Lindsey Hill is lying in a hospital bed drifting in and out of a medicine induced sleep. She is also very tired, her body is fighting a serious lung infection.
She is 40 years old. You cannot tell this by looking at her as her blanket is pulled up to her chin and a tumble of brown falls to her shoulders.
You can hardly see Ms Hill’s face. It is obscured by the oxygen mask she needs to breathe.
It is still a struggle. Her breath is short and shallow and her words are barely audible.
I ask Ms Hill: “Is this the first time you’ve been in hospital this winter?”
She replies: “Yes, it is, but I was here three times last year.”
That’s because Ms Hill suffers from multiple chronic conditions and requires complex care.
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Usually she is monitored remotely but nine days ago she was rushed to hospital as a category one emergency.
I ask her if the ongoing crisis in the health service has made her feel anxious because it might impact on her treatment.
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She says: “I have but I feel support for the workers because they deserve the world.”
Image: Dr Asad Ali
The demand feels endless
Her consultant Dr Asad Ali says extra community support for patients like Ms Hill helps to ease the pressure. But the demand feels endless.
I ask him: “How do you cope with an ageing population with complex medical problems on the resources that the NHS has?”
Dr Ali tells me: “Resources are limited… and with us all living longer and living with more complex conditions means yes, we do need more resources to provide care, but we also need to do an appraisal of how best we are utilising our resources and whether we can get more value.”
Since the pandemic respiratory services have been flat out. And there’s no end in sight.
I was here in University Hospital Coventry in December 2022, at the height of the flu season. Every bed, in every bay was taken. Since then flu cases have peaked but every bed in every bay is still taken. They’re still at 100% capacity. The winter pressures don’t simply go away.
And these pressures have long-term impacts. More than seven million people are waiting for elective care in England. A list that was too long before the pandemic and has only become longer. Hospitals like Coventry are looking at innovations to help them to cope and make headway on elective backlog.
The hospital’s chief medical officer, Professor Kiran Patel said the pandemic had forced change, some for the good.
“We mustn’t miss the opportunity that a crisis affords to us and one of the benefits is that it will force us to transform the way in which we deliver health care,” he said.
“We will need to get better at knowing where our demand comes from, what it looks like. So we need to move from being a reactive health service to being a responsive health service, and ultimately being a predictive health service.”
Until that time, patients will keep coming. Across England more than 10,000 patients were brought to an NHS A&E by ambulance every day. Handover times are at record highs despite staff doing everything they can to diagnose, admit and treat people quickly.
And doctors like Ed Hartley want long-term solutions, not short-term fixes.
“Short-term projects to put a holding pen for ambulances outside the A&E doesn’t fix the NHS,” he said. “Short-term projects to help buy some hotel rooms for care home patients or patients who need to leave hospital doesn’t fix the NHS.
“Long-term investment in the workforce, long-term investment in the right size of hospitals, and recognising the care sector as a rewarding career with progression, and presumably appropriate pay, will go a long way to helping the NHS.”
Ms Hill hopes she can go home soon. Her needs are long-term, complicated, and challenging. The same as the health service she relies on.
Rhianan Rudd, who took her own life at the age of 16, was the youngest girl in the UK to be charged with terrorist offences.Â
The inquest into her death, which concluded today, revealed shocking details about her radicalisation by two American white supremacists, one of whom was her mother’s boyfriend, who the coroner said “played a material role in her radicalisation”.
Rhianan gouged a swastika into her forehead, downloaded a bomb-making manual and told her mother she planned to blow up a synagogue.
Investigated by anti-terrorism police and MI5, charges against her were later dropped, but five month later on 19 May 2022, she was found dead in her shower in a children’s home in Nottinghamshire. Hours earlier she had posted on Instagram: “I’m delving into madness.”
The evidence heard in Chesterfield Coroner’s Court from police, social services and even an MI5 operative, raised questions over the state’s part in her death – and whether, despite her obvious radicalisation, this vulnerable, autistic girl should have been treated with more care by the authorities.
Judge Alexia Durran said: “I’m not satisfied, on the balance of probabilities, Rhianan intended to take her own life. Rhianan’s death… was the result of a self-inflicted act but it is not possible to ascertain her intention.
“Rhianan was known, to family and professionals, to be vulnerable, to have autistic traits and have a history of self-harm.”
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The coroner added: “I find she was highly affected by her arrest and was concerned about being sent to prison.”
It was not known what Rhianan was told by her legal team when the charges were dropped but this may have had a “psychological impact” on her, the coroner said.
Image: Rhianan Rudd. Pic: Family handout
In an interview released at the verdict, Rhianan’s mother Emily Carter said her daughter “should never have been charged”, that she was failed by those investigating her, including MI5 and counter terrorism police, as well as being let down by mental health services and those caring for her at the home.
This was the most complex of cases, set at a time when our security services are seeing a growing number of children being arrested and charged for terrorist offences, while parents often seem oblivious to the radicalising material they are consuming online in their bedrooms.
Ms Durham’s ruling reflected this complexity, finding that while there were some failings the actions of the police and MI5 were “reasonable and proportionate”.
The coroner concluded today that she was satisfied that missed opportunities in her case were “not systemic”.
Judge Alexia Durran said: “In the circumstances I do not consider I should make a prevention of future deaths report.”
At the same she was unequivocal about the “significant” role played by two extremists in radicalising her.
It was her mother’s former boyfriend, an American she’d befriended though a US pen-pal prison scheme, who first introduced Rhianan to far-right ideology.
Dax Mallaburn had been part of a white supremacist prison gang in the US and subsequently came to the UK to live with Rhianan’s mother in September 2017, a year after she’d been to visit him in the US.
In the autumn of 2019, Rhianan alleged that he had touched her inappropriately but later withdrew the allegation and, after a social services assessment, Mr Mallaburn returned to the family home.
Ms Carter says: “In hindsight, he was a bad person but I never saw him talking Nazi stuff with her.”
Before Rhianan was arrested, Mr Mallaburn’s relationship with her mother had broken down and he returned to the US and then Mexico. However, during COVID, Rhianan appeared to contact another far-right extremist, Christopher Cook, and began an online relationship with him.
Cook, who was roughly 18 and living in Ohio, shared far-right texts with Rhianan along with a bomb-making manual, and during this time she became fixated with Adolf Hitler.
Image: Emily Carter, the mother of Rhianan Rudd
Cook’s lawyer, Peter Scranton, says he too was radicalised online, and he came up with a plan to blow up power stations in the US, for which he was eventually arrested in August 2020, and in February 2022 he pleaded guilty to terrorism offences.
Cook, who was a misfit at school, suffering from “severe depression” according to his lawyer and was “essentially lashing out” as he tried to form a group to carry out his plan.
Mr Scranton told Sky News, “It was white nationalism, and they had this idea, and I don’t know why anyone would feel this way or how they thought it would work, that if they tore down the government and started over they could create a new United States of America that could look like the image that they would want – a white nationalist image.”
Mr Scranton says Cook told him he didn’t radicalise Rhianan, and it was the former boyfriend, Dax Mallaburn, who’d initially got her into neo-Nazi ideology. However, the coroner found Cook was “a significant radicaliser of Rhianan” at a time when she was “isolated and unsupervised”.
Ms Carter says Rhianan was interested in German history because she was doing it at school and Cook was able to “pull her in”, to racial hatred and antisemitism. She says she didn’t know what was happening, despite having parental controls on Rhianan’s devices. She said: “I could hear her talking to people on there and I’d say who are you talking to and she’d say – just someone from school – and in fact I found out it wasn’t at all.
“When this person she was talking to disappeared, that’s when she sat down on my lap like a baby and cried. She told me this guy Chris had left her, and she was totally in love with him – then she came down and told me she had downloaded a bomb manual and I was like ‘Oh my god, what have you been doing’.”
Ms Carter decided to contact Prevent – a national program in the UK designed to stop individuals from becoming terrorists or supporting terrorism
She says: “I thought putting her in a deradicalisation programme would be a fairly easy undo ‘brain pick’, But it wasn’t until the police turned up that I thought ‘hang on a minute this is a lot deeper than I actually thought it was at first’.”
Ms Carter and her lawyers have argued that the police were heavy-handed, that there should have been a psychological assessment before she was even questioned over terrorism offences.
“There were 19 police officers to arrest a 5ft 1, 14-year-old girl who weighs seven stone. It was over the top,” says Ms Carter.
Once Rhianan was charged, the deradicalisation work under Prevent was put on hold. Ms Carter thinks this was a mistake.
She says: “Leaving her with her own thoughts throughout the entire time of going through the police interviews and everything else – the deradicalisation would have changed the way she was seeing things – I believe she would have been able to handle it all so much better.”
The coroner described the police arrest and interview as “necessary and conducted appropriately” and that, while ceasing the Prevent intervention was an “unfortunate consequence” of the police investigation, it was “an appropriate step”.
During police interviews, Rhianan described being coerced and groomed, including sexually, and having sent explicit images of herself to Cook.
Lawyers representing the family say police and MI5 knew she was the victim of child sexual exploitation but failed to refer her to the relevant body – the National Referral Mechanism.
It was only after a social worker made the referral, that she was identified as a child victim and then the charges were dropped, by which time she had been subject to investigation and prosecution for 15 months.
The coroner agreed that there was a “systems failure” due to a lack of training both within the police and the Derbyshire council who both had had “significant information” that she was a potential victim of modern slavery.
However, she also said it “was impossible to know” whether this would have led to the CPS dropping their charges sooner, “nor that if had more than minimal impact on Rhianan’s death”.
Ms Carter says if she’d been treated differently “she’d be troubled, but I do think she’d still be alive”.
Rhianan’s family say the security services knew her vulnerabilities and that she had a tendency to self-harm, but they failed to take this into account.
Ms Carter said: “I admit my mistakes and I want the organisations to admit their mistakes. There were failings and they need to admit them.”
This ruling however found that the state did not play a role in Rhianan’s death under article 2 of the European Convention on Human Rights.
For the most part, her vulnerabilities were known and taken into consideration. It does however show how extremists will exploit children with mental health problems, young people who are struggling with life who may be a danger to society, but also a risk to themselves.
Counter Terrorism Policing said it offered “sincere condolences to Rhianan’s family and loved ones for their terrible loss”.
Assistant Chief Constable Di Coulson, speaking on behalf of Counter Terrorism Policing in the East Midlands (CTPEM) and Derbyshire Constabulary, said: “This was a complex case involving a very vulnerable young person, who had been subjected to radicalisation.
“Rhianan’s tragic death was clearly devastating for her family. It was felt profoundly by the officers directly involved, but also across Counter Terrorism Policing as a whole.
“Rhianan’s case was a stark moment for our management of the growing numbers of children and young people in our casework – so often presenting vulnerability as well as risk and threat to the public.
“Since Rhianan’s death, we continue to work alongside our partners to evolve the way we approach cases involving children and, where feasible, attempt to rehabilitate and deradicalise, rather than investigate and convict.
“We welcome the findings of the Chief Coroner today, and while we have already made substantial improvements to the way we manage these cases, we will carefully review the findings and make any further changes in order to improve our protection of the public against terrorism.”
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK
There are considerable problems with the winter fuel payment U-turn, but perhaps the political argument in favour outweighs them all?
First, Rachel Reeves has executed the plan without working out how to pay for it.
This, for an iron chancellor, is a wound that opponents won’t let her forget. A summer of speculation about tax rises is not a summer anyone looks forward to.
Second, the fig leaf that she and Treasury ministers are using is an improvement in economic conditions.
If you were being polite, you’d say this is contested.
The OBR halved growth this year and the OECD downgraded UK forecasts, albeit only by a little, last week.
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The claim that interest rates are coming down ignores that their descent is slower because of government decisions of the last six months.
Third, the question immediately becomes, what next?
Why not personal independent payments (PIP) and the two-child benefit cap?
At this stage, it would feel like a climbdown if they did not back down over those.
But then, what will the markets – already policing this closely – make of it, and could they punish the government?
Fourth, this is aggravating divisions in the Parliamentary Labour Party: the soft left Compass group and ministers like Torsten Bell pushing bigger spending arguments.
Those MPs in Tory-facing seats who rely on arguments that Labour can be trusted with the public finances are worried.
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Given the litany of arguments against, why has it happened?
Because the hope is this maxi U-turn lances the boil, removes a significant source of pensioners’ anger and brings back Labour voters, a price they calculate worth paying, whatever the fiscal cost.
Warning: This article contains references to suicide
An NHS trust on trial following the death of a young woman at an east London hospital has been cleared of corporate manslaughter.
Alice Figueiredo, 22, took her own life while being treated at Goodmayes Hospital in July 2015.
The North East London NHS Foundation Trust (NELFT) had been charged with corporate manslaughter and was found not guilty, following a months-long trial. But it was instead found guilty of failing to ensure the health and safety of non-employees.
A not guilty verdict was also returned for hospital ward manager Benjamin Aninakwa, who was charged with gross negligence manslaughter.
Aninakwa also denied a charge of failing to take reasonable care for the health and safety of patients on the ward. He was found guilty.
The decisions were made after the joint-longest jury deliberation in English legal history.
A spokesperson for the North East London NHS Foundation Trust said their thoughts were with Alice’s family and loved ones.
“We extend our deepest sympathy for the pain and heartbreak they have suffered this past ten years,” they said.
“We will reflect on the verdict and its implications, both for the Trust and mental health provision more broadly as we continue to work to develop services for the communities we serve.”
Aninakwa was accused of failing to remove items from the ward capable of use for self-harm and failing to ensure incidents of self-harm were recorded, considered and addressed.
Ms Figueiredo was described as a bright and gifted young woman, who had been head girl at her school.
She struggled with her mental health and had been diagnosed with an eating disorder as well as bipolar affective disorder.
In February 2015, Ms Figueiredo was admitted to Hepworth Ward, an acute psychiatric unit at Goodmayes Hospital.
During her five months on the ward, the jury at the Old Bailey heard how she had attempted to harm or kill herself on 39 occasions, including 18 times with plastic bags.
Despite this, Ms Figueiredo was able to access a bag, and on 7 July she killed herself using a bag taken from a communal toilet on the ward.
Image: Alice Figueiredo was admitted to Goodmayes Hospital
The trial also heard evidence about the reporting of incidents on the hospital computer system.
Last year, Health Secretary Wes Streeting made damning remarks about NELFT at a conference of NHS leaders.
“I’m very aware of NELFT not least because NELFT has and continues to appear in the headlines for providing really poor quality care,” he said.
Ms Figueiredo’s family visited her regularly in hospital, and repeatedly raised concerns about her care.
The jury heard how her mother, Jane Figueiredo, wrote to managers warning: “It is only a matter of time before there is a fatality on this ward.”
Campaigners believe Ms Figueiredo’s death points to wider problems with mental health care.
Deborah Coles, director of the charity Inquest, said: “I hope that irrespective of the verdict, this will send shock waves and ensure that learning and change is an absolute priority.”
Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK