[2025] EWHC 2684 (KB)

Dr Barker was interviewed on 14^th November 2006, 28^th February 2007 and 27^th April 2007. As I have already set out after receiving the case summary Mr Tarrant prepared an advice note on 19^th November 2007 which concluded that it was not considered that there was a reasonable prospect of a conviction against Dr Barker. It was Mr Tarrant’s view that the enquiry had revealed that it was Mr Deveney as “Head of Care” rather than Dr Barker who decided which patients should be on an extra care charge and “many witnesses describe him” (as he describes himself) as someone who just wanted the opportunity to carry on with his work as “clinician”. It is noteworthy that Mr Tarrant took this decision having considered the summary which set out the evidence against Dr Barker and that he was “suspected of involvement in the extra care allegation”.

In his first Police witness statement Dr Barker set out that he had been a consultant psychiatrist since 1990 and was the clinical director for adult services for most of Norfolk. He left the NHS and became the first consultant psychiatrist at Cawston Park when it opened in the autumn of 2003. At the time of his arrest in November 2003 he was serving out 12 months notice (the notice expiring in February 2007).

It is necessary to set out several extracts from Dr Barker’s first statement given his central role at Cawston Park. He stated:

“…from August 2006 on I found myself being drawn more and more into being asked to give explanations about extra care; and support the idea of extra care. This was something that really hadn’t been on my radar up until then. I felt that I could justify the concept of extra care as a clinical one, whether the name’s correct or not, I don’t know. I was not clear what the company were doing with regard to the charging. I began to feel that I had been, and was being, used to justify this process clinically from a retrospective point of view.”

And

“I felt that staff were not well treated, the appropriate equipment was not procured in a timely manner, and the hospital was not being kept clean enough. Everything had to be justified and it was so time consuming that in the end people seemed to give up.”

And

“Clearly the main facet of the investigation is into extra care and in my view this exists as two things. It can be thought of as a philosophical concept describing the actual style of care and treatment delivered. Whether the name is right or not, I don’t know. It is also a financial construct around charging in order to recover costs, and make a profit. I have had a long time to reflect upon this, and have come to the conclusion that the conflation of these two completely separate strands has caused a great deal of confusion and obfuscation, and probably continues to do so.

When we started, people like me, Andrew Breeze, Mark Deveney, Tony Chancellor, Mark Grainger etc had a view that the way patients were treated in many psychiatric hospitals was damaging. Such treatment involved “specialling” (a nursing technique of dubious value involving an almost custodial approach to patients) people unnecessarily, over intrusive observation, seclusion, aversion risk management and treating them overall in a less than humane way. We all came together and thinking about the way Tony Chancellor had done things at Kelling, we wanted to create a philosophy of care around the therapeutic community concept. This was less custodial and less reliance on strong medication.

This revolves around people being listened to, given a lot more time and not being so restricted (if you restrict someone often the desire to do something becomes stronger). The plan was to have people around to intervene if things did go wrong and to only use specialling if it is absolutely necessary. Also, to be “positive” in the management of therapeutic risk — this means that you have to let people do things, and have plans in place for if it goes wrong, rather than not letting people do things because there is a chance things might go wrong. The other staff knew about this philosophy but would be unlikely to use the term “extra care”. Unit Managers like Mr Mark Grainger would have heard of it but perhaps not in any detail. In fact, on a day to day basis, I don’t think we ever used the term “extra care”. There was no need to, we just did what we had to do.”