The Nottingham killings are a warning sign for the whole of the NHS

The killing of two students and a caretaker in Nottingham last year by Valdo Calocane, who had a history of mental illness, has acted as a clarion call to fix the country’s mental health services.

Calocane was under the notional care of Nottinghamshire Hospital Foundation Trust, and a report by the Care Quality Commission (CQC), the NHS safety watchdog, has now found that there were serious failings within the trust.

The CQC report says that patients regarded urgent services as either “useless” or actually detrimental to their health. The trust struggled with high demand for its mental health services, and the report says: “People described issues including being discharged ‘too soon’ or leaving inpatient services in a ‘worse state’ than when they arrived.” It adds: “This could lead to people being readmitted to services very soon after discharge or rapidly deteriorating in the community.”

The review confirms that supervision of potentially dangerous patients such as Calocane was often inadequate because of the high level of demand experienced by community teams. Thus it was that many of the warning signs in the case of Calocane, who had been diagnosed with paranoid schizophrenia, were not acted on.

The trust has said that it has since recruited more staff, and that it is working to improve an internal culture described by the CQC as a “toxic service environment”. But there is more to be done, and the regulator has recommended that community mental health services be looked at nationally to understand the gaps in care and implications for the safety of patients and the public.

The Nottingham triple killings are at the heart of concentric circles of concern. At the core is the question of public safety. The first priority of mental health services is to protect the general public from the small number of mentally ill people who are a danger to others.

The next circle out includes the problem of the sharp increase in the number of people, especially young people, who are signing out of the labour market as long-term sick with mental health problems. This is adding even more to the pressure on NHS mental health services, which are already stretched. Theresa May’s promise as prime minister to ensure equality of status and resources between mental and physical health services already seems like a very long time ago.

And finally, all this is in the context of a decline in patient satisfaction with the NHS generally, to the lowest level since the last time a Conservative government was swept from office in 1997. The latest British Social Attitudes survey, published on Wednesday, finds that a mere 24 per cent of people are satisfied with the NHS – the smallest percentage in a series that has been running since 1983. This is hardly surprising at a time when A&E departments in many parts of the country seem to be close to breaking point.

Victoria Atkins, who has been health secretary since November, has done many of the right things in her few months thus far in the job. She commissioned the CQC to carry out a swift review of the Nottingham Hospital Foundation Trust, and she has tried to negotiate a settlement with striking doctors. But the NHS – its mental health services in particular, and the provision therein for potentially dangerous patients above all – needs a step change in governance.

It probably needs substantial extra resources as well, but first of all it needs stronger leadership at all levels, and a greater sense of urgency. First, it needs to focus on public safety: not just protecting the public from people like Calocane, but reassuring patients that basic care is safe. This ought to be the very minimum that people can expect from our most important public service.