WHITTINGHAM HOSPITAL (Hansard, 15 February 1972)

§ The Secretary of State for Social Services (Sir Keith Joseph)
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 administration of, and conditions at, Whittingham Hospital, near Preston, Lancashire. The report has been published this afternoon in Command Paper No. 4861.
Allegations of ill-treatment of patients, fraud and maladministration at Whittingham were made in confidence to my predecessor in 1969. These were followed by a special audit investigation and inquiries by the police. Shortly after the police inquiries were completed a nurse was tried and convicted of manslaughter of a patient. As soon as I was free to do so after these proceedings I set up the committee of inquiry, which made its report to me early in November. Publication of the report has been delayed while charges against two other nurses, on which both were acquitted. were before the courts.
The report is very disturbing. It is highly critical of standards of medical and nursing services in some parts of the hospital, particularly for longer-stay patients, and of the management. It also criticises the Manchester Regional Hospital Board, and to some extent my Department also. With a few qualifications, which are not however central to the main issues, I accept the conclusions and recommendations.
The report assesses Whittingham as a hospital of wide contrasts and an extreme example of a hospital which has failed 247 to keep up with the times. Side by side with some good modern services, it found in the long-stay wards evidence of old-fashioned methods, inadequate treatment and rehabilitation, poor buildings and insufficient medical and nursing staff. The report severely criticises the medical and nursing administration, the management structure and the way these worked; it describes the result as a hospital with day-to-day tactics but no overall strategy The committee of inquiry believes that in these conditions there have been instances of ill-treatment and large-scale pilfering by some members of the staff and the further evil of suppression of complaints about such practices when made by junior staff.
As the House knows, I have set up a Committee to review the procedures for dealing with complaints in hospitals, and I have arranged for this most distressing aspect of the Whittingham Report to be brought to its attention.
The report apportions a share of the blame for the general state of affairs at Whittingham to the regional hospital board, which, while pioneering the establishment of psychiatric units in general hospitals, did not adequately recognise the needs of elderly long-stay patients, which led to dual standards of care. I accept that my own Department as well as others may not have been sufficiently alive to this danger in earlier years. Our present policies take full account of it.
The report recommends that all members of the Whittingham Hospital Management Committee should be invited to resign and the committee reconstituted. It also recommends complete operational integration of the medical and nursing services at Whittingham with those of the psychiatric unit at Preston. Such integration is undoubtedly most desirable, but in my view it is doubtful whether it can be achieved satisfactorily without amalgamating under a single hospital management committee the hospitals at present in the Whittingham and in the Preston and Chorley groups. The board has already started local consultations on proposals for amalgamation. The chairman of the Whittingham committee resigned in December on grounds of ill-health, and four other members have resigned in the course of discussions of the proposed amalgamation. With my 248 endorsement the chairman of the board is inviting the remaining member to resign so that a reconstituted committee can be appointed with amalgamation with the Preston and Chorley group of hospitals in mind at an early date. The new committee will need to consider the many detailed recommendations in the report for improvements at Whittingham itself. There have already been important staff changes.
This report highlights two of the most important problems facing the hospital service today: the proper care and treatment of longer-stay and elderly patients in large isolated mental hospitals, and the proper planning of the transition from services based on such hospitals to services based on departments in general hospitals. I have asked all boards to review their services for longer-stay mentally ill patients, looking particularly at outmoded attitudes, at allocation of staff, and at management policies and organisation. Each board is also now working out and discussing with my Department plans for the restructuring of its services for the mentally ill; these will provide for a properly organised transition to services based in general hospitals, and improved standards in the old mental hospitals until they eventually close.
It would be wrong to jump to general conclusions from the indictment in this report of some parts of one hospital. There have been enormous improvements in the last 20 years in nearly all psychiatric hospitals. The great majority of staff, at Whittingham as well as elsewhere, work with patience and devotion, often in difficult and unsatisfactory conditions, which we are now making great efforts to remedy.
I have referred in this statement to the main points which arise from the report. The Command Paper includes a foreword I have written which contains similar comments and also refers in more detail to the recommendations addressed to my Department and to the regional hospital board; action on most of these has already been taken or is under way.
The House will, I am sure, be grateful, as I am, to Sir Robert Payne and the other members of the Committee for the time and effort they devoted to their inquiry and to producing this forthright and constructive report. Ever since I have been in office I have been continuing 249 the theme of my predecessor in concentrating on improvements in this and related fields where they are most needed. The House can be sure that the lessons of this report will not be forgotten.

§ Dr. Summerskill
The right hon. Gentleman is to be thanked for the forthright and clear way in which he has presented the report. In view of the extremely serious and shocking revelations in it, will he accept that the recommendations should be implemented as soon as possible? Will he bear in mind the deep concern of all hon. Members that the report is the latest in a succession of hospital scandals, following as it does the 1968 inquiry into the "Sans Everything" allegations, the 1969 Ely Hospital inquiry and last year's Farleigh Hospital inquiry?
As we are dealing with the most vulnerable in the community, who are entirely dependent on the compassion or the disciplined care of others, I would ask the right hon. Gentleman four specific questions.
First, what immediate steps will the right hon. Gentleman take to ensure that not only in Whittingham but in similar hospitals there is from now on first-class, efficient management and co-ordination between hospital management committees, regional hospital boards and medical nursing administrators?
Secondly, will the right hon. Gentleman take immediate steps to increase the inspection of all such hospitals by the General Nursing Council at more frequent intervals and encourage a more rapid turnover of staff, periodically bringing in new staff from outside, because in such hospitals the staff become as institutionalised as the patients?
Thirdly, will the Secretary of State encourage the more active rehabilitation of long-stay chronic or psycho-geriatric patients, with increased transfer to community care, and will he consider giving greater powers to his proposed community health councils in the forthcoming reorganisation of the National Health Service?
Fourthly, we note no mention in the right hon. Gentleman's statement of the Ombudsman. Will he recognise that there is public anxiety about the lack of investigation of complaints into the 250 National Health Service and that his Committee to investigate the rôle and setup of the Hospital Advisory Service is no substitute for a hospital Ombudsman, because such complaints need an independent procedure outside the National Health Service? Will he seriously consider the setting up of a hospital commissioner?

§ Sir K. Joseph
The Government treat extremely urgently the carrying out of all the recommendations in the report. It is true that there has been a series of revelations connected with the mental-illness and mental-handicap hospitals. These to some extent reflect the higher standards the community now expects, in that conditions are being revealed that used to be taken for granted. On all the hon. Lady's points except two I can give wholehearted agreement. I cannot bind the General Nursing Council, which is an independent body, but I know it will note the hon. Lady's comments. The question of a health commissioner is a separate matter. I am pledged to make a statement to the House about it as soon as possible.

§ Mr. Gardner
I thank my right hon. Friend for his statement, and especially for the answer he gave to my urgent question on Friday. Will he make sure that three things are done: first, that all traces of the causes of the scandals referred to in the report are removed; secondly, that the present loyal and devoted staff who are working to restore the fine reputation of the hospital are given every encouragement; thirdly, that the inquiry into the premature and unauthorised publication of the report last week is published as soon as possible?

§ Sir K. Joseph
I know the intense interest and concern of my hon. and learned Friend about ail these matters. I wish I could tell him there was a magic wand by which any Government could remove instantaneously all the factors that have led to the conditions in question. We shall do our best to act as quickly as possible. Certainly, the Government wish to encourage and pay tribute to the devoted work of the vast majority of the staff at Whittingham and the other similar hospitals. I will certainly let the public know as soon as I have any information about the cause of the leakage.

§ Mr. Mayhew
I thank the right hon. Gentleman for his statement. Does he agree that the final and proper solution to this appalling problem—this horrifying report bears out the worst that has been said against mental hospitals by their most outspoken critics—is to find alternative accommodation for the patients, to empty the hospitals and then raze them to the ground in the shortest possible time? Will he therefore work out and issue a White Paper on services for the mentally-sick as he has on services for the mentally-handicapped, setting out a timetable, budgeting and costings, so that these hospitals can be emptied and finished with, at most within 15 years from now?

§ Sir K. Joseph
The hon. Gentleman's compassionate concern for those who are mentally ill is well known, and I pay tribute to it. But, with the very best will in the world, many of these hospitals will have to remain for 10 or 15 years, and we must look after the morale and the working conditions of the patients and staff involved with them. We cannot magic them away. However, subject to that. I intend to carry out just the policy the hon. Gentleman adumbrates. But will the hon. Gentleman not give circulation to any idea that the conditions revealed in the report reflect the normal conditions in such hospitals? That would not be true.

§ Mr. Fletcher-Cooke
Is my right hon. Friend aware that he has today removed a great cloud from North Lancashire, the terror of the word Whittingham that has been over us for many years, and that we are all most grateful to him for the honest, forthright and radical way in which he has admitted the faults in this service and promised to put them right? Will he accept that we echo very much the views of the hon. Member for Halifax (Dr. Summerskilll that the announcement of an independent grievance machinery in the form of a commissioner, parliamentary or otherwise, is long overdue, and that he should announce it within the next few weeks if the good work he has done today is not to be dissipated?

§ Sir K. Joseph
I am grateful to my hon. and learned Friend, but the House should not deceive itself. The sad fact about many of the people in mental-ill- 252 ness and mental-handicap hospitals is that they cannot speak for themselves, and many have been abandoned by their families. Therefore, the adoption by the Government of health commissioner procedure would not be of use to them. The sad revelation from the report is that when the student nurses brought the scandalous conditions to the notice of the nursing administration they were suppressed by that group of nursing administrators.

§ Mr. Rose
I welcome the open way in which the Minister has dealt with this scandal. This is indeed a change from what often occurs in cases of this kind.
Will the right hon. Gentleman look into some of the general problems in the Manchester area which are faced by the regional hospital board because of. for example, outmoded buildings and facilities, not least in my constituency in relation to Springfield, where the staff and patients alike suffer because of these ancient buildings?
Will the right hon. Gentleman pay particular attention to the problems of inpatients at psychiatric units, in which adolescents and youngsters generally must mix with very old patients? Is he aware that the facilities for autistic children are a real problem in the North-West?

§ Sir K. Joseph
I appreciate that, but the Manchester Regional Hospital Board is not the only board with old premises. The Hospital Advisory Service is now starting to visit some mental hospitals in the region.

§ Mr. Crouch
Does my right hon. Friend recognise the need for a much clearer statement from him about the process of change as we try to take down these old psychiatric hospitals? Is he aware of the feeling among the staff in the hospital service, and especially in these hospitals, that they are forgotten? As my right hon. Friend admits, this is having a grave effect on morale. It is clear that we must spend money in the coming 10–15 years to maintain and even improve these establishments while we consider their removal, but may I ask my right hon. Friend to make the point that they are to be removed absolutely clear?

§ Sir K. Joseph
Certainly, and I would have thought that the hospital staff recognised the increased concern and finances that are now being made available by the Government. One of the satisfactory features of this report is the tribute that is paid to the surprisingly high morale at Whittingham.

§ Mr. Denis Howell
The right hon. Gentleman will appreciate that we have not yet had time to read and digest the report. However, we share the grave concern which has been expressed about the suppression of complaints from members of the junior nursing staff.
The Secretary of State is properly taking action of a severe kind against the group management committee, although it is formed of voluntary people. What action does the report recommend or does he contemplate taking against those with the day-to-day executive responsibility for that situation? Is he aware that it is not good enough to take action only against the voluntary members?
Is the right hon. Gentleman satisfied with the day-to-day and month-to-month control exercised by the regional hospital board when things were allowed to get so out of hand? Does he agree that the board's procedures require a fundamental overhaul?

§ Sir K. Joseph
The principal persons concerned in the nursing administration at the time of the suppression of complaints have left. The regional hospital board, like all other boards, is now much more aware than it used to be of the need for much closer monitoring of these services.

§ Mr. Will Griffiths
Is the Minister aware that his proposal to call for the resignation, in accordance with Sir Robert Payne's Report, of the members of the Whittingham Hospital Management Committee and its amalgamation with the Preston and Chorley Hospital Management Committee will be generally welcomed? May we have an assurance that in the amalgamated committee no members of the Preston and Chorley H.M.C., who are blameless so far as Whittingham is concerned, will be replaced by former members of the Whittingham H.M.C.?

§ Sir K. Joseph
I must be careful about this. After all, amalgamations between 254 groups of hospitals are not infrequent. Without reflection on the individual members, it is necessary in the public interest to choose the most suitable persons from among those available. I must, therefore, keep the hands of the board free in this matter while remembering the hon. Gentleman's argument.