Dear Mr Rebello, Regulation 28 report Thank you for your letter dated 25 November 2022 sent following the conclusion of the inquest touching the death of Mr Battle. I know that you will share my response with Mr Battle’s family and I firstly want to express my sincere condolences to his family. NWAS’ core purpose is to save lives, prevent harm and offer services which optimise the likelihood of positive patient outcomes. It is of deep regret that on this occasion NWAS was unable to attend to Mr Battle as quickly as it should have and I am extremely sorry for that. NWAS takes all adverse events very seriously and it undertook an internal investigation into the attendance on Mr Battle. Through the Regulation 28 report, you have requested that NWAS considers your matters of concern and have suggested that action is taken to prevent future deaths occurring in the future. By this letter, I will address that concern as far as I’m able to do so. Shared resources between Merseyside Police and NWAS. Through the oral evidence that was before you during the inquest, you are aware that in other areas of the North West region there are initiatives in place for NWAS, a mental health service and a local Police force to share a mental health triage car. As you correctly identify in your report, those arrangements do not exist in Liverpool. However, the Psynergy model to which you refer is the only model of its type within the

North West Region and is reflective of the particular demands of that geographical area. The NHS long term plan (2019/20 to 2023/24) makes a commitment to pursuing an ambitious transformation of mental health care, including the improvement of ambulance responses to those patients who need urgent and emergency assistance in respect of their mental health. Indeed, initiatives such as mental health response vehicles form part of this model of improvement. The NHS Long Term plan is clear in its recommendation that the response to mental health problems (including response vehicles) is to be health led as they are health related issues. In the financial year ending 2022/23, NHSE released an amount of capital funding for which ambulance trusts, in partnership with their regional Integrated Care Board (“ICB”) and local mental health trusts, have tendered in order to purchase the mental health response vehicles. The staffing for such response vehicles is separately funded through the Mental Health Investment Standards, which is attached to the NHS Long Term Plan. Within the North West, the scope, specification and operating model of the mental health response vehicles is reviewed and agreed by a pan North West steering group, chaired by the NHSE regional mental health lead, which includes all of the regional ICBs, NWAS and mental health trusts. It is necessary to work together in partnership with one another in order to achieve the commitments made within the NHS Long Term Plan. Police forces have similarly introduced response vehicles in order to provide further assistance to individuals with mental health needs but in relation to policing matters, for example, for the purpose of detection and prevention of crime and reducing the number of patients inappropriately detained under s136 Mental Health Act. Funding for these police vehicles is not derived from the Department of Health and Social Care/NHS but via the local Police and Crime Commissioner. You have asked that NWAS, Merseyside Police and the local mental health trusts work together in concert and share community mental health crisis intervention resources for the good of the community. NWAS and Merseyside Police provide each other with invaluable support and assistance on a daily basis. However, the demands faced by each service are very different, as too are the nature of the calls meaning that the call triage systems, categorisation and dispatch processes are distinct from each other. It is crucial that the respective mental health response vehicles reflect and meet the needs of the two very different services. NWAS, Merseyside Police, local authorities and the local mental health trusts are members and participants of the Crisis Concordat which collectively reviews mental health demand, incidents, local systems and practices in order to improve the outcomes for patients with mental health needs in the local communities. The Crisis Concordat brings together local authorities, mental health trusts and the emergency services into one environment. Through the Crisis Concordat, a suite of mutual training and education sessions have been introduced which are continuing. All participants of the Crisis Concordat are committed to working together to improve the outcomes for the local community. Beyond the Crisis Concordat, NWAS and the Merseyside Police come together again at the Regional Police Forum at which strategic, operational challenges and collaborative working opportunities are identified, discussed and agreed. NWAS has recommended that the incident involving Mr Battle be tabled for further discussion at the next forum. Should any further learning be identified at that forum, I would be very happy to share that with you if it would assist.

I am sorry that you felt it necessary that there was cause to issue a Regulation 28 report and I hope that, by this letter, I have addressed your concerns. Should you require any further clarification or information, please do not hesitate to contact me or the Trust’s Head of Legal Services,

Dear André

I am responding to your recent correspondence pertaining to the death of Mr Battle.

I note that you are inviting Merseyside Police and NWAS to consider joint operability of mental health triage cars. I understand that you have heard evidence as to the existence of a joint operability programme in Blackpool but were unaware of the services available in Merseyside.

Within the Merseyside Police force area the force has three mental health triage cars. At the time of writing these cars operate as follows:

• Wirral Car - 7 late shifts (12.00-00:00 hrs) & 3 day shifts Tuesday, Wednesday & Thursday (0800-1600)
• St Helens and Knowsley car - 7 late shifts (1500-0100). Day shifts are currently suspended due to staffing issues on NHS side
• Liverpool and Sefton - 7 day/late shifts a week 1030-0100. The Liverpool and Sefton car addressed 53.4% of demand across the force.

In considering our response we sought to understand from Lancashire Constabulary how the joint operability model works in Blackpool and have been informed as follows:-

Synergy is commissioned by Local Integrated Care Board (ICB, the new name for NHS Commissioners), and covers Blackpool and Fylde & Wyre operating 1600 – 0000, 7 days a week. The car is staffed with a Response Officer, Paramedic & Mental Health Practitioner. The Synergy car can respond to mental health related police incidents and NWAS mental health related incidents. Which agency’s incident the car responds to, is decided by the staff in the car at the time.

Therefore, the Synergy model does not mean that the police (in company with a MH practitioner) are servicing NWAS incidents (and vice versa). What it does mean is that, often at incidents there is a professional that is not required e.g. an NWAS incident with no policing purpose has an officer attend with NWAS and the practitioner.

Synergy does not have a written remit and Lancashire Constabulary do not have data to identify the split in demand between police/NWAS incidents that it deploys to.

André Rebello OBE Senior Coroner Liverpool and Wirral Area

SK/HJF

20 January 2023

Chief Constable

Lancashire Police have stated that if they were informed of a case similar to that of Mr Battle and NWAS have it as a Cat 3 and have not identified any threat to life, there is no requirement for the police. In my view the way to address this issue would be through the information gathered and the risk assessment during the initial call to NWAS.

Merseyside Police when setting up this service and indeed though review of the service and best practice, have looked at and considered inter-operability models with NWAS, however, they are not considered within this area to be the best use of personnel, as effectively it would lead to a vehicle crewed by three personnel, one of whom would almost always be surplus to requirements and indeed I would suggest that there will be more resource available if the current model is maintained.

I am aware that in Merseyside, NWAS have emulated the police model and they have three designated cars for Merseyside. I am aware that the cars have funding for 7.5 hours per day but it is the aspiration of the NWAS trust to operate them 12 hours per day. I understand the hours of deployment are 0800 – 2000 Monday to Thursday and 1000 – 22.0 Friday to Sunday.

When both the NWAS cars and the Merseyside Police cars are on duty there is communication between the practitioners in the vehicles so that the most clinically effective use of resources can be made.

As you may be aware the demand on all of the emergency services has led to a nationally advocated Right Care Right Person model being developed. The adoption of this model means the appropriate state agency is deployed and that each of police, NWAS etc resources can be deployed as appropriate.

In this case based on the information that the police have from your report there would not have been a requirement for police attendance.

Merseyside Police are committed to working effectively with Blue Light partners, however, having considered the issues and discussed them with NWAS we do not believe that a joint operability model is appropriate for the Merseyside communities that we serve.