Dear Ms Loxton,

Thank you for the Regulation 28 report of 14 November 2024 sent to the Secretary of State for Health and Social Care about the death of Hannah Mary Aitken. I am replying as the Minister with responsibility for Patient Safety, Women’s Health and Mental Health. Firstly, I would like to say how saddened I was to read of the circumstances of Hannah’s death and I offer my sincere condolences to her family and loved ones. The circumstances your report describes are very concerning and I am grateful to you for bringing these matters to my attention. Thank you also for the additional time provided to the Department to respond to the concerns raised in your report. Your report raises concerns over the continued ease of availability of the substance involved in this case (which I will not mention by name) to members of the public. It may first help to clarify the Department’s role in suicide prevention. As lead for suicide prevention policy, the Department’s role is to coordinate activity across government and other agencies to ensure effective and cohesive action is being taken in the right areas. However, suicide prevention is a cross-Government issue and given its complexity, specific actions and mechanisms are led by a wide range of departments and organisations. To support this coordination, DHSC published the Suicide Prevention Strategy for England in 2023, setting out priority areas for action to support joint working. The five-year strategy set out actions aimed at reducing the rates of suicide in England, and work continues to deliver effective suicide prevention initiatives. On methods of suicide specifically, Government departments have taken steps to reduce access to, and awareness of, this substance. DHSC leads a Concerning Methods Working Group to raise awareness of and tackle access to substances such as this one. The working group involves representatives from the voluntary, community and social enterprise sector, police, academics and the NHS, as well as Government departments including Department of Science, Innovation and Technology and the Home Office. The group develops and delivers rapid targeted actions to collectively reduce public access to emerging methods, including this one. Over 30 of the actions identified and implemented by the group have been to tackle this substance specifically.

The group has worked with businesses, including online suppliers and manufacturers of the substance, to reduce people’s ability to purchase it for non-legitimate purposes including suicide, and to raise awareness around safeguarding concerns with businesses where required. Government departments have also previously worked with manufacturers to reduce the lethality of the substance if ingested. This included work with online platforms to remove it from sale to individuals in its pure form. The group continues to work operationally with a range of organisations, and we are actively considering opportunities to work with the Border Force, using existing legal provisions, to help detect packages at the border which may be linked to vulnerable individuals and intended for suicide. The group’s actions are kept under review. On the issue of further regulation, the Department is working closely with the Home Office to convene Government departments and agencies to identify whether regulation is appropriate and would achieve the intended aim, and if so which body is best placed to take forward any reviews into this. You also raised the issue of monitoring. The Department monitors trends of this substance and other concerning methods as part of the working group. We have approaches in place to collect intelligence from a wide range of sources. We use Office for National Statistics data, and we are exploring how to make better use of national near real time suspected suicide surveillance data to make sure we can identify and respond to trends more quickly. Regional Leads within the Office for Health Improvement and Disparities also pass on information from local organisations to central teams for monitoring. Whilst we observed an increase in the number of suicides using this method a few years ago, we have not found concrete evidence that the numbers have increased in the last few years, and since the Concerning Methods Working Group was set up. We are working alongside the National Police Chiefs’ Council to bring together important local intelligence. The government will obtain near to real-time data from across the country on deaths by suspected suicide by gender, age group and method. We will engage with NHS England and others to look for ways we can strengthen information and monitoring routes into and out of national teams to address the concerns raised in your report. More broadly, as part of our mission to build an NHS fit for the future, the Government has committed to tackling suicide as one of this country’s biggest killers and the 8,500 new mental health workers we will be recruiting will be specially trained to support people at risk from suicide. Ultimately, it is our aim to help and support people as early as possible, so they don’t feel the need to turn to these types of substances to take their own life. I hope this response is helpful, alongside a separate response which I understand the Home Office will be providing. Thank you for bringing these important concerns to my attention.

Dear Ms Loxton,

HANNAH MARY AITKEN REGULATION 28 REPORT TO PREVENT FUTURE DEATHS

Thank you for the Regulation 28 report, dated 14 November 2024, sent to the Home Secretary following the inquest into the death of Hannah Mary Aitken, who tragically died on 14 September 2023. I am responding on behalf of the Home Secretary, in my capacity as the Security Minister.

Firstly, I would like to offer my heartfelt condolences to Ms Aitken’s family and loved ones at this difficult time. My thoughts are with them as they continue to navigate their profound loss.

Thank you for the additional time provided to the Department to respond to the concerns raised in your report, which I have carefully noted. I am very grateful to you for bringing these matters to my attention.

Your report has raised several matters of concern, which are relevant to both the Home Office and Department of Health and Social Care, namely:

• The substance in question can be purchased domestically with no restrictions save a duty on sellers to report suspicious transactions;
• The substance in question can be purchased from abroad and imported to Great Britain with no restrictions;
• The substance in question is sold at levels of purity and in quantities which represent significant risk to life whether by self-harm or terrorist use;
• The quantities and purity in which the substance in question are sold do not appear to be those required for their legitimate use;
• It does not appear there is any consideration of regulating/monitoring the use of the substance in question outside the limited provisions of the Poisons Act 1972, and it is not clear which Government department would be responsible for this.

Your report also highlights that there have been several tragic cases where this material has been used in incidences of death by suicide. Please note, following another tragic

2

incidence of death following ingestion of the same substance, the Home Secretary has recently written to Ms Catherine McKenna, the Area Coroner for Greater Manchester North, detailing action the Home Office is taking on this issue. The letter emphasised the Government’s determination to ensure all reasonable steps to prevent further loss of life are taken.

The Home Secretary has also written to the Secretary of State for Health and Social Care to ask that they give priority to this issue as part of their continued work on implementing the goals of the Suicide Prevention Strategy. This sets out actions aimed at reducing the rates of suicide in England. I have provided further detail below on joint action that is already underway.

The substance described in your report is a “reportable” poison listed in Part 4 of Schedule 1A of the Poisons Act. For the avoidance of doubt, this means that whilst it can be bought by members of the public, suspicious transactions need to be reported by retailers if there are questionable grounds for suspecting it is intended for any illicit use. The Poisons Act was amended in October 2023 to strengthen controls, and enhance our suspicious activity reporting requirements, including new obligations for online marketplaces. As well as the requirement to report suspicious transactions, economic operators supplying any reportable substances must now demonstrate that their personnel are aware about which of their products contain listed substances, and are instructed on their obligations.

As your report captures, the Home Office is aware of the issues relating to this substance. My officials have been undertaking work across Government to both reduce access to this substance, and raise awareness to suppliers of the dangers of this substance. To this end, the Homeland Security Group (HSG) have been working to improve retailer awareness of their legal obligation to report suspicious activity for regulated and reportable substances.

Specifically, HSG have engaged with online platforms to encourage them to voluntarily remove the sale to individuals in its pure form. Government expertise in relation to substances of concern is also shared to inform retailer sales practices. This includes encouraging suppliers to use declaration of use forms for sales of such substances. This work will continue to ensure suppliers are meeting their requirements under the Poisons Act. Furthermore, if during the processing of suspicious activity reports a safeguarding concern is identified by Counter Terrorism Policing, consideration will be given to disseminating this intelligence to police forces to consider a welfare check.

Similarly, Border Force has introduced guidance for its officers (operating within its existing legal provisions). This guidance provides instructions on the action they can take if they are in receipt of information, in any form or manner, that leads to a detection of goods at the border containing an item that may be intended to assist with suicide. This of course relies on Border Force working closely with police forces and other relevant agencies to safeguard vulnerable individuals to the full extent possible. This work is complex, and Border Force will continue to monitor its policies, exploring opportunities to improve its ability to take action. Where possible, Border Force will also continue to ensure that frontline staff who may encounter these items know what action to take, and are supported on a case-by-case basis when required.

On the issue of further regulation, an aspect of the concern you have raised relates to individuals based in Great Britain, purchasing this substance from overseas retailers. As the Poisons Act only applies to Great Britain (i.e. England, Scotland, and Wales), there is no obligation for retailers based outside the specified jurisdiction to report transactions which they believe to be suspicious. The Department is seeking to address this, as well as

3

the other issues raised in your report, such as the purity and quantities of the substance in question that are available for sale. My officials are working closely with the Department for Health and Social Care, convening relevant stakeholders to consider the potential benefits and proportionality of further regulation.

Thank you for your report and for bringing these important matters to my attention. I hope that my response, alongside that of DHSC, has been able to address some of your concerns. I can assure you that the Home Office will continue to work in collaboration with relevant Departments and wider partners to take action in this area.