[2025] EWHC 2684 (KB)

And

“At Cawston Park our core costs were competitive. I have come to believe that there was too much looseness around the arrangements for charging for extra care. In my view, it was possible that things went wrong because there were no checks and balances, no real audit trail and insufficient feedback on both sides of the purchaser and provider fence.

I don’t really know where the name extra care came from. I think Mr Deveney conjured up the title in response to questions from providers who could not get their heads round the idea that we did not want to “special” people. I do not know how it developed from a treatment concept over to something that was charged for. As far as I was concerned, I never went on to the units to deliver something called extra care, I went there to do my job as the Consultant Psychiatrist. I feel that was the same for all the staff in the hospital. We treated people according to their needs. Some patients would have greater needs than others.

I have no idea where extra care would be recorded. From my point of view any record of any clinical dealings with a patient would be in their medical case notes. Clinical details like this were not communicated to the financial side of the business and I was not asked for this information.”

And

“We did not discuss who was, or who was not, being charged for extra care, or whether these charges should start or stop. We were not routinely aware of who was or who was not attracting such a charge. Around September 2006 a form was introduced alongside our other paperwork, this was devised by Mr Breeze. This was to look at whether patients were meeting certain criteria with regard to risk, etc. and this form was filled in by the ward doctors at the ward rounds. It was explicit that this form was to be used to feed back to the admin/finance dept, via Mr Richard Mackenzie, who was the Chief Operating Officer.”

And

“I think that the concept called extra care at Cawston Park developed over time, I do not think there was a financial audit trail in place to evidence what the patients were receiving for the charging being made, although they were receiving decent clinical care, with casenotes and progress and outcomes reflecting this. I believe that, on the whole, referring agencies were happy with the care their patients received at Cawston Park, Our case notes were audited by the health records department at Hellesdon Hospital, with whom we had a service level agreement. Our clinical practice was scrutinised by external statutory agencies, including the Mental Health Act Commission, as well as visiting clinical teams.

Decisions made during ward rounds or at any formal meetings were not fed back by me to the finance side, apart from perhaps decisions to discharge patients. As far as I can recollect, or am currently aware, there was no formal mechanism to communicate our clinical deliberations to the admin side of things to be used in decision making processes about levying extra care charges, apart from the form mentioned above, introduced in September 2006. My understanding is that, as Head of care, Mr Deveney undertook this task. Mr Deveney would, to me, have been the logical conduit for such information, and following his departure, I assumed that this role would have passed to Mr Cooper. I now understand that this did not happen.

I now know that Mr Deveney was completing monthly reports which referred to extra care being charged for but I am not aware of that information being fed back into the clinical arena. I have seen some of Mr Deveney’s reports and they are pretty bland. They don’t appear to explain in any detail why extra care charging should continue. I can recall Mr Deveney rushing around towards the end of most months saying that he needed to get his reports done.”

And

“It did not seem that unreasonable to me to have a standard charge for a standard patient and then an additional charge for more difficult ones. I did not make and I do not recall being asked for any recommendations as to how much should be charged in relation to any patient. When we started, Mr Breeze was still registered as a nurse and I believe that he, along with Mr Deveney, made the decisions as to who should be charged what. I am sure that Mr Deveney knew my views on each patient with regard to their progress, level of risk, etc., as well as my treatment plans. He would also have known from his day to day contact with the ward managers, and his understanding of nursing duty rotas, etc. how much resource was being consumed by each patient. He would also have an understanding of the types of risk presented by each patient. Mr Wilson was very much on the finance side, and would, I imagine, have converted Mr Deveney’s and Mr Breeze’s assessments into costs, but I am not sure about that.”

And

“There is a formal process for ‘sectioned’ patients to be granted leave away from the hospital if this was appropriate. I understand that most, if not all, patients who had an extra care charge levied were detained under section. There were clear records of who was sent on leave, for how long, and any conditions attached to their leave. The granting of leave would be a clinical decision which could only be made by the Consultant legally responsible for the patient’s detention. I now know that certain patients who were sent on leave continued to have extra care charges levied. If this was just one or two nights then to continue to charge for extra care might be justifiable. In my view, longer periods would be more difficult to justify but such charging would always be a financial decision, and not within my remit. I am not sure how or why such decisions were made. If your core staff are greater and you can’t stand them down you might need to charge but this would only be for a short length of time, I would think, Also, if a leave arrangement had the possibility of breaking down with a rapid unplanned return to Cawston with the patient in a deteriorated state, then I could see how it might be justifiable.”

And

“I was not involved in the charging. I thought that it was something decided by Mr Deveney and Mr Breeze and then administered by Mr Wilson. None of this had any affect on how I or anyone else treated a patient. When we began, maybe for the first year or so, and also thinking about it now in retrospect I didn’t think there was anything worrisome about the charging or the running of the company come to that.”

And

“I wasn’t aware until I was told by the Police that in fact the extra care charging was made in advance. This surprised me. I remain to be persuaded how you can make a charge like this in advance. I am not sure how someone’s care needs could be predicted a month in advance with any certainty. However, I am not an expert in contract law.”

And

“After Mr Deveney left, basically there was no longer any review of extra care that I was aware of or have become aware of since my arrest. If a proper process had been in place to demonstrate the delivery of resource and its financial impact it should have prevented any allegations of fraud. When the investigation came to light I was surprised to see that “extra care” was still being charged for four or five long term patients.”