HC Deb 31 October 1972 vol 845 cc145-58

9.35 p.m.

Mr. Joseph Ashton (Bassetlaw)

Before the House adjourns I wish to draw attention to the serious situation that exists at Rampton Special Hospital, in my constituency. Rampton Hospital is in a remote area near Retford. The hospital also houses 1,100 criminally insane men and women, with a staff of approximately 500 to maintain security and to give treatment to the inmates.

At present an industrial dispute is taking place at the hospital concerning the number of hours worked and the shift system that is in operation there. I want to go back over the history of that shift system. For 50 years—from 1910 to 1960—the staff was working long days, from 7.30 in the morning until 8 at night. In those days the staff had two days on and one day off. In 1960 there was a reduction in the number of working hours from 48 to 44, and for an experiment they tried a system under which they did not work long days, with a day off; they worked a five-day week in more or less seven-hour or eight-hour shifts. After a twelve-month trial this shift system, by unanimous agreement among the staff of the hospital, was terminated, and in 1962 they reverted to a long day shift system under which nurses worked one day on and one day off on alternate days.

Although they worked long hours each working day it was a totally satisfactory system to the nurses because they had alternate days off. It was also satisfactory to the patients, and security improved. Since 1960 the number of escaping patients has fallen.

There was no dispute at the hospital until about 1967, when allegations were made by some patients that a gang had been formed inside one of the wards and was indulging in violent practices and was more or less running the ward. In 1967 an independent inquiry—the Dolphin Ward inquiry—was set up to examine these allegations, and two of the staff were blamed, or disciplined—or allegations were made that they were not doing their job properly. A further inquiry was set up at the request of the staff, however, which exonerated the two nurses in question and also put forward the view that the working day was too long for proper control to be maintained.

Since the 1967 inquiry pressure has been exerted by the Minister and his Department for nurses to report for work every day instead of operating a one-day-on and a one-day-off system. The Department said that there were advantages in reorganising the shift system, but there were also many disadvantages from the point of view of the staff. As I have said, Rampton is a remote place, six miles from the small town of Retford. Under the new system of working short shifts the staff get only one week off every 11 weeks. It may be argued that under the system of working alternate days although they never get a full weekend off at least they get one weekend day—a Saturday one week and a Sunday the week after—and that enables them to plan their lives.

With the long shift system, with everybody reporting and finishing at the same time, it was possible to provide a bus service—an essential service in this area, since such services are very few. Considering that some nurses have to come from as far as Lincoln and Mansfield, a great deal of extra time and cost is involved in travelling to work each day. It has been calculated that living outside the hospital premises adds about £20 extra in bus fares or travelling costs when nurses have to report to the hospital every day.

The social life of the nurses is seriously disturbed. There is an archaic rule at the hospital which discriminates against women nurses and says that, unlike the male nurses, they cannot have a house on the hospital site. Thus, if a woman nurse is not the major wage-earner in her family she has to live off the site. This means a great deal of travelling for the women involved. Many women took on the job because of the alternative shift system which allows them to make arrangements for baby-sitting and housework, and to fit in with their husband's job away from the hospital.

Under the new system, the meal breaks have been changed. The staff often have only a 20-minute break. At Rampton, the work that the staff do is in an atmosphere of stress, in which the nurse must have his wits about him because many of the patients, through no fault of their own, may get up to certain tricks when his back is turned.

The new shift system is much more costly. Because the nurses have to report five days out of seven, more have to be employed, which costs the Department's over-stretched resources another £30,000 a year. The number of escapes has declined over recent years because of the long shift system. I do not want to create alarm—we saw the row that ensued when Myra Hindley was taken for a walk outside prison—but the staff have told me of instances in which they are not happy about security and have given examples of nurses being used for certain jobs which were not done by junior nurses under the long shift system.

The patients' reaction is very important, since they often react to any change in routine. Many of them have to be under sedation. I have received genuinely written letters, which I would be glad to pass on to the Minister, telling how the new system is upsetting the patients.

The new system gives no apparent benefit to the patients. They get only 20 minutes a day extra on out-of-ward activities such as television, further education, sport or cinema shows.

There is an indefinable atmosphere which an experienced nurse can sense when he comes on duty early in the morning which tells him that the mood of the patients is different, that they may be plotting something. Their mood is like a sea which is calm on one day and not so calm on another. The experienced nurse knows that something may develop later and because his supervision continues throughout the afternoon he can often take steps to prevent it. But if the nurse is changed the new one often does not know what was sensed in the morning.

There is also an effect on recruitment. Many trainees took their jobs on the understanding that it was a day on, day off system. They are now likely to look for other jobs. Absenteeism went up when they reverted to every-day working in 1960 to 11 per cent. When they went on to day on, day off shifts, it dropped to 5 per cent. People often have to have a day off because of illness or a family crisis, and in the latter type of system. by the law of averages, that day is as likely to be a day off as a day on.

Canada, for instance, which went on to another system in a hospital in Winnipeg, is now going over to the one day on, one day off system, and it is being found that it is better for the staff, the patients are no worse off and it is easier to recruit nurses. There they are changing to the system which the Minister is now abandoning at Rampton.

It could be argued that the long-day system, starting at 7.30 in the morning and going on to 9.30 at night, is intolerable by any standards, let alone trade union standards. I accept that if the long-day system were worked every day of the week it might be intolerable. We here in this House know that we work a long-day system, very often having to attend Standing Committee at 10.30 in the morning and yet we are still here at midnight, and people outside criticise us for taking long Recesses. We know we can achieve these long days if we do not have them on every day for 52 weeks of the year. Other people work long days. People in television often work a long day on and a day off. That sort of thing is necessary by virtue of the type of work. It may be necessary to work a day of 12 or 14 hours. It would be intolerable if it were done every day, but if it is done within the limits of a 38 or 40-hour week the day on, day off system can be tolerable, it can work and it can be accepted, as it has been accepted over the past 12 years at Rampton.

I should like now to turn to the recent situation starting on 1st October. On 1st October the Minister was adamant that the new system was to be started. He circulated every member of the staff pointing out the reasons for his wanting to introduce this system.

The staff are a very responsible body of men and women. They are not militant trade unionists. I am a militant, but they are not militant trade unionists and they have never taken part in any sort of industrial action before. They started work under the new system. That would not have happened if such a change had been introduced in the docks, in the coal mines, in a car factory or in any other industry; people would simply have refused to change the status quo. However, the nurses started work under the new system on 1st October because they are responsible people.

It became apparent inside two weeks that the new set-up was totally unacceptable. Their home life was ruined, their social life was ruined; it was not good for the patients; it was not good for the staff. Within two weeks there was a rapid deterioration in relationships at the hospital, so much so that after two weeks the staff decided to take a form of industrial action. No patients took part in any out-of-ward activities; it was a situation where patients were locked in and the staff simply maintained security.

That was a weekend situation. On Monday of that weekend, on 16th October, picketing took place and the situation then started to look fairly ugly. There were one or two demonstrations outside the hospital. Probably due to a misunderstanding, students had been allowed into the hospital at the weekend. That was normally the case, but in a situation where there is an industrial dispute taking place it is not likely to smooth tempers if students are allowed in and try to do the jobs normally done by the nurses. There was a great deal of mis- understanding, but there was an ugly situation.

The nurses asked me to go to a meeting. It took place at 10 o'clock in the evening after the day's work had finished, and over 400 men and women nurses attended at that late hour despite the fact that many had a long way to travel and there was no public transport then. It was almost a chaotic situation in which any experienced trade union organiser, or anyone experienced in such negotiations, would know that something had to be done and done pretty quickly.

I put a proposition to the meeting: that they should return to work on the understanding that, the day after, Parliament was to resume after the Recess and that I would see the Minister, put down Questions and ask for an Adjournment debate, which, Mr. Speaker, you have kindly granted. They agreed to this; they would go back to work on the present new shift system but they would not do it unless some date or deadline were fixed so that there would be pressure to ensure that the negotiations and talks would not go on for ever—like Vietnam peace talks, on and on and on. There was to be a definite date by which a decision would be made. The nurses decided that the date should he Sunday, 19th November. With that, they returned to work and they are working normally.

I thank the Minister for his great co-operation in arranging a meeting and for the speed with which he acted. On the following Thursday the Minister agreed to meet a deputation from the hospital. He listened to us most carefully, with his officials. He was strong in his viewpoint that the long shift system could not be reinstated, but he agreed that negotiations could take place during the month. One meeting has taken place and another is due to be held on 7th November. I do not wish to say anything which may prejudice those meetings but I should like to stress again the absolute determination of the staff about what will happen on 19th November.

On Sunday, 19th November, the "A" shift will arrive for work at 7.15 a.m. and will insist on reverting to long-day shift working. They will then await events to see what the management at Rampton will do and whether it will allow them in. I cannot forecast what will happen then, nor do I suppose that at this stage the Minister can forecast. But there will be a confrontation on that morning and it is a dangerous situation.

It is impossible to keep news of this happening from the patients. We know the situation that is likely to occur. There will probably be television cameras in attendance and representatives of every newspaper in the area will be there. This is something that has not happened previously with a hospital with 1,100 criminally insane patients and 500 staff, the staff wanting to work their hours and a management which wants a different set of hours to be worked.

There is a chance that the deadline could be avoided and I hope that it will be. I hope that before 19th November the Minister will say that the long shift system can begin on 19th November and that negotiations will continue. The staff have shown good faith and have been very responsible. They have at heart the welfare of the patients. During the dispute they have been very strong and have maintained control of the situation. No member of the staff has tried to do anything silly. It has been a well organised protest, if one could call it that, and I hope that bitterness will not develop between now and 19th November, because that would take a long time to eradicate.

As a gesture of good faith on his part, I hope that the Minister will indicate that the long shift working can be resumed on 19th November and can continue. I am sure that the staff will try to reach an acceptable formula with regard to the new 38-hour week.

9.53 p.m.

Mr. J. D. Concannon (Mansfield)

As the previous discussions today finished earlier than usual, I have been given an opportunity to say "thank you" from the constituencies in the areas surrounding Rampton Hospital and constituencies surrounding that of my hon. Friend the Member for Bassetlaw (Mr. Ashton) for the way that my hon. Friend has tackled this problem.

My hon. Friend will no doubt concur with me when I say that this is the concern not only of Rampton Hospital and my hon. Friend. Many of the staff come from the surrounding area. Quite a few of them come from my constituency, which is a neighbour of Bassetlaw and is quite close to Rampton Hospital. It is typical of the way that my hon. Friend works that I have been able to say to people who have inundated me with requests to take part in the debate "It is all right. I can well afford to leave it to Joe." It is typical of my hon. Friend that he has tackled the matter in this particular way.

There is a great deal of concern not only in the constituency of Bassetlaw but also in every constituency in the area. Rampton Hospital, whether deservedly or not, has a certain notoriety in the area. Any unfortunate incident at the hospital is highlighted to the ninth degree and emotions are whipped up.

I again thank my hon. Friend for the way he has tackled this problem and continues to tackle it. I also thank the Under-Secretary for his ready response to my hon. Friend. There is a possé of Members from the surrounding area who are greatly concerned about this issue and who await the outcome of the discussions. I hope that the fact that the nurses and other staff at Rampton have acted responsibly and have taken my hon. Friend's advice will pay them dividends and that a system will be sorted out which is fair to the staff and which gives the patients the care and attention they deserve.

9.56 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Michael Alison)

As the hon. Members for Basset-law (Mr. Ashton) and Mansfield (Mr. Concannon) have said, there is a serious dispute at Rampton Hospital about the sort of shift system which the nurses should work. For many years Rampton has worked what is known as the "long day" or "day on—day off" system. Under this system one group of nurses is on duty throughout the whole of the patients' day. The nurses come on duty in the morning, get the patients up and supervise their activities throughout the day, and ending by seeing them into bed at night before handing over to the night shift.

This "long day" system was once a very common one in the old mental institutions when the main rôle of the nurses was a custodial and care one. This method is as it stands economical of staff but limits scope for active remedial and rehabilitative work.

Ideas on treating the mentally disordered have changed over the years. We now know that there is much more that can be done to improve and develop standards of treatment and care in mental hospitals. In particular, over the past two decades the rôle of nurses in psychiatric hospitals has been changing with the introduction of many new methods of treatment and rehabilitation which have brought on a wide range of mainly occupational and recreational activities in the life of the patient—new ideas on training, education, industrial and occupational therapy, leisure and sporting activities, indeed all the activities so far as one can approach them of normal daily life. These all involve nurses much more actively in the treatment and other activities of patients both as individuals and in groups.

This has resulted, over the psychiatric field as a whole, in nurses increasingly abandoning the "long day" in favour of a system which involves two groups of nurses sharing the day. This is in spite of the "exception which proves the rule" of Winnipeg. One group coming on duty in the morning hands over in the middle of the day to another group which works through to the patients' bedtime. The exact shift system varies widely from hospital to hospital to meet the local situation, but these two day-shift systems have certain common features. They shorten the nurses' working day at a time when the demands on them are increasing in intensity. They lengthen the patients' day and involve the patients in more active therapeutic occupations throughout the day. Thirdly, a two-day shift system provides an overlap in the middle of the day when nurses from one shift can meet those on the next one to discuss patients and ward policies with one another and with the doctors, psychologists, teachers and others involved in the patients' treatment.

It being Ten o'clock, the Motion for the Adjournment of the House lapsed, without Question put.

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Murton.]

Mr. Alison

Rampton has shared in this advance in its treatment and care of patients, and as in other hospitals, the benefits to patients are apparent in the shortening of their stay in hospital and in the improved quality of their life in the hospital. I pay tribute to the way in which Rampton has shared in this national, and indeed international, advance in this field. But the management has felt for some time now that at Rampton the limit to the active involvement of nurses was being reached within the context of their working this very arduous 14-hour day.

In 1971, in anticipation of the introduction of the 40-hour week, discussions were opened on Rampton's local Whitley Committee with a view to changing to a two-shift-day system in line with patterns developing in psychiatric hospitals throughout the country. The response of the Staff Side was a refusal to discuss anything except a day on-day off system. They counter-proposed continuation of the single-shift system with an extension of the span of their working day to 14½ hours with additional days off.

In view of the deadlock at local level, the matter was referred to my Department, and by my Department's officials to the Secretary of State. My right hon. Friend took the view that he could not accept the extension of the "long day" proposed by the Rampton Staff Side and decided that a two-shift system should be introduced. He was, however, anxious that whatever system was adopted should, if at all possible, be agreed with the staff.

At this time in December, 1971, the Rampton Staff Side was informed of this decision and invited to join in further discussions to agree details of a suitable kind of two-day shift system. At the same time, a letter was sent to all nurses at Rampton explaining what was happening and why the Secretary of State had taken his decision. When by June, 1972, we had still been unable to persuade the Staff Side to discuss details of a two-shift-day system, we felt it necessary to give notice that we would introduce the system we had devised from 1st October this year.

The Staff Side secretary was informed accordingly on 16th June and a letter was sent to all nurses informing them of this decision on 28th June last. The letter reiterated the Department's willingness to discuss ways of overcoming personal and domestic difficulties the change might create. They were told that we were willing to provide transport to and from work where this was necessary, to organise shift rotas, so that staff wishing to be on the same or opposite shifts could do so, and to provide a crèche for young children during the period of shift overlap.

The staff were asked to make known their difficulties in these or other areas. In the event, it was possible to meet all requests to be on particular shifts; no requests for the provision of transport were received and the crèche was provided and appears to be working satisfactorily. No further representations were received up to the implementation of the change on 1st October.

We recognised that a change would not at first be welcomed by the staff, but we had done all we could to meet particular difficulties and to avoid any hardships.

In fact, for the first two weeks the new system seemed to be settling down fairly well. Then the staff had a meeting which was called for another purpose, and without further discussion they decided to institute a form of protest action. The hon. Gentleman has described it. Patients were kept in their wards and prevented from taking part in all their usual occupational and recreational activities; even some of the activities which do not involve nurses were stopped. In short, the nurses reverted to something like the old-fashioned purely custodial rÔle.

My right hon. Friend the Secretary of State and I are very sorry that the nurses decided to interfere in this way with the treatment and training needs of patients, and we are grateful to the hon. Gentleman for his intervention which brought the nurses round the table to meet us. We are anxious—I stress this—and have always been anxious to settle this matter by discussion. Here perhaps I might inject a word about a visit made by students from Nottingham University, which seems to have been wholly misunderstood by the nurses. This small group of students made one of their regular visits to the hospital to take part in some of the recreational activities of the patients.

That is a valuable voluntary activity by the students which has a counterpart in other psychiatric hospitals. It helps to break down the isolation from which these hospitals have suffered and it is something which we all welcome, the bringing of the local community, in particular normal youthful members of it, into hospitals of this sort. The nurses seem to have thought that we were contemplating using students to take over normal nursing duties, and made them unwelcome. Nothing of the sort had crossed our mind. I hope that the hon. Gentleman and his hon. Friend, if the matter arises, will reassure their constituents on this matter. We welcome the interest shown by the students in the hospital's work and their willingness to help patients in leisure activities. But the students are not nurses and we had no thought of seeking to use them or anyone else to take over nursing duties.

As the hon. Gentleman knows, as a result of the discussion which I had with the deputation of nurses which he brought to see me, it was agreed that a joint working party led by the Department's Chief Nursing Officer should be set up, to seek to find a shift system which in the interests of the patients meets the requirements of management and the aspirations of the staff. The hon. Gentleman will recognise that form of words.

The working party has had one full meeting, at which there was a useful exchange of views, which I hope has helped all concerned to understand more fully the issues involved. Much work remains to be done but I remain hopeful that given good will a solution can be found that will be acceptable to everyone. We fully appreciate the legitimate aspirations of the staff for good working conditions, and it is now clear that their discontent goes wider than the single issue of the shift system. Probably the hon. Gentleman and his hon. Friend may be able to confirm that. We are examining carefully and sympathetically all the points which they have made. I hope that they for their part are re-examining the department's view to understand why we have approached the change in system in the way in which we have.

Unfortunately the working party is working under the shadow of an ultimatum from the nurses who are threatening to start working an even longer "long day" of 14½ hours from 19th November. I hope that the situation will not arise and that this shadow over the hospital—it is a shadow over the hospital and all sections of the hospital—will be lifted. We are anxious to meet the staff's wishes as far as we can do so in a manner consistent with the Secretary of State's primary duty to the welfare and well being of the patients. We want to reach an agreement as I am sure the nurses do. But they must recognise the Secretary of State's duty and responsibility to ensure that the hospital remains equipped to adopt and pursue progressive policies for the treatment and rehabilitation of the difficult patients which Rampton accepts. I know that the nurses at Rampton want to make their full contribution to this, and I am equally sure that the length of the working day is a very important factor in determining the level of nursing involvement with patients which can reasonably be expected from them.

As the hon. Gentleman and his hon. Friend know, another date for the meeting of the working party has been fixed. The chief nursing officer of my Department has had a close look at Rampton, and this can do nothing but good for an understanding of all the problems involved. I hope that hon. Members will excuse me from going any further into the details of the sort of difficulties which are now being discussed, since I wish in no way to interfere with the progress—fruitful and constructive progress, I hope—of the talks which now lie ahead.

I believe that all of us share the conviction that the nurses at Rampton have a responsible job and discharge it with admirable efficiency and responsibility. For our part, we have a major responsibility also towards the patients in their care. Between us, I am sure, we must find a formula within which the patients are advantaged without disadvantage to either of the other parties.

Question put and agreed to.

Adjourned accordingly at eleven minutes past Ten o'clock.