Oliver Barnett

Fon
Parliamentary Under Secretary of State for Public

Health and Prevention at

Department Department for Health and Social Care

of Health &

Social Care 39 Victoria Street
SW1H OEU

Our ref

HM Coroner Alexander Frodsham
The West Annexe

Town Hall

Sankey Street

Warrington

Cheshire

WA1 1UH

By ©

02 August 2024
Dear Alexander,

Thank you for the Regulation 28 report of 8 June 2024 sent to the Department of Health and
Social Care about the death of Oliver Barnett. | am replying as the Minister with responsibility
for public health and prevention.

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

The report raises concerns over the lack of residential and detoxification facilities for children
and young people in England, the disparity between adult and children’s support, and
parents/ carers having to manage detoxification programmes supported by alcohol and drug
services.

As detoxification and residential rehabilitation programmes are distinct interventions, | will
respond to your concerns in relation to each in turn.

Having taken advice from my officials, my understanding is that it is rare for detoxification to
be clinically appropriate for a child under 18. In instances where it is judged appropriate, as
in the case of Oliver, then in line with national clinical guidelines, most cases can be managed
in the community with appropriate clinical and psychosocial support provided by community
drug and alcohol treatment services. In the rare circumstances where inpatient detoxification
is clinically indicated, this should be provided and managed by the community drug and

alcohol treatment service in partnership with a local NHS hospital or mental health trust.
Relapse prevention support should be provided for as long as it is needed. Throughout this
process, it is important that parents feel supported by the drug and alcohol treatment service
managing their child’s care and appropriately involved in the intervention — parents should
not be left to feel they are managing the process on their own. Any parent who feels they are
not receiving an adequate service should use the treatment service’s complaints procedures
or contact their local authority if they feel their concerns are not being addressed.

In relation to residential rehabilitation, my officials have highlighted that while interventions to
address alcohol and drug use are often similar for adults and children and young people,
there are important distinctions.

Substance misuse among children and young people typically cooccurs with and compounds
other problems and vulnerabilities. Therefore, it is important that links are maintained with
their family and positive social networks, as well as other sources of support including child
social workers, schools, youth offending teams and mental health services. Differences in
emotional and cognitive development, problem awareness and readiness for change, as well
as consent and safeguarding issues, all require a different approach and mean that residential
rehabilitation is not one that easily translates from adult to young peoples’ service provision.

Community-based treatments are generally more appropriate and effective for children and
young people than programmes which temporarily remove them from their family and support
network. Practice standards set out by the Royal Colleges of GPs and Psychiatrists, CQC
as well NICE guidelines, emphasise that professionals working with children and young
people should consider local solutions before looking for residential placements.

While a small number of young peoples’ residential drug and alcohol rehabilitation services
have operated in England at various times over the last 30 years, they have not remained
open as there was insufficient sustained demand and outcomes were mixed. Currently, for
the very few young people it is appropriate for, there are options to provide residential
interventions away from home, such as specialist fostering arrangements, or child and
adolescent mental health inpatient units.

Additional funding of £532 million over three years from 2022/23 to 2024/25 has been given
to local authorities to improve the quality and capacity of drug and alcohol treatment.

Alongside investment in service delivery, my department is supporting Local Authorities,
providing targeted support to areas which need it, sharing good practice and working to
improve treatment pathways for care leavers, and young people not in mainstream education,
involved with the criminal justice system or experiencing cooccurring mental health problems.
As we support quality improvements in children and young people’s alcohol and drug
treatment we will keep the evidence, good practice and the question of the most effective
service models under review.

There has been an increase in the number of children and young people accessing drug and
alcohol treatment recently (28% since March 2022) and | of course want to see that figure
continue to grow and the quality of the interventions continue to improve.

| would like to thank you for bringing these concerns to my attention and | will await the
outcome of the full investigation to consider the matter further. | hope this response is helpful.

Yours sincerely,

INHS|

England
Mr Alexander Frodsham National Medical Director
Assistant Coroner for Cheshire NHS England
The West Annexe Wellington House
Town Hall 133-155 Waterloo Road
Sankey Street London
Warrington SE1 8UG
Cheshire
WA1 1UH
24/07/2024

Dear Coroner,

Re: Regulation 28 Report to Prevent Future Deaths — Oliver Walter John
Stephen Barnett who died on 8 December 2022

Thank you for your Report to Prevent Future Deaths (hereafter “Report”) dated 8 May
2024 concerning the death of Oliver Walter John Stephen Barnett on 8 December
2022. In advance of responding to the specific concerns raised in your Report, | would
like to express my deep condolences to Oliver's family and loved ones. NHS England
are keen to assure the family and the Coroner that the concerns raised about Oliver’s
care have been listened to and reflected upon.

Your Report raises a concern about the lack of residential substance misuse treatment
facilities for children and young people under the age of 18 in England.

Treatment for substance misuse is not something that comes under NHS England’s
remit, although my colleagues from our national Mental Health, Prevention and
Children and Young People Teams have been sighted on your Report.

| note that you have also addressed your Report to the former Secretary of State for
Health and Social Care, Victoria Atkins MP. The Department of Health and Social Care
is the appropriate organisation to respond to your concerns.

Although NHS England is not able to respond to the specific issues set out within your
Report, | would like to provide an assurance on the national NHS England work taking
place around the Reports to Prevent Future Deaths. All reports received are discussed
by the Regulation 28 Working Group, comprising Regional Medical Directors, and
other clinical and quality colleagues from across the regions. This ensures that key
learnings and insights around preventable deaths are shared across the NHS at both
a national and regional level and helps us to pay close attention to any emerging trends
that may require further review and action.

Thank you for bringing these important patient safety issues to my attention and please
do not hesitate to contact me should you need any further information.

Yours sincerely,

National Medical Director