The following letter was originally sent to Jacob Rees Mogg’s office on the 27th of October 2017. However, the office refused to continue to help Julie’s family with their mum’s case, because Julie’s daughter Rebecca is not a constituent (although her son Alex is). This was resolved after a week following a complaint to his office, and the letter was again sent on the 2nd of November 2018.

We are writing to give an update on our mum’s case, which your office has previously been involved in.

In your last email, you suggested that I (Rebecca) contact my MP Harriet Harman, as I don’t live in the constituency myself. However, I am writing to you also on behalf of my brother, Alex Montacute who is a constituent (CC’d). Additionally, the matter concerns the mental health trust which serves Jacob’s constituency; therefore failings of this trust will have an impact on any of his constituents relying on that service, and which Harriet is unlikely to have any previous knowledge of. Therefore, I trust you will be happy for me to continue to correspond with your office, rather than Harriet Harman’s, on this issue.

Since I last wrote to you, the internal investigation has been completed by the Avon and Wiltshire Mental Health partnership (AWP). Additionally, the inquest into my mum’s death concluded last week. The coroner found that there were 9 failings in the care my mum received, including 2 gross failings.

One of the issues highlighted by the inquest is the information available to GPs regarding mental health patients still in primary care, while waiting for transfer to secondary services. In the run up to my mum’s death, she had called the crisis (also refer to as the intensive team) phone number for the AWP several times, but her GP had not been informed of these calls. In his testimony at the inquest, he said that if he had of had this information, it is unlikely he would have cancelled the appointment which my mum had booked for the day before she died. The coroner identified this cancelled appointment as a key missed opportunity for my mum to have accessed the care she needed before her death.

The GP commented that when someone calls 111 or visits A&E, their GP is informed. However, this is not the case for someone calling mental health intensive care lines. A GP can be informed of a 111 call for something as simple as a cold, but not be informed of repeated calls to a crisis mental health line, something which is likely to be a sign of a deterioration in their mental health. I am concerned that this is likely to be a national issue, and would appreciate if you could do whatever you can to find out 1.) whether anywhere in the country this information is shared with GPs, 2.) if there is any reason this information could not be shared, and 3.) who would need to make the decision to share this information, both on a local and a national level.

The coroner did not make any prevention of future death orders. However, we are concerned that there are several issues raised for the first time by the inquest which have not been dealt with, and we are unclear how AWP intend to deal with these in the future. For example, the intensive team is the only support for those in a mental health crisis which is available 24/7. However, this line is only staffed by two people, one of whom is not a registered nurse and who has not had training in performing risk assessments. Something which we believe contributed to the failures in mum’s access to treatment. This individual will often be required to man the crisis phone line alone, when the registered nurse is out on assessment. We believe it is potentially unsafe to leave someone without risk assessment training alone at any point to operate this service. We will be raising this issue further with the AWP in due course, and would greatly appreciate any support from your office on this issue. The AWP provides mental health care for all of Jacob’s constituents, but has been identified by the Guardian as having had the largest number of preventable mental health deaths in the country. What is Jacob currently doing to ensure that the performance of this trust improves, and that all learnings from deaths like our mum’s are acted upon?

We are also concerned that when a patient is on the waiting list for long term mental health support, it is currently unclear whether they, or their GP, have overall responsibility for that patient. Whilst we are confident that mum’s GP has now made changes, including additional checks on mental health patients while they are waiting to be placed into secondary services, we are concerned that other GP practices in the local area are not getting the same opportunity to address this problem. We would appreciate advice and support on how best to ensure that other GPs practices in the local area are able to also learn from the changes that her GP (Harptree surgery) have implemented since our mum’s death.

One of the issues brought up repeatedly by witnesses from the AWP is that they felt under pressure in their workplace, and the inquest process highlighted possible issues in staff workloads. We believe that inadequate staffing of mental health services is likely to have contributed to the failures in mum’s care, which urgently needs to be addressed by the government. Additionally, the waiting list for mum to receive non-emergency mental health support was several months long, and there is the concern that any patient may deteriorate when having to wait so long for treatment. Again, staffing levels are a concern. According to the Kings’ Fund, numbers of mental health nurses have fallen by 13% since 2009. We believe that mum’s case highlights how important mental health nurse staffing levels are to ensuring vulnerable people access the care that they need. We would like to enquire what Jacob’s position is on the fall in mental health nurses, and what work he is doing in parliament to ensure that this trend is reversed.

I would also like to discuss with Jacob the funding that is available to families during the inquest process when there are concerns about the care that their loved one received from state services. We did not qualify for legal aid under the current system, and had to pay £10,000 for a lawyer ourselves; a lawyer who was vital to ensuring that all of the 9 failings found by the coroner were unearthed. Without a lawyer acting on our behalf, I am certain that the sheer scale of the failings in mum’s care would not have been uncovered. Bereaved families should not have to pay out to ensure that the state learns fully from the deaths of their loved ones. The charity INQUEST have written on this issue extensively, and we fully support their call for legal aid to be granted to families in circumstances such as ours. We would like to know whether or not Jacob supports this campaign.

I would really appreciate your help on the issues outlined above, and would like to request a meeting with Jacob in future to discuss the considerable problems in mental health services that our mum’s case has highlighted.

Kind regards,

Rebecca and Alex Montacute