Gross mental health negligence in Britain

Cumulative failure of staff at a London hospital led to the murder of a former banker by a man whose schizophrenic condition made him dangerous, a report into the killing found yesterday. The independent inquiry recorded a number of errors in the treatment of John Barrett, 42, who was allowed to walk out of a secure unit despite a history of violence and mental illness. Barrett repeatedly stabbed Denis Finnegan, 50, a retired banker, as he cycled through Richmond Park on September 2, 2004. Two days earlier, Barrett had been admitted to the Springfield Mental Health Hospital in Tooting after hearing voices in his head, and was in a medium- security unit.

The inquiry named Gillian Mezey as the psychiatrist who made the "seriously flawed" decision to grant permission by phone for Barrett to have an hour's unescorted leave in the hospital grounds, even though she had not assessed his condition.

Robert Robinson, the lawyer who chaired the inquiry, was even more critical of management at the hospital and the South West London and St George's Trust, which runs it. He said that clinical decisions were often unsupported by evidence and were rarely challenged by colleagues. In a direct attack on the judgment of Dr Mezey and other clinicians, he said that staff had been too reluctant to intervene against Barrett's wishes, going along with what he wanted in the hope of maintaining his co-operation. That was con- trary to all legal and clinical guidelines, but management at the trust had failed to take action. "The trust knew there were problems and didn't do anything about them," he said.

Many senior managers have been replaced. In conclusion, the 422-page report casts doubt on whether the new senior staff at the trust were up to the job and recommended that a new team of experts be sent in to force through change. "We doubt whether there is the managerial capacity within forensic (psychiatric) services or the wider trust to achieve the necessary changes," it said. It called for the secure unit at Springfield hospital, in which Barrett was treated, to be closed. The trust has rejected this advice.

Dr Mezey, who is also a police adviser on domestic violence and murder, is still employed by the hospital but no longer deals directly with patients. Nigel Fisher, chief executive of the trust at the time of the murder, has been promoted to a job at the Department of Health, where he advises hospitals on how to win foundation status.

Peter Houghton, the trust's new chief executive, said now that the inquiry had been published he would explore whether disciplinary action would be taken. Along with the criticism of the health trust, the inquiry condemned the independent Mental Health Review Tribunal that allowed Barrett to leave secure care at Springfield hospital in 2003, only a year after he had stabbed three people at random at an outpatient clinic in St George's Hospital. One man almost died in the attack.

The tribunal spent only 45 minutes considering the case, examining reports from Springfield hospital that recommended conditional discharge. At the time of the 2002 stabbing he was considered so dangerous that he was placed under the direct care of the Home Office. Only the Home Office raised objections to his release, making it clear that it did not want him back in the community. Barrett failed to adhere to the conditions laid down for his release, including taking his antipsychotic drugs and staying off recreational drugs. The conditions were not monitored or enforced, and he began to behave erratically and complained of hearing whispering voices. That led to his returning to Springfield hospital on August 31, 2004. He was furious when he was placed in a secure ward, believing that he should have been placed on an open ward. In the hope of calming him down and retaining his co-operation for treatment, Dr Mezey granted him "ground leave" from which he absconded and murdered Mr Finnegan, a stranger.

Michael Howlett, director of the Zito Trust, a mental health charity set up in 1994 after the murder of Jonathan Zito by a man suffering from paranoid schizophrenia, said that it was the most damning report he had seen in the past decade. "It beggars belief that John Barrett, who was a restricted patient under the responsibility of the Home Office for a very serious offence of violence in which he very nearly killed a man in 2002, should have been granted a conditional discharge by a mental health review tribunal as early as 2003," he said.

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Australia: A billion dollars worth of ambulance funding evaporates

Britain is not alone in spending more to get less

The number of emergency service vehicles on Queensland streets has declined over the past three years while community taxes have raised almost $1 billion in revenue for the State Government. Figures from recent Emergency Services annual reports state the number of operational vehicles - including ambulances, fire units and emergency helicopters - had fallen by about 50 each year since the introduction of the community ambulance levy. Last financial year $238 million was raised from fire levies and about $110 million from ambulance taxes.

Across Queensland, 2145 vehicles were stationed last year, a drop of 95 since 2004-05, but these figures were disputed yesterday. Emergency Services Minister Pat Purcell, who admitted on radio that he did not know how many ambulances were in the fleet, said the reporting conditions had changed and there was an increase of 18 ambulances from the previous year. "Vehicles are only one part of the picture," he said.

Opposition emergency services spokesman Ted Malone questioned how the additional funds were spent and called for a review. "The focus has been taken off running a lean, mean department of service delivery right at the cutting edge all the time," he said.

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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