Alex RKIt is perhaps slightly surprising that Right Care, Right Person should make its first reported appearance in case-law in the context of an extradition challenge, but in Platt v The High Court of the Republic of Ireland [2024] EWHC 1821 (Admin), it featured in the challenge to the decision to extradite the claimant to Ireland. The Irish authorities sought his extradition for offences arising out of a claim for damages he had made for personal injury in the Irish courts in which he had given false evidence. A District Judge had ordered his extradition; Mr Platt challenged that before the High Court, his appeal being:
5. […] founded on two factual propositions which, it is said, the District Judge failed or failed sufficiently to recognise:
i) First, “Detention of [the Appellant’s partner] under the Mental Health Act 1983 is a virtually certain consequence of the Appellant’s extradition”; (“Proposition 1”) and
ii) Second, “There is a real risk that public mental health services will fail to ensure that [the Appellant’s partner] does not commit suicide or carry out acts of serious self-harm in the event of the Appellant’s extradition”(“Proposition 2”).
In relation to the second proposition, he sought to adduce fresh evidence, comprising:
61. [….] various articles and reports which raised concerns about the “Right Care, Right Person National Partnership Agreement” between the Home Office, the Department of Health & Social Care, the National Police Chiefs’ Council, Association of Police and Crime Commissioners, and NHS England which was announced at the beginning of 2023 and published on 26 July 2023 (“the RCRP”). The RCRP’s stated aim is to end the inappropriate and avoidable involvement of police in responding to incidents involving people with mental health needs. It provides, in summary, that the threshold for a police response to a mental health-related incident is either to investigate a crime that has occurred or is occurring; or to protect people, when there is a real and immediate risk to the life of a person, or of a person being subject to or at risk of serious harm.
An application to adduce evidence had been dismissed in August 2023, and Linden J was:
89(ii) […] not satisfied that the additional evidence would have resulted in the District Judge deciding the relevant question differently, so that he would not have ordered the Appellant’s discharge: see Fenyvesi [35]. The further evidence is far from decisive: it largely dates back to January 2023 and, in any event, its focus is on anticipated rather than actual difficulties with RCRP. The difficulties and concerns raised in these materials are also expressed in very general terms rather than being specific as to the flaws in the arrangements, the areas which they affect and how they are affected.
A second application, made in June 2024, consisted of:
64. i) Prevention of Future Deaths Report (“PFDR”) of Senior Coroner ME Hassell concerning Heather Findlay dated 16 June 2023, made pursuant to paragraph 7 of Schedule 5 to the Coroners and Justice Act 2009 and regulations 28 and 29 of The Coroners (Investigations) Regulations 2013;
ii) PFDR of Assistant Coroner Adrian Farrow concerning Claire Briggs, dated 8 December 2023;
iii) Letter from Daren Mochrie, Chair of the Association of Ambulance Chief Executives to Steve Brine MP, Chair of the Health and Social Care Committee, 30 January 2024 (“AACE Letter”);
iv) Policy Paper, National Partnership Agreement: Right Care, Right Person, updated 17 April 2024;
v) Addendum proof of evidence of the Appellant dated 6 June 2024.
65. The PFDR in the case of Heather Findlay related to her death in Humberside in June 2020 and said that, from the evidence which the Senior Coroner had heard, the police and the NHS Trust in this case had differed as to who was responsible for a patient who was seriously ill. The Coroner expressed a need for a crystal clear understanding between the partners as to who was doing what in such a situation.
66. The PFDR in the case of Claire Briggs was more recent in time and it concerned a death which had occurred in Stockport in Cheshire after Ms Briggs had taken an overdose of propranolol on 28 November 2022. The police attended but she declined to be taken to hospital during the critical period after she had taken the tablets. The police had called the North West Ambulance Service but there were significant delays in providing an ambulance. The Assistant Coroner said that in his opinion there was a risk that future deaths could occur unless action was taken on concerns which had emerged from the evidence which he had heard at the inquest, which ended on 12 July 2023:
“The evidence I heard was that a Joint Operating Protocol between the North West Ambulance Service and the five regional police forces designed to address the issues of which emergency service should take responsibility for incidents involving drug overdoses and the method by which the police officers attending such incidents prior to the arrival of the ambulance service can escalate their concerns over a person suspected to have taken a drug overdose, was in an advanced stage of completion, but was stalled in July 2022.
Whilst I heard that discussions have recently recommenced, they now encompass the Right Care, Right Person model, the findings of the Manchester Arena Bombing Enquiry and that additionally, the Fire and Rescue Service and the British Transport Police have now become involved.
Pending agreement of a Joint Operating Protocol, there does not appear to be any consistent and reliable understanding in place across the police forces and the North West Ambulance Service to provide clarity as to the roles of the respective services and the method by which concerns about individual patients can be escalated to the ambulance service by police officers dealing with those who are suspected to have taken drug overdoses.”
67. The PFDR was sent to the five regional police forces concerned, including Merseyside Police who are responsible for St Helens, as well as eight other police, health and fire and rescue services, with a response required by 2 February 2024. Mr Joyes told me that he had not been able to find any published response.
68. The AACE letter said that the spirit of RCRP was often not being adhered to by police forces in terms of pace of implementation and that this raised significant safety concerns. There were reports from ambulance services of occasions where the police has not attended incidents when requested to provide support that had subsequently resulted in patient harm or ambulance clinicians being assaulted. It was also said that an ambulance service had been involved in eight Coroner’s inquests in which the Coroner had raised concerns about gaps in service provision relating to welfare calls.
The submission made on Mr Platt’s behalf was that this:
69. [….] fundamentally calls into question what he called the “implicit assumption” of the District Judge that public mental health services in England, and specifically the North West Ambulance Service and Merseyside Police, are able to address the risk of suicide or self-harm by Ms McKenna which would arise as a consequence of the Appellant’s extradition. The lack of reported action in response to the PFDR in the Briggs case provides compelling evidence that a there is a heightened risk of death to Ms McKenna given the location of her home and her stated intention to commit suicide by overdosing on her medication. As a result of RCRP, there is an even higher probability that the steps which the District Judge envisaged would have to be carried out to protect Ms McKenna will not take place, or will not take place quickly enough to guard against the risk of suicide or self-harm. The District Judge’s decision on this issue is therefore unsound.
Linden J noted that the materials had not been available at the time of the hearing before the District Judge. He further noted (at paragraph 90) that “the PFDRs relied on by Mr Joyes and the AACE letter are concerning,” but continued:
they do not begin to constitute a body of evidence of the level of cogency, contemporaneity and thoroughness of coverage which would enable me to conclude that the risk that the police or the ambulance service would fail to respond adequately in the event that Ms McKenna suffered a mental health crisis is such that the District Judge proceeded on a factual basis which was wrong.
91. As a general point, the District Judge accepted that the crisis which Ms McKenna was likely to experience on being notified of the decision to extradite the Appellant and/or upon his extradition would be anticipated and mitigated by secondary mental health care services (see the discussion above) whereas the evidence relied on by Mr Joyes is about the likely reaction of the police and the ambulance service if such a crisis did occur. But, in addition to this:
i). The most relevant of the PFDRs relates to the Briggs case. It is dated 8 December 2023 and, even then, it relates to a death which occurred a year earlier, at the end of November 2022, and it expresses concerns about the evidential picture on or before the inquest ended on 12 July 2023. Although one of the five recipients of the Report was the Merseyside police, Ms Briggs sadly died in Stockport, for which the Cheshire Constabulary is responsible. I accept that Mr Joyes was not able to find any published response to the PFDR, but I am not prepared to assume that there has been none or that no steps have been taken to address the concerns raised, still less that no steps have been taken in the Merseyside area in which Ms McKenna lives. The evidence does not enable me to form any view on this question.
ii). The AACE letter was written in January 2024 and it gives evidence about the position from March 2023. It is non-specific as to where the problems have arisen. Even if it were more specific, again, I would not be prepared to assume that no steps have been taken to address the issues which it raises.
93. For these reasons and others, the additional evidence therefore falls very far short of providing an evidential basis on which an appellate court could revisit the factual basis for the District Judge’s decision on this issue, or conclude that if the current position in St Helens had been known to the District Judge he would have decided the question differently and discharged the Appellant. The fresh evidence tells me nothing about the current position in St Helens in terms of the operation of RCRP.
Linden J dismissed Mr Platt’s appeal.
Comment
Right Care, Right Person continues to be a policy about which different individuals and organisations have strong views. It is also likely to feature in cases in future where it is more directly engaged than in this appeal. One point that I seek to make about it every time that I am asked about it (which happens a lot) is to remind people that, from a human rights perspective, the State is indivisible – it is the State which owes the obligation to secure the rights protected under the ECHR, not any particular agency of the State. That has implications both for how agencies approach their roles, and how agencies work together to ensure that no one falls between the cracks.
