HC Deb 05 July 1977 vol 934 cc1206-18

8.14 p.m.

Mr. Stephen Ross (Isle of Wight)

I am grateful to you, Mr. Deputy Speaker, for allowing me to raise a subject that I intended to raise last Wednesday. I am especially grateful to the Minister for agreeing so willingly to deal with the case that I wish to put to the House after he has already had to deal with a particular probing Adjournment debate.

This is another case in which public funds are badly needed. I can understand the problems that the Department and the Government generally are facing when dealing with areas of special social need. I wish to refer to the distressing case of one of my constituents, Suzanne Cornwell, whose case, regrettably, is not an isolated one, although thankfully, I can say that it is pretty rare. It raises disturbing problems which to date we seem to be unable to cope with adequately.

Suzanne is now aged 19 years. She has been described as having a mental age of no more than 10 years although she can cope adequately with everyday situations such as dressing herself, going to work, going to college, where she was attending, and getting herself through the public transport system.

Suzanne's father first contacted me in September 1976 when his daughter was on remand in Holloway, having absconded from the Medina Training Centre at Newport, Isle of Wight. She had travelled to London under her own steam on stolen money. During the time that she was in Holloway it was alleged that she had been abused. I think that she had been tattooed by other inmates. She was quite rightly removed to the hospital wing.

Strenuous efforts were made by the social services department of the Isle of Wight County Council and by the area health authority to find a suitable placing for Suzanne, regrettably without success. On 6th October 1976 she was fined £10 and released back to her parents although still under the guardianship of the Isle of Wight County Council.

The judge's remarks were fully reported in the Press. I shall read some extracts because I think they illustrate the problem that faced the judge and the social services agencies. The judge said that he was horrified that a mountain of civil servants and administrators could not find her a hospital bed. In a subsequent report in the Daily Express on Thursday 7th October, a very good description was given by Jack Hill of the problems that faced not only the judge but a family with a girl of this age for which there seemed to be no suitable home. The article stated: It was with heavy hearts that Shirley and Howard Cornwell took their daughter home last night. 'I am disgusted at the situation we are placed in', said 41-year-old Mr. Cornwell. He and his wife have little doubt that before long their daughter Suzanne will again be in the hands of the police. Suzanne, aged 18 but with a mental age of eight, is a compulsive thief. And the only hope for her is to be cared for and treated in a psychiatric home. But when Suzanne appeared at Newport Crown Court, Isle of Wight … Judge Ian Starforth Hill set her free with a £10 fine for a petty theft. He was powerless to do anything else—because he was told that nowhere in Britain can a secure bed in a psychiatric home be found for Suzanne … 'If we want to face the truth, there are no such hospitals available. The fault, I suggest lies fairly and squarely with the Department of Health and Social Security'. The judge was told that if Suzanne was freed she was likely to be back in the courts before very long, or would run away to London to become involved in prostitution.

He replied: 'It's all very well pointing this out and nobody, but nobody, comes forward with any solution. It is a mockery, an absolute mockery to sentence this girl to imprisonment'. The Press report continues: At the Cornwell's home in Avenue Road, Sandown, Suzanne played last night with the family's tortoiseshell kitten and said: 'It's lovely to be here … I didn't like it in prison at all.' But her father said: 'She will get into trouble again. She needs a proper place to go to. I don't blame the judge in any way for what he has done now, or for sending her to Holloway in the first place. Probably he is as disgusted as I am. The type of halfway house needed for people like Suzanne, who are not violent or completely retarded, has been wanted for years but the problem has just been shoved into a corner out of sight …' Mr. Cornwell described what life would be like for the family—another girl aged 11, and two boys aged 15 and 13—with Suzanne back home. He said: 'You cannot plan a life around yourself or the other children—it has to be planned around Suzanne. When she comes in from a training centre she will have to stay in with us. When we go out she will have to come out with us. When she goes to bed the door has to be locked so she cannot go out at night'. Unfortunately, those prophecies proved only too true.

Suzanne then attended a modern hostel for people with mental disorders known as Glamis Court at East Cowes, Isle of Wight, where strenuous efforts were made to help her, particularly by one individual. I pay tribute to the time and work that he put in trying to help her. Others were also involved in trying to give her the training that she desperately needs. But it was not a secure institution.

Unfortunately, despite having made some progress, Suzanne again absconded and went on a further spree of stealing, finally committing arson which seemed to be completely out of character. She was not previously associated with anything like that.

Suzanne appeared at Clerkenwell Court on 10th January last and was committed for trial, again being remanded in custody at Holloway. I suppose that it was the only place where she could be kept. However, it seems most unsuitable for someone with her mentality. Whilst in Holloway, Suzanne tried to start another fire within the hospital wing on 16th March. Again, I and others tried to ensure that the right kind of establishment was found for her.

At her trial at the Old Bailey, according to the Isle of Wight County Press, her counsel was reported as saying: This is a young woman for whom society can find no place, and who has committed offences she should never have been able to commit. Judge Karmel said: Society can always find a place for everybody. It may not be the most suitable, but society can find a place. Counsel said that a judge's order was needed to get the Department of Health and Social Security to take whatever steps were necessary to waive the regulations and allow the Hertfordshire hospitals"— —it was suggested that there were places for her in Hertfordshire— to take a patient from another catchment area. Judge Karmel said that he could not express such a view until he had heard medical evidence to support it.

Counsel said that many young people in need of psychiatric help were victims of bureaucracy. He added: I venture to think and express the view that your Lordship stands as the means of the public obtaining from the state these facilities which ought to exist in the interests of the community. Judge Karmel replied: This would sound good at the hustings but it does not sound so good in a court of law. I can only do what the law allows me to do. I am not a politician any more than you are. I do not propose to make an order telling the Department of Health and Social Security what they should do. I can understand that they would regard it as gross impertinence on my part. They have their regulations and must abide by them. And if the regulations are wrong it is for Parliament to say they should be altered, not for the courts. The judge adjourned the case to 22nd April. In the interim, efforts were made to find a more suitable establishment to take Suzanne. Apparently, no place within the Wessex Region could be found. There were suggestions, as I indicated, of places for her at two homes in Hertfordshire. For some reason or other—there is some regulation which the Minister may be able to explain—it is not easy to arrange for a girl who should be in one region to be transferred to another. Anyway, the places that had been suggested in Hertfordshire did not materialise. Therefore, on 13th May an order was made for Suzanne to be admitted to Rampton.

I accept that, following the sentence at the Old Bailey that Suzanne be detained at Rampton for the foreseeable future, the Secretary of State went to the trouble of writing a fairly long letter of explanation to her father. In that letter of 25th May he set out clearly that he thought that the decision was right and he explained the facilities available at Rampton, which he had visited.

I make it clear that I have nothing against Rampton. I have never been there, although I have visited Broadmoor twice. I know what good work is done in that establishment, because another of my constituents, a girl of 15, is at Broadmoor. I have grave doubts whether she should have gone there, and the case has been taken up by MIND. However, I took the trouble to follow that case through and I saw that girl in Broadmoor. I have seen the facilities there. I have no doubt that everything that can be done will be done for Suzanne at Rampton. But Rampton is about as big as Broadmoor. It has about 1,000 patients, 750 male and 250 female.

We know that some drastic patients are taken at both Rampton and Boradmoor. Murderers, people with suicidal tendencies and all kinds of patients with varying mental disorders have to be catered for. Therefore, I question whether these establishments provide the right kind of environment for girls of a similar mental disposition to Suzanne.

Rampton, being Nottinghamshire, is a long way from the Isle of Wight. I should have thought that it was important that the parents should have fairly close contact with her and at as frequent intervals as possible. I understand that her father and mother can claim up to 50 per cent. of the cost of travel by public transport, but if they go by car, which can be cheaper, no allowance is made. There are difficulties for the parents, who obviously want to see their daughter as often as possible. That is another reason why it should be possible to find a suitable place for Suzanne within the Wessex Region.

Is it true that there is nowhere in this country for teenagers like Suzanne and others of whom I have knowledge—there are at least two cases in my constituency—and that they must serve sentences at Broadmoor or Rampton?

I repeat, I am grateful to the Minister for taking this Adjournment debate at short notice. What is being done to rectify the situation? I understand that there was a report about a year ago drawing attention to the deficiencies in the facilities available for cases such as that of Suzanne Cornwell. I also believe that if there is a suitable establishment within the Wessex Region it should be possible for the Minister's Department to insist that a particular case be accepted in that hospital and not leave the decision entirely to the local director. At present, if he does not wish to take a case, he can refuse it. One therefore has cases such as that of Suzanne Cornwell in which local social services departments can apply to no less than 28 homes within the area which might be suitable and no fewer than 28 refuse to accept her case.

The situation is getting worse. What are the possibilities for the future? What hope can the Minister hold out for parents of children like Suzanne?

8.29 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Alfred Morris)

I should like to thank the hon. Member for the Isle of Wight (Mr. Ross) for raising this important matter in the House. He is to be congratulated on his enterprise in securing the debate and on his humanity and concern to help. I shall do my best to reply as constructively as possible.

The case of Suzanne Cornwell, which has attracted wide public interest, highlights the problems which we are facing concerning mentally disordered offenders. As we have heard, Suzanne Cornwell is an 18-year-old mentally subnormal girl with a long history of anti-social behaviour, of absconding and of compulsive theft. She had been attending the Isle of Wight County Council's Medina Adult Training Centre when she committed the several offences of theft which led to her first appearance before the courts. She was made the subject of a guardianship order to the Isle of Wight County Council under the Mental Health Act 1959 on 27th May 1976. Following further appearances in court, she was charged with theft on 10th August and 6th October 1976. On both occasions she was discharged back to the local authority's care.

The Isle of Wight County Council, the Isle of Wight Area Health Authority and the Wessex Regional Health Authority made every possible effort to find a suitable placement for Suzanne. The county council was unable to find a suitable hostel because of her habitual absconding and theft. The area and regional health authorities were unsuccessful in finding hospital accommodation, since medical opinion was that Suzanne required training in secure conditions and that no hos- pital facilities within the Wessex Region were suitable for her. Attempts to place her outside the region also failed. Health authorities must, of course, rely upon the judgment of hospital consultants as to the suitability of their units for a particular patient.

After her discharge from court on 6th October 1976, the county council arranged for Suzanne to attend one of its hostels, Glamis Court, for a period of assessment, and the county council and area health authority staff made strenuous efforts to help and support her. Unfortunately this did not prevent her absconding to London, where she committed the offences of arson, theft and forgery which resulted in her admission to Rampton Hospital following her court appearance on 13th May 1977.

The circumstances under which Suzanne was admitted to Rampton Hospital were as follows. On 25th April 1977, Dr. Sherry of Holloway Prison wrote to my Department requesting a place in a special hospital for Suzanne, who was before the court on a charge of arson. In his letter he made it clear that a place in a special hospital was required because no other suitable alternative hospital place could be found within the Wessex Regional Health Authority area. Dr. Sherry stated that the judge concerned with the case had made it clear that he considered Miss Cornwell to be a serious danger to others and that, if treatment in conditions of security were not available, he would send her to prison for an indetermined period.

As the House knows, the special hospitals were established under Section 40 of the National Health Service Reorganisation Act 1973 for persons who, in the opinion of the Secretary of State, require treatment under conditions of special security on account of their dangerous, violent or criminal propensities. The security provided by the special hospitals is of such a kind and degree as to deter a determined absconder or to prevent the escape of a patient who would, if at large, present a grave and immediate danger to the public.

The application from Dr. Sherry placed the officials in my Department who deal with applications for places in special hospitals in a difficult position. From the papers at their disposal it did not appear that Miss Cornwell met the criteria laid down in Section 40 for admission into a special hospital. At the same time, however, they were aware that there was no place available for her in an NHS psychiatric hospital within the Wessex RHA area and that, in the event of a place not being made available at a special hospital, the court would probably pass a sentence of life imprisonment.

In view of this, it was arranged that one of the consultant psychiatrists at Rampton Special Hospital should examine Miss Cornwell. The consultant's report was that Miss Cornwell was, in his opinion, impusively dangerous—as evidenced by her fire-raising activities—and that she should be admitted into Rampton Hospital. In the light of this opinion, the court was notified that a place would be made available at Rampton Hospital. The court made an order under Section 60 of the Mental Health Act 1959 and it also imposed restrictions under Section 65 of the Act. The effect of the restrictions under Section 65 is that Miss Corn-well cannot be discharged, transferred or sent on leave from Rampton Hospital without the consent of the Home Secretary. Miss Cornwell was admitted to Rampton Hospital on 25th May.

As the House knows, Rampton Hospital is one of the four special hospitals provided for persons subject to detention under the Mental Health Act 1959 who are considered to require treatment in conditions of special security, and it is directly administered by officials of my Department acting in the name of the Secretary of State. It caters mainly for patients who are mentally handicapped, although all forms of mental disorder are treated there.

The hospital, which has about 700 male and 250 female patients, differs from ordinary psychiatric hospitals only in so far as treatment is carried out under conditions of special security. In practice, the perimeter security makes it possible to provide many patients with a much fuller life than would be possible in a hospital where this does not exist.

The Secretary of State has recently visited the hospital and has said that he is very impressed with the high quality of treatment, care and rehabilitation. All the usual forms of psychiatric treatment are available, the medical staff include a number of consultants and there are a visiting dentist, chiropodist, speech therapist and dietician. There are also occupation staff, psychologists and social workers and a high ratio of nurses to patients. The occupational, educational and recreational facilities for patients are at least of the standard to be found in ordinary psychiatric hospitals. There is an indoor swimming pool for patients and a well-equipped gymnasium. Leisure activities include concerts and dances as well as various sporting activities. Patients' relatives are encouraged to visit the patients regularly, and there is financial and other assistance available to relatives who have to make long journeys.

Shortly after Suzanne Cornwell was admitted to Rampton, the Secretary of State wrote to her parents in an effort to alleviate their concern about the decision to admit Suzanne to Rampton. The hon. Member referred in particular to the problems of Suzanne's parents as their home is so far removed from the hospital. That is a point that I shall be looking into with a view to corresponding with the hon. Gentleman as soon as possible.

I am, of course, distressed at the need to detain a young woman such as Miss Cornwell in a special security hospital, but I am quite sure that the court's decision to send her to Rampton Hospital was taken in her own interests.

Since the inception of the National Health Service it has been part of its responsibility to provide facilities to treat all types of patients with mental disorder, the only exception being those who require to be treated in conditions of special security. The Mental Health Act 1959 did not change this fundamental responsibility. The changes of attitude which the Act helped to promote have brought about a vast reduction in the number of patients formally detained and in restrictions on the liberty of patients.

The danger is that this change of attitude could be carried too far. Staff may be reluctant to provide the necessary supervision for the few patients who require it, or they may come to regard these patients as not being their responsibility at all. In fact, some hospitals have become entirely "open" without making any alternative provision for the patients who need treatment in conditions of security short of that provided in the special hospitals.

In the 1960s there was mounting criticism—as the hon. Gentleman will recall—over the refusal of hospitals to admit patients who presented difficulties and a lot of pressure on the special hospitals to take patients not needing the maximum security provided in them. My Department therefore set up a working party in 1971 to consider the present and future needs for security in psychiatric hospitals and units. Its report recommended the establisment of regional secure units, and this was endorsed by the interim report of the Committee on Mentally Abnormal Offenders.

A circular was sent to regional health authorities in July 1974 asking them to take urgent action to establish regional security units. Since then they have been investigating the position in their regions and preparing plans for submission to my Department. For our part, we have promised to meet the capital costs of approved schemes as well as providing special revenue resources. All regions are actively planning secure psychiatric units, and seven of the 14 have submitted preliminary planning proposals. The Government's aim was for all regions to have secure units by 1980.

Mr. Stephen Ross

That is very important and useful information, but can the hon. Gentleman say whether the Wessex Region is one that has those plans? If he does not have the information with him, a letter later will suffice.

The offence for which Suzanne was finally sentenced, which is obviously worrying, was arson. People connected with crime are more worried about arson than any other crime except perhaps murder. However, the offence was completely out of keeping with her character. One cannot help thinking that, had a secure establishment been available for her at a younger age, the offence would not have happened. This is a very important point to remember for the future.

Mr. Morris

I shall be seeking to make as clear as I can to the hon. Gentleman the position in regard to Wessex.

The hon. Gentleman referred to the importance of the plans which are now being submitted by the regions. I take his point, and I will see that everything that he has said tonight is very sympathetically considered. As I was saying, the Government's aim is for all regions to have secure units by 1980. Unfortunately there has been some delay, but we hope that regions will press on urgently with their planning. The recently-established working group should be a real source of help to those regional health authorities which are encountering overcoming local difficulties and misunderstandings.

In the interim, until such time as units are in operation, authorities have been asked to make provision for these difficult patients. The designation of certain wards or hospitals as interim secure units is envisaged. Special revenue allocations have already been made available, and the nursing staff working in them permanently and exclusively will qualify for a special lead payment of £201 per annum in addition to the psychiatric lead.

It is not intended that these units should take all patients who cause difficulties in local hospitals, either by their behaviour or by occasional absconding, but should take only those who so consistently present such problems as to make their local management impracticable with the facilities available. In addition, it is hoped that the units will help the courts by assessing mentally disordered offenders, and also provide places for offenders whose treatment needs require greater security than that available in the "open" wards of ordinary psychiatric hospitals but less than the very high security of the special hospitals.

In Wessex Region the regional health authority has provided an interim secure unit, the Lyndhurst unit, at Knowle Hospital, Fareham, Hampshire. The unit is intended for the mentally ill, and not the mentally subnormal, and its object is to give short-term care and assessment. A gradual intake of patients began in February 1977, and it is expected that the full complement of 14 patients will be reached by the end of July. The unit also has accommodation for 14-day patients, of which there are presently 10. Male patients only are to be admitted for the first year. The reason for this policy is that there are more of these difficult cases amongst men than women, and restricting the unit to one sex will ease the management during the initial period while experience in the running of this type of unit is gained.

The RHA is planning to provide a permanent secure unit of about 53 places, but the siting of the unit has still to be decided. Hampshire Area Health Authority (Teaching) is presently working on a strategic plan for mental illness services in Hampshire which is not expected to be completed until early next year. Once the plan has been accepted, a decision on the siting of the permanent unit will be taken and planning can proceed. I shall be very conscious of the hon. Gentleman's close personal and constituency interest in these developments, and I shall seek to make arrangements for him to be kept informed of the developments as they occur.

In addition, the RHA has established a multi-disciplinary working group to examine the needs of mentally handicapped persons who are profoundly disturbed or psychotic and others who cannot be satisfactorily accommodated in the open wards of a mental handicap hospital or in hostels. This group, whose first meeting is now being convened, will consider the establishment of a regional unit if this becomes the obvious solution to the problems identified.

Regional secure units will form part of the psychiatric services for a region, and we hope that they will fill a gap in the services for the mentally disordered who require treatment in conditions of security. By relieving ordinary psychiatric hospitals of some of their most difficult patients, they should ease the burden on the staff. I feel that the present unsatisfactory situation cannot be allowed to continue and that we must press ahead urgently with the establishment of the secure units. The hon. Member's representations on this matter will certainly be taken very much into account in our further consideration of this very difficult and sensitive area of policy affecting mentally disordered young persons.

Question put and agreed to.

Adjourned accordingly at twelve minutes to Nine o'clock.