Mr Breeze
Mr Breeze
In his statement for this action Mr Breeze set out his extensive experience of work in healthcare after qualifying as a registered mental health nurse in 1976, rising to the post of general manager for adult services at a Norwich Hospital and responsible for all hospital and community psychiatric services and a budget of £26 million. It was whilst in this post that he met Mr Wilson who became the directorate accountant. In 2001 Mr Breeze was appointed to the hospital board. One of the budget managers in the Trust was Tony Chancellor. He left in 1999 to set up a private facility at Kelling Park. In 2002 Mr Breeze met with Mr Chancellor who expressed a desire to open a licensed psychiatric hospital and asked him if he would like to join in the venture. The Cawston Park site was purchased. In due course Mr Breeze discussed the project with Mr Wilson and offered him the chance to join the company, which he did in the autumn of 2003.
Mr Breeze stated that Kelling Park had, from its opening in 1999 a philosophical approach to patient care that did not involve the nursing practice of “specialling” or one to one nursing and that this philosophy was transferred to Cawston Park when it opened in late 2003. Mr Breeze said that because of this philosophy Cawston Park was staffed, as Kelling Park had been, in terms of numbers and skill mix, to deal with any patient eventuality. He stated that referrals came from a combination of PCT commissioners and Social Services, similar to the position at Kelling Park.
In respect of costing of a placement Mr Breeze stated as follows as regards the systems at Kelling Park and Cawston Park;
“The cost of patient placements were arrived at following patient assessment by one of the two senior clinicians at Kelling Park, the same as Cawston Park, by up to three senior clinicians…Assessments were made by the two senior clinicians, in the main Tony Chancellor himself, who then took a professional view on how much to charge, similar to Cawston Park. Costs ranged from £550-£4,500 per week depending on the assessment. At Cawston Park costs varied dependent on the assessment. The more seriously ill the patient, the higher risk to the organisation and the more resource considered by the two senior clinicians carrying out the assessment to be required to manage and treat the patient the higher the cost (extra cost for more difficult and higher risk patients). The same as Cawston Park; known as the “extra care charge”. “Specialling “costs in other mental health establishments and the extra costs applied to patient placements at Kelling Park, were only the same in that they both were an additional cost to funding authorities. Funding authorities were informed the placement cost prior to admission. This was the same as at Cawston Park. The majority of staff did not know what patient placements cost: again the same as at Cawston Park. Placement costs did not go down when patients were on leave or away from Kelling Park for any other reason. This was also the same as at Cawston Park. The Care Programme Approach (CPA) meetings were the audit trail for funding bodies, as at Cawston Park. Funding authorities were encouraged to visit, and many did on a regular basis, at anytime, which was the same as at Cawston Park. All of the above was almost identical to how Cawston Park was operated and yet, to my knowledge, no allegations of fraud were ever made in relation to Kelling Park.”
As I shall set out in due course Mr Chancellor, when interviewed, and in his police statement, gave a markedly different picture in respect of some important elements of what Mr Breeze set out in his statement (which he was not to maintain when giving evidence at the criminal trial). However, an important point arises in respect of this extract which has applicability across the witness statements served in this action on behalf of the Claimants. Care must be taken to focus upon what the Claimants and witnesses said at the time of/during the police investigation in respect to the relevant issues, rather than explanations given/comments made after the event (sometimes many years later). Mr Breeze’s police interviews were extensive (20 hours of interviewing over three interviews) and he also served a defence case statement. It is what he said in 2006-2008 that must be assessed when considering the two causes of action in this claim.
In his witness statement Mr Breeze stated that there were brain storming meetings before Cawston Park was opened, but that “cost wasn’t really discussed”. There had been general discussions whilst Mark Deveney (a nurse and head of care who was responsible for assessments) was travelling around looking for assessments (potential patients). Before a meeting with the commissioners of Norfolk Primary Care trust (who placed the first six patients), there was a discussion about setting a rate and Mark Deveney had said that they should charge extra for those difficult patients coming from places where they were “specialled”, or had one to one supervision, or were generally high risk. Mr Breeze said that he recalled a general conversation with Mark Deveney about what they would call the extra charge and he stated that he had a vivid memory of Mark Deveney saying that they could justifiably charge more for these patients and
“I think the decision to call the concept the extra care charge was made before a meeting with Norfolk commissioners and we knew we couldn't call it specialling as that wasn’t what we were doing. It was Mark that gave it the name extra care charge. Over time Mark simply referred to a patient as being on extra care.”
Mr Breeze stated that when there was a potential patient there would be an assessment, and if the patient was accepted the price for that patient treatment would be agreed including, where relevant, an extra care charge. Mark Deveney and Dr Simon Barker did all the assessments of prospective patients. The cost of a patient was agreed between the PCT commissioners and Mark and/or Mr Breeze, often in consultation with others, including Dr Barker, prior to the patient being admitted. Accordingly, the PCT knew in advance what it would be paying for the placement. Employees were not aware of the extra care charge because it was a financial charge and not a specific nursing intervention. Staff were instructed to give the patients everything and anything they needed regardless of cost. Because they were giving patients everything they needed they did not view giving specific patients anything as giving “extra”. Staffing was always high on the agenda of the Board and “there was never a complaint that staffing was inadequate during this and it was never inadequate and certainly never got so low as to be dangerous. Junior staff were not in a position to have a professional view on staffing.” As he was to concede the comment about there never being a complaint was not correct.
Mr Breeze also stated that the care plan for each patient would set out the details for the treatment, care and support of each individual patient. This would include the level of support required and details of individual needs. The plan would be available to and accessible by each member of staff and also the commissioning agencies.
Mr Breeze explained how Mark Deveney’s plan to set up a unit in competition was discovered in November 2005 and that he was unaware of the allegations made by Mr Deveney in January 2006 until August 2006 when a former work colleague stated that Mr Deveney had been “casting aspersions on our charging for patient placements”. On 3 Sept 2006 Gary Cooper informed Mr Breeze that the police had interviewed him. Mr Wilson then drew up a paper with the assistance of Mr Breeze on the extra care charge “for explanation purposes” for their solicitors (DLA Piper). Linda Todd learned that Mr Breeze was to be arrested and told him on 7th November and he was arrested on 14th November 2006. He stated that on arrival at the police station there were photographers outside so he can only assume that the press must have been tipped off prior to his arrest.
Mr Breeze’s statement covered the history and impact of the restraint proceedings in detail. However those proceedings are not covered by specific allegations in respect of malicious prosecution or misfeasance in public office. I shall therefore only deal with them in brief detail in due course.
Mr Breeze set out a number of extracts from his interviews and commented upon them. He stated that during the interview on the 24th May (his solicitor being present) Officers were “more combative” than during the first interview and;
“DS Brownsell burst in at one point, threw a piece of paper on the table and said to my solicitor “this proves your client's guilt”. This was said off tape. The document was my handwritten notes of a conversation with DLA Piper which I understood would have been subject to legal privilege…This document was labelled DJK/9.”
Mr Breeze stated that he now knew that the statements had been “tampered” with and that;
“It seemed to me there was so much evidence that was either manipulated, not collected, minimised, exaggerated, misrepresented as well as obvious lines of inquiry not followed and of transcripts not being accurately represented in statements. This leads me to believe the investigation and prosecution were brought by the police in bad faith.”
When cross-examined Mr Breeze denied that, at different times, a variety of descriptions had been given of what extra care was. He stated that the extra charge was specific and that he did not think that there were any misunderstandings. It was pointed out that was in contradiction to his own defence statement for the criminal trial which stated:
“On occasions Andrew Breeze was asked to explain the meaning of extra care, and is now aware that in some documentation issued to, from and between himself, Dominic Wilson, Mark Deveney, Dr Barker and the commissioning bodies, there could sometimes be a variety of descriptions or explanations. This was due to the fact that different people attempted to respond to different commissioners asking for different information at different times.”
Having had the benefit of considering a raft of evidence in this case it is my view that there clearly were varied descriptions of what extra care was and how it was justified and it is unrealistic to contend otherwise. I am not surprised that Mr Breeze was, it appears, advised to address this issue in his defence statement “head on”. However he told me that he disagreed with this paragraph of his own defence statement.
During his cross-examination Mr Warnock took Mr Breeze to some explanations/descriptions of the extra care which he suggested were not consistent with the explanation that he had given in his statement in this action and proved that the Police were faced with varying explanations. It is necessary to briefly set them out.
On 28th December 2003 Mr Breeze wrote to Dr Rowley, joint commissioning manager of Ipswich PCT, referring to a patient and an extra care cost of £312 per day and stating;
“The extra care is based on his assessment showing that at least for the first month we would envisage the need for an extra member of staff to be available. Depending on his mental state on admission this could potentially go up to two members of staff. If this were the case we would inform you immediately. This would be at £13 per hour per person. Obviously this element would be reviewed on a weekly basis.”
£312 is 24 hours at £13 per hour. Eventually, Mr Breeze conceded that someone reading the letter, e.g. the Commissioner for the Trust paying for the patient could be led to believe that an extra member of staff would be brought in and dedicated to the patient. This would be wholly inconsistent with the concept of extra care which Mr Breeze said was in operation (whereby there would be no dedicated extra member of staff).
In the case summary DS Brownsell noted a document dated 24th October 2003 seized from Linda Todd which contained the following note
“Additional cover e.g. specialling at £13hr.”
Mr Breeze then signed a service level agreement with Norwich PCT (on behalf of all Norfolk PCTs and signed by Linda Todd) on 6th January 2004 The agreement was for a period between the 21st November 2003 and 31st March 2005 it set out that:
“Special support will be charged at £13 per hour per staff required e.g. 2-1 nursing – 1 hour x £13 x 2 staff = £26.”
On its face this document is also obviously inconsistent with the concept of extra care which Mr Breeze said was in operation and he said had been clearly explained. Mr Breeze agreed that he signed it but said that it was a document prepared by Linda Todd and sent to him. Mr Breeze stated that Ms Todd had “got it wrong”. He stated, somewhat remarkably, and demonstrably (as I shall set out) incorrectly, that “everyone” understood the basis for the charge. Equally remarkably given the sums involved he stated that he did not think that a written contract needed to be in place. His explanation for this document was that that Linda Todd had called and said that she wanted to compare extra costs with the specialling costs she had previously paid elsewhere and wanted an extra rate for extra care charged. As I shall set out in due course this did not marry with the evidence of Linda Todd (in any of her four statements).
It was observed in the case summary:
“The quoted cost is per hour which is the method for normal charging of specialling. It is felt that this would lead PCTs to believe that extra care and specialling were the same. This is discussed under the title of mixed messages.”
When asked in the first interview if there was a definition of extra care Mr Breeze answered that there was a definition for extra care which is written into the Norfolk PCT contract which was “the only PCT we actually have a contract with”. On 18th April 2006 a further Service level agreement was signed which omitted this section but still on one possible reading again suggested the provision of something extra, beyond what was integral to the system of working at the hospital for all patients, and referred to deployment of staff of a variety of disciplines as necessary “to provide extra care”. The case summary also sets out Mr Breeze’s comments on the SLA (during the third interview);
“Breeze said that this was a SLA that was, he suspected, a template for most SLA, this document being the very first document that they had when they opened Cawston Park. Breeze said this document was written by Linda Todd and he suspects that at the point they had not completely made themselves clear on the way that they were working. He went on to say that there was a misunderstanding of what they were doing, he knows this because Devaney had told him “we understand it is not one to one can you please tell us in cost terms what is the equivalent to? Which is where the £13.00 an hour comes from referring to the number of staff involved. Breeze went on to say the definition that they later developed was the one that Linda Todd clearly said she understood just after that time. He stated that the SLA was wrong. Breeze did not state why that document had not been corrected but referred to lots of conversations he had with Linda Todd and Tony Chancellor where they made it clear they did not do one to one nursing, however he suspects that Linda Todd understood it so he signed the document. However the commissioner would clearly have understood what extra care was about.”
In a letter dated 8th March 2004 Mr Breeze stated to Dr Rowley that the extra care cost (£312 per day) was for the provision of an extra member of staff;
“The extra care element of this cost is to provide an extra member of staff to input into Mr H’s treatment package which has been considered necessary following his assessment. This will be reviewed after the first two weeks and only continued if considered necessary.”
Again he unequivocally linked the extra care to an identifiable extra cost and an identifiable additional feature of the care provided. This is incompatible with the explanation of extra care given by Mr Breeze which was that existing regime was able to provide care for all patients. In my judgment the letters to Dr Rowley taken with evidence of Dr Rowley (as referred to in the summary) and the evidence that no extra care was in fact provided would, create a case to answer in the mind of an ordinary and prudent person (i.e. that a Commissioning Trust was being misled).
On 9th July 2004 Mr Breeze also appeared to equate extra care to “specialling” in a letter to Carol Lawton, Peterborough District Hospital. He explained;
“Extra care is what we apply to keep patients safe involved in their treatment programme. Other settings may call it “one to one” or “specialling”. Extra care is applied depending on the risk assessment. It may be applied over the whole the 24 hour period Or only over part of it depending on the outcome of the risk assessment…”
Again extra care was set at £312 per day. As set out in the summary there is no evidence of extra care ever being charged for only part of a day. Mr Breeze stated that he could not understand why he wrote in these terms and that it was wrong. He also accepted that if a PCT Commissioner looked at this letter in isolation they would be likely to form the view about charging that was incorrect. Faced with the difficulty posed by its content he relied on what was said orally and stated that there was “so much around this letter they would not know that we were not working in this way”. Objectively this letter clearly undermined the explanation of extra care advanced by the Claimants.
The suggestion that all Commissioners understood the basis upon which extra care was being charged was also undermined by other evidence obtained by the inquiry teams. By way of examples (others are contained in the case summary);
On 8th September 2004 Melanie Bell, a Commissioner for Selby and York queried how the bill for extra care was in advance of its provision;
“how can Cawston Park Staff know Mr C will require additional care to 30th September at the beginning of the month? I have received no information from Cawston Park to indicate that Mr C has been unsettled or causing staff difficulties; therefore I am again querying why extra care is required.
It is unarguably the case that this letter would support the view that she did not appreciate what, on the Claimant’s case, was a well and widely understood basis for the charge. Mr Deveney’s response (10th September) stated that:
“the costing sent to you initially showed our core cost of £443 a day and an extra care cost of £312 a day…You will note that our charges for extra care are £13 per hour, the cost incurred by Chancellor Care Limited in employing a support worker through a nursing agency…You will recall that Mr C has a recent history of serious physical attacks on staff and conspiracy with fellow patients…in light of the above it appears sensible to ensure that additional staff are available to manage any difficulties in the assessment phase of Mr C’s admission to Cawston Park…Mr C will remain under constant review by the clinical team and, at the point the charge for extra care is no longer necessary this will be reflected in the invoice.” (underlining added)
Mr Breeze said that he did not understand why Mr Deveney wrote this. He accepted that it could be read as justifying the charge as reflecting the direct cost of additional staff for that one patient which would be incorrect (in my view it would be wholly reasonable for someone reviewing the letter to form the view that it could not be sensibly read any other way). No extra staff were brought in at £13 per hour solely for Mr C.”
On 24th November 2004 a document drafted by Mr Deveney was shared with Mr Breeze and Mr Wilson, in which Deveney attempted a definition of extra care to provide to commissioners “who query extra care”. The obvious point made was that if commissioners all clearly understood the basis of the charge then there would be no reason for such document. Mr Breeze conceded that “two or three” commissioners misunderstood what extra care was. Significantly the draft set out:
“It is our belief that staff should be used to maximise the opportunity for service users to engage with others in the therapeutic process, mitigating against risk as necessary, rather than the more traditional approach of limiting the opportunity for engagement through limiting freedom of movement and instituting “one to one observation” for which there is no evidence of clinical efficiency. The latter approach may, in many cases, be counter therapeutic. To this end additional staff of a variety of disciplines will be deployed as necessary to maximise the potential for inclusion of service users who display (sic) in every appropriate part of the programme. Commissioners will note that the costs incurred in making this additional provision are referred to as “extra care” at Cawston Park. The following represent the additional care provided, costed as traditional “one to one” charge showing all other additional costs incurred…(the breakdown was then set out including 1 WTE member on all shifts, additional medical time, additional supervision, additional senior staff time, specialist psychotherapy amounting to a total weekly cost of £4834 and a daily cost of £691). Cawston Park is able to halve costs for extra care by making flexible use of additional staff deployed” (underlining added).
When it was suggested to Mr Breeze that on literal reading of this document a Commissioner would understand that the extra care charge was linked to additional staff he stated that the wording was “clumsy” (in his interview he said it was “sloppily written”). A reasonable and objective analysis could properly go further than this. Mr Breeze also said that he did not believe that the document was ever sent out; however this does not explain its content or preparation (or the need for it) if matters were as straightforward as Mr Breeze contended in his statement in this action.
As Mr Hird set out in his report into extra care it was described within the Chancellor Care 2005-06 price matrix issued to purchasers that;
“To provide extra care staff of a variety of disciplines are deployed additionally as necessary…Some staff replacement cost is incurred in additional numbers on the shift to enhance the service user opportunity for participation and to enable regular staff to provide additional time to them.” (underlining added)
Mr Breeze explained in his first interview as regards a definition of extra care that apart from Norfolk the other PCTs
“Spot purchase from us, so information like that would be passed over to them in discussions and telling them about it...after assessment.”
The evidence set out above would lead a reasonable person to conclude that evidence obtained by the Inquiry was capable of establishing the opposite.
During oral evidence Mr Breeze stated that he thought that there was no problem (with the Commissioners understanding of extra care) and the PCTs were happy as costs were lower; so there was no need to provide further detail. It very well may have been the case that the lower cost meant that PCTs did not challenge costs as much as they might otherwise have done; but that would not directly affect the issue as to whether they were fraudulently misled in respect of what they did pay.
Within the first interview Mr Breeze stated that extra care was a “financial term” (and in his second interview “a charging mechanism”) which was implemented depending upon the clinical information that was coming in and that
“…we needed to find a mechanism for charging more for the more difficult patients.”
He also stated:
“…so the clinical information comes in on a weekly basis and when we started this was Mark Deveney’s job…He would bring the clinical information to myself and Dominic (Wilson) and we've got a list of patients on the board and he would identify for us who clinically was taking up more of the time than other patients…and it was on that basis that an extra care charge was sought.”
It is noteworthy that this explanation of when the charge was levied (which excluded any involvement of Dr Barker) placed the eventual decision making in the Claimants’ hands (one of whom had no clinical training at all).
When asked for a definition Mr Breeze said that extra care means “basically someone who has a higher level of therapeutic intervention put into then than the average patient and that is a clinical decision.” When asked by DC Williams as a follow-up question what form the extra care took Mr Breeze stated that what was in place was a high level of skilled staff and as for who would “target patients”, from a clinical point of view this was a question for Dr Barker and there would be “an extra level going into that patient”. Staff would know who the “more difficult” patients were on the ward but they would not be aware of the extra care charge as this was a charging mechanism. On this basis there would usually be nothing identifiably “additional” or “extra” in terms of resources allocated to a specific patient (contrary to the statements set out above) although there were occasions when extra staff were actually brought in, rather it was charged according to who was perceived to be taking up more of the time than other patients. When asked “who decides how extra care is delivered?” Mr Breeze said that was putting this the wrong way around “you look at what is being delivered and then make the charge” i.e. it was an ex post facto analysis of which patients were actually using up more of the existing staff resources “across the board”. However this analysis could not account for the charge being levied before patients had used any resources. Mr Wilson when asked what extra care meant also described the charge in a different way, more akin to an increased risk premium:
“It’s a way of identifying the particularly challenging risky difficult patient that we’d expect to be using more of our resources, or being more risk to us.”
There is an obvious difference between a charge levied because there is a risk someone will need a service (such a risk may remain constant) whether they actually use it or not and a charge levied because someone actually has used a service (whether it was expected they might or not).
Given the explanations given by Mr Breeze it is also of significance that:
some patients had a double extra care charge; so there was some sort of quantitative analysis of the extent to which a patient was taking up/at risk of taking up more than whatever the baseline for expected/average/normal use of resources was;
the extra care charge continued when patients were not on the premises (so could not actually be using more of existing resources although there was a risk they may return and do so).
Whilst there has been much emphasis on what witnesses said and the documents produced, what was not present was also of central significance in the evaluation of the case against the Claimants. Despite the very large sums of money the PCTs were charged the Claimants never produced (or caused to be produced) a clear and straightforward written explanation of what extra care was and/or the basis for the charge. Also there was no clear audit trail linking the perceived increased taking up by a patient of the existing resources with the levying of the charge These factors appear to have been at the heart of the difficulties the Claimants faced when Mr Deveney made his disclosure/complaints.
Mr Breeze’s claim in the present case is, in effect, that extra care was such a straightforward, simple and transparent construct, which was understood by the Commissioners, that there can be no plausible explanation for why the investigating police officers failed to recognize this other than malicious intent.
During the second interview Mr Breeze’s solicitor stated that there was “a complete and unfortunately fundamental misunderstanding or a lack of willingness to understand extra care”. In my judgment given incorrect information provided, the confusion surrounding the extra care charge and the evidence available to the investigating team that is not a realistic, justified or accurate assessment. From the outset of his involvement in the investigation Mr Breeze has consistently been incapable of accepting any problems in respect of the confused and confusing way that the charge was arrived at and levied. Even during cross-examination he could not see why anyone should question how the company was paid large sums of money without clear contractual terms, a written explanation of its basis or a specific documentary audit trial stating who made the relevant judgments about the charge and on what information.
The Claimants’ case as advanced at trial was that, despite what Mr Deveney had said and the other available evidence, after Mr Breeze and Mr Wilson had given their explanations of extra care during their interviews, the investigation should have not proceeded further and the fact that it did must mean that there was malice. I do not accept that argument.
An essential feature of Mr Breeze’s explanation/rationale of how the extra care system worked at Cawston Park was that there was always a high level of staff, (higher than otherwise needed without catering for the provision of extra care). This became a focus of the Police inquiry.
Mr Breeze set out in his statement for this action the bold statement that there was “never a complaint made that staffing was inadequate prior to the police investigation” and that if a substantive post was unfilled at any stage the gap would be made up by agency staff.
DS Brownsell gave an overview of evidence obtained in relation to staffing levels in the case summary. As with other issues he was not cross-examined upon what he had set out. Apart from the views set out in witness statements within the first iteration of the summary he also referred to a letter of 20th June 2004 referring to dangerously low staffing levels written by David Pyke, a lead nurse in the Grange, to Mark Deveney;
“He is concerned about the low level of mental health nurses employed and alludes to there being a lack of these since the Grange opened in November 2003. He goes on to say that staff are working long hours and the commitment is due to goodwill, however the staff are becoming disenchanted by the poor pay. He states that bulking up on inferior agency staff has left the unit in a potentially dangerous condition and has put the safety of everyone in jeopardy.”
Mr Breeze said that he was not aware of this letter and Mark Deveney must have either sorted it out or disagreed with him.
The summary noted that minutes of an operational meeting on 6th February 2006 mention problems with staffing levels and recruitment being too slow and opines that; “this document corroborates what staff have said about staffing levels being too low”.
Mr Breeze was taken by Mr Warnock to a letter of 27th February 2006 from Kate Willan tendering her resignation as unit manager of the Lodge, amongst the points made she stated:
“Staffing wise I feel we are in a very unsafe position. I now have 10 operational staff of my own, when I should be operating on an agreed minimum of 25…quite how I am supposed to operate a caring, professional and clinically therapeutic environment without due support is beyond me. I have consistently discussed recruitment issues, but am regularly rebuffed…”
Mr Breeze said that he had forgotten this letter as he gave no weight to it. I found this a surprising answer given Ms Willan’s post.
Again matters were not as simple as Mr Breeze set out in his witness statement in this action. There was evidence to support the proposition that staffing levels were a very real concern. This would also have undermined the extra care through, in effect over-staffing, philosophy.
Mr Breeze has come to strongly believe in multiple conspiracies. Apart from his pleaded case in respect of the Defendant Mr Breeze gave evidence that
Mr Ginelly (as an investigator in the NHS fraud team) “made his mind up there was fraud” also that he is not convinced that Mr Ginelly thought that there was fraud and that he had “other motivations”. Mr Breeze said that he did not think that he was acting in good faith; rather he was also malicious.
When challenged that the comment in his witness statement that the Health Care Commission inspection in September 2006 was not “as positive” (as previous reports) did not give a true reflection of the critical nature of the report (given that there were numerous conclusions that standards were not met and major shortfalls where significant action was needed to achieve the required levels of performance), Mr Breeze said he disagreed with the report e.g. that the hospital was dirty. He stated that he believed the Commissioners came in with an agenda having been working with the police and they needed to help the police to sort the fraud out. He obviously believes that there was a conspiracy and that the report was not an honest evaluation of what the Commissioners found.
As regards the July 2007 report of Christopher Hird commissioned by the Board of Chancellor Care and investigating the provision of extra care at Cawston Park between November 2003 and August 2006 (compiled after an audit of 10 sample patients and meetings with fourteen members of staff) Mr Breeze said that Mr Hird was not independent and knew that he was to produce a report that justified his dismissal.
LDC suspended him on the advice of Police officers (as opposed to the company’s own lawyers) and dismissed him as a result of an engineered report (the report of Mr Hird).
Turning back to his criticisms of the police investigation, Mr Breeze stated that evidence had been “tampered with”. Questioned as to what he meant by this he said that things had been deliberately left out of statements or things manipulated. Mr Warnock pointed out that the witnesses had been happy to sign the statements (and some had the assistance of solicitors). However Mr Breeze sought to justify his serious allegation by stating that some witnesses would not have understood what the statements were for, some would have been fed up and some would have skim read it and just signed it. He also believed that some junior members of staff were “led by Police”. In my judgment Mr Breeze has a mind set that readily imputes malice and as I shall set out in due course the allegation the police deliberately “tampered” with evidence is misconceived and without foundation. However I have no doubt that Mr Breeze still believes that his analysis is correct and he will not be persuaded otherwise. There was an illuminating exchange with Mr Warnock concerning Dr Barker. Within his witness statement Mr Breeze gave an example of a witness statement having been tampered with. He stated:
“For example, having read the transcript of Simon's interview where he describes in some detail those patients who were on an extra care charge however that detail is absent from Simon statement.”
Mr Warnock pointed out that the original draft statement sent to Dr Barker had contained details of patients, but Dr Barker had then asked for the details to be removed. In a letter dated 25th January 2008 submitting further evidence to Mr Tarrant it was explained by DS Brownsell that:
“This is the draft statement which Dr Barker has agreed…Doctor Barker was on the cusp of signing it when he decided that he ought to submit it to the GMC as within the statement he names patients and gives clinical information which could be viewed as a breach of confidentiality…and (he) didn't want any more problems with his professional body. A copy of the signed statement will be forwarded to you immediately on receipt.”
Dr Barker continued to refuse to allow the details to be in his statement and specifically addressed his reasons in the revised version;
“The police have asked me to recall details about patients who I now understand were being charged for extra care. In general they were the patients who were at the more challenging end of the scale. I do not feel able to recount clinical details as in order to do this, I would need to seek, and obtain, the consent of every patient I wished to write about…I am not in a position to do this, and I believe that certain patients would not be competent to give their valid consent in any case. In any case, it has been over a year now since I had any patient contact and I have no access to their records.
Remarkably Mr Breeze would not accept this as the true explanation for the draft statement not being signed. Rather he believed that it was a lie that was inserted and Dr Barker signed the statement containing this comment whilst he was under pressure and unwell. This despite the fact that Dr Barker had solicitors acting for him. In my judgment Mr Breeze’s allegation is fanciful and his refusal to accept what was obviously an accurate rationale within the statement speaks volumes of the extent to which he will find a way of attacking the police conduct of the inquiry, however unreasonably.
Turning to the three interviews with Mr Breeze these were conducted with his solicitor present. The very lengthy transcripts are within the trial bundle. DS Brownsell gave a lengthy analysis (stated to be a precis) of what Mr Breeze had said within the case summary and was not cross-examined as to its accuracy. Also, and importantly, transcripts of the interviews were supplied with the summary. I have carefully considered the content and do not see grounds for significant criticism of the summary in terms of accuracy or omissions as regards the interviews.
The summary also did not hide Mr Breeze’s view of the merits of the investigation. It included a specific reference to the fact that during the second interview:
“…Mr Breeze’s solicitor interjected (not for the first time) suggesting there was a complete and unfortunately fundamental misunderstanding or a lack of willingness to understand what extra care was.”
And in respect of the third interview:
“Breeze started off the sets of interviews on the offensive. He asked the interviewing officers if they were interested in getting to the truth as he didn't think they were interested in the truth at all. He stated that he thought that the police were only interested in gathering a body of evidence that supported their theory that there has been a fraud and that they were not interested in gathering evidence that disproves that. He accused the police of being selective in their evidence gathering and that the complaint from the NHS was driving the inquiry and that they only had one goal which was to gather enough evidence to put to the CPS so that he would be charged and that was all they were interested in. He went on to say that the evidence had been gathered in a biased way. He then said that members of his staff had been interviewed who had positive views about what had gone on have not had statements recorded from them…Breeze said that the police were not interested in seeking the truth and they were being driven by the NHS who have spent a huge amount of resource on an investigation and they want a result for him to be charged. Breeze said that the powers that be was Chief Inspector Chris Hobley as well as Frank Ginelly from the NHS.”
And
“Breeze stated that he had explained extra care many times and the interviewing officers were choosing not to understand the concept.”
So Mr Tarrant was unarguably well sighted in Mr Breeze’s view that the investigation had not been properly conducted.
Having considered all the available evidence, I do not accept that there was any aggressive or intimidatory conduct at any stage during the interview process. In my judgment Mr Breeze was more than capable of holding his own when questioned and, as set out above, felt able to be very critical of the officers. Mr Breeze stated that during the second interview on 24th May 2007 (during which, it appears, he chose not to look directly at the officers), DS Brownsell “burst” into the interview room at one stage flourishing a document which he said proved Mr Breeze was guilty. When shown a transcript of the interview (conducted by DC Horsburgh), which, Mr Warnock suggested to Mr Breeze demonstrated that his solicitor already had the document and that the ensuing discussion between the solicitor and Mr Brownsell was about privilege, Mr Breeze stated that the document was not the one labelled DJK/9 as his witness statement specifically stated, rather a piece of paper with one line on it. I do not accept this as an accurate account and instead accept DS Brownsell’s account, namely that there was merely an argument between him and the solicitor about privilege, which was resolved by him agreeing to have the document reviewed again. DS Brownsell’s evidence is in line with his roughbook entry.
Mr Breeze described the officers as “gloating” whilst he was charged. It is my view that this is not founded on a reasonable assessment/description of the behaviour or attitude of such officers as were present. Despite making many complaints in the past Mr Breeze did not raise this issue before setting it out in the witness statement in this action. Mr Breeze’s solicitor was present and Mr Wilson and Mr Breeze were charged within 30 minutes of each other and Mr Wilson made no such allegation. I prefer the evidence of Mr Flynn that there was not a crowd of officers and there was no gloating.
Mr Breeze made a number of complaints about officers attending at the City Club. It was his view that that DC Baker and DC Flynn attended the City Club on 28th March 2008 for lunch (after the interview with Martin Ward) so that they could intimidate him. There is a dispute as to whether it was the 28th March or some other date when both officers attended the Club, but in my view nothing turns on this issue. Rather I am wholly satisfied that on the one occasion that the two officers did attend the City Club (DC Baker was a member; he is now president and took DC Flynn as a thank you for a favour) they did not expect Mr Breeze to be present and had certainly had no intention of intimidating him. They attended due to a failure by the steward to provide the agreed warning that Mr Breeze would be present (a system which DC Baker had instituted). It is also very difficult to see how the officers could have intended to achieve any intimidation or the possible point of it. This is an example of how Mr Breeze’s belief in conspiracies to cause him unnecessary personal harm has turned innocuous conduct into what he believes to be malevolent behaviour.
- Heading
- Evidence 14 - 16
- Defendant’s witnesses 124 - 169
- Law 201 - 203
- Analysis 215 - 216
- Introduction
- Facts; an overview
- The Parties’ Cases
- PARTICULARS OF MALICIOUS PROSECUTION
- PARTICULARS OF MISFEASANCE IN PUBLIC OFFICE
- Evidence
- Defendant’s witnesses
- Mr Deveney’s disclosure and associated evidence
- Lisa Vescio and Paul Vincent
- Case Summary and MG6
- To summarise At this juncture in the inquiry it is evident that
- MG6
- The drugs investigation
- Claimants witnesses
- Mr Breeze
- Mr Wilson
- However he also explained that
- The following points are noteworthy
- Mr Ward
- Mr Chancellor
- He continued
- Anthony Bull
- Mr Drewery
- Charles Bott KC
- Margaretha Gaisford
- Mr Cooper
- There was then a diversion into small talk and it was later stated by DS Brownsell that
- City Club Evidence
- Victor Miller
- Mr Pointer
- The restraint proceedings and the evidence of Mrs Breeze and DC Wilcox
- Other witnesses
- David Prior
- David Graham
- Mr Graham continued
- Susan Smith
- Raymond Adcock
- Sandra Grunwald
- James Braithwaite
- Richard Innes
- Sir Norman Lamb
- Corinne Scicluna
- Dr John Olive
- Defendant’s witnesses
- Closed mind
- Conduct of officers
- Pressure to achieve a result
- Health Care Commission
- Mr Cooper
- Ms Gaisford
- Deveney’s computer
- 14 th November 2006
- Linda Todd
- Mr Prior
- Dr Barker
- Missing Rough Book
- Dr Badcock
- Charges levied
- Kelling Park
- PwC
- Questionnaire
- Mr Bull
- Mr Drewery
- Exclusion from court
- Mr Breeze’s interviews
- Weight attached to other evidence
- DLA Piper letter
- Mr Ward
- DS Brownsell’s mindset
- Pleaded case
- DC Baker
- SIOs
- Mr Cooper
- 14 th November, Ms Gaisford and arrests
- City Club
- Mr Bull
- Mr Chancellor
- Mr Ward
- DC Deacon
- DC Wilcox
- DC Flynn
- Willan and Woodhead
- Mr Bull
- Mr Ward
- Judith Cass
- Draft, unsigned statement of Mr Tarrant
- Other Statements/Interviews
- Dr Barker
- And
- Linda Todd
- And in respect of the meeting to agree terms
- Documentary Evidence
- The Hird Report
- The trial and the failure of the prosecution
- After Mr Brook gave evidence Counsel took stock. As they stated
- Post Prosecution
- IPCC
- Reasonable and probable cause
- Honest belief
- Objective analysis
- Malice
- Misfeasance in public office
- Conduct in the exercise of public power
- Acting dishonestly/in bad faith
- Limitation for misfeasance in Public office
- Analysis
- The investigation and prosecution; a critique
- Interviews
- Witness tampering
- The honest belief of officers
- Other pleaded issues
- PwC
- Healthcare Commission
- Was the case summary deliberately “slanted”
- Was there reasonable and probable cause?
- Malice
- The prosecutor?
- Conclusion
- and
- Sept – Oct ’03 Cawston Park site purchased
- 25 May ’05 Management buy-out of Chancellor Care Ltd
- 15 Aug ’05 Mr Cooper commenced employment at Cawston Park as Operations Manager
- Dec 2005 (per Particulars of Claim)
- 27 Jan ’06 Allegation made by Mr Deveney to NHS CFS
- 4 July ’06 Report prepared by DS Kirkham re Operation Genus addressed to Det Supt Julian Blazeby
- 1 Aug ’06 Meeting between NHS CFS and the Major Investigation team
- 19 Sept ’06 Unannounced inspection of Cawston Park by HCC
- 29 March ’07 Statement signed by Mr Brook
- 23 Aug ’10 Outcome of Operation Meridian Review communicated to Claimants
- Letter of Response
- Amended Reply to Defence
- Conclusions
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