the stairs

Counsel: You weren’t at the house at the time?

RN: No, but it was a big event

Counsel: The run up to Jessie being on Mill View, you were aware of hospital admission in January due to self-harm, and increase seizures, was physical treatment leading up to her admission to Mill View? [missed]

It was that suspected sepsis I think and increase in seizures that required investigation, that was reason she went into the general hospital to start with

RN: Mmm

Counsel: And you’re aware from there decision was made to section her by medical professionals in the hospital? So, things happening whilst she was in the hospital, medical professionals considered she should be under section.

Next counsel asked a question about the social work response to the safeguarding alert.

RN: My recollection of events around safeguarding, I just know I had to chase it up a couple of times.

Counsel: Thank you very much, no further questions

Then it was over to counsel for Sussex Partnership Trust.

Counsel: I’ve a question about records, recording. Is right to say isn’t it as an employee of Sussex Partnership Trust, is it right you record on care notes the electronic system operated by SPFT?

RN: Yes, I must admit, I try to be good about that

Counsel: It’s not a criticism of you, it’s about reporting and who has access to it, not a challenge at all. You’re recording on care notes, electronic system SPFT use, and everyone else in SPFT is also recording on same recording system?

RN: Yes

Counsel: So the report for example TCAT prepared, did you find that on care notes?

RN: Yes

Counsel: I don’t know whether you were in court when Alison Woolfenden gave evidence, her evidence was upon being allocated the safeguarding that you highlighted, she talked to others, read the notes, and she had access to both care notes and Brighton and Hove’s notes. Is that your understanding? She’d have access to everything on care notes?

RN: Yes

No questions for Ms Nathan from the jury. Coroner thanks her for giving her evidence and attending court twice. She says that she is really sorry to the family and that she really cared.

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