§ The Secretary of State for Wales (Mr. Nicholas Edwards)
With permission, Mr. Speaker, I should like to make a statement on St. David's hospital, Carmarthen, and mental illness services in Dyfed.
A series of reports since 1974 has drawn attention to the poor quality of mental illness services at St. David's hospital and elsewhere in Dyfed. These include two unpublished reports by the National Health Service health advisory service in 1974 and 1977.
In the course of the regular contacts by my officials, it became increasingly clear that the necessary remedial action was still not being taken by the authority. In September 1981, the General Nursing Council decided to withdraw approval from St. David's hospital as a statutory nurse training school. In November 1981, arrangements were put in hand for a formal visit by professional staff of my Department.
The visit took place in January of this year, and, as a result, a team from the NHS health advisory service was invited to conduct a special review of the shortcomings and deficiencies of the service. The team's report has just been presented to me and made available to the health authorities in Dyfed and the county council. I have discussed the report with the chairman of the East Dyfed health authority. The authority will consider it at a special meeting next week. In view of its nature, I thought it right immediately to make it available to Parliament, and copies have been placed in the Library.
The report confirms the sharply critical nature of so many earlier comments about St. David's hospital and states that no real progress has been made in remedying the very serious deficiencies that are revealed. It speaks ofa marked absence of discernible, credible leadershipat the hospital, states thatno one seems to be responsible and accountableand concludes thatthe management structure has not proved equal to its task and has failed at all levels".There is criticism of the approach and attitude of some of the doctors and staff and of unsatisfactory relationships between staff. The health authority is criticised for failing to set proper standards of performance and failing to control and monitor those who should be responsible for supervision. The report is strongly critical of the relationship between the health authority and the social services department.
As a consequence of these failings by management, standards of nursing in some wards are described as deplorable. Some wards are said to be filthy and, in the opinion of the team, little regard is paid to privacy and the preservation of human dignity. Standards of hygiene are poor.
Conditions due to overcrowding in some long-stay wards are described as intolerable. The report makes depressing reading, but I should make it clear to the House that there is no suggestion in the report that there has been any wilful mistreatment or cruelty to patients.
The report refers to the relative underfunding of Dyfed health authority and states that the underfunding of psychiatric services is a major factor causing many of the problems. The report is also citical of the present system of joint financing in Wales.
550 A detailed prescription for action can be prepared only after the health and social services authorities have considered the report, but I intend to see that two of the main recommendations of the report are carried out without delay. The first is that there should be an immediate exercise involving outside expertise to improve management structures and attitudes in the mental illness services in Dyfed.
Secondly, I am establishing a review group for a limited period to ensure that the performace of the organisation makes progress towards agreed objectives and the main recommendations of the report. This review group will be appointed by me. It will be chaired by one of my officials, and it will report direct to me. It will include independent senior professional staff from outside Dyfed.
As to Dyfed health authority's underfunding, I have continued the efforts, begun in 1975 by the previous Government, to tackle this longstanding problem. In all, since 1975, in addition to its share of general growth, Dyfed has received extra growth resources of over £3.2 million, of which the present Government have provided over £2 million. Between 1974 and 1982, no other health authority in Wales has received so large a percentage share of growth.
However, I have to say that the health authority has within its discretionary resources accorded very low priority to mental illness services, despite increasing pressure from my Department to give it higher priority and to remedy the acknowledged deficiencies.
There have been capital developments. I have approved central funding projects worth over £5 million in total to improve accommodation and relieve overcrowding at St. David's hospital and to improve facilities for the mentally ill in Dyfed.
Regarding joint finance, as part of the "Care in the Community" consultation exercise, the Government have been carefully considering the case for liberalising the present arrangements, and we hope to make a statement before the House rises for the recess.
As to the immediate future, the Welsh Office will pay the costs of the review group and the management exercise I have described. I shall also be urgently reviewing the financial requirements of the East Dyfed and Pembrokeshire health authorities in the context of the needs of the Health Service in Wales as a whole to ensure that the authorities give at least the same priority to the development of mental illness services as most of the other health authorities have done for some considerable time past.
I shall be considering further action necessary in the light of this report, and I shall, of course, keep Parliament fully informed.
§ Mr. Alec Jones (Rhondda)
It is right and proper that the Secretary of State should have come to the House to make the statement and to publish the report. It is important that all those involved in St. David's and everyone responsible for the care of mentally ill patients in Dyfed should be aware of the totally unsatisfactory conditions that prevailed at St. David's, as the report clearly shows. Does the Secretary of State agree that the report confirms previous reports and reviews carried out by professional bodies and justifies the criticisms made by the responsible trade unions, NUPE and COHSE, in the report that they submitted to the Secretary of State earlier this year?
551 This depressing report draws attention to the most disgraceful conditions in St. David's hospital. In its reference to overcrowding, the report describes intolerable conditions in some long-stay wards, especially for elderly people. It talks of poor facilities and filthy wards, showing little regard for the preservation of human dignity. It also talks of staff shortages, which mean that some nurses work 14½-hour shifts. The underfunding still persists, despite the efforts of successive Governments.
I am pleased to join the right hon. Gentleman in saying that there was no evidence of wilful mistreatment or cruelty to patients. Does he agree, however, that overcrowding, staff shortages and lack of facilities are not evidence of the best treatment to which people are entitled?
Above all, does the right hon. Gentleman agree that the report is mainly highly critical of management, of the health authorities and of the extremely poor liaison that existed between the health authorities and the social services.
The report says that there isa marked absence of discernible, credible leadership".Does that not show that a fresh look needs to be taken not only at managerial structures but at certain managerial personnel? I am not suggesting a witch hunt. However, I do not believe that such a report can be produced and that no one can be responsible for what it reveals.
I accept the action that has been taken on underfunding. Is the Secretary of State prepared to take some urgent steps to correct what is still obvious underfunding by the East Dyfed area health authority?
I welcome the Secretary of State's decision to bring in outside expertise and to establish the review group. Does he agree that a top priority must be to recreate conditions that would allow the General Nursing Council again to approve St. David's as a statutory training school?
The Opposition will support the Secretary of State in any action that he proposes to take to put right the appalling wrongs in St. David's. I recall previous inquiries into mental hospitals in Wales. The late Dick Crossman, following the Ely report, said that there was a need for "eyes and ears" within the system. This report shows the need for brighter eyes and keener ears within hospitals in Wales. We wish the right hon. Gentleman to take action immediately to correct the defects and to ensure that this does not happen again.
§ Mr. Edwards
I agree with practically everything that the right hon. Gentleman said, especially his remarks about conditions. It is because I share his views that I thought it right to publish the document immediately. I am grateful for what the right hon. Gentleman said about its publication. The document repeats almost verbatim, in large part, similar criticisms made in the 1977 report that was not published. There is a clear advantage in publishing reports of this kind. It is one way of obtaining action.
The NUPE and COHSE report was one of a large number of reports by different organisations which said the same thing. That report was published just after the visit by my senior officials, to which I referred, who reported in ever more critical terms to me. Therefore, it was one of a number of reports.
The right hon. Gentleman spoke of the whole matter being "depressing" and "disgraceful", and I do not disagree. He referred to the examples of filth and the little regard for human dignity. We should not disguise these 552 matters. However, the reporting team thought it right not to list particular examples, because that might put the blame on those responsible for specific examples when others might be equally responsible for examples not selected. I was told about wards where the smell of urine was intolerable, where urine-soaked pillows were dried on radiators and where naked female patients were sitting on commodes while there were male visitors in the ward. That kind of thing is intolerable.
The right hon. Gentleman will know, because he was a Minister in the Labour Government, that successive Governments have begun the process of correcting the relative underfunding of this authority. Dyfed received an increase in funding between 1974 and 1982 of 28.7 per cent., compared with 24.1 per cent. for Wales, but during much the same period allocated an increase of only just over 6 per cent. on the mental illness services. Although central Government have the problem of allocation, there is also a clear responsibility on the health authority.
The right hon. Gentleman referred to management. He is right in saying that the central theme of the report is the complete lack of an effective management structure and control. Clearly, the health authority, which is the operational authority, must take a major share of responsibility for that.
I asked the chairman of the authority, with whom I discussed the report this morning, how he would react to this, and, reasonably, he fell that his authority—it received the report only this morning—should have an opportunity to consider its response. It would be right to hear its response before coming to any further conclusions on the matter.
§ Mr. Donald Anderson (Swansea, East)
Are the faults revealed in the report, faults of the system and of the structure rather than of any individuals, including those in the authority? It would be helpful to know, so that we can draw inferences. Do the problems that have been revealed in the allocation of resources for psychiatric hospitals have general implications for Wales as a whole?
§ Mr. Edwards
With regard to responsibility, many faults are shown in the report. The team is right to say that an inquiry in the form of a witch hunt of individuals would probably not produce satisfactory results. The report clearly identifies a lack of adequate management structure. In any organisation there must be clear personal responsibility. At the end of the day, personal responsibility over the operational side lies with the health authority, just as overall responsibility for the allocation of resources and general maintenance of standards in Wales rests with me. I accept my responsibility for the distribution of resources.
We have made it a major priority to allocate additional resources to the Dyfed authority and we have continued and accelerated the process begun by our predecessors. I have undertaken to have another look at the matter, although I must not allocate resources in such a way as to penalise authorities that have given a high priority to mental health services. In other words, it would be wrong to penalise authorities which, over many years, have given mental health services a high priority, so as to rescue the Dyfed authority from the lack of priority that it gave to this matter.
§ Mr. Tom Ellis (Wrexham)
Can the Secretary of State explain the extraordinary fact that, although a report was 553 prepared in 1974 expressing concern about conditions in the hospital, the General Nursing Council did not withdraw approval of the hospital as a statutory training centre until the latter part of last year? Does the right hon. Gentleman agree that administrative clinical questions, such as this and other similar matters in the Health Service, should be left exclusively to the professional body involved?
§ Mr. Edwards
The professional body involved has a clear responsibility in this matter, and it must take its own decisions. The authority made certain appointments and hoped that those appointments would lead to an improvement. Clearly, they did not. However, it would have been better, and we should have got on better, if the early reports had been published. We could then have measured progress. It is for that reason that I have chosen to publish the report today.
§ Mr. John Morris (Aberavon)
I welcome the fact the Secretary of State has come to the House to make the statement. Does he accept that one of the most trenchant, but easier to remedy criticisms in the report is in the words:There is a failure to do simple things well.When does the buck stop? Who will shoulder the responsibility at the hospital? Does the right hon. Gentleman know how painfully slow the negotiations were to set up a hospital check list, particularly at hospitals for the mentally handicapped? Why was that list not extended to the mental hospitals, and is it working well?
Would it not be better for somebody other than an official in the Minister's Department to chair the review—somebody who has knowledge and understanding of the inherent difficulties of hospital services?
§ Mr. Edwards
I shall consider the right hon. and learned Gentleman's last point. I agree that in any organisation, there must be an acceptance of responsibility. However, as the report has not yet been seen by the authority and the chairman received the final report only today, I think that I should allow the authority time to discuss it before coming to any conclusions. The authority should decide, in the light of what is said and of its own discussions, who, if anyone, should accept responsibility.
§ Mr. D. E. Thomas (Merioneth)
Does the Secretary of State accept that his decision to publish the report is warmly welcomed? Will he tell the House that he intends to publish all health advisory reports of this kind? Does he accept that had the reports produced under previous Administrations been published, action could have been taken earlier? Does he further accept that what he has now published shows that the criticisms of the hospital made by MIND and other mental health organisations in Wales over the years have been justified?
Many of us who have been concerned about the quality of service for the mentally ill in Wales find it unacceptable that heads should roll for other matters that affect national security, but that they have not yet rolled for the matters that affect the privacy and dignity of human beings who are mentally ill. Does the right hon. Gentleman accept that we shall not be satisfied until those who are responsible 554 for tolerating this state of affairs and allowing the incidents referred to in the report to take place have been removed from public office?
§ Mr. Edwards
Some reports are not commissioned by my Department, and there may be circumstances in which it is not possible to publish a particular report. This report was commissioned by the chairman of the authority and the authority after discussions with my officials. My inclination is to publish reports whenever possible. If there are certain matters that people feel they cannot adequately examine in an open way when they know that a report is to be published, we shall have to consider their representations. However, I agree that reports should be published.
The hon. Gentleman is right in saying that the criticisms that have generally been made have been justified except, notably, for those published in the Daily Mirror some time ago. That newspaper made accusations of attacks on individuals. There is no suggestion in the report of ill-treatment as such.
§ Mr. Ray Powell (Ogmore)
Does the Secretary of State accept some responsibility for the underfunding of this hospital? Will he say when he first became aware of the deplorable conditions there? Did he contact the health authority so that he might go to the hospital and see for himself the conditions there? When did he last visit a mental hospital in Wales?
§ Mr. Edwards
The hon. Gentleman first asked me about underfunding. I have given this a high priority and have allocated an average of about £625,000 a year of additonal growth money on top of the general growth money to Dyfed, which is more than my predecessors were able to find, seeking to do the same task. We have also agreed a number of major capital developments—more than £5 million worth—and I have agreed this week the contract for new developments which will reduce overcrowding. Those are developments at Bryntirion hospital at Llanelli, which will reduce overcrowding here. My hon. Friend the Under-Secretary of State for Wales, the hon. Member for Conway (Mr. Roberts), who has day-to-day responsibility for health affairs in Wales, has visited the hospital. It has also been visited regularly by my officials.
§ Mr. William Pitt (Croydon, North-West)
I am sure that the Minister will agree—and I know that my hon. Friend the Member for Cardigan (Mr. Howells), who is engaged on duties elsewhere, will agree—that this is an appalling and horrifying story of intolerable conditions being suffered by people who are unable to look after themselves. Is not it clear that there are only two possible solutions to the problem? The first is to make funds available now so that the hospital can again become a humane and efficient establishment. The alternative, if the funds are not available and are unlikely to be available in the very near future, is to consider closing the establishment so that the patients may be relocated in more humane and more efficient establishments elsewhere.
§ Mr. Edwards
Before the patients can be put elsewhere, obviously we have to try to provide the new facilites. That, of course, means the co-operation of the Dyfed social services department. It is the policy of my Department to try to move patients out of these large, old-fashioned hospitals into smaller units in the communities, 555 and, in the world of mental handicap as opposed to mental illness, I have just launched a major new initiative to do this. I hope to make a statement about it in the very near future.