HC Deb 26 April 1977 vol 930 cc1191-200

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

11.18 p.m.

Mr. Dudley Smith (Warwick and Leamington)

Andree Pearce was a 41 year-old woman whose parents are my constituents. They live in Leamington Spa. She was not mentally afflicted in the sense of that phrase as we would understand it, but because of her peculiar physical condition, which created certain problems for her, she became a voluntary patient at Abbeyfields Hospital at Studley in Warwickshire, which is not in my constituency.

It is a matter of crucial importance that I should state right at the outset that her condition made it vital that she should have medication every 24 hours, otherwise her life would be at risk.

On the last day of last year, 31st December 1976, Andree Pearce, who had struck up a friendship with a man patient, a Mr. Donald Newton who was detained in the hospital under the Mental Health Act, went out with him during the afternoon. They did not return. Her dead body was found in a derelict house in Redditch 13 days later. The police, of course, had been informed of the woman's disappearance and of her need for drugs because of her condition.

The parents tell me that the Medical Superintendent, Dr. Goulden, telephoned to tell them that Andree was missing. Subsequently, they contacted the hospital on a number of occasions, and when they discussed their anxieties with the superintendent, knowing that she could not survive without the right kind of medication, they allege that he seemed unconcerned about that aspect. They stressed that she would go into a coma after two days without her tablets, but he suggested that it would be perfectly simple for her and the man that she was with to approach a local doctor in the locality to obtain the necessary medicine. If that was his reaction—and I do not disbelieve my constituents—I find it totally inexplicable and in itself meriting the formal inquiry into this case that I have already requested. Indeed, my two constituents accuse the hospital of negligence, and I certainly think that there is a case to answer. Public disquiet over what has happened can be dispelled only by an inquiry.

When Andree's body was found, the police, who appear to have acted perfectly properly throughout, contacted Mr. Pearce and asked him to go to Redditch. The hospital, however, remained aloof. It neither wrote to the parents at the time nor telephoned them to express even routine regret. As the Minister of State has already admitted to me in a letter, it was certainly at fault there.

I suggest that it was at fault in other directions, too. The hospital had Andree as a voluntary patient, but, whenever she returned home to Leamington, Mr. and Mrs. Pearce had to sign a form saying that they would be responsible for her safety. Yet she was allowed to wander off with another patient who was detained under an order, despite the fact that it was well known that her very survival depended on regular drug treatment.

Why, therefore, in the circumstances, was she not medically assessed as requiring special supervision or, if that was not available because of staff shortages, why was she not transferred to a more appropriate hospital? Surely patients who must have regular tablets or medicine on a life-or-death basis need the closest possible watch kept over their interests.

I got the distinct impression, having become involved in the case, that there was a good deal of back-tracking by officials when the facts began to come to light. Efforts were made to keep it reasonably quiet, but, thanks to the Birmingham Post, it came to light and, as a result, the parents sought my help.

I find it amazing that the coroner for the area where Andree's body was found dispensed with having an inquest, apparently on the ground that she died from natural causes—asphyxia due to an epileptic fit. Had such an unfortunate death taken place at home or in hospital, I can understand that decision being taken. But who among us would not expect a coroner's inquest if we had a relative who had disappeared and was found dead 13 days later—and in a derelict house at that?

The parents have never been told what transpired after their daughter left hospital. I understand that the police ultimately received a message from Newton's sister in Redditch indicating the whereabouts of the couple, as they understood it, at the time. A police officer was despatched to the home of Mr. Newton's niece and found him there. Newton then took the officer to a deserted house where Andree's body was discovered. I am told by the Home Office that Mr. Newton was confused as to when he had last seen her alive. I am also told that he has now been transferred to another mental institution.

I bring out these details in public because they should have been stated at an inquest and they ought also to have been given at an inquiry which the Department of Health, on the suggestion of the area health authority, refuses to hold.

I do not like naming mental patients, but I should be failing in my public duty to my constituents if I did not give all the facts as I know them. I submit that too many questions still remain unanswered in this matter. For instance, I am not satisfied that the hospital authorities emphasised to the police the urgency of tracing Andree. The attitude of the medical superintendent, if what I am told is correct, suggests that they were not particularly worried over what had happened.

I believe that this unhappy affair throws into question the whole business of voluntary patients and their supervision, particularly where, like Andree Pearce, they require regular and consistent medication in order to stay alive.

There have been a least two other cases in the Midlands during the same period where patients have wandered off and have subsequently been found dead. That is why I think it is in the Department's interests to have an inquiry into this case and why I now urge the Minister of State to have second thoughts about it. Public confidence will be restored if he does and, indeed, I can assure him that he will gain public support for such a move.

I emphasise that I am not against the principle of voluntary patients. A valuable part of the health system is to deal with the very necessary work involving mental patients. But in cases like this our concern—and it is of paramount importance in the public interest—is that there should be greater supervision than apparently there is at present.

11.26 p.m.

The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)

This is a sorry little case that we are discussing tonight. I can understand the concern of Mr. and Mrs. Pearce over the circumstances of their daughter's death. I offer my sympathy in their bereavement and I hope that the hon. Member for Warwick and Leamington (Mr. Smith) will convey it to them on my behalf.

The essential facts are that Miss Pearce had been a voluntary patient at Abbey-fields Hospital for about two years prior to her disappearance and death. She was missed at about 6 o'clock on the evening of 31st December last year and was found dead on 12th January. A Home Office pathologist carried out an immediate post mortem and advised that Miss Pearce had died from asphyxia due to epilepsy.

I ought to give the hon. Gentleman an indication of Miss Pearce's mental and medical condition. She had been assessed by a psychologist as only just mentally handicapped. In other words, she was between the bottom of the normal range of intelligence and the range that we define as mentally handicapped. She was thus much more able than many mentally handicapped patients. Indeed, I understand that at one time she held down a full-time job. In many ways Miss Pearce's main problem was her severe epilepsy, for which she received daily medication and, to some extent, she was incontinent.

There are, of course, provisions under which patients can be compulsorily detained in hospital where this is for their own health and safety or for the protection of others, but certain additional criteria have to be met. The power which enabled detention for other than a short period is in Section 26 of the Mental Health Act. This cannot be used for a person who is over 21 years of age who is merely mentally handicapped. It can be used for persons over 21 only if they are suffering from mental illness or severe subnormality. It is clear that Miss Pearce was not severely mentally handicapped.

Epilepsy can be associated with mental conditions which would bring it within the scope of this section, but on its own it would not. In other words, there would have to be something besides epilepsy and mental illness. The Act covering these matters is the Mental Health Act 1959. A major aim of that Act was to enable the vast majority of patients to be dealt with informally and to limit the use of compulsory powers to those who are unwilling to be treated voluntarily and whose mental state is such that they cannot be left to take a decision not to seek treatment. From the information available to me this was certainly not the case with Miss Pearce who was, by all accounts, both willing to receive treatment and reliable in taking it. It seems to me that under the terms of the Mental Health Act and its philosophy she was properly a voluntary patient.

I turn to the question whether Miss Pearce was adequately supervised at Abbeyfields. This has to be considered in the light of the modern approach to caring for the mentally handicapped.

For many years the main form of residential provision for many mentally handicapped people was the large single-purpose hospitals, often situated well away from any town and with many hundreds of beds. We have come to recognise that many people formally put into these hospitals have noticeable potential and that, with the right sort of training and support, they can lead fairly independent lives and certainly do not have to spend their entire lives in hospital.

This is particularly true when, as in the case of Miss Pearce the degree of mental handicap is not severe. We seek to place great emphasis on developing patients' potential by education and training and on avoiding unnecessary segregation from the community in general. Thus it is now quite usual for mentally handicapped patients to be allowed, indeed encouraged, to leave hospital during the day and, either on their own or with a member of the hospital staff, to visit neighbouring towns and villages. The opportunity to become involved in everyday life is a significant element in treatment and rehabilitation and is encouraged.

The result of treatment in Miss Pearce's case led to her being said to have been well integrated and happy, and she was regarded as a very reliable high grade patient. She was quite capable of travelling by bus and shopping on her own, and quite often went into Studley. Until 31st December last year she had never disappeared from the hospital unexpectedly, nor was she ever missing when her medication was due. On the basis of that the hospital staff saw no reason to discourage her visits to Studley, nor did they believe there to be a risk of her not returning for medication, which was vital to her.

During her last few months at Abbey-fields Miss Pearce formed a relationship with another patient, with whom she ultimately disappeared, and this was of concern to the hospital staff. Dr. Goulden even suggested to Mr. and Mrs. Pearce that their daughter should be transferred to another hospital nearer their home at Leamington Spa, but the Pearce family would not agree. I do not criticise them for that. They had no reason to know what was to happen. Nevertheless, that is why she was not transferred. The staff, however, had no reason to believe that the couple would disappear.

The patient with whom Miss Pearce formed a relationship was at the hospital under Section 60 of the Mental Health Act. Possibly this should have made the authorities more vigilant in their supervision of Miss Pearce. The patient concerned had a history of petty theft and indecent exposure and is alleged to have set fire to some buildings at a hospital he attended many years before. However, he had, and indeed has, no record of violence and the hospital authorities saw no reason to confine him to the hospital grounds. There is certainly no suggestion that he exercised violence towards or harmed Miss Pearce in any way.

When Miss Pearce was reported missing—this was at around 6 o'clock in the evening when her medication was scheduled—Miss Pearce's consultant informed her parents and the police were alerted. A constable visited the hospital during the same evening to get details of both patients, and the police have confirmed that the hospital made it clear to them that Miss Pearce suffered from epilepsy, was dependent on drugs and was at risk without them. On the third day after Miss Pearce's disappearance the hospital rang the police again to emphasise the danger to her health if she was without medication.

When the hon. Gentleman wrote asking that an inquiry be set up into the circumstances surrounding Miss Pearce's disappearance, two questions seemed to be of key importance. Was there any indication of irresponsibility on the part of the hospital, and was there any failure in putting in hand efforts to find Miss Pearce?

The Warwickshire Area Health Authority had already started its own inquiries, and we considered its findings. I sent the hon. Gentleman a copy. I concluded that there was no reason to have expected the hospital staff to exercise any more supervision over Miss Pearce, or the other patient with whom she disappeared, than they did, and it is quite clear that they notified the police promptly and gave them details of the risk Miss Pearce ran through lack of medication. In these circumstances, I saw no reason to ask the area health authority to set up a formal inquiry.

There is, however, one aspect of the hospital authority's part in this sad story with which I was not happy, and that is the point which the hon. Gentleman made about the hospital's failure to contact Mr. and Mrs. Pearce after their daughter's body had been found. The hospital knew that it did not have the task of notifying Mr. and Mrs. Pearce of their daughter's death, as the police had done so, but it would have been only normal courtesy to write and express sympathy. The area health authority chairman has since tried to repair this omission by writing to Mr. and Mrs. Pearce and offering to meet them to discuss events, but they have not, so far, perhaps understandably, been prepared to take up his offer. It is still open, and if it would help them I am sure that he would be only to willing to meet them.

After Miss Pearce disappeared from the Abbeyfields Hospital, the fact was reported to the Warwickshire police. Later that day, details of both patients were circulated and the West Mercia police were asked to make inquiries of the other patient's sister, who lived in Redditch. She was visited that evening, and again on 1st and 2nd January, and asked to inform the police if she became aware of the missing persons' whereabouts. All the uniformed patrol officers at Redditch were informed of their details and of Miss Pearce's medical condition and of the concern for her health.

Police patrols in the area, to whom Miss Pearce's companion was well known, kept observation, but it was eventually through his sister that the police learned of his whereabouts on 12th January; he had turned up at her daughter's home. The patient then took the officers to the derelict house where, it appears, he and Miss Pearce had been staying. There, Miss Pearce was unfortunately found dead. It was subsequently found after a post-mortem examination that Miss Pearce had been dead for some days.

The Chief Constable of West Mercia, who is responsible for the deployment and questions of his officers, has informed my noble Friend that he is satisfied that there was no incompetence on the part of his officers at Redditch in their efforts to trace Miss Pearce and the other patient. I point out that the police are not under any statutory duty to trace missing persons, but in a case such as this they do what they can to help. I think that the hon. Gentleman will agree that in the circumstances they made considerable effort to trace these two patients.

Mr. Dudley Smith

I appreciate that the police did all they could, given the circumstances. But did the hon. Gentleman's inquiries lead him to believe that there should have been a coroner's inquest, and, if so, what comments has he on the point?

Mr. Moyle

The hon. Gentleman has anticipated me. I am coming to the fact that there was no inquest. The hon. Gentleman is rightly concerned about this matter and it may be possible to say that the coroner made an error of judgment.

My right hon. Friend the Secretary of State for the Home Department informs me that where a person dies a sudden death, the cause of which is unknown, the coroner has power under Section 21 of the Coroners (Amendment) Act 1926 if he is of the opinion that a post-mortem examination may prove an inquest to be unnecessary, to order such an examination to be held without opening an inquest. So the coroner had the power to act as he did.

In this case, he probably had before him the report of the Home Office pathologist which showed a post-mortem examination revealing that Miss Pearce had died from asphyxia due to an epileptic seizure, which was, in her case, a highly likely cause of death, given her general medical condition and her absence from hospital for 13 days without any medication.

Mr. Dudley Smith

I realise that this is not entirely the Minister's province but surely the chapter of circumstances—the disappearance of the woman from the hospital, her going off with a man who was under an order and who had some question marks against him, and her being found dead in a derelict house—presupposes that any normal coroner would hold an inquest.

Mr. Moyle

That might be so. Perhaps the coroner will read the hon. Member's strictures. But, like a judge, a coroner is a totally independent judiciary officer and a decision to hold an inquest is entirely for his discretion. It is not subject to political, governmental or administrative direction. Neither my right hon. Friend nor any other Minister can comment on the way in which an individual coroner carries out his statutory duties either in general or in regard to particular cases. There is a remedy through the law but the law may only be reviewed by legal procedures.

It is open to Mr. Pearce, if he considers that the coroner has refused or neglected to hold an inquest which should be held, to make application to the High Court under Section 6 of the Coroners Act 1887, through, or with the authority of, the Attorney-General, for the court to order an inquest to be held. I cannot, of course, say whether such an application, if made, would be likely to be successful.

That is Mr. Pearce's remedy. I regret that there is nothing that my right hon. Friend can do to provide an administrative remedy. The remedy lies at law and Mr. Pearce should take legal advice, if he so wishes, about how he should proceed further along those lines.

Question put and agreed to.

Adjourned accordingly at seventeen minutes to Twelve o'clock.