[2025] EWHC 2684 (KB)

Mr Ward is a mental health nurse by background but describes himself as “a practitioner, researcher, educationalist, manager, politician and writer”. He worked at Cawston Park from September 2003 until late 2007 as a professional advisor. By 2007 he had 35 years of experience within the field of mental health.

In his statement in this action Mr Ward set out that he met with the Claimants:

“...to discuss with them the possibility of developing an initiative that sought to provide high quality psychiatric care at an unusually high quality site in Norfolk. During this initial meeting they outlined their plans to purchase and develop Cawston Park as a private hospital for people with severe mental illness and those suffering borderline personality disorders. I was struck by both the sincerity and passion of the two men to develop a service that was both clinically efficacious as well as being a sound business proposition. Over a two or three week period we held several meetings and it became obvious to me that they wanted to use their considerable experience to make the Cawston site a centre for clinical excellence, offering patient centred care based upon a Modified Therapeutic Community (MTC) model and to gain a reputation for undertaking psychiatric care that was both contemporary and evidence based.”

Mr Ward explained that as a professional advisor he spent several weeks on site during the hospital’s set up period. He drafted the hospital’s manifesto explaining its philosophy of care. He was also partly responsible for educational packages given to staff and was contracted for 40 days per year to conduct research at Cawston Park which he would usually do for blocks of one week at a time as he lived in Malta.

Mr Ward said once he knew of the police investigation into the hospital that he had assumed that as he had been a “key player” in the startup of the hospital he would be interviewed very quickly. However by the middle of 2007 he had still not been interviewed. He spoke to Mr Breeze and told him that he was happy to support him and after that he was contacted by DLA Piper (the Claimants’ solicitors) and a statement was produced which he signed on 27^th August 2007.

In that statement (“the DLA Piper Statement”) Mr Ward said that he was convinced of the genuineness of the Claimants to establish a service that was inherently patient centred and as a good psychiatric hospital should be run. In respect of extra care Mr Ward stated:

“Extra care was an invoicing mechanism designed to pass on the increase in support required by certain patients to the Commissioner responsible for their placement. This is standard practice throughout the independent sector as this is often the way that increases in care can be monitored when using the traditional specialling model of care i.e. bringing in extra staff. However, certain key issues need to be addressed at this point to clarify what was happening at Cawston during the first two years of its development.

Firstly, as described above and from my own examination of patient records for later research purposes, the documentation systems, as described above, were not sensitive enough to be able to detect the increase in staff support for individual patients. Staff spent time with the patients sorting problems and difficulties out rather than sitting in an office writing reports. Whilst this perhaps represents some organisational naivety it reflects the stage of development that the organisation had reached and its desire to meet its clinical ethos using the “right" approach to care, not just the most expedient one.

Secondly, much of what went on as an increase in care came, certainly in the early days, from the senior staff who were at that time living on-site. They it was who would often act as the back up person in difficult to handle situations and their input was seldom, if ever, recorded in the patient's notes.

Thirdly, even if these senior staff were not on site during incidents requiring additional resource input, this would invariably come from the senior staff on the unit, not additional staff from the nursing pool or an agency. There were, of course, incidents where this was the case, however, in most part it was dealt with from within existing resources. My understanding was that an additional charge for the increase in support and care level would then be reflected in the invoicing process. In the morning meetings with the Head of Care, the senior management would discuss the previous day’s events and those patients who had required, or continued to require, additional support and interventions. There were no formulae, or scientific calculation, for this calculation merely an evaluation by the team of the extent of additional support required. However, I am not aware of how the figure to be charged for each patient was arrived at. Given the structural developments at that time this would appear to be a perfectly appropriate way of determining the cost to the organisation and any suggestions that this was not so would indicate a complete lack of understanding and experience of clinical practice and the demands placed upon skilled nursing and support staff at times of crisis. It also places too much emphasis on the mechanical process of offering extra staff for extra care. Patently this is not the way it works and any suggestion that it should merely reflects an uniformed and perhaps stigmatised view of the way that people with mental illnesses should be treated.

Fourthly, as described above most independent institutions invoicing for extra care would be able to show the necessity to bring in extra staff to undertake either specialling activities or to manage seclusion because of either their reporting mechanisms or the bill for bringing in additional staff from either bank or agencies. Cawston managed to do this from within its own resources, providing additional support and care that needed to be paid for. The outcomes from the approach undertaken at Cawston, versus those of many other more traditional establishments, should beg the question who is actually cheating who here? Many of the patients transferred into Cawston had received specialling in one form or another during the length of their various hospitalisation period. None of them appeared to have benefited therapeutically, they were simply still alive but with the same debilitating mental health and behavioural problems. Where was the cost effectiveness in this one must ask…

Fifthly, the decision as to who would attract extra care charges was that of the Head of Care in discussion with the CEO, the Medical Director and the Director of Finance, at either their informal daily meeting or the more formal weekly ones. Clinical data was discussed and if it was agreed by the team that additional resources had been, or were continuing to be, required, charging was made accordingly. This was the agreed arena for these discussions and many of the decisions about the day to day running of the organisation, as reported to me informally and in our own meetings by the participants of these meeting, were apparently made by this senior group as a working team. It was not something about which the support workers or nurses on the unit would be aware of.”

These extracts were clearly supportive of the Claimants.

Extracts from the statement were provided to Mr Tarrant by DLA Piper in a letter dated 1^st February 2008. Mr Ward stated that an interview with the police was arranged for the 28th of March 2008 (after he had been contacted 3 or 4 times to arrange a date). Prior to the interview Mr Breeze had asked if his solicitors could be present “to protect Andrew's interests and not there as my representative”. Mr Ward said that DC Baker stated that this would not be possible but when he was contacted by Mr Breeze prior to the interview it was confirmed that the solicitors would be there.

On the morning of the 28^th March he attended at Hellesden Station in Norwich as agreed. He assumed that a representative from DLA Piper would also be attending. In the statement for this action he stated:

“...there was a delay before the interview started. One reason was that the other officer could not get the recording machine to work, another was that we were waiting for a representative from DLA Piper to arrive. The interview eventually began, without any DLA representative.”

As regards the interview Mr Ward stated:

“I got the impression that the officers were not interested in what I had to say, but they were just going through the motions. DC Baker made no notes during the interview…I definitely felt that my role in the investigation was a bit player.”

Mr Ward stated that at the beginning of the interview one of the officers mentioned to DC Baker “what about the other thing” and he stated “No we’ll deal with that at the end”. After the tape had finished recording DC Baker raised with Mr Ward his work with the Royal College of Nursing. Mr Ward stated that he explained that he had been dismissed after a bogus accusation made against him that he had been spending money inappropriately and unfortunately the College felt they had no option but dismiss him as the paperwork was incomplete. DC Baker indicated that they knew about this as the information had been in one of the box files in the documents they had seized. Mr Ward then stated:

“DC Baker then went on to say words to the effect that I should realise that if I went on the stand as a hostile witness to the CPS, they would have to raise this because it showed that I had a shady background and my word was not necessarily credible….DC Baker continued to say that if I didn't appear that wouldn't matter, but if I were to be a witness for the prosecution, then my dismissal from the RCN would not be raised. I remember thinking at the time, how on earth can I be a witness for the prosecution when everything I presented supported the stance taken by the company and Andrew. Throughout this part of the discussion, DC Baker's demeanour did not change. The fact he continued to speak in a friendly manner made the message even more chilling…. I have no doubt this was a premeditated ploy to discourage me from being a defence witness carried out in a way to achieve optimum impact. DC Baker then told me to go away and think about it.”

And

“I was and to this date remain horrified by this whole conversation. I had wanted to be put forward to assist Andrew in the case, but with DC Baker's words the dominos fell down. Following this conversation, I wanted to put as much distance between myself and this matter as fast as I could.”

Mr Ward’s statement (for this action) continued on to state that DC Baker had a cigarette with him whilst the tapes were checked and that he told him that he thought he was a good chap and that he did not want to see him damaged by the inquiry. Mr Ward likened it to a scene of interrogation by the Gestapo and that:

“he did a fine job in scaring me off.”

As I shall set out in due course when he gave evidence DC Baker confirmed that it was his decision to tell Mr Ward that they knew of his dismissal for fraud at the end of the interview (as opposed to the outset) to spare him embarrassment. However his recollection of events differed in that he said that Mr Ward asked him whether, if he gave evidence in Court, the matter may come out and he replied “possibly”.

Mr Ward confirmed that after the interview a draft statement was sent to him and that;

“I amended some things and returned it to him. I signed the final draft and returned it to him. I signed the statement hoping I would not have to play any further part in the case.”

After the trial ended Mr Ward provided a further statement to the Independent Police Complaints Commission regarding the events surrounding the interview (I shall refer to this complaint in due course). He confirmed that Mr Breeze was a friend as well as a colleague and that Mr Breeze had indicated that he was happy for Mr Ward to see DC Baker. He said that save for a failed telephone call his contact with DLA Piper was through Mr Breeze. He said that at the beginning of the interview he did not remember waiting for anyone else (contrary to his recollection as set out above) but that he could be wrong. The statement then varies significantly to the details in his witness statement in this action.

As for the interview process he stated:

“The interview started and I have no complaints about the interview, the officers were polite, I felt comfortable and not stressed, the officers were not hostile towards me in any shape or form. Although on reflection, I do not think they were that interested in what I had to say, they were going through the motions…”

Mr Ward described the interchange with DC Baker in broadly similar terms to his description in his witness statement for this action. He said of DC Baker’s comments about his dismissal;

“He continued to tell me that of course it will come into the public light and therefore it will affect your professional career as a professional consultant; people will know what happened and wouldn't employ me. It wasn't said as explicit as that, but that is what he said and the implication was it would damage my career…When discussing the RCN details, DC Baker was not threatening when he spoke, it was very much a case of bon hommie, and although I was shocked, I was friendly back thanking him for alerting me to the possibility and said what a nice thing to do. My inner feeling at the time was that I was horrified that this should be said to me…”

Returning to the interview and the extra care charge process Mr Ward said that there was “very little” in terms of audit processes and that

“…any audit for psychiatric establishment is based primarily on the medical and nursing records, that's where it starts…”

And

“…there was an absence a good record keeping right at the very beginning, that was addressed I would say relatively quickly and within the first four or five months it became obvious they needed to increase their record keeping but that was essentially the responsibility of the head of care Mark Deveney…”

There was the following exchange;

Given the allegations made by the Claimants in respect of the Officers dealings with Mr Ward, it is necessary to set out the significant parts of the statement he signed. Mr Ward described his knowledge and understanding of extra care as follows;

“I had no part in its concept or application as it was a clinical matter and as such something I would not be involved in. I have never seen an invoice for it but understood that the term was used as an invoicing mechanism.

…

I know that if a patient needed a higher level of input from more qualified people then Simon, Mark and Andrew would be available most of the time to give it as for a long time they lived on site. They would of course been available to any patient not just those for whom extra care charges were being made.

I have been present at a few morning meetings involving the management team when issues would be discussed about individual patients, who were having problems, and that there was a need for extra staff to be brought in to keep them safe. It is my understanding that those resources would either be brought in from other units if there was flexibility to do that, or staff would be paid overtime, failing that they would be brought in from agencies.

If Cawston incurred additional expense I feel it would be appropriate to make a charge for this to the relevant PCT’s.

I would without any doubt expect that if an “extra care” charge was made then the patient would be receiving something “extra” for it. This could be extra therapy or input from more qualified staff or simply an additional staff member to be there for them during periods of some sort of crisis, but it would be something “extra”.

For example if three people were in a room for three hours and after the three hours they all left happy that would be normal and I would not expect any one to pay extra for the experience. Now if it took four hours for the same three to reach the same state or an additional person was added to work with one or all of the three to reach the same state then that would clearly be something “extra”.

It’s irrelevant, I think that the staff would have already been there or not, it’s the Extra service that you are paying for.”

And

“I did not know who attracted an extra care charge and I have been asked who should know. The level of care would be dictated by clinical need and it would be the clinical staff who would convey this back to either the Head of Care or the Medical Director. I would not expect the unit staff to be told what was required, it was, and remains, their job to identify this and communicate it to clinical management. To attract the charge then the patient concerned would be getting more resources anyway but it would not be necessary for staff to be aware of financial matters, only that they got what they needed.

I have no problem morally with charging extra care in advance in some cases. For example a new arrival who has previously been specialled may attract the charge as its fair to assume that they, at least in the beginning, will need extra resources in place for them, but again the default position is that they would receive that extra resource. Ultimately it comes down to some ones extra time.

The charge should also only remain for the period of time that the extra level of care was required. I have been asked if it would be reasonable to make the charge for months on end. I would say that as a Commissioner I would want that justified and as an advisor I would want whatever extra resource/input that was given correctly recorded.

I have also been asked my opinion on charging extra care for someone on leave. My view on this is again as long as the resource is in place should it be required than its expectable however I can see how it could be seen as questionable practice.”

The Police statement, which, it bears repetition, Mr Ward chose to sign (after he had returned to Malta) was very significantly less favourable to the Claimants than the DLA Piper statement had been. In particular the emphasis on an “extra care” charge reflecting the actual receipt of something “extra”. Indeed Ms Morris suggested in her cross-examination of DC Baker that it was less favourable to the defence case.

Mr Ward is an intelligent man and he well knew the potential implications of some of the content of the Police statement. He would also have appreciated that Mr Breeze and DLA Piper would come to appreciate that he had not given the clear and strong support which the first statement had provided. Significantly Mr Ward had given his views during the interview before the issue of his dismissal from the RCN was raised (so it cannot be the case that what he said during the interviews was due to any pressure placed upon him to assist the Prosecution).

During cross-examination Mr Ward was taken to an e-mail which he sent to Mr Wilson on 20^th October 2006 after there had been an attempt to set out what extra care was within a document (the document dated both 10^th August and 19^th September produced by Mr Wilson) which contained these comments

“There is, however, one small issue I want to raise about the extra care document. It reads well and contains an absolute wealth of material but there are occasions where it repeats itself…anyway the most significant thing about the document from an observers point of view is it despite telling me what extra care is not, you do not give the same clear, concise and absolute description of what it actually is. If you look at the bullet points of the Exec summary for instance, you go to great pains to say that it is not this and it is more efficacious etc etc but even here you do not say what it actually is. The reader has to plod through the document to discover what it entails, and, almost inevitably, you spend far more time telling the same reader that it costs less than the traditional specialing but again the actual, physicality of it is still elusive. If I were a commissioner reading this I would assume that you were trying to convince me of the worth of your decision and that extra care was as elusive in practice as it is within the document. Now, descriptions of what extra care do exist but my advice would be to put a short and straightforward description of it right at the beginning of the Exec summary -not hidden away on the sports pages. Tell me what it is before you tell me what it is not. When I came to editing the research report to ensure that I complemented the extra care report I use my notes from our conference call rather than the document to help me do this. Otherwise it seems to me that you have covered the territory very well. Hope that helps and that you are not now wishing to lynch me.”

The content of this e-mail does not fit easily with the very positive content of Mr Ward’s DLA Piper statement.

The main factual issues in respect of Mr Ward are whether there was a legitimate interest in, and assessment of, what he had to say as opposed to disinterest and also whether improper pressure was deliberately applied by DC Baker and DC Flynn in an attempt to persuade Mr Ward not to give evidence.

Having carefully considered all the relevant evidence I am satisfied that an entirely proper interview and (in respect of the issues at the heart of this claim) statement preparation process took place (I have borne in mind findings of the IPCC which I shall set out in due course) with appropriate interest in what Mr Ward had to say; and with the central issues appropriately explored. It is very difficult to reconcile his comments that the Police officers were not interested in what he had to say with the detailed interview (and statement). In his e-mail of 4^th September 2009 to the IPCC Mr Ward stated that

“the interview itself was held in the most professional way.”

He said in cross-examination that he had no idea why he did not mention that he thought that the officers were not interested in what he had to say (which would clearly be unprofessional).

Mr Ward accepted that his views about the interview had changed over time and after reflection.

In my Judgment given the statement which Mr Ward provided after his interview the view could reasonably and properly taken that the DLA Piper Statement did not significantly alter any assessment of the merits of the case against the Claimants made to that stage because Mr Ward had given a far less favourable account of how extra care charges came to be levied.

As for improper pressure Mr Ward was only told about the Police knowledge of his dismissal after he had been interviewed and given his version of events which, as I have stated, on any realistic appraisal was more favourable to the Prosecution case than the content of the DLA Piper statement. I am satisfied that Mr Ward knew that his Police evidence was not as favourable as what he had previously set out and that this weighed on his mind. As he stated in his e-mail of September 2009 as a “…result of this interview...I chose not to have contact with Mr Breeze or his counsel prior to the trial” Mr Ward stated that he knew that he would be “discredited on the stand” and was depressed that he was unlikely to be “unable to defend the working practices of people who had done nothing to warrant their predicament other than to do a good job.” Mr Ward explained that his relationship with Mr. Wilson is “now completely destroyed and only time, and the goodwill of Mr Breeze will tell if we are able to resume as both professional colleagues and friends.”

In my judgment Mr Ward knew that if he gave evidence for the Defence that what he had said to the Police would be raised. He stated in his IPCC statement;

“I didn’t contact Mr Breeze afterwards and I didn’t get in touch with him whilst I thought about what had been said. I spoke to my wife and I thought that if I gave evidence at trial I could be more harm to Andrew than not, bearing in mind that I knew the CPS were going to discredit me.”

In my view this gives only a partially accurate picture. Mr Ward was in a difficult position given his professed support of the Claimants and the fact that he had given a statement which was not wholly supportive of them. I am satisfied that he was worried by the prospect of his dismissal from the RCN being brought up should he give evidence, but it was only part of his concerns. In my view what has subsequently happened is that Mr Ward has sought to explain away his reluctance to assist the Claimants at trial as solely due to improper pressure in relation to his dismissal from the RCN. This is not correct. It is pleaded (at paragraph 176) that following the interview with Mr Ward, DC Baker indicated that “Mr Ward’s career would be ruined if he gave evidence for the defence”. I reject this allegation having heard Mr Ward and DC Baker. Mr Ward clearly felt concerned about the prospect of his dismissal being brought up in Court should he give evidence but it is difficult to disentangle his complex inner feelings from what was actually said and the manner in which it was said. Had the dismissal never been mentioned it is difficult to see how Mr Ward could have believed that his evidence would not have been, at its highest, a mixed bag from the Claimant’s perspective, and capable of doing more harm to the Claimants than good.

For his part DC Baker thought that he was giving a fair and proper indication that the dismissal might be brought up in Court. I do not accept as accurate the recollection of Mr Ward of the suggestion that if Mr Ward gave evidence for the Prosecution it would not be brought up. This may have been Mr Ward’s interpretation of what was said/the situation; but I do not accept that it was said to him.

In conclusion in my judgment there was nothing malicious or deliberately improper in the interaction with Mr Ward. DC Baker did not handle the interaction with DLA Piper as well as he could have done and the comments about dismissal should have been on tape. However the reality of the matter is that Mr Ward was simply not as “favourable” about the extra care charge in interview and in his (voluntarily signed) statement, as he had been in the DLA Piper statement.