Name NHS staff who failed in killer's care, families say

The victims' families spoke in London after the release of a major review into the NHS on Wednesday

The mother of one of the victims of the Nottingham attacks has called for NHS staff responsible for failings in the care of triple killer Valdo Calocane to be named.

Barnaby Webber and Grace O'Malley-Kumar, both 19, and Ian Coates, 65, were stabbed to death by Calocane, who has paranoid schizophrenia, on 13 June 2023.

An independent review into his NHS treatment and care said it showed the "system got it wrong" and identified errors, including poor communication, missed opportunities and families not being listened to.

Mr Webber's mum Emma said the professional implications of being named were no comparison to the loss of a family member, while Ms O'Malley-Kumar's father, Dr Sanjoy Kumar, added: "We demand accountability."

The review, by Theemis Consulting - which was published on Wednesday - looked into the treatment given to Calocane by Nottinghamshire Healthcare NHS Foundation Trust before the killings, as well as the interactions the NHS had with other agencies involved in his care.

The report found a number of failings, including his risk not being "fully understood, managed, documented or communicated", and identified missed opportunities to take more assertive action towards Calocane's care.

• As it happened: Families condemn triple killer's NHS care

NHS England said it was "clear the system got it wrong" and apologised to the victims' families "on behalf of the NHS and the organisations involved".

Similarly, Ifti Majid, chief executive of the Nottinghamshire Healthcare NHS Foundation Trust, apologised and said it would accept the report "in its entirety".

He also told the BBC the trust would be investigating whether anyone should be facing disciplinary action as a result of the latest report.

Neil Hudgell, solicitor for the families, and Emma Webber called for greater accountability

At a press conference in London, Dr Sanjoy Kumar said he would be writing to Health Secretary Wes Streeting to order the mental health trust to hold individual clinicians responsible.

"This report published highlights the failures of the mental health trust, but it fails my wife and I, as clinicians working at the NHS, for the failure to treat Valdo Calocane appropriately.

"We demand accountability," he added.

Dr Kumar's partner, Dr Sinead O'Malley-Kumar, echoed this view while speaking on BBC Radio 5 Live, saying "nothing changes without individuals actually having to focus their thoughts".

James Coates, son of Ian Coates, said: "The report shows the failures in just this individual case.

"Imagine what's happening with every other patient.

"To the people of Nottingham, you have been failed and will continue to be failed until changes are made."

Ian Coates, Barnaby Webber and Grace O'Malley-Kumar died on 13 June 2023

Since the publication of the report, which Mrs Webber described as a "horror show", the government repeated its commitment to an inquiry into the attacks, with work ongoing to establish its scope.

But Neil Hudgell, solicitor for the families, said: "We want it to have teeth, and be judge-led."

Mrs Webber called on the government to make the inquiry statutory - in which witnesses can be compelled to give evidence - and pleaded for ministers to "make this trauma stop, and make our fight stop now".

She added: "I do think it's time now that we get the opportunity to meet with the prime minister."

A spokesman for the prime minister welcomed the new report and said the government was "focused on delivering the change needed to ensure that these failings do not happen again".

Nottingham's three Labour MPs Nadia Whittome, Lilian Greenwood and Alex Norris issued a statement saying they would continue to "hold the NHS locally to account".

They added it was vital the inquiry took place "as soon as possible and that it is highly robust, so as to receive the full breadth of evidence relating to the attacks and to hold those responsible for failings to account".

Calocane was diagnosed with paranoid schizophrenia before the attacks

Calocane was sentenced to a hospital order in January 2024 after pleading guilty to three counts of manslaughter on the basis of diminished responsibility, and three counts of attempted murder after using Mr Coates's van to drive into three pedestrians - Wayne Birkett, Marcin Gawronski and Sharon Miller - all of whom were seriously injured.

Speaking outside Nottingham Crown Court following sentencing, Mrs Webber said "true justice has not been served", adding the families had been "let down" by the police and the Crown Prosecution Service (CPS).

A review into the CPS found that prosecutors had been right to accept Calocane's pleas, they could have handled the case better.

And in May last year, judges ruled Calocane's sentence was not unduly lenient.

A rapid review of Nottinghamshire Healthcare Foundation NHS Trust, published by the Care Quality Commission (CQC) in August, found "a series of errors, omissions and misjudgements" by mental health services.

In addition, the Independent Office for Police Conduct (IOPC), is looking into prior contact that both Leicestershire and Nottinghamshire police had with Calocane.

Nottinghamshire Police has previously admitted it should have done more to arrest Calocane sooner, revealing that a warrant was issued one day before he was discharged by the NHS.