Tuesday, 9 August 2016

Marking Your Own Homework

It looks as if David Cameron's legacy has started to unravel quite quickly with yet more bad news concerning his poor judgement skills that have echo's of the money he was persuaded to throw at failed charity Kids Company. It's also a perfect example of the flaws inherent in Payment by Results scams. We start with a comment from this blog on 3 June 2015 at 07:38

"no link between performance and bonus"?

I watched with interest an article on Newsnight this week about the governments Troubled Families project. Local councils were given considerable funding on a PbR basis for successful outcomes in turning troubled families around. There was apparently 120,000 families requiring intervention, although no one could identify how this figure was reached. The councils were left to determine what interventions were necessary, and also left to their own determination of what a successful outcome would constitute, (marking their own homework was the phrase used). 

Amazingly, all 120,000 families had their lives successfully turned around! Not one failed which was 'lucky' for the councils as they could claim the maximum amount available under their PbR contract for their success. No doubt some got pretty good bonuses, and no doubt CRC owners have learned a lot about how to make a PbR model really pay dividends - and achieve a 100% success rate!


Well, like a dog with a bone, BBC's Newsnight have returned to the subject. This from the BBC website:-

Troubled Families report 'suppressed'

An unfavourable official evaluation of the government's flagship policy response to the 2011 riots has been suppressed, BBC Newsnight has learned. The analysis found that the Troubled Families programme had "no discernible" effect on unemployment, truancy or criminality. The initial scheme sought to "turn around" 120,000 households at a cost of around £400m. The local government department has been approached for comment.

The report, which the government has had since last autumn - and seen exclusively by BBC Newsnight - is embarrassing for ministers, who not only implemented the scheme, but have since decided to extend it. They had trumpeted previous assessments of the scheme, which had suggested that 98.9% of families participating in the scheme had been "turned around".

Furthermore, a second wave of the Troubled Families programme was announced in June 2013, and began to roll out in April 2015. It covers another 400,000 families at a further cost of £900m.

The "troubled families" programme was aimed at those affected by high unemployment, truancy and anti-social behaviour. The scheme was intended to save money and prevent future rioting by reducing the problems of this group of disadvantaged families. A senior civil servant told Newsnight that the report is "damning", and attacked the scheme as "window-dressing".

Troubled Families was a project pushed by the last prime minister. In August 2011, shortly after the riots, David Cameron announced that he would "put rocket boosters" under existing plans being drawn up in Whitehall "with a clear ambition that within the lifetime of this Parliament we will turn around the lives of the 120,000 most troubled families in the country".

In December 2011, the then prime minister added: "Some in the press might call them 'neighbours from hell'. Whatever you call them, we've known for years that a relatively small number of families are the source of a large proportion of the problems in society." The government also committed that the effectiveness of the policy would be measured by a consortium of analysts led by a consultancy called Ecorys. The evaluation was expected to be published. But the document has been kept under wraps in Whitehall. An official who had read the report told Newsnight that it was being suppressed because of its findings.

No measurable impact

This official analysis of data from 56 local authorities covering the first 18 months of the programme states: "The lack of obvious effect from the programme across a range of outcomes indicates that the programme did not have a measurable impact on families within the time-frame over which it was possible to observe its effects."

It found "no discernible impact on the percentage of adults claiming out-of-work benefits" and "no obvious impact on the likelihood that adults were employed" 12 or 18 months after starting on the programme. The analysis also found it "did not have any discernible impact on adult offending" seven to 18 months after the family was booked into the programme.

They added: "Whilst it was more difficult to match the treatment and comparison groups when looking at child outcomes, the findings suggested that the programme also had no detectable impact on child offending." Their analysis of truancy got different results depending on how the data was analysed, leading analysts to conclude that "any impact that the programme had on the absence rate was not robust".

The researchers reported some problems with data quality and representativeness. "The sample sizes that the national administrative data provided meant that it was feasible to detect impacts which were relatively small in magnitude," they wrote.

The trouble with Troubled Families

The Troubled Families programme always had strange design features. Each local authority was given a target number of families to identify and recruit for the scheme - getting a payment of £3,200 for each household that they signed up.

The choice of families - households with some combination of factors such as truancy, anti-social behaviour and adult joblessness - did not seek to identify people involved in rioting. The ambition of the scheme was that the family would be assigned a single, co-ordinating key-worker who adopts a "persistent, assertive and challenging" approach and can "get to grips" with the whole family and look at the family "from inside out rather than outside in".

But the success criteria were very vague - families could be deemed "turned around" even while the children were still persistently truant or committing crime, just so long as they did so less frequently than they had done before. And councils received a further payment of £800 when the family met certain criteria that meant they were deemed turned around. Local authorities, therefore, had strong incentives to declare successes: lots of councils claim to have had 100% success rates.

Nationally, 98.9% of the 118,000 families in the scheme were deemed "turned around" - a remarkable success rate in any policy, let alone one working with people who have complex and multiple disadvantages. These figures were taken as proof of the success of the scheme.

Speaking in June 2015, Dame Louise Casey, until recently the civil servant in charge of the scheme, said: "It's fantastic news that the programme has now turned around the lives of so many troubled families. That's almost 117,000 families where kids are back in school and youth crime and anti-social behaviour has been cut, and in more and more of these homes an adult has now moved off benefits and into work."

Stephen Crossley, a researcher at Durham University who has been examining the scheme, has described the success rate as "unbelievable". A civil servant involved in the Troubled Families scheme, however, argued that while the programme might not work effectively "more money for social work probably can't be a bad thing right now".

This from the Guardian:-

£1.3bn troubled families scheme has had 'no discernible impact'

The £1.3bn government “troubled families” scheme to tackle entrenched social problems following the riots in 2011 has had no discernible impact on unemployment, truancy or criminality, an unpublished Whitehall report has found. The official evaluation of the programme launched by David Cameron has not been published because it would be embarrassing to ministers, it has been claimed.

A senior civil servant, interviewed for an investigation by BBC’s Newsnight, described the report by independent consultancy Ecorys as damning.

The initial troubled families scheme, launched by Cameron in 2012, sought to “turn around the lives of the 120,000 most troubled households in the country” at a cost of about £400m. A second wave of the scheme has since been launched to cover another 400,000 families at a further cost of £900m.

Cameron said he wanted to put “rocket boosters” into the system to underline the importance of strong parenting in preventing the kind of social problems that led to the riots in London and elsewhere. It aimed to break the cycle of problems such as poor parenting, domestic abuse and other issues including institutional care identified by Dame Louise Casey as contributing to the transmission of problems through generations.

Last year Cameron pronounced the scheme a runaway success with 117,000 families “turned around”, saving £1.2bn in the process. But a separate government-commissioned audit of the effectiveness of the programme has concluded differently. According to Newsnight, the Ecorys report examined data from 56 local authorities and concluded there was “no discernible impact on the percentage of adults claiming out-of-work benefits either 12 or 18 months after starting on the programme” and “no obvious impact on the likelihood that adults were employed 12 or 18 months after starting on the programme”.

“Participation did not have any discernible impact on adult offending” seven to 18 months after the family was booked into the programme, it said. Ecorys added: “Whilst it was more difficult to match the treatment and comparison groups when looking at child outcomes, the findings suggested that the programme also had no detectable impact on child offending.”

They also identified problems with the data quality and representativeness. “The sample sizes that the national administrative data provided meant that it was feasible to detect impacts which were relatively small in magnitude.” It said the success criteria were also vague – families could be deemed “turned around” even while the children were still persistently truant or committing crime, just so long as they did so less frequently than they had done before.

Councils were paid £3,200 for each family they signed up to the programme with a further payment of £800 when the family met certain criteria. Nationally, 98.9% of the 118,000 families in the scheme were deemed “turned around” by the government.


So, yet another social problem sorted by the 'Tsar for all seasons' the now handsomely-rewarded Dame Louise Casey, DBE CB. We all remember her famously getting to grips with homelessness by discouraging soup kitchens and criminalising thousands with ASBO's. She's moved on again of course and this from the BBC website explains what she's up to and the secret of her success:-

Louise Casey: The Asbo tsar set to tackle extremism

Louise Casey is to lead a review into improving the integration of Britain's minorities as part of a broader effort to tackle extremism. Why do prime ministers keep coming back to this most unorthodox of civil servants?

Call Casey - that's the cry that seems to go up in Downing Street whenever there is a hot button social issue to be tackled. For nearly two decades now, she has blazed a trail through Whitehall, charming Labour and Conservative leaders alike with her blunt, no-nonsense approach to complex problems.

She is the social worker who doesn't sound like a social worker, the policy expert who doesn't send you to sleep. As a result, she has collected more titles than a member of the Russian royal family. She was Tony Blair's Anti-Social Behaviour tsar, and then his Respect tsar and then - as the Labour government gave way to the coalition - the first Independent Commissioner for Victims and Witnesses for England and Wales (or Victim's tsar).

She gave up that role to take charge of an inquiry into the 2011 London riots. Then, in September last year, she was appointed by former local government secretary Eric Pickles to head the independent inspection of children's services at Rotherham Council in the wake of the child sexual exploitation scandal and examine whether it covered up information about the abuse.

Since 2011, her main job has been director general of the government's "troubled families" unit. She has her critics - she was once branded the "punitive face of Tony Blair" by probation officers' union boss Harry Fletcher, who took exception to her work on anti-social behaviour. But politicians seem to value her because, in the words of former Labour Home Secretary Jacqui Smith in a 2010 Radio 4 profile, she can "really cut through the bureaucracy and Blarney" and get things done. In a world of cautious, politically correct, hedge-betting civil servants, 50-year-old Casey has always stood out.

'Yob culture'

Casey was born in Cornwall and grew up in Portsmouth in a working class household - she and her brother were the first members of her family to go to university. She studied history at Goldsmith's College, London, and threw herself into student activism, marching against student loans and becoming a member of Amnesty International. Friends recall a big character, funny and charismatic, who loved making speeches and could not resist a karaoke night (Billie Holiday and The Beatles were favourites apparently).

Her first job was as a benefits clerk for the DHSS but she soon moved into the charity sector, with the London Homeless Network. By 27, she was deputy director of homeless charity Shelter. She was drafted into government in 1999 as the head of Labour's Rough Sleeper's Unit and ran into immediate controversy by suggesting that homeless charities were making it too easy for people to sleep on the streets by providing soup runs and top-of-the-range sleeping bags.

In 2002, Tony Blair made her head of the government's Anti-Social Behaviour Unit, with a brief to tackle "yob culture". She almost came unstuck three years later when she was secretly recorded making an expletive laden speech to police officers and senior civil servants in which she appeared to mock her own department's stand on alcohol abuse.

"I suppose you can't binge drink any more because lots of people have said you can't do it. I don't know who bloody made that up; it's nonsense . . . Doing things sober is no way to get things done," she told her audience.

'Sleep with the devil'

She also took a swipe at one of the favourite Whitehall obsessions of the era: "If No 10 says bloody 'evidence-based policy' to me one more time, I'll deck them." She came close to being sacked over that incident but was cleared by an internal civil service investigation. She became a little more guarded in her public statements after that but still managed to grab headlines on a regular basis.

"The Daily Mail don't like me 'cos I'm female and fat and lefty. Other people on the left think I sleep with the devil," she told The Guardian in 2013. The problems Casey has been asked to tackle during her career are often hard to define and even harder to measure.

Is there less anti-social behaviour in Britain and more "respect" as a result of Casey's work? Anti-Social Behaviour Orders were hugely controversial, with critics claiming they were too punitive and arbitrary. Casey claimed they transformed lives and they have survived, in modified form, to the present day. The troubled families unit was meant to "turn around" the lives of 120,000 families by May this year.

'Shame and guilt'

"We are not running some cuddly social workers programme," Casey told The Daily Telegraph when the scheme was launched. "We should be talking about things like shame and guilt...we have lost the ability to be judgmental because we worry about being seen as nasty to poor people."

The idea was to ditch the patchwork of different agencies in favour of a single, dedicated intervention worker, who would effectively take over the chaotic lives of those identified to be causing the most problems in their area. Casey ordered them to go where other social workers feared to tread.

"Some of these women are on child protection plans because of the men they insist on living with. Family intervention is about getting in there and saying 'actually, you know your kids are going to be taken away if you don't do something about this fella - I'll help you do it'. And they do," she told BBC News in 2013. Local authorities were paid by results, such as getting a child back into school, reducing crime or a family member getting, and keeping, a job.

In November last year, Eric Pickles said that more than 69,000 families had turned around their lives according to this criteria and the government was well on the way to meeting its target - but some wondered whether the improvements to the families in the programme would last.

'Crack alley'

Perhaps Casey's real value to politicians - and the reason she keeps being asked to produce reports on difficult social problems - is that she say is able to say things in public that they think privately (that social workers are too "soft" for example). She has the authority of someone who has got her hands dirty - she would go down a "crack alley" to find out why someone was taking drugs, a friend told a BBC Radio 4 profile - and the sort of drive to get the job done that is highly prized in the civil service.

But she also appears to have a handle on the emotional lives of those she is trying to help. "They've got trouble in their souls, trouble in their heart, troubles in their head," she said of the young single mothers who were the focus of the troubled families unit, arguing that their problems stemmed from "not having enough love or of having too much pain".

Her latest role - to produce "a comprehensive review into boosting opportunity and integration to bring Britain together as one nation", which David Cameron hopes will lead to more people from ethnic and minority backgrounds feeling they have a stake in society - must be her toughest, most wide-ranging and politically sensitive challenge yet.

One thing is certain though - she won't sugarcoat her conclusions.


  1. This is what CRC's are applying to Through the Gate. Every prisoner has a 'basic' risk assessment which is blank, a 5 minute meeting with an employment/housing advisor whether they need it or not, and a release date. Job done, targets met - kerching!

    1. It's deliberately not a risk assessment, see NOMS guidance, but a screening of what a prisoner says they need. So, not linked to any other information about risk or need, how useful or safe is that?

  2. "The Daily Mail don't like me 'cos I'm female and fat and lefty. Other people on the left think I sleep with the devil," Its not about her being a woman, or her dress size or who she sleeps with - Casey's real value to politicians is that she's a rhino-skinned judgmental bully who happily takes anyone's cash & has no qualms about fabricating outcomes to justify her actions. The sad fact is that through her ego-centric need to please her political masters (& her bank manager) she has taken large sums of public money away from those who need it.

    God help us all now she's been let loose on the new Tory obsession, i.e. their "one nation" project.

    1. Ego? What ego? This from .gov.uk - "Director General, Casey Review Team - At the request of the Prime Minister, Louise Casey is leading a review into opportunity and integration in some of our most isolated communities."

    2. Oh Yes Our Louise!!, the Justice seen Justice Done Tsar, employed by Blair to look at CP. Remember in 2009 she wanted Orange Jump suits USA Style for CP. We settled for orange H&S Vests with Community Payback and the "Frog" Payback logo. She slagged us off as too liberal and no community involvement in projects.Now CRCs cannot involve communities as it's too costly to deliver a service which is localised. In PF areas they will have PRCs running CP across 5 very large areas of England, not very local, but safe in the knowledge that they will still be wearing orange Hi vis Tabbards. Justice seen Justice Done.... Then our Louise moves to Victims Tsar (To be continued)....

  3. June 2015 - Huffington Post: "Cameron - "This has saved as much as £1.2 billion in the process. And in the next five years, we will work with 400,000 more.” Mr Cameron said that for years many thousands of hard-to-reach families had had visits from police or social workers but the Troubled Families programme actually sent specialists into the home to provide support. “It’s not that they don’t get intervention from the state. They get buckets of intervention. But what they don’t get is someone working in the family. And that’s what the troubled families programme has delivered. In some ways, it’s like old fashioned social work that’s been rediscovered and that’s no bad thing.”

    But within minutes of his speech, Jonathan Portes, Director, National Institute of Economic and Social Research (NIESR) told The Huffington Post UK that he stood by his claim that the purported savings were ‘pure unadulterated fiction’. In a blog for NIESR published earlier this year over similar claims, Mr Portes said ‘I doubt the North Korean Statistical Office would have the cheek’ to put out such statistics."

    1. Do As I Say, Not As I Do... In stark contrast to her past record (which has served the world of Dame Casey very nicely) here are some of Casey's own words from her 12 July 2016 speech to the Local Gov Association Conference:

      "... an MP simply has to swear to “be faithful and bear true allegiance to Her Majesty Queen Elizabeth the Second, her heirs and successors, according to law”.

      I think we might need to do better than this across our public sector, including councils, and set ourselves some higher standards.

      People should be proud to be a politician and public servant. It’s a good, decent and worthy thing to do. And the public should be able to be proud of you.

      I want 3 things from my political leaders – elected or otherwise:

      I want them to be kind, I want them to be honest and I want them to represent all of the people and not just some of the people, or sectional or special interests."

    2. From that 2015 NIESR blog post:-

      A troubling attitude to statistics

      Last week, a government press release trumpeting the success of the “Troubled Families Programme” (TFP) claimed:

      More than 105,000 troubled families turned around saving taxpayers an estimated £1.2 billion

      Much of the press was too supine and lazy to bother to question this, so many stories simply copied the press release. Sadly, that’s pretty typical, although the Mirror was a commendable exception.

      But the headline is untrue. We have, as of now, absolutely no idea whether the TFP has saved taxpayers anything at all; and if it has, how much. The £1.2 billion is pure, unadulterated fiction.

      The reasons why we don’t know yet are pretty simple and entirely justifiable. TFP is a complex, multi-agency intervention with a fuzzily defined target group and very diffuse costs and benefits. Evaluating its impact is a tough job. That’s why CLG, commendably, commissioned an independent evaluation of its impact from a consortium led by Ecorys. [Full disclosure: NIESR is part of this consortium, although I personally am not involved.] The evaluation has, as yet, again for very good reasons, not produced any estimates of impact, even preliminary.

      So where did CLG get the £1.2 billion number? The answer appears to be that they compared very rough, self-reported, estimates, by seven local authorities, of the amount spent by some local services on those families supposedly “turned around” by the programme, before and after the intervention.

      And why is that meaningless as an estimate of savings? Well, there are obvious problems with sample size, selection bias, and the fact that the local authorities get paid according to the number of families they have supposedly “turned around”. But even if we leave those issues to one side – even if we take a giant leap of faith and assume that the figures are somehow accurate - they tell us almost nothing about what would otherwise have been spent on those families, and hence of the savings. We do not know what would have happened without the programme. There is no counterfactual, and hence there can, by definition, be no estimate of “taxpayer savings”.

    3. To see this, think about someone who gets flu and is running a temperature of 38.5. We give her drugs, and a week later she’s running a temperature of 37.5. Did the drugs help? Maybe. Or maybe she would have got better anyway. Maybe the drugs delayed her recovery. Who knows? We don’t know the counterfactual. And on the basis of the information we have so far, we can’t.

      The only way we’ll know is by comparing her with someone else, also sick, and roughly similar, who didn’t get the drugs. That is the counterfactual. And that is what – using complex econometric methodologies and lots of data – the evaluation will try to do. But at the moment we have no idea what the answer will be.

      So are CLG officials stupid or ignorant? Of course they’re not. Do they not understand the basic principles of programme evaluation – that you just can’t use figures like this? Of course they do. Buried in a “methodology report” on the CLG website is the following statement – not even referenced, let alone reflected in the press release:

      The Cost Savings Calculator (CSC) estimates the fiscal savings expected from the change that families experienced following support from the Troubled Families Programme. However, it is likely that some improvements in outcomes would have happened in the absence of any intervention. The improvement that would have happened anyway is commonly referred to as ‘deadweight’. As part of the independent national evaluation of the programme, data on a representative comparison group is expected to be used to estimate the outcomes that would have occurred without the programme. This will allow the evaluation of the additional impact of the programme at a national level, and produce estimates of ‘deadweight’ to be used in the CSC in the future. In the interim, the CSC uses the best available ‘deadweight’ estimates, based on whole population changes. However, in the report, all the figures provided are gross.

      “All the figures provided are gross”: in other words, exactly as I explain above, entirely meaningless, at least as estimates of “savings to taxpayers”. Until the results of the evaluation are in, we know nothing about whether there any savings, let alone what they are. In other words, civil servants knew the truth. And still they allowed the publication of a press release which, in a bold type headline, deliberately and successively sought to mislead the press and the public.

      There is lots more to criticise about the CLG publication. In particular, as Stephen Crossley points out, a close reading of the CLG report reveals that:

      Manchester (for example) have identified, worked with and turned around a staggering 2385 ‘troubled families’. Not one has ‘slipped through the net’ or refused to engage with the programme. Leeds and Liverpool have a perfect success rate in each ‘turning around’ over 2000 ‘troubled families. By my reckoning, over 50 other local authorities across the country have been similarly ‘perfect’ in their TF work. Not one single case amongst those 50 odd councils where more ‘troubled families’ were identified or where a ‘troubled family’ has failed to have been turned around.

    4. In other words, CLG told Manchester that it had precisely 2,385 troubled families, and that it was expected to find them and “turn them around”; in return, it would be paid £4,000 per family for doing so. Amazingly, Manchester did precisely that. Ditto Leeds. And Liverpool. And so on. And CLG is publishing these figures as fact. I doubt the North Korean Statistical Office would have the cheek. For those interested in this topic, Stephen has much, much more on the inconsistencies in the CLG analysis here.

      Frankly, this whole episode is disgraceful. Of course, it reflects badly on Ministers – and not just Eric Pickles, but Danny Alexander, also quoted in the press release. They are looking for positive stories about a programme for which it is simply too early to give any sort of verdict. So they are making claims that are not true. That’s politics, although I don’t much like it and I don’t think we should stand for it. But it reflects far worse on the civil servants whose professional duty it was to stop them. Deliberately misleading the public is not public service.

    5. Deliberately misleading the public (usually for personal advancement) is all that most politicians & civil serpents concern themselves with these days but as the blogger points out, "Much of the press [are] too supine and lazy to bother to question this, so many stories simply copied the press release. Sadly, that’s pretty typical..." There are exceptions & some exceptional journalists but presumably their editors/owners veto the truth to keep their political bedfellows sweet. Meanwhile La Casey joins the ranks of pantomime dames, alongside the dreadful Permanent Secretary (Brennan?) who fucked up at the MoD, got shifted to MoJ, talked shite about TR & retired into well-heeled obscurity. Oh to be in England...

  4. Not sure if i can change the subject but would be interested to know peoples views on fines, fines courts and these private companies ( bailiffs or fines collectors ) i have spent quite some time this week dealing with angry/ worried or upset service users who are dealing with baillifs or summons to fines court. Another sent to custody 2 weeks ago and the court didn't bother to even tell me! They are mainly unemployed or in and out of work with children. Who do the fines actually help when they are coming out of benefits anyway!

  5. National recommendations regarding courts/police working with probation... http://www.telegraph.co.uk/news/2016/08/09/convicted-rapist-killed-his-parents-after-being-released-on-bail/

    1. Convicted rapist killed his parents after being released on bail for knife offence

      A coroner is demanding the Home Office clarify bail rules for criminals on licence after a knifeman was freed to kill his parents and himself.

      Achraf Amrani, 30, was high on cannabis and ecstasy when he strangled and battered mother Zohra Amrani, 59, and stabbed father Hassan Amrani, 72, to death.

      The killer's body was discovered after falling 30ft onto a first-floor roof at his estate in Westbourne Park, west London, on February 13 last year.

      Three days earlier Amrani had been arrested after threatening a man named James Given with a knife on the same road.

      He was eventually released on "street bail" - usually reserved for minor offences - despite being on licence following his release from a seven-year sentence for rape in July 2013.

      An inquest into the deaths at the Royal Courts of Justice heard Amrani should have been recalled for 28 days following his arrest.

      But officers didn't inform the Met's Jigsaw team, which deals with registered sex offenders, or his probation team before Sergeant Sandy Gordon decided to bail him for a week.

      Sgt Gordon told the inquest he made the decision with "insufficient information" about Amrani's mental state and admitted he got it "very wrong".

      He received a written warning following an Independent Police Complaints Commission investigation, which recommended changes to the Police National Computer system.

      The Met are planning to change the PNC software so an automatic email will be generated and sent to Jigsaw teams if any changes are made to a sex offender's licence conditions.

      The changes will have to be agreed with the Ministry of Justice and the Home Office and are expected to be completed in October.

      Coroner Bernard Richmond QC said: "None of this works unless the probation service are thought of as being an integral part of the notification process."

      He continued: "In these circumstances that would not have stopped the problem would it, because essentially all the stuff that went wrong went wrong after office hours."

      He added: "What's really needed is a direction to all people considering bail that if we have a sex offender who is or may be on licence you shouldn't bail without phoning the probation service."

      The inquest jury ruled Mr and Mrs Amrani were unlawfully killed after suffering a knife wound to the abdomen and fatal blunt force trauma to the neck respectively.

      The seven men and four women opted to return narrative verdicts in respect of all three deaths.

      'The fact that the Jigsaw Team and the Probation Service were not informed of their son's arrest and the decision taken to grant him street bail were both significant contributing factors," said the foreman.

      Jurors also highlighted the same issue as a "significant contributing factor" in Amrani's own death.

      Of Amrani, they concluded: "Mr Amrani took his own life whilst the balance of his mind was affected."

      When officers arrested Amrani on February 10 they took him to be treated at St Mary's Hospital in Paddington because he was "high as a kite" and had overdosed on ecstasy.

      Police were aware he had previous convictions for carrying a weapon and cannabis possession before being jailed for rape in 2010.

      But Sgt Gordon told the inquest he thought the 'danger had passed' and bailed him for a week.

    2. The officer said he thought Amrani had "learned his lessons and was a grown up" because he had not been in trouble since being released from prison in July 2013.

      "There were two or three things from when he was younger but after the rape he had been in prison for three-and-a-half years and had not come to attention," said Sgt Gordon.

      Amrani agreed to stay in hospital for 48 hours but discharged himself and was spotted behaving in a deranged manner by a number of neighbours on his estate.

      Hospital staff did not inform the police that he had discharged himself.

      After the jury returned their conclusions, the coroner said he would be writing a report to the Home Secretary seeking answers to two crucial questions.

      "Firstly, whether or not there needs to be some national policy in place telling people to notify probation as soon as they become aware somebody is on licence," he said.

      "Secondly, whether street bail should ever be granted once you become aware somebody is on licence. The law requires that I get an answer to that."

      After thanking the jurors for their diligence and efficiency he added: "I want to offer my condolences to the family.

      "It is clear their daughter's statement that her parents and brother were well loved people. I am sorry it is this tragedy which has brought us together."