§ The Secretary of State for Social Services (Mr. Richard Crossman)
With your permission, Mr. Speaker, and that of the House, I should like to make a statement on the Report of the Committee of Inquiry into the Ely Hospital, Cardiff, which has been presented to the House this afternoon as a White Paper, Cmnd. 3975. I apologise for the length of this statement.
The Committee of Inquiry was set up in 1967 by the Welsh Hospital Board, at the request of my right hon. Friend the then Minister of Health, to investigate allegations of ill-treatment of patients and of pilfering by staff which had been made by a nursing assistant employed at the hospital. The Committee was also asked to make its own examination of the situation in the hospital at the time of its inquiry.
The Committee, under the chairmanship of Mr. Geoffrey Howe, Q.C., has done its work with a thoroughness, fairminded-ness and humanity which must command universal respect. This makes it all the more disturbing that the Report is highly critical and will, I am sure, cause as deep concern to Members as it does to me. It is for this reason and because I consider that it should be used at once as a basis for remedial action that I have decided to take the unusual course of publishing it in full, omitting only the names of individual patients and staff.
The Committee finds, first, that most of the specific incidents alleged by the nursing assistant as examples of ill-treatment did occur. Secondly, the Committee finds that many members of staff in the wards made use of food supplied for patients, and that excessive quantities of meat were provided to nursing staff. These aspects of the Report have been referred to the Director of Public Prosecutions. Thirdly, the Committee finds that an atmosphere existed in which well-intentioned members of the nursing staff felt it hazardous to complain; two who did so had to leave the hospital.
Responsibility for serious deficiencies in standards of medical and nursing services and of administration is attributed to the senior staff of the hospital, to the hospital management committee and 1809 to the Welsh Hospital Board. The Committee also criticises the present procedures for dealing with complaints in the hospital service as a whole. And finally the Committee recommends that a system of inspection of such hospitals is needed—the form of which it leaves me to consider.
The House will, I am sure, wish to study the; Report before coming to conclusions. Nevertheless, I think hon. Members will expect me to say today what the Government's attitude to it is. As the Minister responsible, I accept the Committee's findings and recommendations about Ely. I add, however, that it would be quite wrong to draw conclusions about the standard of care in long-stay hospitals from these findings. I would remind the House that these findings do not apply to the whole of the hospital service or even to the whole of Ely Hospital: they apply only to four wards and one villa for children. To draw general conclusions from this limited evidence would be quite wrong. Indeed, in the course of an extensive series of visits up and down the country I have myself been deeply impressed by the skilled and devoted service given by staff in long-stay hospitals, who have, all too often, been working for many, many years under heartbreaking difficulties, and I am very much aware that if this Report were published without a firm assurance of strong remedial action, it could shake their morale. In expressing my confidence in them, therefore, I at once add this assurance to them and to the House. The conditions which have existed for so many years to which many of them have been calling attention for a very long time and in which such grave deficiencies as have been revealed at Ely can far too easily breed, are fully and frankly recognised by my Department, and I am already taking steps to ensure that they will be dealt with effectively by the Regional Hospital Boards.
One of these conditions is professional isolation. The main recommendation of the Report is that a new system of regular visiting and inspection is needed. I agree. And while the details are being worked out I am setting up a small working party in my Department to analyse the knowledge already available on these hospitals, and to supplement this survey where necessary with its own investigation.
1810 Secondly, I have already asked each regional hospital board chairman to reassess the situation in his region and to present a report to me at our next meeting in April.
I hope the House will permit me one further general observation. We are in the midst of a medical revolution in the treatment of the diseases of old age and mental illness. As the span of life is extended, long-term, often permanent, hospitalisation, which only 20 years ago was the norm for these patients, is being replaced by intensive treatment given in short spells in hospital. In planning the Health Service of the future, therefore, we are able to assume a massive reduction in the proportion of hospital beds—and of long-stay hospitals—required for geriatric and mentally ill patients.
Unfortunately, this does not apply to anything like the same extent to the mentally subnormal. For the foreseeable future many thousands of them will need resident hospital care for very long periods; and this means that there is no prospect of doing without this class of hospital, which I am afraid still remains a deprived area within the Health Service as, indeed, it was long ago when the Service came into being. The advice issued by my Department in 1965 to stimulate improvements, which this Report commends, was a good beginning. It shows what can be done. These hospitals must be given their fair share of manpower and money, even if this means, as it will mean, a reallocation of resources within the Health Service. I shall be considering with the Boards ways and means of starting this difficult operation as soon as possible.
§ Lord Balniel
This is a very grave and disturbing Report, and the right hon. Gentleman is absolutely correct to publish it in full. We must await our study before we reach a final conclusion. But what disciplinary action is the right hon. Gentleman intending to take following the Report?
We have considerable reservations about the system of inquiry which was set up after the allegations made in the "Sans Everything" booklet, partially because the inquiries have no power to secure the attendance of witnesses, and partially because there is uncertainty as to whether their function is an executive 1811 function to secure improvements in hospitals or a judicial function to secure a judgment of allegations.
I welcome the decision to establish an inspectorate because this will be a mark of public concern for the inarticulate and unfortunate, and I believe that it will be of value not only to the patients but also to the staffs, the vast majority of whom are dedicated to the service which they render to the unfortunate. Is it the intention of the Secretary of State that the reports of the inspectorate should be published so that we can have a well-informed public discussion annually on the hospital service?
Does not the heart of the problem lie in the fact, as shown in the last Annual Report of the Ministry of Health, that the major building projects of the hospital service amount to £215 million while only £7 million is devoted to the building of psychiatric hospitals?
§ Mr. Crossman
I thank the hon. Gentleman very much for the way in which he has listened to this extremely unpleasant statement. He asked me first about discipline. Consideration of disciplinary proceedings must be postponed so long as the Report is under consideration by the Director of Public Prosecutions. I can say, however, that the charge nurse who was implicated—the nurse called "U" in the report—has been suspended pending these proceedings, and that the chief nurse in charge may be moved to another hospital. The rest of the disciplinary action must wait until the Director of Public Prosecutions has completed his consideration.
I agree with the hon. Gentleman about the system of inquiry. This is something which the Howe Committee made very clear to me. One of my aims in producing this new department for scrutiny is to ensure that we distinguish between scrutiny and the study of complaints. For the study of complaints, we may well have to consider the possibility of having a Health Services' Commissioner. I want to have a continuous scrutiny here such as other Departments have, although I do not like the word "inspectorate" because there is a long tradition of resistance to it in the nursing and medical professions. We have to think of an equivalent in terms of something that 1812 they will accept and which the nurses will feel that they can go to without fear of victimisation.
I shall ensure that the head of the new department is responsible personally to me so that there is no doubt of the department's independence in the service. We shall have to consider the question of publication of the reports later, but I agree that we want to get the maximum publicity about the conditions of the Service—remembering that what we have to discuss today is, I am sure, an odious exception.
§ Mr. E. Rowlands
This Report is shocking and a tragedy for both patients and staff, perhaps most of all for those who were found doing what they were doing. The House welcomes the great candour with which my right hon. Friend has dealt with the problem and also his decision to publish the Report.
The disciplinary measures taken have been a specific action. What now does my right hon. Friend intend to do to try and restore the morale at the hospital? In particular, does he intend to announce any measures to improve the facilities there?
Secondly, while his new Working Party is trying to work out the new procedures of inspection and scrutiny, will my right hon. Friend ensure that the maximum co-operation and consultation is carried out with the medical and nursing staff in the service, because it is desperately necessary to restore the morale of the whole nursing staff in this type of hospital?
§ Mr. Crossman
A good deal has already been done at Ely Hospital, I am glad to say. First, the hospital management committee in question is being disbanded and a new one created which will include not only Ely but other hospitals together so as to bring it up to the level of the others. Of course, once the old hospital management committee knew about the situation, I am also glad to say that the hospital was given £10,000 additional revenue for this year and is being given £20,000 next year.
Thirdly, and not least important, a League of Friends of Ely Hospital has been started locally. Half the trouble has been lack of local contact, a certain isolation, and I am delighted that the League of Friends has been set up.
1813 The nursing staff establishment has also been increased. The physician-superintendent has been moved elsewhere and the junior medical officer most severely reprimanded in the Report is leaving and a locum is taking his place. Drastic things have been done, but I remind the House again that what is involved is only four wards and one villa in one hospital, and I know that the House will want the hospitals to feel encouraged that these things will be put in order.
I could not agree more about the medical and nursing profession. It is no good simply copying other Departments. We cannot have H.M.I.s in the Department of Health. It is not the tradition. Whatever organisation we set up for scrutiny and advice must have the full support of the professions, and I shall be consulting the professions at every stage.
§ Mr. Turton
While appreciating the danger of drawing general conclusions from this unfortunate case, may I ask the right hon. Gentleman whether he will not take the opportunity to review his policy of treatment of the elderly long-stay patients with a view to securing that they are not kept in large institutions very far from their own homes and visitors?
§ Mr. Crossman
I agree with the right hon. Gentleman. As he knows, he and I have a great deal in common in our general attitude to this subject. But the preservation of old hospitals remote from centres of population is one of the things we have to consider as a danger. We have a dual responsibility. We want to enable old people to live in their own homes if possible by providing good community services. But if they have to go to hospitals, they must be under the very best medical supervision. We must ensure that if possible.
§ Mr. Moonman
There will be considerable respect, both in the mental health organisations and in the House, for the Secretary of State's courage in publishing the Report in full. What action does he intend to take at the hospital itself to deal with the matter? How does he intend to ensure a proper feed-back? In view of the increasing number of people needing medical treatment—now one in 10 of the population—will my right hon. Friend seize an early opportunity 1814 to make a policy statement on this in the House?
§ Mr. Crossman
It is not really for me to suggest what we should debate in the House, but the whole problem of long-term stay is something which I hope the House will take seriously, because it is a most tremendous community problem.
I must make a sharp distinction here between hospitals for the subnormal and hospitals for the treatment of mental diseases. The problems arise mainly in hospitals for the subnormal precisely because there is so much less that one can actually do in cure. There is not so much incentive in that sense for good doctors to be in such hospitals. So far as we can see, there is less need for anxiety about hospitals which are psychiatric in the sense of curing mental diseases.
I have given a list of the improvements made in Ely Hospital and have referred to the removal of certain persons. I think that the basic clean-up, if I may put it that way, which was necessary has been achieved. From 1st April next, my right hon. Friend the Secretary of State for Wales will be in charge of the health services in Wales and will be answering questions on the details of Welsh hospitals.
§ Mr. Hooson
While reserving general comment until I read the Report, there is one matter of importance I wish to raise now. Did I understand the right hon. Gentleman to say that two well-intentioned nurses who reported these matters were forced to leave the hospital? Were not these cases of victimisation? If so, surely these matters should be referred to the Director of Public Prosecutions if morale generally in the hospitals and with regard to discipline is to be restored. If these two young men made complaints and as a result were forced to leave the hospital, surely the matter deserves investigation by those responsible for prosecution?
§ Mr. Crossman
I do not think that this matter is for the Director of Public Prosecutions but rather for the administration, the regional hospital board. One of these nurses has been restored to a position already. I must say that victimisation of this sort is, among all the other things that I found in the Report, most odious and alarming. These 1815 two nurses genuinely tried to complain and each in a different way lost his job. Victimisation of a nurse who wants to put things right must be avoided at all costs in working out our scheme for professional advice or scrutiny. It is immensely important to have a system whereby such people as nurses can make a case without fear of victimisation. This is the biggest single deficiency which Mr. Howe's investigation has exposed.
§ Mr. Driberg
Is my right hon Friend aware that autistic children who are often not mentally subnormal are often sent to hospitals for the mentally subnormal where they should not be, and where there is no treatment available for them? Secondly, when the inspectorate, or whatever it is to be called, is set up, will the inspectors pay their visits without warning to the hospitals for the mentally subnormal, and will there be an early visit to South Ockenden, from which there have been some very disturbing reports?
§ Mr. Crossman
The problem of the autistic child is very difficult. It is a problem which is to do with the psychiatric hospitals. Often we find at a hospital that the subnormal children are not strictly subnormal but are diseased in the mind and should be getting treatment in a special institution, such as the hospital next door, in this case, which was a very good psychiatric hospital. One of the problems is the contrast between the goodness of one hospital in the group and the weakness of another. As to South Ockenden, this is something which my hon. Friend should put to me by way of a Question.
§ Mr. Maurice Macmillan
Can the right hon. Gentleman give us some idea of the implications of the Report for administration? He has said that the difference between the good and the bad hospitals in a group can be considerable. Has he considered what changes may be needed in the structure of the regional boards, chairmen of the management committees and so on? Can he say whether he has any ideas in future to secure the high quality of public chairmen in the structure of the boards?
Secondly, does he really think it realistic to assume that he can get the money needed for this purpose, bearing in mind 1816 the special needs of hospitals for the subnormal by switching within the Health Service? Does he not think that this requires a larger amount of money being put into the Health Service?
§ Mr. Crossman
I am always glad to have support for getting more money out of the Chancellor. As to the structure, it was interesting to me that the Committee specifically mentioned that in its view the tripartite artificial separatism of the hospital service, with G.P.s and the local authorities, was one of the causes of what happened at Ely. I only report the fact that those of us who favour a unitary service received considerable support from the findings of the Committee. I felt that it would be a help in our later deliberations.
On the subject of personnel, and I am glad the hon. Gentleman mentioned this, I have no doubt that the Minister must take responsibility for the fact that so much of the report is concerned with the inadequacies of people on the hospital management committee, which I do not directly nominate, and also on the regional hospital board. We have to face it, that if we have selection, and people are nominated, they should not be there for ever. They should not be regarded as permanent fixtures. We must get young, vigorous people who really will do a job. I take this as one of the personal lessons of this Report. What I have to do, and persuade each regional hospital board chairman to do, is to harden his heart and rejuvenate some of his committees.
§ Mr. Pavitt
Is my right hon. Friend aware that the balanced responsibility of his statement and its perspective will give a great deal of satisfaction to thousands of mental nurses and other staff giving devoted service for the mentally subnormal? May I express the hope that the way in which the Press reports it will reflect that balance? Does he recall that in 1965, when regional hospital boards were instructed to restrain expenditure, the two exempted categories were mental health and geriatrics? In the light of this Report, would he add his support to the Parliamentary Labour Party's Health Group which is demanding a Select Committee on the National Health Service constantly to examine health organisation and its problems?
§ Mr. Crossman
I will give my support to any Select Committee which will investigate something I want investigating. With regard to 1965, my hon. Friend is quite right. In 1965 my hon. Friend the present Minister of Planning and Land gave specific instructions that special priority should be given to these mental hospitals, and hospitals for the subnormal. It is to his credit that the number of nurses has risen more sharply in our subnormal hospitals than anywhere else in the Health Service—from 12,000 to 14,000—and that the capital investment programme even though it is still inadequate, has gone up from its former miserable level. These are things which we started, and which we now need to accelerate. I could not agree more with my hon. Friend's other point. In deciding to publish this Report, despite the possible harm it will do to the patients, I was concerned with the public interest. The presentation of the Report by the Press will very largely determine whether it has a catastrophic result on morale in the service. I hope that the Press will bear in mind what my hon. Friend has said.
§ Mr. Dean
Does the right hon. Gentleman accept that this grave Report is bound to cast a cloud over all long-stay hospitals and those associated with them? In view of this, will he press ahead with all speed in establishing an inspectorate, which he is now proposing and which we have been proposing from this side of the House for some time, so that the overwhelming majority of staff in these hospitals, carrying out devoted service, will be given a clean bill of health? As to the hospitals for the mentally subnormal, will he bear in mind in his discussions the growing burden on the staff as the life-span of the very severely disabled is increased through medical science?
§ Mr. Crossman
I agree with what the hon. Gentleman has said. In reply to his last point, we have not only the lifespan to consider, but we have to face the fact that in some parts of the country people are decanted into long-stay hospitals because they are an embarrassment elsewhere. We shall have to harden the hearts or strengthen the courage of those who run the hospitals, to refuse to overcrowd them. If we are soft-hearted and say that there is to be a fourth line of 1818 beds in a certain ward because the local authority wants us to take more, we ruin the chances of these people who are resident there having a decent life. We have to lay down minimum standards for them and maximum numbers, and insist that they are kept, whatever the difficulties to the local authority.
§ Sir M. Galpern
My right hon. Friend has referred to the heart-breaking conditions that often obtain in these hospitals. Is he attributing the causes of these conditions to the boards of governors, the regional managers or the hospital staffs, or is he conveying to the House that there has been a sad neglect in the provision of reasonably modern conditions for the inmates of these hospitals?
§ Mr. Crossman
I hope that I have referred to the last position. In my statement I described these hospitals as still a deprived area within the service. They have been that ever since the service was started. We all bear responsibility for leaving it there, and unless we think of these things without blaming others we shall not get them put right. Public opinion has to face it, that if we are spending vast sums, as we are, on making wonderful new hospitals for acute illness and acute surgery, we must bear in mind the hundreds and thousands of people in these other places and realise that if the gap between them is intolerable then the danger of an Ely becomes greatly increased.
§ Several Hon. Members rose—
§ Mr. Atkinson
On a point of order. My hon. Friend the Member for Barking (Mr. Driberg) has asked questions about the South Ockendon Hospital. I have a constituency interest in that point. I must ask for your sympathy to be allowed to put my question.
§ Mr. Speaker
If the hon. Gentleman has a special constituency interest in this problem I think he has a right to put a question.
§ Mr. Atkinson
With regard to the South Ockendon Hospital, may I bring to the attention of my right hon. Friend the case of a young patient who died on 22nd February as a result of violence? That boy has not yet been buried. His 1819 mother is extremely anxious, not knowing what is happening to the boy. She has not been told, she only knows of his death. We cannot get anything from the hospital as to what is to happen to the boy, and the police say that they are not satisfied with their inquiries. There is no knowledge as to when his funeral will take place. May I ask my right hon. Friend to take some urgent action to look into this case and secure this boy's burial?
Of course, I can say that the case is being looked into, but I beg my hon. Friend, if he cares about these things, to put Questions down as soon as he hears about them and not wait for a debate on another subject. South Ockendon must not be mixed up with it. This is a quite different problem, and I am looking at it.
§ Mr. Arthur Lewis
Further to that point of order. May I raise a similar case affecting the same hospital? I have taken my right hon. Friend's advice and put down a Question, and I have written to him about it. I am still awaiting a reply. Will he please do something urgently?
§ Mr. Crossman
I appreciate what my hon. Friend says, and remember his letter to me. The case is being looked at with great urgency. I will give my hon. Friend a reply, but I am sure that he would rather wait for the proper reply than not have a thorough investigation.
§ Mr. Speaker
Order. I stretched a point in giving the hon. Gentleman his 1820 question. I hope that we can now get on.
§ Mr. Speaker
Order. That is not a point of order. There are often differences of opinion between hon. Members who ask questions and Ministers who answer them.
§ Mr. Brooks
On a point of order—and I hope that you will regard this as a genuine point of order, Mr. Speaker. As my right hon. Friend has indicated that criminal proceedings are actively under consideration, it might be for the convenience of the House to have guidance on whether the Report will contain the minutes of evidence or other material which, if quoted outside, might involve certain legal difficulties.
§ Mr. Speaker
Order. That is not a point of order, but a question that the hon. Gentleman might have asked if he had had the good fortune to catch my eye. Many hon. Members wish to ask questions on statements. I cannot call them all.
§ Mr. Brooks
Surely it is important that hon. Members should know whether, in comments they make outside the House, any references to, or elaborations of, points in the Report might involve difficulties in the light of future criminal proceedings?
§ Mr. Speaker
Order. As I heard the Minister, he did not indicate that criminal proceedings have begun. I leave it to the Minister, if he wishes to answer.