Casey Brittle

Commissioner‟s report Commissioner's Report Investigation into the police management of reports of domestic abuse made by/in relation to Casey Brittle

Table of contents IPCC Commissioner’s Report Casey Brittle Introduction ......................................................................................................................3 Background ......................................................................................................................3 Referral..............................................................................................................................4 Chronological summary of events..................................................................................4 Misconduct Outcomes...................................................................................................12 Findings ..........................................................................................................................13 Review of Nottinghamshire Police‟s Revised Domestic Abuse Policy and its Implementation...............................................................................................................17 Commissioner‟s Conclusions.......................................................................................22

2

Introduction 1. This report sets out the IPCC independent investigation‟s findings into Nottinghamshire Police‟s handling of domestic incidents involving Miss Casey Louise Brittle prior to her murder in October 2010, as well as Commissioner Amerdeep Somal‟s response to those findings. 2. In addition to considering the policies and guidelines the force had in place relating to the policing of domestic incidents, the investigation also examined the way in which Nottinghamshire Police had responded to previous recommendations for improving their performance in this area of policing. These recommendations were derived from the IPCC independent investigation into the serious assault of Gail Hdili by a former partner (See appendix A for a copy of the relevant IPCC press release)

Background 3. Casey Brittle, 21, was murdered on Sunday 3 October 2010 at her home on Springfield Street, New Basford, Nottingham. 4. As a result of the Nottinghamshire Police investigation into the murder, Sanchez Williams, Miss Brittle‟s estranged partner and the father of her daughter, was charged with murder on the 6 October 2010. He was subsequently convicted of murder in March 2011 and sentenced to life imprisonment. 5. Sanchez Williams, 27, had an extensive criminal record and warnings on the Police National Computer for violence. He did not have any previous convictions for domestic abuse related offences.

3

Referral 6. The murder investigation established that there was a history of domestic abuse between Miss Brittle and Mr Williams. Between September 2008 and October 2010 a number of incidents were reported to Nottinghamshire Police by both Miss Brittle and third parties, none of which resulted in criminal charges. 7. Following concerns raised by an internal review by the force about how these incidents were handled a referral was made to the IPCC on 12 October 2010. On 13 October 2010 this became the subject of an independent investigation. 8. The IPCC reviewed the circumstances of each incident and identified ten officers whose actions would potentially justify the bringing of disciplinary proceedings. The six Police Constables (PC), three Police Sergeants (PS) and one Acting Police Sergeant (A/PS), all based within the force‟s City Division, were therefore served with misconduct notices.

Chronological summary of events 9. This investigation identified 11 separate incidents involving Miss Brittle and Mr Williams. The incidents, which occurred between September 2008 and August 2010, including two incidents on the 18 March 2009, are detailed below. 10. While reading details of the incidents it is important to be aware of the process Nottinghamshire Police used to assess and respond to risk following domestic incidents during the relevant period. 11. Following a domestic abuse incident officers should have completed a domestic abuse form and sent it to the City Division domestic abuse unit. Once submitted to the unit an assessment would be made of the risk posed to the victim, with the unit 4

then providing the officers with a standard set of suggestions for further actions they could undertake, dependent on the level of risk identified. If no risk assessment form was submitted, the domestic abuse unit would not be aware of the incident and would therefore take no action.

6 September 2008 12. At 11.47am police received a call from a woman to say that her cousin was beating his girlfriend up. The caller did not give, nor was she asked for, her name or the name of those involved in the incident, meaning checks could not be carried out police databases. The call handler also failed to establish if children were at the address despite them being audible in the background, and repeated incorrect details back to the caller. 13. When an officer arrived Mr Williams answered the door and told the officer he had been arguing with a friend, not his girlfriend, and there had not been any violence. A woman appeared at the door and confirmed Mr Williams‟s story. After the attending officer spoke to the dispatcher via his radio the log was closed and the officer left the address. 14. The officer accepted the word of Mr Williams even though it was contrary to what had been reported in the initial phone call. The officer did not any conduct house to house enquiries, or contact the caller at a later date to establish what had really happened. 15. As the officer did not believe a domestic incident had taken place neither a domestic abuse or a child protection form was submitted to the City division‟s domestic abuse unit.

5

13 October 2008 16. At 12:01pm Miss Brittle called 999 reporting that she had been assaulted in the street by her live-in boyfriend. Miss Brittle said she was very frightened, it was not the first time it had happened and that they had a child together. She said her partner had driven off and she was on her way to a friend‟s address. 17. Despite her reluctance to deal with the police the handler encouraged her to speak to officers about what had happened. PC A attended and Miss Brittle said that she did not want to pursue the assault and refused to name her boyfriend. After half an hour PC A left and informed the control room that Miss Brittle was unwilling to cooperate. 18. PC A told the IPCC investigation that she checked the force‟s intelligence system and that showed there was no other domestic incident involving Miss Brittle. 19. PS A, PC A‟s supervisor, reviewed the crime management system entry and called Miss Brittle, who repeated what she had said to PC A about not wanting to assist an investigation. 20. No domestic abuse forms were submitted to the domestic abuse unit as the officer believed that as Miss Brittle did not wish to proceed with an investigation there was no need to.

30 October and 4 November 2008 21. Miss Brittle made a 999 call to Nottinghamshire Police at 5.32pm, reporting that her ex-partner had just assaulted her in front of her 11 month old child. Miss Brittle said he had assaulted her in the past but that she had not reported it. 22. As Mr Williams had left the scene the call was downgraded so an appointment could be made for an officer to see Miss Brittle at a later time. When officers later attempted to visit her she was not available.

6

23. In the early hours of 4 November officers stopped Mr Williams for a traffic offence and arrested him for the alleged assault. Several hours later he was bailed until early December, at which point he went to Springfield Street, where he spoke to a neighbour who persuaded him not to confront Miss Brittle. 24. Later on the morning of 4 November Miss Brittle contacted the police. She told A/PS A that Mr Williams had attended at her address at 5am and spoken to a neighbour blaming her [Miss Brittle] for his arrest. She was upset Mr Williams had been arrested without her „say so‟. 25. That afternoon Miss Brittle attended a police station and retracted her original assault allegation. A different officer dealt with her and filled in both the domestic abuse and child protection referral forms and sent them to the division‟s domestic abuse unit, despite her being unwilling to assist the police investigation. This was in accordance with the force‟s domestic abuse policy. 26. The domestic abuse unit risk assessed the incident on 29 January 2009 - a delay of three months. 27. Mr Williams did not answer his bail and there is no indication that any effort was made to trace him. No restrictions were put on his bail e.g. prohibiting contact with Miss Brittle. In late December his bail was cancelled after the CPS advised no charges should be brought.

18 March 2009 28. At 1.07pm a resident of Springfield Street reported an incident in which a man was hitting a woman with a broom in Springfield Street. Police attended quickly and arrested Mr Williams for assaulting a neighbour of Miss Brittle. He was bailed without conditions. Attempts to progress the investigation by obtaining statements

7

from other witnesses were frustrated and following a review of the case it was closed. Mr Williams' bail was therefore cancelled. 29. Several hours later, while Mr Williams was in custody, Miss Brittle called police and told them she did not feel secure in her own home; that Mr Williams was repeatedly turning up; their daughter was scared of him; that domestic violence had been going on „for ages‟ and that she wanted to get out of it. She asked for a crime number so the council would change the locks on her door. 30. An appointment was made and PC B went to Miss Brittle‟s home on 20 March. Miss Brittle downplayed the incident and said Mr Williams had now taken his belongings and returned his keys. She said there had not been any violence at this time.

4 August 2009 31. At 11.08am a 999 call to Nottinghamshire Police reported a violent domestic incident taking place at Miss Brittle‟s home. PS B and PC C attended and spoke to Miss Brittle. She acknowledged she had been arguing with someone, but would not say with whom or about what, only that the matter was „sorted‟. 32. The officers did not speak to the original caller or other neighbours, despite Miss Brittle‟s acknowledgement that something had actually happened at the address. 33. Their response was also hampered by the call handler noting the wrong house number for Miss Brittle‟s address. This meant the officers were denied information relating to previous incidents at the address 34. PC C did not fill in a domestic abuse form as he believed risk assessments were only required for cooperative victims, nor was an incident created on the force‟s crime recording system as he did not believe it was suitable for incidents reported by a third party.

8

10 November 2009 35. Miss Brittle made a 999 call at 10.22pm to report that her front door had been kicked in and that someone may have been trying to break in. She explained her partner had given chase and the suspect had not entered her property because a neighbour had startled them. She advised that her daughter, aged nearly two, was at the property. 36. Officers arrived quickly, during which time the call handler had established there was a history of domestic violence at the property. Neighbours also told them they thought Mr Williams had damaged the door, but they did not want to get involved. 37. When officers returned the next day Miss Brittle gave a different account, saying that she and Mr Williams had caused the damage themselves as they had locked themselves out and wanted to get in. 38. No risk assessment forms were sent to the domestic abuse unit, which the IPCC investigation found justifiable in this incident.

4 June 2010 39. A colleague of Miss Brittle at the West One store in the Victoria Centre, Nottingham made a 999 call to report that Miss Brittle had been assaulted by her boyfriend, 40. Before police arrived Miss Brittle told a security guard that her ex boyfriend, Mr Williams, had entered the store and thrown her into a changing room. The security guard recalled that she had red marks round her neck and was clearly shaken, but she was also trying to play the incident down. 41. When PC D arrived Miss Brittle refused to provide details of the offender or her child. Miss Brittle‟s colleague similarly refused to talk to PC D, although the colleague was told a third party complaint could lead to a prosecution. A check with

9

the shopping centre revealed there was no CCTV of the incident. The incident was closed without a crime number being requested or domestic abuse forms being submitted.

25 July 2010 42. At 5.21pm Miss Brittle made a non-emergency call to Nottinghamshire Police to report that Mr Williams had been to her house about an hour ago, threatened her and taken her mobile phone. She told the call handler that they had a 30 month old daughter together. 43. When an officer arrived Miss Brittle explained what had happened and asked for advice on how to seek a civil injunction against Mr Williams. She also said she did not want to make a complaint regarding the theft of her phone, nor did she want the officer to attend Mr Williams‟ home to warn him. An entry to this effect was signed by Miss Brittle in the officer‟s pocket notebook. 44. The officer spoke to Miss Brittle about her relationship with Mr Williams and filled in domestic abuse and child protection forms, which were sent to the domestic abuse team. They gave Miss Brittle a medium risk level. 45. The officer returned to Miss Brittle‟s home in early August and advised her of the outcome of her risk assessment. He also spoke to the local beat manager to let him know of the incident.

10 August 2010 46. Security staff at the Victoria Centre, Nottingham, called police at 4.07pm and told them a man had head butted a woman and thrown her into a photo booth. The man was still at the scene, in company of other men. Police assistance was requested, as it was anticipated that the man would “kick off”.

10

47. PC E, an officer of less than two years‟ service at the time of the incident, and PC F attended. PC E dealt with Miss Brittle. His pocket notebook records the following signed entry: „My name is Casey Brittle 11/4/1989 and I live at Springfield Street An incident occurred today at Next in the Victoria Centre involving my ex-boyfriend Sanchez Williams. He assaulted me in the Victoria Centre but I do not wish to give a statement or make any complaint as I‟m unwilling. I‟m happy for the incident to be dealt with by police informally.‟ 48. Despite Miss Brittle admitting she had been the victim of an assault, PC E decided it was not appropriate to arrest Mr Williams as he felt there was no realistic chance of prosecution. This was not a decision for the officer to make. 49. Instead PC E decided the matter could be dealt with by way of a harassment warning, but subsequently decided that this was not appropriate given Miss Brittle was willing to have contact with the offender. 50. PC F spoke to Miss Brittle‟s friends, who were shopping with her at the time of the incident and obtained Mr Williams‟ name from them. 51. Neither officer was able to provide a detailed description of their actions that day, only vaguely recalling that they had spoken to a security guard briefly and that the incident was not covered by CCTV. 52. Following Miss Brittle‟s murder it was established security guards at the centre had retained CCTV of Mr Williams in the centre, the names and dates of birth of Miss Brittle and Mr Williams, as well as contact details for her friends. They also made contemporaneous notes about the incident. 53. In a statement to the murder investigation one of the guards added she saw injuries on Miss Brittle and that Mr Williams had threatened to kill Miss Brittle. Mr Williams had also rung her mobile 10-15 times after the assault and on the one

11

occasion Miss Brittle answered, the security guard heard Mr Williams shout: „I‟ve got a gun, I‟m going to do your mum and grandma.‟ 54. Miss Brittle told the guard Mr Williams had access to firearms, something that also featured on Mr Williams‟ police intelligence profile. 55. PC E submitted a domestic abuse form nine days after the incident, instead of before the end of his tour of duty as the force‟s policy said it should have been. He had crossed through all the questions, added inaccurate information about the offender being unknown and that he believed it likely Mr Williams would do it again. The risk was assessed as standard, but the IPCC investigation felt that the true risk from this incident was medium - consistent with the previous assessment conducted by the unit. 56. The incident was reviewed by PS C, who was satisfied there were no further lines of enquiry. There is no record of statements being taken from the security guards. 57. Following Miss Brittle‟s murder it was also found that PC E did not respond to two emails from Victim Support. These emails asked whether the officer had informed Miss Brittle of their service and whether they had permission to contact her. The link with Victim Support was introduced by the force to try to help the charity provide victims with support and advice, but the organisation can only contact them directly if permission has been given.

Misconduct Outcomes 58. The IPCC investigation recommended that six officers should be required to attend misconduct meetings. All six officers entered guilty pleas. The outcome of the meetings is as follows:, • 4 August 2009 - PC C and PS B. No further action 12

• 4 June 2010 - PC D received management action. • 10 August 2010 - PC F and PS C received management action while PC E received a written warning. 59. The four other officers who were not required to attend misconduct meetings were subject to unsatisfactory performance procedures.

Findings 60. Aside from the failings of officers the IPCC investigation also found serious systemic failings by the force. These will be explored in the following section. 61. When the majority of these incidents occurred Nottinghamshire Police did not have a domestic abuse policy in place. In October 2008 the force, recognising that the policy was not fit for purpose as it was outdated, removed it from circulation. A revised version of the policy was made available to officers in March 2010. In the intervening time period no interim policy was put in place, which is clearly unacceptable. 62. A lack of knowledge on the part of divisional officers and lack of support from the force therefore accounts for some, but not all, of the following themes that characterised many of the responses to incidents involving Miss Brittle.

Failure to Pursue Lines of Enquiry 63. Although there were occasions when officers took positive action and arrested Mr Williams, all too often the investigation found that officers placed too much emphasis on Miss Brittle‟s unwillingness to proceed with criminal allegations. 64. Rather than seek independent evidence that may have assisted prosecutions, officers appear to have been content to take no further action. 13

Completion of risk assessment forms 65. Many officers told the IPCC they were not aware of, or were unclear about what to do when responding to domestic incidents. In Miss Brittle‟s case seven incidents required the completion of the domestic abuse and child protection forms, but only three domestic and two child protection forms were submitted. As a consequence the force and its officers failed to provide adequate support and safeguards to a vulnerable victim and her child. 66. The need to ensure officers were submitting risk assessment forms was highlighted to the force in late 2009 following the IPCC‟s investigation into a serious domestic incident which resulted in Gail Hdili sustaining serious injuries at the hands of her ex-partner . The repetition of these failures indicates the force‟s efforts on this front were not sufficiently robust. 67. The investigation also found that in most of the incidents Miss Brittle was not provided with a leaflet that would have outlined steps she could take to secure support from other organisations. Some officers were not aware of the leaflet and one stated that they had to photocopy the original as the force had not provided any more after the initial print run.

Lack of Proactive work by Domestic Abuse Units 68. During the relevant period the City Division‟s Domestic Abuse Support Unit did not take any proactive steps to identify and risk assess domestic incidents that may have occurred in the local area. This is disappointing given that the Hdili investigation highlighted the limitations of relying on divisional officers submitting risk assessment forms. 69. The findings of that investigation should have prompted the force to reconsider the

14

role of the units, with a view to making them more proactive, as opposed to reactive, as a matter of urgency. 70. The City Division‟s domestic abuse unit‟s working hours were 0800-1600, Monday to Friday. There were no contingency arrangements for „out-of-hours‟ incidents. Therefore a domestic incident reported on a Friday evening would not be risk assessed until the following Monday morning. 71. The IPCC investigation acknowledges that a search tool has been developed that allows domestic abuse units to review all potential domestic incidents on the crime management system. The tool was designed on the assumption that domestic incidents are recorded with „domestic no crime‟ numbers. However, given that three of the incidents considered by this investigation were not given „domestic no crime‟ numbers when they should have been [incidents of 6 September 2008, 4 August 2009 and 4 June 2010] this process still has potential loopholes.

Scheduled appointments 72. The force operates a „Managed Incident Car‟ (MIC) service, which is essentially an officer who attends pre-arranged appointments with members of the public who have complained regarding matters that do not require an immediate or priority response. The force‟s MIC policy advises that it is not to be used for domestic abuse incidents; similarly, these appointments cannot be booked for immediate or priority incidents due to a command and control block on such action being taken. Control room staff twice manipulated the system by downgrading incidents to book appointments for officers to visit Miss Brittle. The investigation was also told that the practice was common in the force‟s control room.

73. The force‟s Call Grading policy contradicts the MIC policy, as it states that in some

15

circumstances it may be appropriate to use the MIC for domestic incidents. The investigation therefore suggests the guide is reviewed to remove the inconsistent advice. It may be that some lower level domestic incidents are suitable for MIC appointments with the approval of a control room supervisor, but this needs to be properly considered and documented.

Police bail: lack of conditions 74. The force domestic abuse procedure advises officers that consideration should be given to imposing bail conditions, yet on both occasions when Mr Williams was arrested and bailed, no bail conditions were imposed. This meant that officers were unable to arrest Mr Williams for breaching bail conditions when he was subsequently involved in incidents involving Miss Brittle. 75. This is particularly concerning as the force had put a marker on Mr Williams‟ profile to indicate he offended whilst on bail. Neither of the Custody Sergeants who bailed Mr Williams documented their rationale for failing to impose bail conditions; as a result there was no clear audit trail.

Recording Incidents and Intelligence 76. When Nottinghamshire Police receive a call the control room create a log on their Command and Control system, VISION. Domestic incidents should be given a domestic qualifier in order that they are easily retrieved when the system is searched for such incidents. In addition, domestic abuse incidents should be given a „domestic no crime‟ code which essentially means that the incident will be progressed on the force‟s crime recording system in the same way as a crime. A sergeant will then review the crime record before it is closed to ensure there are no outstanding actions.

16

77. It was a feature of the incidents involving Miss Brittle that three incidents were not closed with the correct domestic „no crime‟ code. 78. Control Room supervisors should also quality check three calls a month per call handler, and one of these calls should be a domestic abuse incident. The investigation was told this does not always happen. 79. The investigation found that the officers should also have made greater use of the force‟s intelligence system, MEMEX, to record details of incidents so that future risk assessments and incidents are better informed.

Review of Nottinghamshire Police‟s Revised Domestic Abuse Policy and its Implementation 80. In March 2010 Nottinghamshire Police published its revised domestic abuse policy. In late 2010 they also introduced the Domestic Abuse, Stalking and Harassment (DASH) model for dealing with domestic incidents. 81. While the introduction of the DASH model will have undoubtedly improved the handling of domestic abuse incidents in the force, two of the incidents involving Miss Brittle occurred after the revised policy‟s introduction. As failings were found in these cases it was felt the force‟s revised policy should be reviewed as part of the investigation. The following section highlights concerns raised by this review. 82. The IPCC investigation found that despite introducing DASH the force‟s revised policy had not been further updated to reflect this and therefore reflected old domestic abuse model and practices. The outdated policy was also overdue for review by four months when the IPCC began its investigation in October 2010.

17

Implementation of Domestic Abuse Stalking and Harassment Model 83. The DASH model is nationally endorsed and requires the attending officer to identify the level of risk at the time of the incident, using their professional judgement. The officers are assisted in this regard by the DASH Risk Identification Form which provides indicators and definitions of the three risk levels (Standard, Medium and High). Under the previous model risk was assessed if/when the forms were received by the domestic abuse unit. 84. Having identified a level of risk the officer is responsible for implementing immediate control measures. Medium risk cases should be referred to supervisors at an early stage, and high risk cases should be referred to a duty Inspector and ultimately the Daily Management Meeting. 85. This model was introduced on City Division in December 2010. Of the ten officers served with notices in the course of this investigation, four stated that they had not received any domestic abuse training, and a further two officers stated that they had received very little training. 86. This lack of a thorough corporate approach to domestic abuse continued with the implementation of the DASH model. The various divisions across Nottinghamshire implemented DASH training and the research tool (see paragraph 71) at different times. A more coordinated approach would provide a more consistent level of service to the public; it was not sensible for different divisions to use different risk assessment models and risk identification tools, as this could result in a „postcode lottery‟ in police responses to domestic incidents. 87. DASH training for City Division officers started in June 2010 and was completed in mid-September; it was implemented on the City Division in December 2010. However, a number of officers told the investigation they had still not received any domestic abuse training. IPCC enquiries in early 2011 indicated that two of the

18

officers had still not attended DASH training. 88. Despite the domestic abuse form changing as a result of DASH, old forms were still being submitted to the domestic abuse units. Officers who submit the old forms are advised they should use the new template. This suggests some officers are not following the new process. 89. The investigation is encouraged to find that there is a process for informing officers who submit the old form but we are concerned that the domestic abuse unit does not ask the investigating officer to resubmit the correct forms on that occasion- the assessment is conducted using the old assessment process. This is not appropriate, as these incidents will essentially receive less scrutiny than those handled in accordance with the DASH model.

Victims who are reluctant to assist the police 90. Neither the original nor the revised version of the force domestic abuse policy give any guidance whatsoever on the approach officers should take when dealing with victims of domestic abuse who are reluctant to engage with the police. This investigation demonstrated that divisional officers need explicit instructions and insight into the consequences of failure to do so in these circumstances. 91. In the relevant time period the unit was largely dependent on officers submitting the relevant forms, as no proactive trawl for domestic incidents was conducted. The duty Inspector‟s briefing book was reviewed, but this would only include reference to matters sufficiently serious to have been escalated to the duty Inspector. 92. In the event that an officer submits the new form after dealing with an uncooperative victim the officer‟s sergeant should then review the form with the officer to ensure all appropriate checks have been conducted.

19

Third party reports 93. At present third party reports of domestic abuse not confirmed by the victim are not given crime numbers (crimes/domestic no crimes) and therefore not recorded on the crime recording system, which is problematic (see paragraph 71). It is suggested that in future such reports should at the very least be recorded on the force‟s intelligence system so the force is able to build up an accurate risk profile for the victim. 94. In addition, whilst difficult, it is not impossible for a domestic incident to be prosecuted even without the victim‟s cooperation, provided that sufficient independent evidence is available.

High risk victims: Access to Multi Agency Risk Assessment Conference (MARAC) and other support groups 95. Victims who are deemed to be at high risk of significant harm are considered for inclusion in a MARAC. However, only a small number of high risk cases can actually proceed to MARAC due to resource constraints. 96. Those high risk victims who are not forwarded to MARAC receive a lower level of intervention than medium risk victims, who may receive support from the Community Beat Manager (CBM). High risk cases that do not progress to MARAC remain with the original investigating officer and do not get CBM support. This is neither logical nor safe. 97. A minimum of forty cases are discussed at the Nottingham MARAC every month. A discussion as to which cases will then be taken to MARAC takes place, although the rationale for these decisions is not documented. 98. The current domestic abuse policy does not contain reference to Victim Support and how officers can introduce victims to the service. There is a general document

20

regarding the information sharing relationship between the force and Victim Support, but this investigation found it to be an impenetrable document.

Access to the Child Abuse Tracking System 99. Access to the child abuse database would have been of limited use to Control Room staff in this case, as only 3 of a possible 7 domestic incidents were recorded on the database due to officers failing to submit forms. Therefore, an interrogation of the system would not produce an accurate reflection of the frequency and severity of incidents. 100. However, it is of concern that database access has still not been successfully rolled out to all control room staff despite concerns being raised by the Gail Hdili investigation. The IPCC has been told that some but not all control room staff have access. We acknowledge that the force has encountered a number of problems that have frustrated the desire to give universal access to the system, but these appear to be a result of a lack of coordinated work across different business groups within the force. 101. The investigation was also advised that it is still not unusual for officers to fail to submit a child protection form.

Use of the Force Intelligence System 102. The force‟s domestic abuse policy made one reference to MEMEX entries: it states that reports made by third parties not via the control room should be subject of MEMEX entries. The document is otherwise silent on the issue of domestic abuse intelligence despite clear national policies that highlight the benefit of recording such information on local intelligence databases.

21

Commissioner‟s Conclusions

103. Casey Brittle was a young mother who was killed by a man well-known to local police for his propensity for violence and threatening behaviour. Her death is a tragedy for her friends and family. 104. It is also tragic that it takes such a death to serve as a poignant reminder to all police officers and the police service, of the vital need to remain vigilant to the consequences of not taking positive action when dealing with domestic abuse. 105. When a woman reports violence at the hands of a man who has already abused her, the police service must take effective and positive action. It is established that taking such action helps prevent needless deaths of women like Casey. 106. In this case it is clear that a number of officers failed to perform to the level expected of them. This was borne of a lack of knowledge and a willingness to accept the word of a woman who had suffered years of abuse when she said she did not want or need their help. As a result basic actions that may have helped others see the full picture of her suffering were not completed. 107. No consideration was given as to why Casey was reporting domestic abuse but then saying that she did not want police help. This was a young mother living in constant fear of a man for what must have felt like an eternity to her. Little thought was given finding a way to prosecute Williams without the need to rely upon Casey as a witness. This is particularly pertinent as there were independent witnesses to some of the incidents. Not least, security guards who saw visible injuries on Casey, heard Williams threaten to kill her and were present when he telephoned her and threatened to shoot her family with a gun. Sadly, this evidence which could and should have been obtained at the time was not obtained until after she had been murdered. 22

108. It is clear that beside the failings of individual officers, Casey was significantly let down by systemic failures within Nottinghamshire Police. 109. The facts of this case are particularly distressing as Nottinghamshire Police were given impetus to improve following the horrific attack on Gail Hdili. As we now know the changes that were so obviously needed then were not made. 110. The IPCC makes recommendations to police forces, to help improve their response in dealing with domestic abuse and to ensure that lessons are learnt from cases we investigate. This is to ensure the same mistakes are not made again. 111. Having been told where to make improvements previously Nottinghamshire Police failed to put in place the right systems and policies that would have helped their officers deal with the abuse Casey was suffering. The lack of a corporate approach first seen in the Hdili investigation are present in Casey‟s case, from the incremental roll out of training, through to the failure to update the force policy despite the prompting of a review date and the introduction of the DASH model. 112. Having considered all the information gathered we have been unable to say with certainty that if officers or the force had served Casey better then she would still be alive today. Sanchez Williams was a violent offender with scant regard for the law. It is impossible to judge what impact any positive action taken by the force would have had on him and his attitude to Casey. 113. Members of the public will no doubt be shocked by the findings of this investigation and it is of great concern to me that it may mean that victims may hesitate to report domestic abuse to the police. I would urge those who find themselves suffering at the hands of an abuser not to take this course of action. Reporting domestic abuse is an act of enormous personal courage and involving the police is still the main way victims can break the cycle of abuse.

23

114. During the course of these incidents and our investigation Nottinghamshire Police has been subject to an intense period of change and scrutiny. We have been reassured by the force that lessons will be learned on this occasion and I hope, for the sake of those who need the police‟s help, this truly is the case this time.

Commissioner Amerdeep Somal Date 15 September 2011

Appendix A http://www.ipcc.gov.uk/news/Pages/pr_281010_hdili.aspx

A Commissioner's report is not an IPCC Investigation report. The purpose of a Commissioner's report is to share with the public the key findings and summary of the IPCC investigation, including the Commissioner's own decision making, the outcome of any legal processes that followed from the investigation, and the learning recommendations. The report belongs to the IPCC Commissioner who retains oversight of the investigation. The Investigation report is provided to the family or complainant, the police force, individual officers, and with a Coroner ahead of any Inquest. The Investigation report and related evidence is also provided to the Crown Prosecution Service when the IPCC considers that serious consideration should be given to whether or not a person should be prosecuted for a criminal offence. Investigation reports are published only in exceptional circumstances because of data protection or other legal restrictions.

24