Source · Investigations in the NHS

Independent investigation: Pauline Cole (partner), Manor Park, London (2003)

London Incident 23 Jul 2003 Subject Pauline Cole (partner)

Index summary

MH patient Kills 2 in 1985 then fatally stabs partner in 2003. Ind Inq 2006. Previously murdered wife and GP in 1985

Recommendations

5 total
1 Addressed to: East London and The City Mental Health NHS Trust No Response Published

Link to recommendation 1

Recommendation · source text
East London and The City Mental Health NHS Trust (now incorporating Newham community mental health services) should 1) review the implementation of its CPA policy with a view to establishing the reasons why the referrals of PC to the East Newham CMHT in 2002 and 2003 did not occur and/or were delayed, 2) review the definitions and inclusion criteria of standard and enhanced CPA.
2 Addressed to: Barnet, Enfield and Haringey, and East London and The City NHS Mental Health Trusts No Response Published

Link to recommendation 2

Recommendation · source text
Barnet, Enfield and Haringey, and East London and The City NHS Mental Health Trusts, should review the implementation of CPA policy to ensure compliance with current guidance relating to the needs of carers.
3 Addressed to: The Home Office and Department of Health No Response Published

Link to recommendation 3

Recommendation · source text
The Home Office and Department of Health should jointly commission research into the effects of an absolute discharge on compliance with supervising teams, rates of recidivism and relapse.
4 Addressed to: Barnet, Enfield and Haringey and East London and The City Mental Health NHS Trusts No Response Published

Link to recommendation 4

Recommendation · source text
Barnet, Enfield and Haringey and East London and The City Mental Health NHS Trusts should a) review the application of CPA principles, and b) ensure that the Barnet MDO team reviews its allocation of cases and application of CPA to all cases that are open but not active.
5 Addressed to: Barnet, Enfield and Haringey Mental Health NHS Trust and East London and The City Mental Health NHS Trusts No Response Published

Link to recommendation 5

Recommendation · source text
Barnet, Enfield and Haringey Mental Health NHS Trust and East London and The City Mental Health NHS Trusts should review all forensic patients with an element of care in another locality to ensure the application of CPA principles and follow-up.

Acceptance status

Per recommendation
No Response Published
5

Total recommendations
5
About this data

Acceptance status records the published response to each recommendation. Acceptance does not establish that an action has been completed.

Independent health investigation reports and reviews commissioned by government or NHS England.

About this investigation

Source & metadata

Independent investigation report. Recommendations and any published response are extracted below.