Independent investigation: Lorna Thomas, Milton Keynes (1995)

The Milton Keynes Council and Buckinghamshire County Council Social Services Departments and the Milton Keynes Community NHS Trust should review their referral policies to allow Psychiatrists in Learning Disability to refer patients with a mild learning disability and mental health needs, who may benefit from the service, to Keystone or any other similar service.

The Buckinghamshire Health Authority should ensure that the Milton Keynes Community NHS Trust provides a more comprehensive inpatient service for people with mild learning disability. This should include access to beds within the Campbell Centre or other appropriate local resource, for those who are or may also be suffering from mental illness and need a period of observation and treatment. Even though day to day management decisions could be the responsibility of the sector Consultant, overall clinical responsibility for such individuals should remain with the Learning Disabilities Consultant(s) to ensure continuity of care. These services need to include some staff trained in both mental health and learning disability.

The Milton Keynes Council and Buckinghamshire County Council Social Services Departments should review their "appropriate" adult procedures to support people with a learning disability who are to be interviewed by the Police and should provide the necessary continuing support afterwards.

The Milton Keynes Community NHS Trust, Milton Keynes Council and Buckinghamshire County Council Social Services Departments should ensure that there is an express recognition of the need to engage service users and carers as far as possible in the planning and delivery of care and after care. Service users and carers should be active participants in the assessment of need, planning, treatment, risk assessment, discharge and follow-up support. Special consideration should be given to home circumstances. The views of service users and carers should be sought and recorded.

The Directors of Social Services for Buckinghamshire County Council and Milton Keynes Council should take steps to ensure the accuracy and completeness of Social Services record keeping.

The Milton Keynes Community NHS Trust should ensure that all community support workers and other professionals having direct contact with patients are aware that they are allowed access to patients' notes to enable them to have a better understanding of clinical needs.

The Department of Health and the training bodies should encourage cross-disciplinary training in mental health, substance abuse and learning disability for nurses, social workers and all those who might be appointed as keyworkers to persons who have dual diagnosis.

The Thames Valley Police Authority should review the systems and the links in place between the Family Protection Unit and the rest of the Police service. Information sharing should extend not just to inter-agency but also intra-agency in circumstances such as Lorna's case.

The Social Services Departments of Buckinghamshire County Council and Milton Keynes Council should ensure that when they "close" a case, this is handled with sensitivity and openness. The client and their families should be aware that the case has been closed, and the reasons notified in writing.