§ Motion made, and Question proposed, That this House do now adjourn.—[Lord James Douglas-Hamilton.]11.18 pm
§ Mr. William van Straubenzee (Wokingham)
I am grateful for the opportunity of a short debate in which I can raise the matter of what is generally called unmodified ECT, and its use at Broadmoor hospital, in my constituency. I say a "short debate" without a note of complaint. I am grateful for the opportunity to speak on this subject, and for the presence of my hon. Friend the Under-Secretary of State for Health and Social Security at this late hour in his busy day. It is not always understood that these are brief debates, with 15 minutes for the hon. Member who is raising the matter and 15 minutes for the Minister to reply. I shall naturally try to watch the clock carefully, to adhere to that, so that I divide the time fairly between us.
This matter derives from public accusations made on 19 December 1979 by the organisation MIND. It made a large number of allegations at that time. I shall not touch on the others; there will be other opportunities for me to do that. The accusations were widespread. MIND accused the medical and nursing staff of brutality and worse, against patients at Broadmoor hospital. But it also—and this is the reason for the debate—referred specifically to what it regarded as the widespread improper use of unmodified ECT.
I am anxious to establish clearly my viewpoint in these matters where anything improper is concerned. I use words that I used when I was guest speaker at the annual conference of the special hospitals division of the Prison Officers Association on 29 October. I said:Throughout recent controversies affecting the special hospitals, in which I am proud to have taken a prominent part, I have always stressed that you are in a position of special trust in relation to the patients in your care, and that if at any time any one of you falls from the high standards of professional conduct which you expect of yourselves and which the general public expects of you, then retribution must follow. I shall never be a party to any cover-up.I may say that those words were received with acclamation by the conference. I was able to add:Incidentally, it has been my experience throughout the years"—and they are now 21 years—that it is the doctors and nurses themselves, caring for the mentally ill, who feel strongest about their own standards of conduct.I say that at the outset to make it perfectly clear that I do not believe in any kind of cover-up in matters of this sort. I believe very firmly in the highest possible standards of professionalism in the care of the mentally ill—
The particular accusations of which I speak—those generally and those connected with unmodified ECT—were spearheaded by two young former nurses at the hospital—Mr. Colin Byrne and Mr. Tony van Roon.
My case has always been—and remains—that essentially the motivation behind these accusations was political, and not professional. Tonight, I can offer some firm evidence to back my assertion.
On 12 March 1980 the all-party mental health group met to hear these two young nurses make their accusations. 745 The minutes of that meeting were prepared by MIND. Therefore, presumably they will not be challenged by that organisation.
Perhaps by way of background I may say that when I saw Mr. Byrne something stirred in my memory. I thought at the time—though I felt that I must be mistaken—that I recognised him. The minutes record:Mr. van Straubenzee asked Mr. Colin Byrne if he had ever sold or distributed copies of Militant newspaper. Mr. Byrne said that he had not done so.This, in itself, is a trivial matter. This is a free country. Anyone can sell or distribute a newspaper, or anything of that kind. There is no reason for any of us to be ashamed of doing that. But it is on record that that was the reply given to me by Mr. Byrne at a meeting in one of the Committee Rooms of this House.
I can now tell the House that I have in my possession two affidavits sworn by two members of the nursing staff. I have interviewed one of them very carefully. I have not had an opportunity to interview the other. However, with some experience, I can say that the one that I interviewed was a very good witness. Both swear that on two separate occasions they have seen Mr. Byrne selling the newspaper Militant—in fact, in Bracknell, in my constituency. On one occasion one of those affirming was accompanied by his wife, and on both occasions they spoke to Mr. Byrne.
As I say, that is not important in itself—in a free country, what Mr. Byrne did is something that any one of us is free to do—but when one discovers that the evidence given by a witness in one particular is at least suspect, one is, I think, entitled to be very questioning about the rest of the evidence that he has given.
Let me deal with one other point before I come to the main question of ECT. It might be said that I should have put that matter to both these young men. The answer is that I have tried to do so. I have tried to do so in the most obvious way—that is, to write to them, to make contact with them through MIND. This is the reply that I received from Mr. Smythe:I shall inform Mr. Byrne and Mr. van Roon that you wish to contact them, and no doubt they will get in touch with you if they are agreeable.That is typical of the offensive way in which he normally conducts his correspondence.
My understanding of the matter of unmodified ECT is that it is governed by the statement formulated by the council of the Royal College of Psychiatrists and endorsed at a meeting of that council in May 1980 at which Dr. Anthony Clare, the medical adviser to MIND, was present. I understand that it lays down that it is always desirable that the treatment should be modified with an intravenous anaesthetic and muscle relaxant. It goes on to say that nevertheless there are certain rare situations when it is both correct and necessary to give it unmodified, and the statement sets those out.
My understanding—this is the question that I ask my hon. Friend—is that that is precisely what is followed at Broadmoor hospital. I should be grateful if my hon. Friend the Minister could tell me whether that is also his understanding. As a result of inquiries that I have made, it is certainly mine, but in order to try to resolve the matter, I have sought to bring all the parties round a table. On more than three occasions, in writing, I have offered to act as the chairman, the catalyst--whatever term one cares to use—to bring round one table the professionals. I am speaking not of the agitators or the paid men who do these things; I am talking about the professional medical 746 advisers. I have sought to bring them round a table, at Broadmoor or anywhere else, in order that these matters may be further examined, but I have totally failed. I believe that a body that was motivated by professional understandings would have responded to that.
I remember very well that when my right hon. Friend the Secretary of State increased to no less than £275,000 the grant to MIND, he made some cogent comments about the attitude of a voluntary body. This is what he said:Where a voluntary body chooses to accept public money in aid of its work, it has, I believe, a duty to act with the utmost responsibility, particularly in its relations with Government. A body which wishes to be free from this constraint would be much better advised not to accept public grants.It is my charge that the organisation MIND, under its present professional leadership—I am talking not about the admirable voluntary people who serve it but about the full-time professionals--has not applied that criterion to its work. Let me give the very latest example in the work of Mr. Smythe.
Like everyone else, Mr. Smythe is fully entitled to his political views, and I do not for one moment seek to suggest otherwise. He turned up in the constituency represented by my hon. Friend the new Minister for Social Security as part of a deputation of the Hornsey Campaign for Nuclear Disarmament.
I repeat that Mr. Smythe is entirely entitled to take a personal view. This is what he was quoted in the local newspaper on 2 January as saying:Like everyone else we are worried sick', said Tony Smythe, Director of MIND, the Mental Health Group who was in the delegation. 'Working in social welfare we are constantly told that there's no money for decent services. It's all going on bombs and missiles. Mr. Rossi's Government has a lot to explain.Yet Government this year increased the grant to that remarkable organisation.
I believe that at the circumference MIND does splendid work. It has worked devotedly for those who have been in mental hospitals and the like. But in the International Year of the Disabled it is handicapped by the professionals at present in charge of it, and no self-respecting Tory ought to subscribe a cent to its central funds, while still, of course, supporting its work at the circumference. Part of my complaint lies in the matters that it has raised on the subject of unmodified ECT which, for 15 minutes, I have been privileged to raise tonight.
§ The Under-Secretary of State for Health and Social Security (Sir George Young)
My hon. Friend raised a number of very important issues concerning the activities of MIND, which I hope to deal with later on, but I would like to address the bulk of my remarks to the question of the administration at Broadmoor of the use of unmodified electro-plexy, which is the subject of the debate. This has been the subject of a good deal of correspondence between MIND and the Department and has been discussed in the professional press and within the Royal College of Psychiatrists.
The House may find it helpful if I explain that electro-plexy is a synonym sometimes used as an alternative to the more usual term "electro-convulsive therapy", or ECT. This has been used extensively in this and other countries for more than 40 years and is widely regarded as being of value to many patients with certain forms of mental illness. Over the years it has been the subject of a considerable volume of research, and this is continuing. 747 The use of ECT was considered in depth in 1978 by the Royal College of Psychiatrists and it concluded that amongst other things, there was clear and substantial evidence that ECT was an effective treatment in severe depressive illness.
Over the years there have been great improvements in the method of administration of ECT. and a number of studies have indicated the types of mental illness for which ECT is most effective. The Medical Research Council has advised that ECT, given in a proper manner and with proper safeguards, has not been shown to cause serious side effects; in its view the risks involved in modern ECT treatment are small and well known to the doctors who administer it. ECT is said to be given in an unmodified form when it is administered without the use of muscle relaxant and without the use of an anaesthetic.
The correspondence and discussions to which my hon. Friend referred have their roots in a speech made by a former Broadmoor nurse in the summer of 1979, in the course of which he described an occasion at which he had been present when one of the Broadmoor consultants prescribed and supervised the administration of ECT to a patient without the use of a muscle relaxant or an anaesthetic. In the course of an article in the November/December 1979 issue of the MIND journal MIND OUT, the nurse's description of this occasion was reported and discussed in the context of guidelines issued by the Royal College of Psychiatrists concerning the use of ECT. This section of the article ended with the sentence:We"—and in the context I take this to mean MIND—cannot think of any possible clinical justification for this—even in an emergency".It is not disputed that on a few very exceptional occasions ECT has been administered to patients at Broadmoor hospital without the use of either a muscle relaxant or an anaesthetic. On, these rare occasions this treatment has been given because on each occasion it was the clinical judgment of the consultant concerned that this exceptional measure was the best course of treatment at the particular time in the particular circumstances prevailing. I will explain why in a moment.
The House will, I am sure, recognise that the choice and application of medical treatment to a particular patient at a particular time is primarily a matter for the professional judgment of the doctor concerned. Management—and by this I mean local hospital management, health authorities and the DHSS—has, of course, to ensure that the service is within acceptable professional standards. The consultant psychiatrists at Broadmoor are in this respect in no different posxerition from consultant psychiatrists working elsewhere. They have a clinical responsibility for their patients and in the exercise of this responsibility are answerable to their professional disciplinary body and, where appropriate, to the court in precisely the same way as their psychiatrist colleagues elsewhere.
In January 1980 my right hon. Friend the Secretary of State was asked by my hon. Friend the Member for Cheltenham (Mr. Irving) about the allegations that had been made against Broadmoor. In his answer, and in particular in the supplementary letter, a copy of which he placed in the Library, my right hon. Friend explained that because he recognised that there could be a fear and 748 misunderstanding about ECT, and because he was concerned that the publicity at that time might make the public uneasy about this important and useful clinical treatment, he had gone into the matter in some detail.
The memorandum—this is hememorandum compiled by the Royal College of Psychiatrists—provdes guidelines on the use of ECT. It makes no direct mention of unmodified ECT, as it was rightly assumed that under all normal circumstances the treatment would be given with anaesthetic and muscle relaxant.
The Royal College of Psychiatrists has, however, recently set out its views in greater detail on the use of unmodifid ECT and has made these available to my Department. It states:It is conceivable that there could be medical contraindications to the use of anaesthetics and/or muscular relaxants and yet the ECT be urgently needed to control the patient's behaviour. In these circumstances it would of course need the clinical judgment of the psychiatrist in charge of the case to decide whether to proceed after due consultation. There might also be situations in which anaesthetists are not available at short notice or even a second psychiatrist experienced in anaesthetic techniques. Again it would be a matter for the clinical judgment of the consultant whether in those circumstances he would be justified in going ahead without the modification.Here I respond to my hon. Friend's direct question. My Department is satisfied that the use of ECT at Broadmoor is in line with current practice and that use of unmodified ECT takes place only in exceptional circumstances where, in the clinical judgment of the doctor, this is the best course. My Department will, however, continue to keep the question of ECT in general under review. As was explained in my reply, published in the Supplement to the Votes and Proceedings for 14 December to a recent petition, my Department is sponsoring research by the Royal College of Psychiatrists into the present use of ECT in England.
At about this time, as my hon. Friend and the House may recall, there was some correspondence in the medical journals about this subject, and on 9 February last year the British Medical Journal published a letter from Professor Pond, now Sir Desmond Pond, the president of the Royal College of Psychiatrists, in which he explained the views of the Royal college in terms broadly similar to those that I have just quoted. At about the same time the medical adviser of MIND, who had been concerned about these cases, was, I understand, invited by the Royal college and attended a meeting of its council for a discussion on the matter.
I understand that subsequently the registrar of the Royal college reported the outcome of these discussions at the spring quarterly meeting, in May 1980, of the Royal college, which by coincidence happened to be at Broadmoor hospital, in the following terms:A draft memorandum entitled Ethical Consideration of Electroplexy prepared by the joint ethical working party was discussed by Council. After careful consideration Council decided not to publish the memorandum at this stage, but it was agreed that the new Memorandum and the 1977 College Guidelines on ECT would be reviewed when the results of the current ECT research project were available. In view of correspondence in the medical and national press Council discussed whether a statement on the use of unmodified ECT should be published but decided that there was no need to add to the President's statements in the medical press.That report, I am told, was accepted without comment by the meeting at which the MIND adviser, as well, of course, as a number of the Broadmoor consultants, was present. Both parties seemed therefore to be content for the time being to let the matter rest on that basis.
749 I hope that in the light of what I have said my hon. Friend will accept that the issue of professional propriety of the use of ECT in what is termed the unmodified form has been fully aired by the appropriate medical experts in the appropriate forum, namely, the Royal college. He will note that the Royal college will be giving further thought to this when the results of the current ECT research project are available, and that it will consider then whether its existing guidance should be amended or supplemented. This seems to me to be the right way to proceed in matters of this kind, my hon. Friend suggested that a further meeting between the Broadmoor consultants and representatives of MIND might be arranged. Whilst I will certainly do all I can to foster good relations between the hospital and MIND I doubt whether a further meeting on this point—that is, the use of ECT—could take us any further, at any rate at present.
Perhaps I could here say that I share my hon. Friend's concern about the way in which some of these matters were commented on at the outset. Some of the comments made in this case—as has happened in relation to allegations about other special hospitals and, indeed, other institutions of all kinds—seem to have been made on the principle that if an allegation is made about staff behaviour it must be true unless the staff can prove without a shadow of doubt that it is not.
I fully agree with my hon. Friend that this is grossly unfair on staff who have a difficult and, at times, dangerous or disagreeable task to perform. They are entitled—as is everyone else—to a presumption of innocence or of acting in good faith unless there is clear evidence to the contrary. That is not to say that their actions and judgments should never be questioned. Of course they should he, and the Broadmoor staff recognise and accept this. Wherever detained patients are treated, it is to be expected that from time to time there may be questions and debate about their treatment.
MIND's role in this matter raises fundamental questions which my hon. Friend touched upon towards the end of his remarks. One concerns the propriety of Government support for voluntary organisations whose campaigning activities may lead them at times to be critical of the Government or public authorities and institutions. My right hon. Friend the Secretary of State for Social Services spoke at Redbridge on 14 June 1980 about this, and my hon. Friend quoted from parts of his speech. In connection with MIND's activities he saidThat where a body chooses to accept public money in aid of its work it has a duty to act with the utmost responsibility, particularly in its relations with governmentandespecially must this be so when allegations of impropriety are being made.He went on to say that 750Governments should be exceedingly slow to allow disputes of this kind to influence the question of grant-aid".On the value of MIND's work, I fully share my right hon. Friend's high regard for the wide range and considerable volume of services provided under the umbrella of MIND by local MIND groups or associations of mental health, and I pay tibute to the devotion and skills of all those who have contributed to their development and help to maintain them today. I also fully appreciate and endorse the value of many of the services for the mentally ill which are provided on a regional and national basis by MIND.
§ Mr. David Ennals (Norwich, North)
I much appreciate the tributes that the hon. Gentleman paid to MIND. Does he agree that the continued vendetta by the hon. Member for Wokingham (Mr. van Straubenzee) against Tony Smythe, the director, and many of his officers cannot help but do harm to an organisation that is clearly doing a fine job, sufficiently so to warrant an increased grant by the DHSS?
§ Sir George Young
Over the past 18 months my hon. Friend has certainly spent a lot of his energy and talent on this matter. I know that senior staff at MIND have also spent a lot of time dealing with it. Both parties have the interests of patients and staff at heart. But I think that it would be in everyone's interests if the matter could be laid to rest as soon as possible.
Perhaps I may ask my hon. Friend the Minister for Social Security, who has responsibility for the disabled, to deal with the specific point that my hon. Friend made about an event that took place in Hornsey, the constituency of my hon. Friend the Minister.
Grants to all voluntary organisations, including MIND, are based on the merits of the work done by the organisation in question. To return to my right hon. Friend's Redbridge speech; he said,it would indeed be a sad day if it were ever thought that this Government was trying to silence its critics by cutting off public funds. To be frank I have never for one moment contemplated letting the incident influence in any way my decision on grant-aiding the work of MIND … the decision has been taken, as it has been in the past, entirely on the merits of MIND's admirable work for the mentally ill".Those principles still apply.
I am grateful to my hon. Friend for enabling me in this debate to set out formally the Government's position both on the particular question of the use of ECT at Broadmoor and on two general issues that have become linked with it; the place of clinical judgment in its professional context in the health services and the relationships between Government and voluntary organisations in receipt of grant aid.
§ Question put and agreed to.
§ Adjourned accordingly at sixteen minutes to Twelve o'clock.