[2025] EWHC 2684 (KB)

An MG6 form was issued to inform the CPS of relevant background information. It is stated that:

“This file is submitted for advice as to the validity of whether in the CPS’s view there is a criminal case that has a realistic prospect of conviction at court. We believe the file as presented evidences in broad brush strokes terms that at Cawston Park Andrew Breeze and Dominic Wilson defrauded the NHS PCTs for some considerable amount of money not only for the extra care scam but for the overcharging for drugs. A decision is sought as to how Dr Simon Barker may fit into this.”

As with the summary it is not necessary (or in terms of length of judgment appropriate) to set out all the content in detail. It is observed that:

“we have tried to keep the main thrust of this inquiry as straight forward as possible. Basically the allegation is that PCTs were charged for extra care and nothing was delivered to them over and above that that a patient was receiving as part of their normal treatment.”

DS Brownsell the author stated his view that:

“It is my opinion that the extra care concept was probably quite noble in its inception. Initially it would appear that Cawston Park were slightly oversubscribed in terms of staff to deliver a form of extra care should a patient have an episode. They had the resources to cope with a patient going through a heightened state of their illness. As the company expanded the over subscription of staff numbers was not maintained… we have gathered evidence from a broad spectrum of staff that shows that staffing levels were low, sometimes apparently dangerously low, or best adequate. Later after the management buyout it is evident that money was the driving factor which impacted on staff numbers. Facts alluded to by several witnesses. How do you provide extra care when you are understaffed?”

As for commissioning managers it is stated;

“There is a significant element of trust between the commissioning managers and service providers-in this case Cawston Park. It should be noted that Deveney has talked about some commissioning managers being a softer target than others. This is evident as some took a robust line when the extra care charge was pushed their way, either questioned or refuse to pay it. If that was the case Cawston Park didn't try it on again. However, clearly there were some commissioning managers who didn't ask questions as seemingly they were the regular recipients of invoices marked extra care. This is proven to be somewhat of a difficulty with commissioning managers some of whom are going to be potentially embarrassed by the fact that they made no checks what they were getting for the public money they were spending. We believe that this was potentially the catalyst that drove Linda Todd to tell Breeze about the impending police raid on Cawston Park. Especially as Todd was Cawston Park’s biggest customer.”

As for the understanding of the term extra care it was stated:

“The suspects speak of extra care as a concept. We've included some of the explanations. It is of profound interest to note that no one outside the suspects actually knew what extra care was. The actual practitioners of day-to-day care did not. The new management (Reardon and McKenzie) who were brought in had a look at the concept after they were aware of the police investigation. They could not find out what it was and how it was applied.”

And

“We have looked at patient records and from our lay perspective we can see nothing extra being given to Extra Care patients in comparison with non Extra Care patients. This in tandem with the fact that they were understaffed has led us to conclude that nothing extra was delivered for the charge.

There is no audit trail to show how Extra Care was delivered. Breeze didn’t think it necessary to have an audit trail. Wilson thought it would be too expensive to evidence this treatment contemporaneously. Barker said that he didn’t know who was in receipt of Extra Care and patients got what they needed.

We explained our lack of understanding of how the Extra Care was delivered to the suspects. This drew a variety of responses from re-explaining the concept to accusing us of being ignorant and choosing not to understand the concept.

Latterly this prompted DLA Piper to write to Chris Tarrant at CPS Fraud in which they outlined their concerns that the officers did not understand Extra Care. They attached a lengthy explanation of Extra Care. It would appear that they have missed the point. There is no explanation as to how Extra Care was actually delivered to justify the cost. It remains to us, an ethereal concept for which there is no tangible evidence of delivery to patients.”

Importantly in my view it was recognised within the MG6 that:

“Criminal intent or dishonesty will be a difficult area to show. All of the named are of previously good character and arguably of some standing in their professional world. The intent or dishonesty element will no doubt be considered in CPS’s decision making.

We cannot show that there was a particular moment when the suspects formed a criminal intent to request payment for services that were not provided. I am of the opinion that once they charged the ‘Extra Care’ charge, batted off some early questions about it; it was very easy to continue to charge it. Besides, the charges associated with ‘Extra Care’ had been factored into their business plan as part of the MBO. I believe that they got locked into a cycle of charging for it, not providing anything for it, were never questioned about it and it helped to meet forecasts.”

Given the Claimants’ arguments concerning the assessment of Mr Deveney’s credibility the analysis of his credibility is of particular significance; it has been set out above.