HC Deb 11 November 1980 vol 992 cc193-209 3.30 pm
The Secretary of State for Social Services (Mr. Patrick Jenkin)

With permission, Mr. Speaker, I should like to make a statement about Rampton special hospital.

Following the showing of a programme on Yorkshire Television on 22 May 1979, I invited Sir John Boynton to lead a team to review the management of Rampton special hospital. I am today publishing the team's very thorough report. Sir John and his fellow members had a most difficult task, and I am deeply grateful to them for the work that they have done.

The report praised both the dedication and hard work of most staff at the hospital and many of the facilities there. I endorse this praise. However, the team was also critical of the way that the hospital is managed and called for major improvements in the treatment and care of patients. Some of the main proposals were discussed by the team with staff at the hospital, and I can tell the House that some changes are already being made by the hospital, including much-needed changes on the male block wards.

I accept the team's analysis of the hospital's and the Department's short-comings and the main thrust of the reforms that it proposes. It concludes that Rampton should continue to operate as a special hospital. I agree. I also accept its proposal that for the next three years Rampton should be supervised by a local board to be called the Rampton review board. This board will guide and support local management in securing the implementation of the changes that the team has proposed. The necessary order and regulations to establish the board as a special health authority will be made as soon as possible. I expect to announce soon the composition of the board. I hope that it will be able to begin its work by the turn of the year.

In addition, I have accepted the team's proposals for a reform of local management and for the appointment of a medical director, who would provide the leadership for the hospital that has been lacking. I shall be advertising for the post of medical director very shortly.

Another of the review team's main recommendations to which I attach great importance concerns the transfer of those patients at Rampton who have been waiting, some of them for a very long time, for places in local hospitals. I share the team's concern on this difficult issue and I am writing personally to all regional health authority chairmen about it, urging them to make swifter progress.

Some of the recommendations by the team extend beyond Rampton and will require wider consideration. In particular, it proposes a body to inspect and monitor all institutions where patients are detained under the Mental Health Act. This proposal has already been put to me in relation to legislation to amend the Mental Health Act. Sound and effective monitoring systems are essential to the proper running of all health services in this country, including those institutions that hold Mental Health Act patients. I am now considering the various ways in which this requirement can be met.

In the interim, three of the four special hospitals will have schemes to involve in their work people from outside the hospital. Rampton will have its review board. At Moss Side and Park Lane hospitals the local community health council has, as the House already knows, arranged to make regular visits. I am urgently considering how a similar arrangement could be made at Broadmoor.

Change cannot be achieved overnight. Implementation of the review team's recommendations requires changes in attitudes as well as staff and financial resources. The team noted that management and staff appear to accept the need to examine traditional attitudes, practices and regimes and we must seek to ensure that, through the Boynton report, a much stronger impetus is given to the improved running of the hospital and higher standards of patient care. To achieve this the hospital will need the full understanding and support of all of us—the professions, the public and Parliament. The patients for whom we care deserve no less.

Mr. Moyle

We should like to join in the thanks that the Secretary of State expresses to Sir John Boynton and his staff on the hard, patient and conscientious work that they have put in on the report.

We must all hope that the report will provide the basis for resolution of the problems uncovered by Yorkshire Television in May last year and for the proper care of the patients at Rampton. We endorse the report's view of the majority of the staff at Rampton and their conscientious work.

As the Secretary of State said, there is a great amount of detail in the report, and we shall want to give it careful and detailed consideration. However, broader questions arise. First, the right hon. Gentleman spoke of support and human sympathy for the staff and patients at Rampton. Will he undertake to make available any extra finance that may be needed for implementing the report, where necessary? Secondly, bearing in mind the fate of the Elliott report in 1973, which is still not implemented, will the Secretary of State consider setting a date for the full implementation of this report, which we can all work towards? Thirdly, there is much press and public interest in the matter, particularly in the area concerned. Will the right hon. Gentleman take steps to ensure that the Official Secrets Act applies only to discussion of the hospital's security system and is not a blanket coverage of the whole of its activities? Specifically—and the Secretary of State was not clear about this—will he review all the special hospitals and their procedures in the light of the report?

There are a number of recommendations aimed at improving industrial relations in the hospital. The right hon. Gentleman did not say whether he intended to proceed to the negotiation of their implementation forthwith. Does he intend to do so? Does he believe that the recommendations will improve the industrial relations atmosphere, bearing in mind what happened to last week's arranged press visit to the hospital, which had to be called off due to staff resentment? Does he believe that the recommendations will remove Rampton's sense of geographical and profesional isolation?

Finally, it is assessed that there are about 130 patients who should not be there. The right hon. Gentleman talks about transferring them to other hospitals. Last March his Department produced a study on the transfer of patients out. Has the rate of transfer of patients out of Rampton increased since the tabling of that study? We shall be pleased to hear the answers to those questions.

Mr. Jenkin

I thank the right hon. Member for Lewisham, East (Mr. Moyle) for his kind words about Sir John Boynton and his colleagues.

One of the points that the report makes is that shortage of finance has not been part of the problem at Rampton.

Mr. Kilroy-Silk

It is attitudes.

Mr. Jenkin

That is what the report says. The hon. Gentleman is right. The main problem is attitudes.

At present it would be difficult for me to find additional finance, but I shall want to look at that very carefully.

I am reluctant to set a date for the implementation of the recommendations. The appointment of a review board to carry forward the implementation of the recommendations is the best way to make progress.

The right hon. Gentleman mentioned the Elliott report. Previous reports have never carried the full support of the staff at the hospital, whereas Sir John has been able to say that the staff accept the need for changes in traditional attitudes and practices. That is a cause for optimism.

The staff at the hospital are effectively civil servants and therefore are automatically bound by section 2 of the Official Secrets Act. I hope that it will be possible in future to adopt a much more liberal attitude to the publication of factual information about the hospital and professional views of matters of professional concern at the hospital. I shall want to examine carefully how we can substantially liberalise such procedures. As the right hon. Gentleman recognised, the security arrangements at the hospital must obviously remain subject to the Act.

Many of the lessons of the report will be applicable to other hospitals, though the others have not suffered problems to anything like the degree that Rampton has. In particular, the other hospitals have all accepted a proper complaints procedure whereas at Rampton that is still bogged down in negotiations with the staff interests.

It is for the review board to implement the recommendations, under, of course, the general direction of my Department.

I regret that the journalists who visited Rampton last week were not able to be given the same facilities as had been given to, for instance, journalists from The Sunday Times who visited the hospital some months ago. However, I can understand the suspicions of the staff at the hospital who have not been dealt with kindly by the press in the past and who need some reassurance. I hope that we can make progress.

I understand the point that the right hon. Gentleman made about geographical and professional isolation. We shall pay particular attention to the recommendations that there should be much more movement of staff between Rampton and other mental health institutions and that there should be many more opportunities for staff to visit other institutions and to see modern practices elsewhere.

I cannot tell the House that the rate of transfer from Rampton to other mental health hospitals has increased. It has not. That is a matter to which we wish to give urgent attention. We want to ensure that NHS hospitals realize that they have an important role and responsibility, as part of the continuum of care that makes up our pattern of mental health services, to take patients who are recognized as suitable for admission to those hospitals by the consultants in charge of them.

Several Hon. Members

rose—

Mr. Speaker

Order. If hon. Members co-operate I shall hope to be able to call all those who wish to question the Secretary of State.

Mr. Paul Dean

I welcome what my right hon. Friend said about the steps that will be taken to strengthen the management at the hospital—the new review board—and the proposal to associate people from outside Rampton and the other special hospitals with their general management. I also join my right hon. Friend in his tribute to the staff, who have an intensely difficult job at Rampton and the other special hospitals.

Can my right hon. Friend say a little more about the publicity surrounding the hospitals? Are not short press visits by people who inevitably know little about the problems inside the hospitals likely to create difficulties for staff and patients and is there not a need for great discretion on the part of the media if they are not to intensify already difficult situations?

Mr. Jenkin

I am grateful to my hon. Friend for his welcome of the main thrust of my statement. I agree wholeheartedly that the work of the staff at Rampton and other special hospitals is intensely difficult. They are dealing with some of the most difficult patients with whom we are asked to cope. By definition, those patients are classified dangerous, violent or criminal. We constantly have to bear in mind the nature of that work when we are considering these problems. It is invaluable that my hon. Friend has pointed that out.

I assure my hon. Friend that those responsible for making arrangements for press visits carefully chose the journalists who visit hospitals. They are those who have an understanding of the problems that they will be studying and they can, one hopes, be relied upon to treat the matter seriously and not sensationally. Visits by television crews are always a difficult matter, for reasons of internal security and the personal privacy of patients. Many consents have to be obtained before there is any question of admitting television cameras to a hospital such as Rampton.

Mr. Ashton

Is the right hon. Gentleman aware that my constituents, particularly those who work at Rampton, will welcome the report, the fact that it states that the team found much that is good, and the tributes paid to the professional dedication and hard work of those in this dangerous job? There will be no trouble with about 200 of the 205 recommendations. On the remaining four or five, the staff are willing to talk about the flexibility of hours and other such matters. In general, it is a report to be welcomed.

However, I draw the right hon. Gentleman's attention to page 1, where the team reports that it found no evidence of ill treatment in Rampton. The committee was allowed access everywhere. It had its own keys, and was allowed to talk to everybody, both patients and staff. It came across no evidence of ill-treatment. Yet the Yorkshire Television programme alleged that the standard practice for subduing patients was to throttle them with a wet towel; that female patients were kept naked and whipped with chains; that there was a torture chamber stained with blood, where women had scratched at the walls to get out; and that patients were kicked and beaten with rubber plimsolls. The report proves that those are not standard practices.

Is it not a fact that the Government—any Government—must do something about trial by television—show trials where the prosecution presents its case and witnesses for the defence are not interviewed, or have no chance of making a counter-statement? Statements are flashed on television screens from notoriously unstable ex-patients and broadcast as though they were the truth and nothing but the truth. Have not such programmes set back places such as Rampton many years, and soured relations between the staff and their neighbours outside the hospital? Was not that programme in general to be deplored?

Mr. Jenkin

I should like to pay tribute to the helpful and responsible way in which the hon. Gentleman dealt with an extremely difficult situation in his constituency following the showing of the Yorkshire Television film. I should like the House to know that that is sincerely meant.

I must make clear at the start that Sir John Boynton's review was not concerned with the allegations of violence and brutality. I saw a preview of the film and I decided before it was shown on television that the only way of dealing with it was to refer the matter to the police and eventually to the Director of Public Prosecutions. Sir John's review was expressly precluded from examining any of the matters that were properly the the subject of police investigation. As far as I am aware, the team had only one, rather ancient, allegation of violence referred to it. It did what I had asked, which was to refer it immediately to the police. The two matters must be kept separate. Where charges have been preferred matters are sub judice and the police investigations have not finished.

It would be unwise for me to pass any general comment on the television programme. It is part of the benefit of a free press that, however uncomfortable it may be for us at any particular time, when things are going wrong and someone wishes to bring the matter to public attention—I hope always responsibly—that can be done. It would be difficult for me to put my hand on my heart and say that without the YTV programme there would have been a Boynton review. I doubt whether there would have been.

My predecessor was aware of some of the difficulties at Rampton and he tried to do something about them, but some good may come from the fact that the programme brought matters to the public's view in the way that it did. However, I entirely understand and have sympathy with the stresses, strains and difficulties that the hon. Gentleman's constituents faced in the months following that programme. I hope that the report will have gone some way to clear the air and that we can look forward to the future and not dwell too much on the unhappy events of the past.

Sir Frederick Burden

I hope that my my right hon. Friend will look upon the report as an encouragement to investigate the situation in a number of other special hospitals. Will he look, in particular, into the position at Leybourne Grange, in Kent. There is no doubt that the staff are dedicated and do their utmost in the conditions, and with the equipment they possess. I believe, however, that such hospitals are often brushed aside in the general arrangements for improving such places. People are there for no other reason than a mental disability for which no blame can be attached. Will my right hon. Friend ensure, in a spirit of compassion, that proper conditions apply in these places and that the staff possess the equipment that they need?

Mr. Jenkin

My hon. Friend has raised a valid point. Leybourne Grange is a hospital managed by the Kent area health authority. If difficulties are being experienced there—I have had none drawn to my attention—this is a matter in the first instance for the authority. The health advisory service has a roving role to visit hospitals and to assess the quality of care and standards of management being followed at long-stay hospitals. This is one way in which we can monitor the quality of care received by mental patients. By definition, mental patients are perhaps a good deal more vulnerable than many other patients. That imposes on us—Ministers and all concerned—an added responsibility to see that such vulnerability is not abused or taken advantage of.

Mr. Freud

Will the Secretary of State accept that there was great public concern over the Yorkshire Television programme, not only for the content but because of the source—the fact that this information should come through an ITV company rather than a Government watchdog committee? Was there not a strong case for bringing out an interim report to clear the air rather than waiting for the excellent but much fuller report from Sir John Boynton? Will the right hon. Gentleman say why prison visiting should not be extended to all people held in custody, irrespective of their mental or physical state? When the Rampton hospital board is set up, will the right hon. Gentleman consider having representatives both of the Prison Officers' Association and of the patients?

Mr. Jenkin

It would have been difficult for Sir John to issue an interim report, given that the main purpose of the television broadcast was to expose allegations of brutality. Those allegations were outside Sir John's terms of reference and were referred, as I have explained, to the police. I believe that Sir John's report has been well worth waiting for. It is extremely well written. It is very thorough. It provides a valuable blueprint for the review board that I hope to set up shortly.

Rampton is not a prison; it is a hospital. The persons treated there are patients. The nursing staff has special training in psychiatric nursing, either as fully trained nurses or as trainee nurses. To refer, in this context, to prison visitors is perhaps a little unfortunate, as I think the hon. Gentleman, on reflection, will recognise. Part of the criticism of Ramp-ton, as the report says, relates to the nurses' uniforms. This is because some staff have seen their role as more custodial than therapeutic.

This is part of the inherited attitudes of the past, to which the report has been at pains to draw attention and to suggest a way out of. We want the fresh air of outside scrutiny blowing through Ramp-ton. The accusation of the secret hospital has some validity. It is in no one's interest, certainly not the staff or the patients, that the appellation "secret hospital" should remain. It will require a good deal of patience on the part of all concerned to change that, but we are determined to do it.

Sir Graham Page

Is my right hon. Friend aware that two of the four special hospitals that he mentioned—Moss Side and Park Lane—are in a residential area in my constituency? I appreciate that it is necessary to rehabilitate some of the patients who are fit for it by gradually allowing more freedom, but is it not just as important to assure the residents in the area of safety against the relapse of those being rehabilitated by freedom?

Mr. Jenkin

I understand entirely my right hon. Friend's concern, which he expresses fairly and moderately on behalf of his constituents. I am satisfied that security in all four special hospitals is of a very high order. That must remain the situation. It is crucial that the safety of the public should have a high priority. At the same time, it is right that when the doctors, in consultation with the other professions, as now happens, consider that a patient can be released on parole, such a step should not be precluded because of an over-zealous attention to security. There was an unfortunate episode earlier this year at Broadmoor—the case of Ronald Sailes—which achieved wide publicity. As a result, some procedures have been strengthened and improved, notably the question of alerting the police where a patient is let out on parole.

My right hon. Friend will understand that the clinical and therapeutic work of doctors and nurses to whom we give the onerous responsibility of caring for these patients would become more difficult if they could not see, as the result of their work, the prospect of improvement, leading in some cases to the eventual release of patients into the community. If that were not possible I would have thought that any kind of work in a hospital such as Broadmoor or Rampton would become intolerable.

Mr. Kilroy-Silk

Does the Minister accept that the report paints a depressing picture of a hospital that has lacked proper professional leadership and where the quality of life has fallen well below what are considered acceptable standards? While part of the responsibility must rest with the attitude of staff, the major responsibility necessarily rests at the feet of this Department, which is firmly and directly responsible for the running of the four special hospitals?

Is it not the case that the right hon. Gentleman and his predecessors failed to implement the recommendations of the Elliot report in 1973 and the more recent unpublished report on psychiatric training. Had they been implemented, many of these recommendations might have obviated the need for this sudden, important inquiry which came about only because of the public outcry occasioned by the television programme. Why, in particular, is the Secretary of State only now taking action to transfer 50 patients who have been waiting for two years for transfer to NHS hospitals? Why has he not taken action along those lines before, when complaints have been made from both sides of the House on the issue?

What is the Secretary of State intending to do about the 130 patients in the hospital whom the Boynton report says should not be there and who are therefore presumably being illegally detained? Although one accepts that it is a hospital and not a prison, the Minister must also accept that it is a maximum security hospital. There are tremendous security conditions at the hospital. It is a secret institution. While it may be inappropriate to have prison visitors, it would be right and proper to have an independent lay inspectorate of the hospital and its conditions. Will the right hon. Gentleman not think about that?

Mr. Jenkin

I should like to pay tribute to the hon. Gentleman for his efforts over many years to secure the right of transfer to other hospitals of patients from the special hospitals. It is a subject to which the hon. Gentleman has devoted considerable energy. He is not wholly fair to my predecessor or myself in suggesting that nothing has been done. The figures for transfers from Rampton to other hospitals, including the Eastdale unit at the Balderton hospital nearby over the last five years have been 83, 72, 80, 74, and, for the first half of this year, 36. The Dell report, to which the hon. Gentleman referred, showed that the main obstacle was getting the acceptance of the receiving hospital to take the patients from Rampton.

The hon. Gentleman has been forthright in his comments about some staff attitudes. It is also possible that some of the medical attitudes have made it difficult for patients to be transferred. I am sure that the most important step to get transfers of this sort is proper consultant contact to satisfy both parties that the transfer is appropriate for a particular patient. I hope that we can build on that.

The hon. Gentleman favours a lay inspectorate. I see the role of the review board in that light. It will have the responsibility for carrying forward the recommendations but it will also be an outside lay body, which is able to supervise the implementation of the report and the running of the hospital. We have the question of wider monitoring under review and I shall direct some remarks to it when I reply to the third report of the Select Committee, to which we shall be giving an answer shortly.

Mrs. Knight

Now that the necessary and important report has been made with great scrupulousness and efficiency, and now that almost all of its recommendations have been accepted, is my right hon. Friend really convinced that, given the existence of all the other watchdog bodies, and since the report has been published and is known to all the staff at Rampton, it is strictly necessary to set up a review body for this lone hospital? How many members does he envisage will be on the board, and what will it cost?

Mr. Jenkin

It has been recognised for some time that there are considerable difficulties in hospitals that are run directly by the Department of Health and Social Security, as are all special hospitals. The report brings out clearly that the relationship between the dedicated officials who bear the burden of the work and the hopsitals is not easy, particularly when distance is involved as it is at Rampton. The central recommendation of the report is that there local review board.

We are making efforts to find people from the regions concerned who can bring to bear their skills, experience and expertise to help the new management of the hospital to achieve the reforms that, as the hon. Member for Ormskirk (Mr. Kilroy-Silk) said, have been mooted before in earlier reports but on which little progress has been made. We must sustain the impetus. The suggestion is that the review board should exist for three years in the first instance. It is a valuable suggestion, and it is right to give it a try.

Mr. John Home Robertson

Is the Secretary of State aware that one of the stars of the Yorkshire Television programme, Steven Wilkins, was subsequently transferred, and immediately went out and murdered my constituent, Sidney Mowitt, of Coldstream, with a knife? Is he further aware that it is possible that the press attention that Steven Wilkins received could have contributed to his disturbed state of mind? Will the right hon. Gentleman say more about the role of the press in this sad story? Will he make it clear that the safety of society is as important as the interests of patients at Rampton and, indeed, as the freedom of the press? The Secretary of State referred to people being made uncomfortable by the freedom of the press. Does he accept that my constituent is not uncomfortable—he is dead?

Mr. Jenkin

The hon. Gentleman must take responsibility for the charges that he makes against the press. I am not aware of the details of the case to which he refers. It is right to reiterate that the safety of the public must always have the highest priority. That is what a maximum security hospital is all about. Such a hospital exists to ensure that people with exceedingly dangerous propensities are held in secure conditions so that the public can be as satisfied as possible that their safety is being looked after.

Miss Fookes

May I urge upon my right hon. Friend the importance of appointing a strong medical director as soon as possible, since that would give the sense of direction, which so far has been lacking? Will he confirm that the director —or whatever title he may be given—should be a will be given full powers?

Mr. Jenkin

Yes. My hon. Friend visited the hospital as a member of the all-party mental health group and saw for herself some of the difficulties. This is a central recommendation of the report. We intend to appoint a person with considerable leadership. Leadership is the key. We need someone with leadership capability who can lead the professional teams and the hospital as a whole in the work that needs to be done. I shall keep in mind what my hon. Friend has said.

Mr. Ennals

Does the right hon. Gentleman accept that as his predecessor I warmly welcome the very thorough report, its recommendations, and the responses in his initial statement and in his answers to questions put to him this afternoon? Is he aware how warmly I welcome the statement by Sir John Boynton in his report about the tireless care and attention that the staff at Rampton give to their patients? Does he share my hope that this will do much to raise the morale of people who are undertaking a difficult task?

Mr. Jenkin

I am grateful to the right hon. Gentleman. I have no doubt that his remarks will be brought to the attention of the staff at the hospital. A great deal of fine work is done at Rampton in spite of the difficulties and the management problems under which the staff have had to work. We must move ahead and look to the future. An enormously valuable compendium of advice and guidance is contained in the Boynton report and we must make the best of it.

Mr. van Straubenzee

I refer to the question asked by my hon. Friend the Member for Plymouth, Drake (Miss Fookes). Does my right hon. Friend envisage this important appointment to be broadly analagous to that of the physician superintendent at Broadmoor hospital? If he does, does he appreciate that finding a man or a woman who combines qualities of leadership, professional expertise and organisational skill will not be easy, to put is mildly? However, that does not make the recommendation bad. Does my right hon. Friend understand how welcome are his understanding words about the staffs at the special hospitals? As one who sought to cool it at the appropriate professional conference, may I remind him that honourable men and honourable women who are doing a difficult task are getting close to the end of their tether?

Mr. Jenkin

I understand the last part of my hon. Friend's remarks. The reports that I have seen of what my hon. Friend said in the face of the anxieties expressed to him by the staff at special hospitals are entirely admirable and I thank him.

I do not wish to add further to what I have said about the qualities that we are looking for in the medical director for Rampton. Certainly, Dr. McGrath, the medical director at Broadmoor, has established an unparalleled reputation as the manager of a hospital under extremely difficult circumstances. He deserves the highest praise. If we can find someone of his calibre to run Rampton we shall be doing extremely well.

Mr. Whitehead

May I congratulate the Secretary of State on the measured words that he used about the media and other organisations involved in the welfare of patients at Rampton? As he said, without them we might not have had the Boynton report.

I refer to the question asked by my hon. Friend the Member for Ormskirk (Mr. Kilroy-Silk). Why is the right hon. Gentleman optimistic that he can persuade regional health authorities that either the Dell report or chapter 15 of the Boynton report is applicable to them, since they have consistently refused to build interim secure units and have often confined patients to Rampton when they need not have gone there, and since they are not often willing to take patients who need to be transferred from Rampton?

Mr. Jenkin

I am opening the first regional secure unit the week after next. It is a valuable stage, but I recognise that we have a long way to go. The hon. Gentleman referred to interim secure units. I have discovered something which has long puzzled me. There is a curious misunderstanding by many members of the nursing staffs in particular about what is meant by an interim secure unit. Some staff members regard such units as assessment centres where patients are sent in the interim. They are not intended for that purpose. They are intended to be secure units, if necessary for long-stay patients, to be operated only until a full regional secure unit is built. I am considering how, in mental hospitals and in the places where the units will be built, we can achieve a better understanding about their precise purpose. I shall bear in mind the hon. Gentleman's remarks.

Mr. Christopher Price

What changes is the Secretary of State considering for the special hospitals operating committee within his Department? Is it really sensible for the four special hospitals to be operated by an anonymous committee of civil servants, which cannot be contacted by those with sensible suggestions to make about the operation of the hospitals? Would it not be better if SHOC was a more open body with the names of the individuals involved made public? It would then operate openly rather than in a secret manner.

Mr. Jenkin

There is a great deal of merit in the hon. Gentleman's remarks. As the Boynton committee recommended, I shall consider carefully the future management pattern for the special hospitals. As I indicated earlier, there are difficulties with direct management of those large and important institutions by my Department. Although those concerned have carried out their work with great dedication it is not necessarily the most suitable way. I shall consider whether there is a better way that we can build into the future.

Mr. Fell

I apologise for the fact that I am only now rising. I do so because, in answer to a previous question, the Minister spoke about interim secure units. He may know that I have been in correspondence with his Department in Norwich about that issue. As I understand the matter, once a decision has been made the Minister has no power over the way in which an interim secure unit should be run. That is a serious matter, because the area health authority has carte blanche. As soon as the Minister has made his decision in principle that a unit will be built, the local health authority can do what it likes. It can start an interim unit, which can run for as long as five years, until the new unit is built in the old hospital. If that is true, it is a dreadful matter. I trust that the Minister will help us on that matter.

Mr. Jenkin

I assure my hon. Friend that that is not my view of my accountability to the House about the way in which the National Health Service is run. I wish to consider in some detail my hon. Friend's remarks about the interim secure unit to which he referred. Any health authority is expected to comply with broad Government policy in the running of the Heath Service. It is a difficult and complicated question. I shall be dealing precisely with the question of my accountability and the autonomy of health authorities when I reply to the third report of the Select Committee, chaired by the hon. Member for Wolverhampton, North-East (Mrs. Short).

Mr. Moyle

Is the Secretary of State aware that I agree with him that without the catalyst of Yorkshire Television we should not have had the Boynton report? I asked one question that he did not answer, probably inadvertently. Does he now intend to negotiate the implementation of the changes in staff conditions recommended by Boynton to improve the position in the hospital? He said that he did not require more resources but that he wanted a change in attitude. How is it proposed to do away with the 14-hour shift without buying it out?

Mr. Jenkin

The right hon. Gentleman obviously did not appreciate that I said that it was a matter for the review board to take forward the implementation of the recommendations in the report, including those on terms and conditions of service. That will have to be done in negotiation with the staff association involved, which is the Prison Officers' Association, which represents the nurses at the hospital.