[2025] EWHC 2684 (KB)

The Board of Chancellor Care commissioned a report by Christopher Hird (an experienced registered mental health nurse) into the provision of extra care at Cawston Park between November 2003 and August 2006. The report dated July 2007 was compiled after an audit of 10 sample patients and meetings with fourteen members of staff (including Mr Brook and Ms Grunwald).

A copy of the draft report was attached to the case summary. DS Brownsell noted that it reflected many of the findings of the police inquiry. Notably it was stated that:

“It is evident that there were differing levels of awareness and understanding of extra care at Cawston Park. Senior managers and finance staff appeared to have the most awareness, whilst middle managers such as charge nurses have the least awareness (within the report he elaborates on this as these were often the most experienced staff and should be central to the delivery of care).

Concern was expressed about staffing levels, particularly by senior nursing staff, that levels were not always adequate and high levels of agency staff were used.

Senior staff could not recollect any interventions being provided by themselves or other senior staff for specific difficult patients over and above their normal duties.

There was no reference found within the clinical records to extra care, as defined by Chancellor Care, in the progress note entries relating to increased or enhanced levels of observation. The only reference to the term extra care was found in relation to the use of the extra care suite.

No clear evidence was found of review of individual extra care charging by clinicians and managers with an auditable communication trail between clinical and financial departments.

It has been difficult to identify the availability and deployment of extra care resources, as defined, to those patients subject of extra care charges sample this part of this inquiry.

Six of the ten patients had overnight leave granted whilst being subject of extra care charges. A minimum of 164 nights leave was taken equating to approximately £52,480 of revenue, based on the conservative daily average charge of £320. Continued charging whilst the patient was out of the hospital will be difficult to justify should the commissioners wish to have queried it. Knowingly charging for service which has not been provided is highly questionable and is both unethical and unprofessional.”

DS Brownsell stated Mr Hird noted that his report has not been prepared with the criminal standard in mind “but he is aware that the police have a copy enquiries are in hand to produce this in evidence”.

Ultimately the report was ruled as inadmissible. However, on the evidence available to me it was reasonable for DS Brownsell to consider it as potentially supportive evidence (he was not cross examined on the view and the construction he sets out in the summary). The conclusion was plainly critical:

“As extra care was a major revenue stream for Chancellor Care Limited, particularly in the fiscal (sic) 2004 and 2005, one would expect to find clear transparent processes in place for the assessment, planning, implementation and recording of any additional or extra service being provided. This is not evident from the records which were audited.”

Whilst disagreeing with the contents of the report, and stating that it was his view that the result was, in effect preordained/required by the Board so as to justify his dismissal Mr Breeze accepted that the police looked at it and agreed that a view could be formed that it would assist them in building a case against the Claimants.