Doctors knew Emily’s killer was threat to children... so why weren’t carers told?
Leaked medical report reveals cat alogue of blunders that left Albanian mental patient free to att ack 7-year- old on Mother’s Day
MEDICAL staff knew that a mentally ill Albanian woman who cut a girl’s throat on Mother’s Day was a threat to children – but those monitoring her in the community were unaware of the danger, a damning report reveals.
A Mail on Sunday investigation today exposes a catalogue of failures that meant killer Eltiona Skana was free to roam the streets despite a shocking history of violence and her refusal to take anti-psychotic medication.
Skana, 30, a paranoid schizophrenic who entered the UK illegally, grabbed seven-year-old Emily Jones as she rode past her on a scooter in a park in Bolton and slashed her throat with a craft knife. She died shortly afterwards.
This newspaper has obtained an internal NHS report which details a string of blunders and missed opportunities by Greater Manchester Mental Health NHS Foundation Trust, which was responsible for Skana’s care. The report, marked ‘strictly confidential’, reveals:
Three years before Emily’s brutal death, Skana had threatened a 13-year-old girl while possibly armed with a knife – but this disturbing incident was not included in her risk assessment;
Skana was twice detained in psychiatric hospitals before killing Emily, but repeatedly escaped;
Her mental state was assessed just once in the three months before she killed Emily;
Skana had a long history of violence, including wielding a knife and a brutal attack on her mother;
Clinicians ‘reluctantly’ bowed to her demands and changed her medication to less effective drugs – despite concerns that her condition would deteriorate;
Her sister warned staff ‘early on in her illness’ that Skana refused to take her anti-psychotic tablets. A month’s supply of unused medication was found at Skana’s flat after she killed Emily.
Skana’s prosecution for murder was dropped on Friday after prosecutors accepted there was no realistic prospect of a conviction.
She pleaded guilty to manslaughter on the grounds of diminished responsibility and will be sentenced on Tuesday.
Emily’s grieving father, Mark, last night said Skana was a ‘ticking time bomb’ who should be locked up for the rest of her life. ‘I think she is vile,’ he said. ‘How dare she take my child away from me.
‘The coward murdered my child. I personally think she is a threat to the public and I want her to spend all her days in prison.’
Despite cataloguing so many failings, the serious incident review commissioned by the trust after Emily’s killing clears its staff of any blame. ‘In our opinion, unfortunately the incident could not have been predicted or prevented. E S [ Eltiona Skana] was managed appropriately given the clinical findings,’ the report, written by a doctor and two nurses, states.
And in what appears to be a shockingly insensitive comment, the report stressed that two of Skana’s care staff ‘wanted it to be known that when well, they regarded E S as a kind and lovely person’.
Mr Jones demanded that the trust apologise for its failings and said health bosses who oversaw Skana’s care should be sacked. ‘I want some senior heads to roll. I don’t like the fact that they are hiding in their ivory towers. I hope they can’t sleep, like I can’t.’
Skana was first referred to mental health staff in Manchester just three months after arriving in the UK in 2014 and was assessed as having psychotic ideas, including fears her neighbours were planning to harm her by using electricity.
In July 2015 she was sectioned and admitted to a psychiatric unit after she wielded a knife against her neighbours. She was discharged but arrested in February 2017 after attacking her mother. ‘She began saying that when she killed her mother, then everything would be OK,’ prosecutor Michael Brady QC told Minshull Street Crown Court in Manchester last week.
Police discovered Skana had disconnected the electricity to the property’s boiler, removed light bulbs and thrown away her TV, which she claimed was transmitting her neighbours’ voices. The court heard how she was detained in hospital again but escaped and turned up at a friend’s house, asking to see her friend’s 13- year- old daughter for no apparent reason ‘while possibly armed with a knife’.
When asked by her friend about her short haircut, she replied that she ‘cut her hair off, rather than cutting off other people’s heads’.
After her return to hospital, medical staff made a ‘child safeguarding referral’, which should have warned all those involved in her care that she posed a risk to children. But crucially, the trust’s serious incident review found that while this disturbing incident was documented in Skana’s notes, it was not ‘easily accessible’.
And while her violence and use of weapons was recorded in her risk assessment – the danger she posed to children was not. As a result, neither her consultant psychiatrist nor the nurse responsible for her day-to-day care were aware of ‘the specific risk to children’. The psychiatrist even told the review team that he did not rely on her risk assessment to manage her care.
The review insists that knowing the potential risk Skana posed to children would not have altered ‘her management in the community’ because she was judged to be stable before she killed Emily.
But Julian Hendy of the charity Hundred Families, which campaigns for families affected by mental health murders, said the failure to flag up the threat she posed was a ‘shocking admission’.
‘Potential threats to children are a complete red flag which need to be highlighted prominently,’ he said. ‘If there is a risk to children it has to be recognised by the professionals treating her.’
Skana was ‘most stable’ when taking anti-psychotic medication in the form of monthly injections. The report reveals that staff would
‘Health bosses are hiding in their ivory towers’
‘reluctantly’ prescribe oral medication, which she ‘preferred’.
She was allowed to switch from injectable drugs to twice-daily tablets in August 2019, even though Victoria Fagan, Skana’s nurse since November 2018, told the court she had ‘concerns’ she would relapse.
Ms Fagan’s fears were soon realised: the report reveals that Skana was judged to be paranoid on eight separate occasions between August and December 2019. After the switch in medication, Skana was assessed by mental health staff twice a week but in mid-December these visits abruptly stopped.
Astonishingly, despite her record of violence, there was no assessment of her mental condition, or whether she was taking her drugs, between December and March.
Ms Fagan was on sick leave for a month between January 20 and February 24 and the report suggests no one took on the responsibility of checking on Skana. Ms Fagan saw Skana for the final time on March 11 – just 11 days before she killed Emily.
During an hour-long assessment, Skana discussed her plans to attend college and Ms Fagan said ‘ she seemed fine and settled in her mental state’. Skana assured the nurse that she was taking her medication, but she was lying. When police arrested her, they discovered just one tablet missing from a package of medication, and found a stockpile of tablets in her flat, suggesting she had not taken her medication for a month before the killing.
Such behaviour should have come as no surprise to mental health staff. ‘Her sister confirmed early on in her illness, and when interviewed after the incident, that E S did not take her medication as prescribed,’ the report states.
At the time of Emily’s death, Skana was being cared for by the Bolton North Community Mental Health Team, which has just two consultant psychiatrists overseeing 855 patients. Staff use a traffic-light system, with ‘red’ denoting higherrisk cases and ‘green’ for ‘stable’ patients. The review says that ‘at the time of the incident, E S would have been recorded as green’.
Greater Manchester Mental Health Trust declined to answer a series of questions from the MoS.
Trust chief executive Neil Thwaite said: ‘We recognise the devastating impact Emily’s death has had on everyone who knew and loved her, and offer our heartfelt condolences to Emily’s parents and family. We treat incidents of this kind with the utmost seriousness and completed an internal rigorous review.’