‘Litany of failures’ in case of patient killed on NHS mental health ward

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1:07Hello, I'm James Kamarasamy. Thank you for downloading the BBC's World Tonight podcast for Monday the 14th of September. We hear about the shocking story of staff failures on the night when one patient killed another in an NHS mental health unit. We'll learn about the details that came out in the inquest and ask the head of Mental Health UK what lessons should be learned. Also on the programme, as President Trump calls people warning about the dangers of AI, revolutionaries for a bad and evil cause. We hear from a senior figure at the AI company Anthropic and discuss the potential economic risks posed by the technology.

1:43Plus a leading oncologist on the pioneering story of breast cancer medicine. and we're live on the blue, that's right, the blue carpet at this year's Emmys. The facts of the case are bad enough. In January 2023, a patient at an NHS mental health unit in East London, 34-year-old Hugo Flint Khan, was killed by another patient. Worse still was the litany of failures by staff who are asleep or on their phones at the time and who falsified the records that the inquest found today had contributed to the unlawful killing. And even worse, according to the coroner Graham Irvin, were the repeated failures by the East London Mental Health Trust, which he described as being like Groundhog Day.

2:27Hugo's brother Jolian, who is an NHS doctor himself, spoke to the BBC social affairs correspondent Alison Holt. I currently have no faith that the observations that have been recorded at any hospital in the last hour that's just gone are in any way true or accurate. the nurse in charge wrote that Hugo was in bed asleep when he was dead and how do we know that in the last set of observations that have been taken for any patient in this country they are even alive well Alison Holt joins us live now um Alison we've got a flavor there of what came out of this inquest but uh perhaps you can uh elaborate what what did it find well it the findings were shocking um certainly from the family's point of view they they say they started out thinking well perhaps there was some unfortunate unexplained accident that had happened and then they they described to me their journey if you like as they discovered more and more about what had happened to hugo um and they moved from from that you know what they would describe as naivety to cynicism, then to anger about the failings in Hugo's care, which had been highlighted by the coroner.

3:46Now, he was extremely unwell. He'd been at Newham Centre for Mental Health in East London for about five months when, or for about six months when the attack happened in the early hours of January the 3rd, 2023. He was beaten and strangled to death by another patient, 22-year-old Roland Torres-Pena, who had recently been admitted to the acute ward, he too was extremely unwell. And the inquest heard that there were three staff on duty, two nurses at the time of the attack were in an office which was just a few metres away. The door to that was closed and the healthcare assistant was asleep down the corridor.

4:30The court heard that staff took unauthorized two-hour long sleep breaks. And they were also meant to be checking on the patients every hour. But it was nearly two hours before Hugo's body was found. The observation records had been falsified at 2 a.m. and 3 a.m. saying that he was in his room, that he was alive. On one, he was said to be awake. On the other, he was said to be asleep. He was in fact dead, sadly, in another room. And even when it came to the emergency response, the inquest was told that was chaotic. And there was a 20 minute delay in starting resuscitation. All of these things, the family of Hugo, say, have been failings highlighted in previous inquests.

5:20And they believe that it's a sign, if you like, for failure to learn from mistakes. Yes. And what about the trust itself? What has it said tonight? Yes, they've just in the last 20 minutes or so issued a statement. And the chief medical officer of the East London NHS Foundation Trust, which runs the Newham Mental Health Centre, says that they are all deeply sorry for the failings that occurred in Hugo's care, that it fell well below the standards that they want to provide. They also agree with the coroner that it's wholly unacceptable the way in which staff acted and doesn't reflect the standards, values or behaviours that they expect.

6:11They say one member of staff has been dismissed. Others involved are being further investigated. They've also, they say, improved observations and strengthened emergency responses and a lot of checks and balances. Alison, many thanks. Alison Holt there. Brian Dow is the Chief Executive of Mental Health UK. It's a coalition of four mental health charities. I asked him whether the failures in care in this case were unusual. I think in a way one of the most shocking aspects of this case is that it's not particularly shocking. We have seen cases tragically like this before and although the particular circumstances of this, including staff falsifying records, really do beggar belief.

6:56It just reminds us that in those instances where people are in the most difficult wards, they are the most vulnerable people, I think ethically and morally that demands that we provide the highest quality of care and frankly too often as this really terrible case shows that is the opposite of what happens. Is there a particular problem with staff though? You mentioned the falsifying of records but also obviously falling asleep, delayed resuscitation. There's a lot here isn't there? I think it's really important when talking about cases like this, shocking as it undoubtedly is, that the vast majority of staff who are delivering care are doing a really good job, often in very difficult circumstances.

7:47but when things go wrong as they have done in a way that I think most people who if they had a family member in a unit like this would be appalled to discover then we have to learn the lessons and we've seen cases before where people have fallen asleep we've seen cases before where people have not been assessed properly where the monitoring hasn't happened and in the end we have to ask ourselves a really simple question do we want to be back here again talking about the death of a very vulnerable person or do we actually want to learn the lessons that we need to learn as a society? And I really hope that it's the latter.

8:25Why is it so difficult? You referred to maternity services and issues there and problems that have been highlighted. And as you say, this particular case, though shocking, is not at all rare in mental health units. Why is it so difficult to learn lessons from previous cases? Part of the reason it's so difficult to learn lessons, I suppose, is that the system is under such intense pressure. So we know that over the course of the last four or five years, the demand for mental health services has risen, that the levels of acuity, in other words, how ill people are, have also increased. And that means that there are more people who are vulnerable, requiring a higher level of care.

9:10And to be fair, often in these units, they are very difficult places to work. People are often very unwell. They may be experiencing all sorts of mental health problems arising from their mental illness. And so therefore, the standard of care that's required has to be really high. Now, you know, I think on the one hand, we have to have an approach to these things where we're willing to be open and we're willing to learn the lessons. and we're willing to, as a society, accept that things go wrong. But if in the end, actually, we just keep coming back to the same place because, for example, staff are not being honest when they have a duty of candour to be so, then I think that raises very big questions about how we care for the most vulnerable in our society.

10:00I don't think that we should keep coming round to the same point. Yeah, I mean, laws are being changed, aren't they, to try and deal with this, but how much is it down to the framework? How much is it down to the finances, the economy, the fact that there are not enough staff, not enough facilities? We have about 2 million people who are currently waiting for mental health treatment. Now, obviously, the vast majority of those are down in primary care or in tertiary-secondary care, but that pressure builds. And so when we end up in a scenario where you have people who are sometimes detained under the Mental Health Act, so they are receiving care because they don't necessarily have the capacity to make decisions, then we need to make sure the right resource is there.

10:49And ultimately, the answer to this has got to be that we help people who are suffering from kind of moderate to mild health conditions much better. We get people much quicker access to treatment so that we don't have pressure building and building where people are waiting and waiting, waiting, becoming more unwell, and we have more people in the most difficult, most expensive and most intense units. That is the answer to this problem at a national level. So that will require investment, but it will also require us learning lessons from tragic cases like this. That was Brian Dow, Chief Executive of Mental Health UK.

11:25And coming up later, we'll be live at the Emmy Awards in Los Angeles, where the makers of the British thriller Slow Horses are hoping for a win from their nine nominations. It's got a very specific tone to it. It's very British. It's funny. It's serious. Yeah, it's very difficult to put your finger on exactly what it is, which I think is why it's so appealing to so many people. Live there a bit later on. But now there is a new hoax on the loose, according to Donald Trump. After a weekend of warnings from AI bosses about the potential dangers posed by their technology developing too quickly, the American president pushed back against calls for regulation.

12:04The only control or guardrails that AI needs is a strong and smart high IQ president, and the USA has that in spades, he wrote on his true social platform. And a short while ago, he used a new post there to add that people warning that AI is a danger were revolutionaries for a bad and evil cause. Mr Trump's particularly exercised by warnings from the boss of Anthropic, the AI company which clashed with the Pentagon after refusing to let the military use its AI models for certain tasks, including autonomous weapons. The BBC's economics editor, Faisal Islam, has been talking to a senior figure at Anthropic, Jack Clark.

12:43He's a co-founder and head of public benefit at the company. And he says that while Anthropic would like to see more industry-wide regulation, the company is already addressing many of the safety concerns. We've taken actions which exercise our agency, like putting third-party evaluators in. we have published some of the best science on how to control and prevent these things there is a huge amount to do and there is lots of work that has been done here so don't don't take from this it is for industry saying oh no like a really bad thing is coming and there's nothing we can do that's the opposite of the message the message is okay the serious moment for the technology has arrived it's no longer just got to be industry calling the shots here it needs to be industry and governments and we need to get some kind of policy regime in place okay well response you will have seen uh from the president the only control or guardrails that ai needs is a strong and smart president the usa has that in spades his ai czar david sacks said you could voluntarily do almost this yourself looking for a cartel or duopoly stop pretending you need permission go ahead and pace the frontier yourself uh we're grateful that the president of the united states is paying attention to this issue.

13:54As I said, it's important that we have a national conversation here. The other point is, look, how do you lose a technology? You lose lead on a technology if you lose public trust. And how you lose public trust is you have a horrible accident. This happened with nuclear power, where as a consequence of the Western world screwing up nuclear power, we ceded that whole technology to China. China builds nuclear reactors every six months now. China is undergoing an energy miracle that many, many other nations are envious of. How do we avoid this for AI is you need to build public trust and you need to avoid an accident or a disaster.

14:31Like that's what we're trying to do here is we're trying to get ahead of things that otherwise might happen and cause us to lose trust in the technology, not build it and not get any of its benefits. Right. You've suggested there'll be some coordination is required. But the Chinese response was that this is a Cold War mentality. It's malicious competition. And of course, in their minds, they have cheaper models that cost a fraction of the price of your models that are 90 to 95 percent as effective. And this is part of an attempt to stop that competition. The risks of this technology only become really clear when you when you play around with it.

15:07China is six months to a year behind the West. So they haven't seen out of control agent swarms yet. Their models are too dumb. Well, give it a few months and they're going to be dealing with the same set of risks that we've dealt here in the Western world and has caused us to have this conversation. These risks are real. This isn't a fake. And we want to talk about these issues internationally because that's how you get to a safe outcome. Now, if Donald Trump doesn't want to do anything, that seems to be the clear message from the president. What's your message to the prime minister, Andy Burnham and the other G7 leaders?

15:39In pretty much any country in the world, I have young children. If you want to sell like baby toys or baby food, there's a bunch of standards you have to go through to bring those to market, which basically check like, do the toys have sharp things on them? When my baby inevitably sticks the toy in its mouth, will it poison the baby? And if you fail those tests, you don't get to sell it in the country. That's because we have just sensible, common sense safety standards for things that get sold in countries. Any country in the world can implement a set of safety standards which AI companies need to pass to bring things to market.

16:10it. That's something that any nation can and should do. Anthropics Jack Clark speaking to the BBC's economics editor Faisal Islam. Well earlier today the US Vice President J.D. Vance was asked whether he thought Americans should be scared of AI. Any technology has risks. Any new technology is going to bring both risks and benefits. I think what the President has said is we want to be smart about making sure we stay on top of the risks. I don't think Americans should be scared of anything. I think that we have to be mindful that there are risks, there are downsides to anything, and that's certainly true of AI.

16:45So could one of those risks be economic? The recent warnings about AI's potential for harm and the subsequent calls from AI bosses to slow down the development of the technology have led to a sell-off of AI-related stocks, with memory and chip companies being particularly affected. So how worried should we be about an AI bubble bursting? Dean Baker is senior economist at the Washington-based think tank, the Centre for Economic and Policy Research. He runs the AI Bubble Monitor. It's a website which tracks Wall Street indicators and compares them to historical averages. So does he think we're witnessing a bubble?

17:20Yeah, I mean, to me, it's very hard to see how it's not a bubble. So we have price-to-earnings ratios in the stock market. They're just about the same as what we were at the peak of the tech bubble in the 90s, around 40 to 1. And it's very hard to see a story where future profits will rise enough to make those stock prices make sense. So it looks to me very much like we have a bubble, very similar to tech bubbles, because you have a lot of companies with enormous market capitalizations, things like SpaceX. And SpaceX loses money hand over fist, as does OpenAI, as does Anthropic. And it looks to me like everything's set up for a really big crash.

18:01A really big crash. Well, you've evoked the specter of the tech, the dot-com bubble in the early 2000s. And on that occasion, S &P 500 lost 50 percent. NASDAQ lost 80 percent. How exposed are we all to this? It's going to be a huge deal. I mean, there's 80 trillion, a bit less than 80 trillion in value in the U.S. stock market. If you take that extreme case, 50 percent decline in the general market, that's$40 trillion in wealth. So that's pension funds, people's retirement funds. There's a lot of foreign holdings in the U.S. market. So we're pretty much for sure talking about a recession and possibly a pretty bad recession.

18:41I doubt it would be as bad as what we had after the collapse of the housing bubble in 2008. But likely a very serious downturn that's really going to change how we think about the world. Could there be a knock-on effect beyond these companies if the bubble bursts? Absolutely. And again, that's something I think is underappreciated from the tech bubble, that we look at the tech companies that lost a huge share of their value. But even companies like General Motors, McDonald's, that weren't in any obvious way connected with tech, they lost 40%, 50 % of their value. So again, I'm not going to say that that's going to be the case this time.

19:15But you're very likely to see that other companies, even not in any obvious way connected with AI, still take a very big hit to their stock price. And if we're looking outside the United States, say in this country, is there going to be a knock-on effect on pension funds, for example? Well, two things. One is a lot of those pension funds do have money in the U.S., so they're likely to see a big loss on their holdings. But the other is I'd expect markets around the world are going to fall, not as much as the U.S. does. And again, referring to the tech bubble as a model here, markets in Europe fell as well, not nearly as much as the U.S.

19:51markets. They hadn't gone up as much. but I think you will see a hit there. In some markets, you look at a country like South Korea where it's very much involved in the AI bubble, they might see a very big hit. Could it hit sooner because of a backlash against data centers? Absolutely. So what actually causes it? Very hard to say. If companies are having trouble getting their data centers located, that could be the sort of thing that people suddenly realize, okay, there's not this big fortune here. Another thing that could very well do it, there's been this concern in the last week or so. It really blew up in the United States with the heads of the AI companies giving a warning saying, we're worried about the safety.

20:31Now, they focus it themselves on like a extinction event that the AI wants to kill us all. And again, I don't know, maybe that's a non-zero probability, but what strikes me as much greater risk is that an AI system messes up and it's inside a bank and it destroys all the records. So no one knows how much money they have or gets into an insurance company and destroys the health records of people. So you could think of a lot of really bad incidents that aren't – it's not like an extinction event, but really serious incidents. And I can imagine that one of those could happen, and that could be the sort of thing that may burst the bubble.

21:10Again, I'm not hoping anything like that happens, but I think the longer we go, the greater the risk of that. We've talked about the tech bubble in the early 2000s, the housing bubble not long afterwards. Why don't we ever seem to learn? That's a great question. I think the biggest problem is that there's no consequences for the people who make the big mistakes. So you or I might put our money in a fund and gets caught up in the bubble. And again, we regret it. But what really matters is the people are controlling billions, tens of billions. The people running pension funds, hedge funds, they don't pay any consequence.

21:46And I make the joke, if you have a custodian who doesn't clean the toilet, they get fired. But here you have someone who could be running a pension fund with tens, hundreds, billions of dollars and loses 30 percent of it and no consequence. That was the economist Dean Baker, who runs the AI Bubble Monitor website.

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23:11Now winning an election by a landslide is no guarantee to having an easy time in office just ask Keir Starmer but that is not a problem that will face the winner of yesterday's general election in Sweden. Swedish political parties coalesce roughly into two blocks but as of now with 95 % of the votes counted neither of them can claim an outright victory. If the right-wing coalition is able to form a government. It would mean the first ever ministerial posts for the far-right Sweden Democrats. But as I heard from Evelyn Jones, political reporter with the Swedish newspaper Dagens Nyheter, the current state of play favours the left bloc led by the Social Democrats.

23:50At the moment, the opposition parties here in Sweden are leading this election and it seems that that will be the final result, but we don't know yet. It's a very close call. Usually we do get a result Sunday night, but the thing is, votes from abroad or like people who voted early, those votes haven't been sent to the right places yet. So those are the votes that will be counted on Wednesday. And since it's such a close call at the moment, those could actually shift the results, even though the chances are very slim at the moment. So as things stand, the opposition, the left bloc, is likely to get into government.

24:32Yeah, it seems like it at the moment. But no one wants to, like, call it because it's still... Don't want to jinx it. No, exactly. If that is the outcome, what is the initial assessment of why the election went that way? Yeah, that's really hard to say because the Social Democrats, who would be the party that could form a government, they actually did a really bad election. They've had, like, really good polling numbers since the last election. And now they have a historically low result. So if they win and they'll do it by such a small margin, I mean, obviously they will celebrate if they can form a government.

25:12But it's not like it's a win for them because it's been such a bad result. Interesting. Well, the other history-making part of this election that was certainly being focused on from abroad was the potential for the Sweden Democrats party on the far right to get into government. But it looks as though that's unlikely to happen now. Exactly. The Sweden Democrats, they've been in this government coalition, but not in government as a cooperating party. But the prime minister, the sitting prime minister, he promised that if they won this election, the Sweden Democrats for the first time would have minister seats in a government.

25:53But then also the Sweden Democrats, what's historical for them in this election is that for the first time, they didn't gain more votes. They actually lost three percentage points in this election, which is the first time they ever go back in an election since they came into parliament in 2010. What people are wondering now is what happened. Why did the Sweden Democrats for the first time not gain more votes? Is one possible answer that other parties have come across and are espousing policies closer to theirs, in particular on immigration? That could be one of the reasons. And also in the last year or so, there's been a discussion in Sweden about these young people who've been in Sweden for a long time, who when they turn 18 have been sent back to their countries, even though they've had their education here, lived here for a long time.

26:46And suddenly that kind of shifted the discussion on migration. So a lot of people got upset that this was happening. and different parties, like for example the Social Democrats who have tried to put themselves really close to the right-wing block when it comes to migration, suddenly had to think about the fact that it seemed like people were thinking in a different way about migration. That was Evelyn Jones, political reporter with the Swedish newspaper Dagens & Newhater. Now there are any number of committed doctors who've spent decades working in their particular field amassing expertise, but there are perhaps fewer who've witnessed the sort of transformation that the oncologist Professor Ian Smith has.