Stuart Tokam

From Gillian Keegan MP 
Minister of State for Care and Mental Health 

39 Victoria Street 
London 
SW1H 0EU 

Coroner Graeme Irvine  
HM Acting Senior Coroner, East London 
Walthamstow Coroner’s Court 
Queen’s Road 
Walthamstow 
E17 8QP 

  Via email  

Dear Mr Irvine, 

26 October 2021 

Thank you for your letter of 13 August 2021 about the death of Stuart Tokam.  I am replying 
as Minister with responsibility for mental health, and am grateful for the additional time in 
which to do so.     

Firstly, I would like to say how saddened I was to read of the circumstances of Mr Tokam’s 
death and I offer my sincere condolences to his family and loved ones.  The circumstances 
your report describes are very concerning and I am grateful to you for bringing these matters 
to my attention.  

I am aware from the Trust's response to you that the Trust is undertaking quality 
improvement work to look at how it manages demand and capacity, including triage 
processes and clinical review.  Clinical involvement and leadership in referral screening has 
increased and new processes have been introduced.  In addition, the Trust has introduced 
consolidated waiting lists to its Complex Depression, Anxiety and Trauma Service, with the 
aim of achieving greater transparency and parity in waiting times.  The CDAT service is 
supported by a 'Duty clinician system' that can respond as necessary to escalation of risk. 

It is essential that the Trust takes all the necessary learnings from Mr Tokam’s death and I 
am encouraged that it has taken these steps.  

You may wish to note that the Care Quality Commission, the independent regulator for 
quality, will review the Trust’s response to your report, as part of its ongoing monitoring, and 
consider whether any further action is required. 

At a national level, NHS England and NHS Improvement (NHSE/I) recognise that 
considerable improvements are needed to reduce the treatment gap in mental health 
services, and ultimately ensure that everyone that needs high quality care and support can 
access it in a timely manner.  The importance of this is reflected in the commitments set out 
in NHS’ Long Term Plan1 to improve community mental health, so people receive the 
support they need to help them stay well.  

1 https://www.longtermplan.nhs.uk/online-version/ 

 
 
 All local areas have received funding to develop, and begin delivering, new models of care 
that integrate primary care and community mental health services for adults with severe 
mental health problems.  The national ambition for these new models is set out in the 
Community Mental Health Framework2, which aims to ensure all people requiring support, 
care and treatment in the community have a co-produced, personalised care plan in place 
which takes into account all of their needs.  By the end of 2023/24, all areas will have one of 
these models in place, with care provided to at least 370,000 adults per year nationally. 

While the level of planning and coordination of care will vary, depending on the complexity of 
an individual’s needs, one person should have responsibility for coordinating care and 
treatment, and this coordination role can be provided by workers from different professional 
backgrounds.  This is also described in the recently published Care Programme Approach – 
Position Statement3 which sets out how community mental health services should be 
working towards a minimum standard of high quality care for everyone in need of community 
mental health support, including ensuring everyone has a named key worker with a multi-
disciplinary team approach to both assess and meet the needs of patients.  

These improvements to community mental health services will give people greater choice 
and control over their care.  They will also improve access to a range of interventions and 
support, including psychological therapies, physical health care, employment support, 
medicines management and support for self-harm and coexisting substance use, with care 
being increasingly personalised and trauma-informed. The new models should also ensure 
appropriate links are made with other mental health services (such as inpatient and crisis 
services), to ensure patients have a seamless experience of care and that their needs can 
be met in the most appropriate setting.  

In relation to access, NHSE/I is developing and consulting on a potential new access and 
waiting time standard for adult and older adult community mental health services.  The 
introduction of this new standard could be a powerful lever to address key challenges in the 
delivery of our NHS Long Term Plan ambition for adults with severe mental illnesses, 
including addressing historical underinvestment, disruption to delivery as a result of the 
pandemic, and increasing concern about long waits in some pathways.  The new standard 
would measure the number of people presenting to services receiving help within four 
weeks, and is relevant to your concern about the timely provision of assessment and 
treatment. This new waiting time standard would be part of a range of metrics to enable the 
timeliness and quality of care to be monitored  

Reducing suicide and preventing self-harm remains a key priority for the Government and 
the Department is working closely with NHSE/I and UK Health Security Agency to support 
local areas to deliver multi-agency suicide prevention plans.   

As part of the £2.3billion settlement for mental health in the NHS Long Term Plan, the 
Department is providing targeted and ring-fenced funding to integrated care systems (ICS) 
so they can deliver their multi-agency plans. This includes suicide prevention activities, 
initiatives to prevent self-harm and putting in place postvention bereavement support. 

2 https://www.england.nhs.uk/wp-content/uploads/2019/09/community-mental-health-framework-for-
adults-and-older-adults.pdf  
3 https://www.england.nhs.uk/wp-content/uploads/2021/07/Care-Programme-Approach-Position-
Statement_FINAL_2021.pdf  

 
 
 
 
 
 
 
 
 
 In order to support ICSs, there is a bespoke national suicide reduction support package with 
the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) and 
National Collaborating Centre for Mental Health. Key components of the programme include 
supporting services with safety planning, and using resources such as NCISH’s ‘Safer 
services: A toolkit for specialist mental health services and primary care’, which includes 
guidance on depression.  

I hope that my response provides the necessary information to address your concerns.   

Yours sincerely, 

                Gillian Keegan