JOHN ROY WILSON (Hansard, 14 December 1977)

Mr. Alan Lee Williams (Hornchurch)
John Roy Wilson, aged 25 years, is a patient in Rampton Hospital and has been there since 1970—seven years ago. He suffers from subnormality and has a history of maniac depressive episodes. Earlier, he was admitted to South Ockenden and Warley Hospitals but was discharged, in my view, too soon after admission.
His parents could not cope with him at home, so, following an incident with his father in 1970, it was realised by his parents that he needed more help. His father took him to court for assault. The court acted in pursuance of Section 5(1)(c) of the Criminal Procedure (Insanity) Act 1964. Because of his dangerous and uninhibited behaviour, the court decided that he required treatment under conditions of special security. The Home Secretary issued a warrant for his admission to Rampton.
In accordance with Schedule 1 to the 1964 Act, John Roy Wilson was subjected to a hospital order under Section 60 of the Mental Health Act 1959, together with an order under Section 65, which, as my hon. Friend the Minister of State will know, can mean that he can be detained without limit of time and that he may not in fact be discharged or transferred without the consent of the Home Secretary.
John Roy Wilson responded well to treatment at Rampton, although not without difficulty. My information is that in the last two years he has progressed 880 relatively well. His consultant psychiatrist, Dr. Rodriguez, has indicated his desire to release John Roy Wilson from Rampton, and he placed him on a waiting list on 30th January 1975, stating: I do not wish to detain John in Rampton any longer than is absolutely necessary. John Roy Wilson has been on the transfer list now for three years. A social worker, in a letter dated 10th October 1975, wrote: John's father seems to have been led to believe that John would require a locked ward and therefore has no alternative but to remain in Rampton. This is not so and the fact that he has been approved for transfer from Ramp-ton indicates that it is no longer felt that he needs conditions of this level of security. Needless to say, with the trend towards making more hospitals open, there is sometimes some anxiety about accepting special hospital patients on transfer, but this is by no means an obstacle which cannot be overcome. Since that time some two years ago, the parents of John Roy Wilson have been coming to see me at my advice bureau and I have written letters to a number of Ministers, including the Minister of State, Department of Health and Social Security. I have consulted the medical officer for Barking and Havering. Because of the difficulties in finding him a place in the two local hospitals, I have suggested that the Department might try to find a bed for him in either Sussex or Kent. In correspondence I have suggested a number of alternative hospitals.
There is a particular difficulty at the Warley Hospital because of a dispute with the union COHSE. I understand that there are difficulties there about admitting patients who might be difficult.
In my view, my constituent has been detained in Rampton for too long. His continued detention there is unjustified. I know that this is accepted by my hon. Friend the Minister of State, by the hospitals and by all the authorities concerned. But the difficulty of finding him a bed remains.
How many cases of this sort are there? How long will it be before John Roy Wilson is transferred from Rampton to a local hospital? Although his history is difficult, one must not draw too much from the past. He was a young man at the time. He is still a young man, and there is no doubt that he has responded to treatment.
881 His past difficulties were severe, but the consultant psychiatrist believes that he is now safe to be moved. I appreciate the anxieties about this type of patient. Many people are misled to believe that because a patient is from Rampton he is necessarily dangerous. That is not so, any more than a patient from a normal hospital is necessarily not dangerous.
The time has come for the red tape to be cut and a bed to be found for John Roy Wilson. His continued detention is unjustified.

§ The Minister of State, Department of Health and Social Security (Mr. Roland Moyle)
I am grateful to my hon. Friend the Member for Hornchurch (Mr. Williams) for raising this important matter in the House and for his continued interest in this case. He has already written more than once to my Department about it and we have discussed the case. He has been remarkably assiduous in pursuing his constituent's interests.
As my hon. Friend has said, we are discussing the case of John Roy Wilson, at present a patient in Rampton Hospital. Rampton is one of the four special hospitals for those who require treatment under conditions of special security on account of their dangerous, violent or criminal propensities.
John Wilson is now 25 years of age. He appeared before the North-East London Quarter Sessions on 20th August 1970 and was found to be under disability and unfit to plead to a charge of assault occasioning actual bodily harm. The court made an order under Section 5(1)(c) of the Criminal Procedure (Insanity) Act 1964 and he was admitted to Rampton on 23rd September 1970. The effect of the court order is that he is as if subject to a hospital order under Section 60 of the Mental Health Act 1959, together with an order under Section 65 of the Act restricting discharge for an unlimited period. This means that the consent of the Secretary of State for the Home Department is required for transfer or discharge.
The circumstances leading to John's being charged are as follows. During 1970, while living at his parent's home, he caused damage to the house and furniture during episodes of violence, and attempted to set fire to the house. In 882 June 1970 he attacked his father with a piece of wood and then chased his parents from the house with threats. As my hon. Friend said, his parents felt that they could not cope with him. Ten days later the police were called to the house and took John into custody for using threatening behaviour in the street.
Unsuccessful attempts were made by the police to have John admitted to Warley Hospital, a mental illness hospital where he had been before, and, as his parents refused to have him back home, he was charged with threatening behaviour and with the assault on his father. This, as I have said, led to his being admitted to Rampton Hospital.
John had the misfortune of having been born with a hare lip and cleft palate deformity. Surgery was performed when he was only 18 months old but, sadly, left a severe speech defect. He developed a progressive emotional disturbance from about the age of 13 and thereafter he was admitted on several occasions to Warley Hospital. He also spent over a year in South Ockenden Hospital, which is a mental subnormality hospital. After improvement there he was discharged to the care of his parents in early 1970. The offence with which he was later charged took place in June of that year.
John made slow progress at Rampton. He was suspicious of those who were trying to help him. But one of the heartwarming aspects of this case is the constant and devoted way in which Mr. and Mrs. Wilson, John's parents, have visited him at Rampton, one or both of them coming to see him every week. John's case was heard three times by the Mental Health Review Tribunal, on 13th July 1972, 31st May 1973 and 17th December 1974. In March 1975, acting on the advice of the tribunal, the Secretary of State for the Home Department consented to John's transfer to a National Health Service hospital if a suitable vacancy could be found. We have been trying to find such a vacancy since then—that is, for over two years. We have corresponded with the Essex Area Health Authority, the Barking and Havering Area Health Authority, and the North East Thames Regional Health Authority. I am sorry to say, however, that so far we have not succeeded. We have also considered the possibility of 883 his discharge direct into the community from Rampton, but on the whole it is felt that this would be a premature step.

Mr. Alan Lee Williams
I agree with my hon. Friend. That is the view of his parents. They do not wish to have him directly released so that he comes home.

§ Mr. Moyle
We are all agreed, therefore, that the best thing is to transfer him to a local National Health Service hospital, from where he could be eased back into community life. But we are having some difficulties in implementing that course of action. Where a patient is to enter hospital, whether from the community or from a special hospital, the views of the staff of the hospital to which he is to be transferred are of great significance. They will want the answers to two questions. First, is the problem one which will respond to the form of treatment and care available to them? Secondly, is it in the interests of the other patients and staff to admit a particular person?
Psychiatrists at Warley Hospital have held that the diagnosis is one of a behaviour disorder in a mentally handicapped patient, that social rather than health care is appropriate and that the hospital lacks the skills, staff and security facilities that Mr. Wilson would need. South Ockenden Hospital believes that the degree of mental handicap does not really place him into the category of patients for whom it cares. There is a conflict of clinical opinion here between the three hospitals. A further consultant, who has received the case notes but who has not seen the patient, has stated that he believes that there has been better control in the conditions provided in Rampton, but there is no evidence of clinical improvement. Other consultants have differing views. Even if there were unanimity of opinion among the consultants, there is the need to consult the nursing staff and the staff unions in the hospitals concerned.
Although doctors see patients from time to time, nurses have round-the-clock responsibility for their patients. We have to face the fact that staff are not unnaturally concerned about their own safety and the safety of other patients whom they may be called upon to treat in the same premises.
884 Very few members of the hospital staff would deny care and help to patients, however difficult they have been in the past, if it were possible to look after them under conditions which ensured staff safety. But in some of our large mental hospitals it is unfortunately true that there are times when there may not be enough staff on hand to cope with unexpected incidents—for example, at night when a nurse may be alone in a ward. If that ward contains more than a few patients whose behaviour is thought to be unpredictable and at the worst potentially violent, some staff may believe that it is in the interests neither of other patients nor of the nursing staff to accept the risk involved.
The result is that in some mental hospitals staff impose a sort of blanket prohibition. For example, staff will not accept patients who are under certain sections of the Mental Health Act 1959 or those who have been in-patients at one of the special mental hospitals. Any ill-considered attempts to force the admission of a patient in those circumstances could, indeed, lead to industrial action. I understand the fears and the feelings which prompt the staff to impose blanket bans of this sort, but I am bound to say that I regard them as being unfortunate and misconceived, because bans of this sort can cause real hardship and injustice to some individual patients. Once the attitudes based on blanket bans have developed, the problem becomes essentially an industrial relations problem. The matter has to be discussed with the staff with a view to removing misconceptions.
Unfortunately, a blanket ban of this type exists at Warley Hospital, the mental illness hospital which on a geographical basis is the one to which John Wilson ought to go. The mental handicap hospital for the area, at South Ockenden, has a somewhat different problem. It is faced with very heavy demands on it, with tremendous pressure for admissions. Faced with a waiting list, the staff have difficult choices to make. Naturally they go for the types of patient whom they feel they are best equipped to deal with, and they do not feel that. John Wilson falls into that category.
Where problems such as those at Warley arise, we have to discuss with staff interests the precise nature of the problem, consider the problems posed by the 885 admission of different categories of patients and what facilities are needed, and see what can be done to make the appropriate facilities available. In other words, the risks which might face staff have to be carefully assessed to see how real they are and how best they can be minimised. But the problems at Warley in that respect have not been overcome.
Other hospitals have been approached. My hon. Friend mentioned Kent as an area, for example, where we might look. But, of course, a number of our mental hospitals are under considerable stress, and it is our policy to provide each district with a mental hospital service by a specified hospital, or division within that hospital, so that we can have fair play in admission and opportunities for good clinical work, enabling us to treat patients as close to their homes as possible and as close to their family and friends as possible. Individual professional teams within the hospital can provide a sensitive local service for their particular communities. It is, therefore, not surprising to find that hospitals at a greater distance from a patient's home are loth, particularly if under pressure, to admit a man who is not accepted by the hospital normally responsible for his district. That is 886 another of the problems that we are facing.
My hon. Friend asked how many cases of this sort there are. I cannot give him precise figures, but I can say that cases of this sort are not unusual and are not by any means unique to his part of the world.
My hon. Friend asked when I could promise that John Wilson will be transferred. All I can say, I am afraid, is that it will be done as soon as we can manage to solve the problems that my hon. Friend and I have been discussing. We are not complacent about the situation. I think it is fair to say, too, that many patients who no longer need the security of a special hospital are transferred to local hospitals and that no problems arise. But in some cases, of which this is one, we encounter difficulty. We have not lost sight of John Wilson's case. I sympathise with his wishes and those of his loyal parents that he should not remain at Rampton longer than is absolutely necessary, and we shall continue to do all we can to secure his transfer to a local hospital just as soon as it can be arranged.