HC Deb 21 November 1978 vol 958 cc1093-104
The Secretary of State for Social Services (Mr. David Ennals)

With permission, Mr. Speaker, I should like to make a statement about the report of a committee of inquiry into events at Normans-field hospital for the mentally handicapped, which I have published today. Because of printing difficulties, I have placed a limited number of typescript copies in the Vote Office for hon. Members. For this reason, I hope that the House will forgive me if my statement is a little longer than might otherwise be the case.

On 5th May 1976, following a long period of difficulty, there was a strike at the hospital and nursing staff refused to resume work until the consultant psychiatrist, Dr. Lawlor, was suspended from duty, as he was later that day. The regional health authority set up an inquiry which was unable to function effectively when Dr. Lawlor declined to give evidence and the medical member of the inquiry withdrew. I therefore had no alternative but to establish a statutory inquiry.

I am most grateful to the chairman, Michael Sherrard, QC, and the members of the committee for the thorough way in which they have conducted the inquiry and for the clarity of their report. The main findings include the following: the quality of life of patients at Normans-field was impaired by lack of co-operation between Dr. Lawlor and other staff; although, with one exception, there was no evidence of cruelty or ill treatment of patients by members of the nursing staff, the standard of nursing care was generally extremely low; maintenance of the buildings and standards of hygiene were also highly unsatisfactory, and some patients were improperly secluded.

Dr. Lawlor is held responsible for much that was wrong. The report describes his approach as—I quote—"intolerant, abusive and tyrannical" and states that he "needlessly and harmfully restricted" the lives of patients and drove away other staff.

But the faults were by no means his alone. There are serious criticisms of senior nurses at the hospital and the administrator and of some officers of the area and regional health authorities and of the authorities themselves, who failed to come to grips with the problems at Normansfield over a long period and specifically failed to tackle the grievances which led to the strike. There are also serious criticisms of two officials of a trade union. I hope that these will be heeded.

I am referring the grave criticisms of NHS staff to the responsible health authorities so that they can take appropriate action.

As recommended by the committee, certain of Dr. Lawlor's practices, concerning drug prescribing and certain aspects of a research project involving some of his patients, will be referred to the General Medical Council.

After the committee had finished taking evidence in May 1978, it revisited Normansfield and reported to me that it was disturbed at what it had seen. I therefore visited the hospital myself, and a subsequent exchange of letters is published with the report. It is very much to be regretted that the efforts to improve the position at Normansfield had met with only limited success, but it is important to remember the circumstances in which the staff of the hospital had been working during the previous two years with the inquiry in progress. After discussion with the chairmen of the health authorities, a task force of senior medical, nursing and administrative staff was appointed to run the hospital.

Normansfield faces great difficulties in the months ahead while this report is considered and action taken on its recommendations; but I am confident that the area health authority, as now constituted, will lead the staff and the patients into a better future. A new building development has started. A total of £ ½ million has been spent on maintenance and repairs and the task force is now at work in the hospital.

The report may cause grave concern about the care of mentally handicapped patients generally. The Government's aim is to enable as many mentally handicapped people as possible to live in the community, but hospital care will be required for many of these patients for a long time to come. The sort of behaviour and the poor standards of care revealed at Normansfield must not be tolerated in our hospitals.

In recent years, staffing numbers have been greatly improved. The Government have given high priority to services for the mentally handicapped, and I shall continue to press health and local authorities to secure for them a growing share in the expanding health and social services budgets. I shall ensure that health authorities next year are able to continue the improvements in mental handicap services made possible by the injection of £50 million for the NHS as a whole in April.

We are giving a strong lead nationally on ways of improving the quality of care. Three years ago, the Government set up the national development group and the development team for the mentally handicapped. The group reported recently on "Helping Mentally Handicapped People in Hospital". I have placed in the Library a copy of the statement I made on publication of that report, in which I set out the steps that the Government are now taking to improve the quality of care.

There have been other disturbing reports in the past, and the House and the country will share my concern to ensure that events of the kind described in this report are not repeated in other hospitals, now or in the future. To this end I am taking three further steps.

First, it is clear that the health authority failed in its duty to monitor performance. Such a failure must not be repeated elsewhere. I am therefore asking all area health authorities to review urgently their monitoring arrangements and I shall be impressing the importance of this on area health authority chairmen when I meet them in the next few days. I am asking regional chairmen to tell me the outcome of the reviews when I meet them in March.

Secondly, the development team for the mentally handicapped will continue to be available to authorities to advise them on how services can be improved, but I shall now strengthen the team and I have decided that in future, as well as going by invitation, the team will, where necessary, visit hospitals on my instructions.

Thirdly, following discussions with leaders of the main trade unions and health professions, I have recently made proposals for a new NHS disputes procedure designed to settle local management disputes quickly where they arise, rather than allowing them to fester and erupt finally in industrial action. These proposals are in line with the proposals in the report and are being considered by the General Whitley Council, which I hope will embody their essential features in an agreement for early implementation

In conclusion, while condemning the faults revealed by the inquiry, let us remember that they are not typical of mental handicap hospitals in the country and let us not forget that the task of caring for mentally handicapped people requires great dedication, and there are many examples of this dedication throughout the country. Those who undertake it deserve our respect and our understanding and support.

Mr. Patrick Jenkin

We are grateful to the Secretary of State for that long but very disturbing report on the problems of Normansfield. Will he accept that we associate ourselves with the remarks he made about those who devote themselves to the care of the mentally handicapped? Is he aware that, with one or two commendable exceptions, the report discloses a history of failure over a prolonged period as shocking as anything that one can remember reading?

I have two questions, the first of which relates to monitoring. Does the right hon. Gentleman recall that the principal cause of the trouble at Normansfield lay in the intolerant character and tyrannical methods of Dr. Lawlor, coupled with weak and ineffective control at area level? Is it not equally clear that the only effective way of dealing with that kind of situation is by firm and authoritative monitoring from outside? In this regard, will the right hon. Gentleman now seek to strengthen both the constitution and the terms of reference of the Health Advisory Council, as it was originally set up in order to monitor the problems in mental hospitals?

My second question relates to what the inspector described as the "principle recommendations". These are set out on page 564 of the report. One of the recommendations states: When a conflict arises between rights of the patients not to be endangered by industrial action on the one hand and the rights of staff to take industrial action on the other the rights of the patients should prevail. Does the Secretary of State unhesitatingly accept and endorse that recommendation?

Mr. Ennals

I am grateful to the right hon. Gentleman. As he rightly says, this is a very disturbing report. Of course, the industrial action itself was unprecedented. The strike was unprecedented in the history of the NHS. Immediately following on the right hon. Gentleman's last point, I would say without hesitation that I agree with the statement which he quoted relating to where the balance must lie. It must always be the rights of the patients which should prevail. This principle shines through the recommendations in the report. These are certainly issues which I now want to discuss with the leaders of the unions and the leaders of the professions as we look further at how we can improve industrial relations within the Health Service.

As to monitoring, the trouble is—the report makes it clear—that many people knew just what the position was. Some of them were in positions of authority with power to act, but they failed to act. The lesson from this is clear: that those who hold positions of authority really must accept the responsibility that goes with it. As to whether it would now be wise to make a change in the health advisory service, I think the right hon. Gentleman knows that since 1975 the development team for the mentally handicapped has taken over the task of advising on mental handicap services. I said in my statement that I am strengthening the team in order to ensure that it has the opportunity of visiting hospitals whether or not it is invited, so that in future it will be able to do so on the decision of the Secretary of State.

Mr. Jessel

As the Secretary of State said that the standards of nursing care were extremely low, and as good nursing is vital to the well-being of patients, when will new senior nursing appointments be made at Normansfield hospital, which is in my constituency, and the nursing staff brought up to establishment? As to the position of the consultant psychiatrist, why is it, not only in the National Health Service but throughout the public services, that if someone is hopelessly or even dangerously unsuitable it is almost impossible to move him? That was why, in this case, it took a strike to force the hand of the regional health authority.

Mr. Ennals

With regard to establishment, I am certain the hon. Gentleman knows—the hospital is in his constituency—that it has been very difficult to appoint new permanent staff during the period of the inquiry and until the report came out. That was why some time ago I appointed a task force to give medical, nursing and administrative leadership there. It is now our hope that, in place of the locums who have been appointed, it will once again be possible to increase establishment at the hospital, although I think the hon. Gentleman will have seen from the report that there is no suggestion at all that what happened at the hospital was due to financial problems.

As to Dr. Lawlor and the question of discipline, this is a matter for the employing health authorities. As I have said, certain aspects of his clinical behaviour will now be referred to the General Medical Council. I hope that health authorities will learn a lesson. They must monitor the responsibilities which are being carried out, whether by psychiatrists, doctors or administrators, and if the job is not done properly it is the responsibility of those in charge to see that proper persons are put into such posts.

Mr. Moonman

I have no doubt that members of the all-party committee on mental health will be relieved that there is no evidence of brutality in the report. I am also sure they will respect the work done by Patricia Mills, who has done much to make this report possible.

I should like to ask the Secretary of State two questions. First, why did the Department fail to act in September 1975 when it had a warning from a key member of staff about the difficulties at the hospital? Second, as three disastrous appointments were made at the hospital, what advice can the Department give to such hospitals with regard to making the right selection?

Mr. Ennals

As to brutality, I think that I had better quote direct from the report, because it is much clearer than my hon. Friend said. The report said: There is, with one exception, no evidence whatsoever of cruelty or ill-treatment of patients by members of the nursing staff. It is at least a relief that we are not dealing with that sort of situation. That does not mean that the standards of nursing care were not abysmally low.

My hon. Friend asked why the Department did not take action in 1975. The responsibility for the running of the Health Service and of particular hospitals is that of the health authorities. Although many people are criticised in the report, and those criticisms have been made frankly, one thing that comes through is that there has been no criticism whatever of the way in which my Department has carried out its responsibilities. I should very much like to consider whether any further guidance can be given in terms of appointments to psychiatric posts.

Sir Derek Walker-Smith

The report, albeit perhaps a particularly disturbing one, is by no means the first of such reports, which are always followed by reassuring statements from the Government Dispatch Box such as that to which we have listened today. In the context of monitoring, will the right hon. Gentleman say what practical assistance, apart from exhortation, he proposes to give to area health authorities in this task?

Secondly, in the financial context, will the Secretary of State review the balance of financial provision within the NHS, where this particular service has always been something of a Cinderella, to see how far staff difficulties and shortages can be overcome by the provision of proper finance?

Mr. Ennals

Let me first say that I am not giving reassuring statements from this Dispatch Box. However much one would like to do so, it would be impossible to give a guarantee that some such situation may not occur again in some other of our mental handicap hospitals which may cause the same sort of sense of shock as this has done. We must do everything we can to see that this does not happen. But let it be recognised, and I am certain the House will do so, that great priority is now being given to these services.

As I said, the ratio of staff to patients has almost doubled since 1969, overcrowding has been greatly reduced and the number of patients is down considerably because of increased provision in the community. We are seeing a much faster rate of spending in this Cinderella area than in other areas of the National Health Service.

Several Hon. Members

rose—

Mr. Speaker

If the House will cooperate, I hope to call all those hon. Members who have stood up. However, there is another statement to follow, so I hope that Questions will be brief.

Dr. M. S. Miller

Does my right hon. Friend agree that it is not so much exhortation that is needed as a little bit of exorcism? Will he indicate the active steps being taken by the GMC to ensure that a crackpot like the man who was in charge of this hospital, who himself probably needs psychiatric treatment, is not permitted to carry on?

What steps have been taken to ensure that this situation will not occur again? It is most disconcerting trying to read a report like this with 700 pages and to find descriptions of a National Health Service hospital as looking like "a 19th century workhouse". Are things better in Normansfield now, and is there a better spirit among the staff?

Mr. Ennals

The three wise men procedure has been followed on the question of whether Dr. Lawlor needs psychiatric treatment. There was an examination of him and it was thought that he might be suffering from a mental illness. Subsequently a psychiatrist who examined him found no evidence of mental illness, and Dr. Lawlor remained in his job. This is now a matter for the GMC, and there are conclusions that it will draw in general and in particular from this disturbing situation.

As far as the present situation is concerned, I was very encouraged to read the recently published report of the local community health council which played a very important part in bringing these facts to light. The council said in its annual report on 30th June: The CHC is concerned that the publication of the report should not upset the constructive and ever-growing teamwork which has been evidenced in the improvement in our local mental handicap services. That was a reference to Normansfield. I believe that progress is being made. I shall visit the hospital again shortly to discuss with the staff how they can work together to build a better future for those who live and work at Normansfield.

Mr. Penhaligon

Will the Secretary of State agree that there were people in authority who knew what was going on, that they had power to deal with it and that they clearly did not do so? How many have been sacked?

Mr. Ennals

The report has been published only today. It is for the area health authorities now to decide what action should be taken in the light of the very severe criticism contained in the report of many individuals.

Mr. Molloy

Is my right hon. Friend aware that his statement this afternoon and the words from the Opposition Front Bench will cause grave concern nationally about this appalling story? Will he note that it would appear that this inquiry totally rejects the biased and inaccurate reporting of the medical press? Will he consider that it would appear that the remainder of the staff— particularly the nurses—seem to have been absolutely and unduly provoked by the actions of those in charge? If there is to be any form of penalty, these nurses should not be held responsible for the woefully shoddy administration at this hospital.

Mr. Ennals

Certainly Dr. Lawlor is held responsible for much of what was wrong, and there was a great deal of provocation by him which was not dealt with by the health authorities. There is no doubt that there were genuine grievances and that those grievances were not dealt with. If, however, my hon. Friend is asking me in any way to condone the action of those who went on strike and abandon mentally handicapped people, I simply cannot do so.

Mr. Peter Bottomley

Will the Secretary of State accept that we would like to have rather earlier whistle-blowing on situations like this rather than expensive witch-hunts afterwards? Will he consider whether arrangements can be made, particularly when dealing with mentally handicapped people and perhaps sick children as well, for people who believe that things are going wrong and who cannot find satisfaction through the proper management channels to have the opportunity of raising the matter with an outside body? In this way, an investigation could take place earlier.

Mr. Ennals

Of course, everyone has the absolute right to discuss these questions with the community health council, and that council can raise the matter as a matter of concern, as, indeed, it did in this case. I reiterate the point made by the hon. Member about witch-hunts. It is important that consideration should be given to whether those who are named should be disciplined, and, if so, in what way. I hope that there will be no other witch-hunting, and I hope that this report will stimulate those in the community around Normansfield and around other hospitals for the mentally handicapped to help in a voluntary way in order to throw the light of day on these hospitals where the staff desperately need support.

Mr. Sever

Will my right hon. Friend indicate whether what happened at Normansfield was primarily due to staff shortages or to cuts in public expenditure?

Mr. Ennals

If I may quote from the report, The main cause for the shortfall in patient care and development was not lack of finance but a failure of duty". I reiterate that.

Mr. Pattie

Does the Secretary of State agree that a debt of gratitude is owed to the task force which has been operating the hospital for some months under considerable difficulties? Will he tell us what confidence he has that the area health authority will act more promptly in future when faced with similar situations?

Mr. Ennals:

I welcome the hon. Member's remarks. He has in his constituency Botleys Park hospital, which has done a lot to help and support Normansfield in its time of difficulty. Very many of those now on the area health authority are not those who were there when these events took place. The authority has a new chairman and many different members. Also, there are some different staff. I have absolute confidence that those who now lead the area will be able to take this hospital through its very difficult period.

Mr. Litterick

However deplorable this case study may be, will the Secretary of State agree that it would be unfortunate if these bizarre events were allowed to divert public attention and also the attention of his Department from the general condition of mentally handicapped people who reside not in hospitals but in hostels? There is virtually no monitoring of these hostels, as is the case in Birmingham, where mentally handicapped people are abused, have no rights at all and are treated like rubbish for the benefit of property speculators and for the advantage of Conservative politicians in that city.

Mr. Ennals

I know that the situation to which my hon. Friend has referred is one which he intends to draw to the attention of the Minister of State later today. It is important that we understand that there are problems in hospitals for the mentally handicapped in different parts of the country. But we should also recognise that there has been a threefold increase since 1969 in the number of residential places in the community, and it is important that the local authorities should fulfil their knowledge and responsibilities relating to that residential accommodation.

Mr. Eldon Griffiths

Since another tribunal, of which the right hon. Gentleman is aware, has revealed other though lesser cases of bullying in a West Suffolk hospital, may I say how much I welcome his words about the need for intelligent monitoring by the area health authorities? I also welcome his forthright statement that, in weighing the balance between the welfare of patients and the rights of staff to take industrial action, the patients must come first. Will the right hon. Gentleman now apply that judgment, with which the whole House will concur, to other industrial action now being taken in some of our hospitals?

Mr. Ennals

There is no doubt that that set of principles must apply to all those who work in the Health Service, he they doctors, nurses, administrators, supervisors or whatever.

Mr. English

Who audited the expenditure upon this hospital and by this hospital? Was it the Exchequer and Audit Department again? Does not my right hon. Friend now agree that the Select Committee on Public Expenditure, the Select Committee on Procedure and the former Shadow Leader of the House were right in advocating an independent audit by this House which would cover not merely financial corruption but efficiency and effectiveness?

Mr. Ennals

There is no evidence of corruption in this case, but I will reflect on the point put by my hon. Friend. He may care to put down another Question.