NHS failures that led patient to murder pregnant woman in a Grimsby street

Alan McMullan killed pregnant Claire Wilson by stabbing her in the back as she walked to work in June 2009.

McMullan was assessed three times under the Mental Health Act and admitted to hospital twice in 2008, after handing himself into a police station armed with a knife and claiming voices were telling him to harm or kill people.

He was left unmonitored in the community after mental health services lost touch with him when he was discharged from hospital for the second time, the independent report for NHS Yorkshire and Humber said.

McMullan, who was jailed for life in 2010 for the murder of 21-year-old Miss Wilson, never received a full psychological assessment, and systems failures meant information about his risk level was not shared between agencies.

Today’s report found the murder could not have been prevented.

But it said elements of McMullan’s care and treatment by North East Lincolnshire Care Trust Plus, which provided mental health services in the area at the time, could have been much better.

The report said: “We concluded that Mr A’s assessment by the mental health service was incomplete, his diagnosis was unclear and staff did not really get to know him.

“He was not followed up assertively when he left hospital but staff did not know where he was living.

“We identified problems within the organisational processes but we found no causal link between these problems and the tragedy of 2009. Many substantial improvements have since been introduced.”

The CTP’s psychological service was described as “not fit for purpose” and missed an opportunity to carry out a full psychological assessment of McMullan.

McMullan, who was 53 at the time, was described as being calm and pleasant, with no history of violence, but the report found that factors suggesting he was a higher level of risk were not taken into account.

There were “significant” gaps in his records, and discharge and follow-up arrangements were described as “inadequate”.

The report found: “He should have been monitored in the community with a better understanding of the risk he might pose to the public.”

McMullan went into a police station with a knife for the third time less than two weeks after being discharged from his second stay in hospital - having spent a total of five weeks on a mental health ward.

On this occasion he was assessed under the Mental Health Act but was not admitted to hospital.

No system was in place to let his assessors know he was recently discharged from hospital or to let his psychiatrists and GP know he had again gone to a police station with a knife.

“This meant his risk profile was not reviewed and the opportunity to engage with him again was missed,” the report said.

Dr Peter Melton, speaking on behalf of the CTP at a news conference in Willerby, East Yorkshire, today said: “We would like to reassure both the family of Claire Wilson and the wider public that everything was done to ensure our mental health services were, and continue to be, safe and of the highest quality.

“Incidents like this are thankfully very rare and as has been previously stated were not as a result of the care Mr McMullan received.”

Kevin Bond, chief executive of Navigo, which now provides mental health services in North East Lincolnshire, said assessments of McMullan nearly a year before he murdered Miss Wilson did not find any symptoms associated with mental health problems.

He said: “I wish we were able to answer the most key question that has been often asked, as to why this man did such a terrible thing. Sadly, we cannot.”