Thank you for sending through the response from the AWP. Before going on to discuss that response, can I please ask for Mr Rees-Mogg’s views on the following (which we asked about in our previous correspondents):

•  According to the Kings’ Fund, numbers of mental health nurses have fallen by 13% since 2009. Staffing levels were also raised by the coroner in our mum’s case. Does he feel that current levels of mental health staff are adequate? If not, what will he being doing in parliament to address this issue?

•   We did not qualify for legal aid under the current system and had to pay for a lawyer ourselves; a lawyer who was vital to ensuring that all of the nine 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? – https://www.inquest.org.uk/access-to-justice-for-families

These issues are separate to the support we’re asking for from Jacob in contacting the AWP, and your office have not yet responded to us on these points. 

Thank you for the update on your representations on our behalf to the Secretary of State for Health, please let us know if you hear anymore. 

Coming to the AWP’s response, we feel that our concerns have not been adequately addressed by the Trust in their reply. We have written to the Trust (see below) to explain our outstanding concerns, and if they are not addressed we will be referring the Trust to the parliamentary health ombudsman. 

Our response to the trust is below:

Thank you for your response regarding our mum’s care under the AWP. 

We do not, however, feel that our concerns have been adequately addressed by the Trust. We hope to be able to deal with these issues without referring the Trust to the parliamentary health ombudsman, but if these concerns are not dealt with, we will have to do so. 

We would prefer to communicate with you in writing, rather than meeting with the Trust in person – so that there is a clear record of our concerns, and we are able to give you the necessary level of detail in our replies. 

Sharing information with GPs 
We understand the issues around sharing information from the crisis line with GPs – however, we strongly believe that doing so has the potential to improve safety for patients. For example, a system could operate in which not every call was communicated to a patient’s GP, but whereby if a patient is calling repeatedly (e.g. once they have made three or more calls to the service within a month) that no matter how the calls are dealt with by the AWP, an alert is sent to their GP. That would allow a patient’s GP to know that their mental health concerns may be escalating, which in cases like our mum’s can be vital for a GP to be aware of. 

Such a system would appear to be both proportionate and sensible, to keep GPs up to date with patients they still have responsibility for before they are transferred into secondary care – and presumably could be done using the same infrastructure by which GPs are currently kept up to date by the AWP? We would appreciate an update on your meeting with GPs and commissions regarding information sharing with GPs, and any issues that arise from that meeting. 

Staffing levels on the crisis line
We are seriously concerned that the Trust’s mental health crisis line is putting too high a burden on unregistered practitioners to make risk assessments and decisions on access to care, even with the changes already made by the Trust. 

Unregistered practitioners taking calls on the NHS’ 111 line are required to have a high level of training, always have access to registered members of staff to ask for advice (which indeed forms a core part of their training), and are guided through decisions using an online tool, NHS pathways. The system is designed in that way to ensure that unregistered practitioners are not making clinical decisions themselves. 

In contrast, unregistered practitioners working on the AWP’s crisis line – a vital gatekeeping service to mental health treatment in a similar way that 111 does so for physical health– do not appear to use a system like pathways to make decisions, that means that they are instead making decisions themselves, without adequate training, on which cases to escalate. We believe they should run through a clear framework of questions, with cases escalated automatically through that pathway in cases where a registered practitioner is needed – without unregistered practitioners having to make these decisions without that clear guidance. 

Additionally, during the periods in which an unregistered and a registered practitioner are staffing the line together (for example overnight), the registered practitioner will at times be required to go out on-call to deal with someone in acute crisis. (I believe that this was the case on at least one of the occasions that our mum called the crisis line), so there was no registered practitioner available to consult. We believe that this practice is unsafe, and at a minimum, if unregistered practitioners are manning the call line, there should always be a registered practitioner available in the office for an unregistered practitioner to consult.  

We would appreciate if you could please provide details of the suicide prevention training given to staff following our mum’s death, including 1.) who delivered the training 2.) what their qualification for doing so was and 3.) how often this training will be repeated/whether this training will now be delivered to all new staff before they begin work on the crisis line. Can you please also outline in detail all of the training given to unregistered practitioners working on the crisis line, in addition to that given specifically on suicide prevention after our mum’s death. 

Staffing levels
We understand that the Trust is attempting to make efficiencies to ensure staff workloads are better managed. However, if these efficiencies still do not allow the staff in place to do their jobs safely, which given the large reduction in mental health nurses nationally, is likely to be a concern – how does the AWP escalate this to request more funding for staff? If the AWP do not have the budget to make this decision themselves, who can they appeal to for additional funding? 

Kind regards, 
Rebecca and Alex Montacute