What happened
On 2 July 2023 Kazeema Afzal was working at Heath Lane Hospital in West Bromwich, run by Black Country Healthcare NHS Foundation Trust. A male inpatient, Kieffer Sutton, 25, became angry when a personal alarm went off and told her to take the battery out. Minutes later he charged at her and, within seconds, had the drawstring of his hoodie round her neck and knotted it.
She could not swallow or cry out. “I was looking at the door thinking someone will come and save me. I went numb and floppy. I thought, I’m going to die now.” She lost consciousness.
Afzal told the BBC that trust policy was to keep two staff in the room while a patient changed or went to the toilet, and that it had lapsed. Sutton’s care plan required the second member of staff to leave while he changed.
The outcome
A jury at Wolverhampton Crown Court convicted Sutton of attempted murder in May 2024. On 23 May 2024 Judge Simon Ward sentenced him to life with a minimum term of 13 years, calling him “a devious, manipulative person” and a “persistent danger” to the public. The court accepted that his personality disorder reduced culpability, and said the public needed protection. It heard he had 46 previous counts of violence, almost all against healthcare staff.
Afzal was left with PTSD and feared for her children. The trust declined to comment on the specifics.
What went wrong
The control that failed was a staffing rule. Two staff in a room with a high-risk patient is a structural control: it gives one person the job of watching while the other provides care. Afzal’s account is that the rule had lapsed, and that the care plan then required the second person to step outside at the point where the patient was changing.
That leaves a lone worker behind a closed door with a man who had strangled a nurse before. The plan was written for privacy, and privacy was allowed to outrank the presence of a witness.
The second failure is what he was wearing. A hoodie drawstring is a ligature, it was in reach, and no source records it being removed or secured.
The third is the alarm. He began by telling her to disable it, and no source records that being treated as the start of the attack.
What it teaches
Lone working is not only a home visit in a car. It is a side room on an inpatient ward, with the door shut and the second nurse outside because a plan says so. A service that counts bodies at the door has to count them again inside the room.
Where a care plan requires a staff member to leave, that is a decision about risk, and it belongs to someone who has read the history. Ligature risk includes clothing: drawstrings and cords belong in the same assessment as fixtures, and the check is routine rather than exceptional.
Questions for the room
- On your ward, who is the second person in the room, and what makes their presence non-negotiable?
- When a patient tells you to turn off your alarm, what happens next, and who is told?
- If a plan asks you to step out and leave a colleague alone, who reviews that plan?
Evidence and limits
Confidence: confirmed. Two BBC News reports were read in full, on the trial and sentence. The account of the lapsed two-staff policy and care plan is Afzal’s own, given to the BBC. No trust investigation is in the sources, and the trust declined to comment on the specifics. The 46 previous counts are as the court heard them.
Our lone working training covers lone working inside staffed buildings, including the side room and the second pair of eyes.
Sources
- BBC News, May 2024 · https://www.bbc.com/news/articles/clww2wv79dgo
- BBC News, 2024 · https://www.bbc.com/news/articles/cnd6kxw0xdlo
Reviewed 20 October 2026.