Thomas Gallagher
11 Aug 2016 · Coroner L Hashmi · Greater Manchester (North)
A similar concern from this report was raised again 1 time later. See the linked reports.
The coroner's concerns
1. lack of formal training in risk assessment and child mental health
“The lack of formal training in relation to risk assessment and child mental health”
2. intentional disregard of Force policies and protocols
“Save for the initial call handler, that all staff demonstrated intentional disregard of Force policies and protocols - including those with operational/management responsibilities and the Operational Communications Branch (OCB - see above)”
3. no set minimum staffing levels
“That the Force has no set minimum staffing levels, including within divisional response and the OCB”
4. insufficient action to match staffing with required numbers
“That when the persistently low staffing levels were brought to the attention of GMPs' SLT, on more than one occasion, insufficient action was taken so as to ensure that the number of officers on duty matched those identified as being required 'on paper'”
5. lack of documentation and communication of resource allocation decisions
“That when decisions were taken not to allocate additional cover/resources: i) no rationale was recorded, ii) no minutes were kept in relation to the decisions taken during the Monday meeting iii) no contemporaneous record was made by the Chief Inspector regarding his decision to reverse the earlier agreement to allocate additional resources &, iv) the Chief inspector did not communicated his decision to those who needed to know”
6. 14 delays placed on FWIN 0405
“That there were 14 delays placed on FWIN 0405”
Linked reports
Identical hazardConfidence 0.90 · high
This report
“The lack of formal training in relation to risk assessment and child mental health.”
Later report
“The inquest was told that the DASH risk assessment is a national tool. However training of GMP officers on understanding how to evaluate risk and score risk was limited.”
Responses
Thomas-Gallagher-Response.pdf ↗· Greater Manchester Police
Stated action
“The OCB has set minimum staffing levels with regard to Command & Control.”
Stated action
“The OCB Branch Commander and Superintendent have completed one to one meetings with all Supervisors to offer absolute clarity over their role in identifying and managing an effective response to all reports of vulnerability.”
Stated action
“A Quality Assurance 'audit' process has been introduced to review incident management by individual staff, enabling a feedback mechanism, post assessment, highlighting good and poor performance.”
Stated action · August 2016
“The reviewed policy was prepared in June 2016 with a formal launch across Force in August 2016.”
Stated action
“GMP is developing a business case to have two mental health professionals posted to the OCB during key demand times to professionalise the Police response to mental health calls”
Stated action
“The specific officers identified from the IPCC investigation into the death of [the deceased], have received detailed development plans of which mental health is a key provision.”