HC Deb 18 October 1982 vol 29 cc119-31

'( ) No member of those other professions referred to in section 49 (1)(b)of this Act shall be under any duty whether by contract, or by any statutory or other legal requirement to engage in the forcible restraint of patients detained under the principal Act or this Act other than in accordance with their own professional judgment . ' .—[Mr. Christopher Price.] Brought up, and read the First time.

Mr. Christopher Price

I beg to move, That the clause be read a Second time.

We have had two mini-debates on the Wexham Park affair, but the new clause goes to the centre of the affair and perhaps it would be fair to the House—it is nice to see it so crowded and attentive at this early hour—to sketch out what has happened. The clause would give to nurses the same professional rights as are accorded to all the other professions that operate in the Health Service.

Wexham Park was unknown to the House until a few months ago. It is a psychiatric hospital just outside Slough, in what used to be Bucks and is now Berks. It came into public prominence because of what happened between June and September this year. There is much to be said for the claim that it goes back beyond June, but I shall come to that later. It came to particular attention between June and September because of an incident that occurred during that period.

I shall try to be fair in sketching out what happened and no doubt the hon. Member for Beaconsfield (Mr. Smith), who is the local Member, will interrupt me if I am not being fair. A woman was admitted to the hospital and the doctors extended her section 26 admission procedure. The nurses involved felt that that was unnecessary. On a particular date the doctors instructed the senior nurse and some of his assistants to hold the woman down so that she could be compulsorily injected with a drug, on the ground that she needed it, in the doctors' professional opinion. The nurses said that in their professional opinion she did not need the drug and that, as she was shortly to come before a mental health review tribunal, that tribunal was the proper body to decide whether she should receive the drug.

However, the doctors persisted in their instruction. The nurses persisted in their refusal. When the case came to the mental health review tribunal on 14 September of this year, the tribunal decided that, whatever the merits of her original sectioning, on 14 September the woman was not properly sectioned, and it declared her sane and released her from hospital.

One of the reasons—and only one—given by the doctors for the woman needing to be injected with a heavy tranquilliser was that she might leave her husband and not return to her marital home. That was only one of the many other reasons that were given.

As a result, the nursing press in this country—theNursing Mirrorand theNursing Times—has printed news about little but Wexham Park. Whether one likes it or not, it has become a test case of multi-disciplinary procedures, which are at the heart of this Bill and, as members of the Standing Committee will agree, were at the heart of almost every debate which we conducted in that Committee. What is the real nature of multi-disciplinary procedures? Are they just a sham, a charade, which one carries out, up to the point at which the doctor has the final word and says to the nurse, "Hold down that patient while I inject this dose"? Or are multi-disciplinary procedures a reality in which all the disciplines responsible for the patient at that time come together and agree in some way or other about the proper treatment? The crunch came at Wexham Park because that is where the first incident took place since the introduction of the Bill—there have been many incidents over the past decade—to illustrate the reality of what this House has to decide about multi-disciplinary procedures.

Some nurses in this country are proud to be nurses. They consider that their profession, which goes back to Florence Nightingale, is quite as noble and glorious as the medical profession. They believe—in my view, quite properly—that the job of the nurse is to be the patient's advocate. They have to keep faith with the patient in a peculiar way, and they break their professional faith if they fail to keep that faith.

Nurses take their skills as seriously as do members of the medical profession. They believe that those skills involve obtaining the voluntary co-operation of the patient in his treatment, however long that might take and however difficult it might be. They believe that to resort to forcible restraint and injection means a failure of their skills. Nursing is a noble profession and hon. Members should support it as much as they support the medical profession. What happened at Wexham Park goes against the multi-disciplinary approach that we have discussed. I should be sad if the Minister simply asserted medical primacy and said at the Dispatch Box "At the end of the day, doctors are right and nurses are wrong," but he must do that if he is to defend the attitude of the management at Wexham Park.

What has happened at Wexham Park? For the first time in recent months, although not for the first time ever, nurses have said that an instruction given by a doctor is something that they believe is unprofessional. They do not say that the doctor must not carry out the practice. He has his professional code of practice and can do so, but if he instructs six nurses to sit on a female patient while he injects the drug, they will say that they do not wish to take part in the operation. If the doctor wishes six other doctors to sit on the patient, he is at liberty to ask them to do so, but the nurses believe that they have a right, as professionals, to withhold their labour from an operation that they consider unprofessional.

It has been said that Paul Walsh at Wexham Park was a way-out nurse. Marian Morgan, the president of the Royal College of Nursing, said recently: I am not yet privy to all the information, but if, on the basis of what is public knowledge, this young man is to be disciplined for standing by his professional and humanitarian principles, it will set back the course of nursing. We have in front of us a conscience clause—new clause 12—that is central to the entire debate on the Bill.

I remind the House that in 1967 it passed, easily and with minimal debate, a conscience clause for nurses during discussion on the Abortion Act. It recognised that some nurses felt so strongly about abortion that they should have the freedom, not to interfere with abortion operations, but to stand back and to say "I do not approve of that operation and I wish to have the legal right not to participate in it."

I am asking for a similar conscience clause for nurses so that they can refuse to participate in any violence used by a doctor to inject heavy tranquillisers of the kind frequently used in our psychiatric hospitals. The doctors should be free to make such injections if they can find the helpers, but a nurse should be able to say "My professional ethic is that such an operation must take place with the voluntary co-operation of the patient."

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I shall make a comparison. We are talking about mental health. Doctors and nurses working with drugs agree that a drug addict will get better only with his co-operation. We have swept from the law power to detain drug addicts compulsorily. Parliament has said that the only way to salvation for a drug addict is by his own efforts. In mental health, we have decided differently. We still say that some form of restraint is necessary. I agree that some restraint is necessary when a florid emergency occurs in mental health, but I ask the House to consider that we should give a right of withdrawal to mental health nurses involved in violence similar to that which we gave to nurses involved in abortion.

The management at Wexham Park has already sacked two nurses—although appeals have to be heard—and it has suspended a further 16. It is extraordinary. When there is a breakdown in relationships, one expects the buck to stop at the top. One would expect the administrator to take the responsibility for a total breakdown in management of the hospital. One would expect him to say "I am sorry; I shall resign."

That has not happened. A two-man inquiry was set up. It was so unsatisfactory that no-one took notice of it. Then an inquiry on a better basis was set up under a Mr. Camp, a lawyer—not a QC, although he may be one day since he is on his way up. He produced a large and thick report. He says that management at the hospital has broken down and, instead of blaming the person paid the top salary, he goes five grades down and finds a nurse scapegoat. "Sack the nurse and solve the problem" is his answer, but instead of the nurse going quietly, an absurdly, unnecessarily large number of good, professional nurses have to go. What has happened is quite dreadful. Even more dreadful are the actual charges against Paul Walsh, which were delivered to him three days ago. Charge No. 2 reads: During the first few months following your appointment as Senior Nursing Officer (Psychiatry), you brought about a change in the attitude of nursing staff to the permissibility of treating unwilling patients under Section 25 of the Mental Health Act 1959. What an extraordinary charge to make. Incidentally, that charge was not read to Mr. Walsh before he went to the disciplinary hearing. He was sacked, and when he asked why he had been sacked, this absurd charge was typed out and he was accused of it.

Charge No. 15 read: On 22 March 1982 you took a perverse and unhelpful and legally unsound view about the alleged invalidity of Section 26 papers. Fancy sacking a person for being legally unsound. Who would 'scape whipping? Who in this House has not been legally unsound? Even the Minister, brilliant, rising Prime Minister material, lawyer that he is would not plead not guilty to having been a little unsound in his life.

Yet this so-called health authority, the East Berkshire health authority of 81, Frances Road, Windsor, Berks, seriously levels that charge as a sackable charge against a nurse five grades down and leaves all the senior management, all the senior nurses and all the senior doctors still in salary, in post and in charge of their jobs.

Charge No. 17 said: In December 1981, your investigation of a serious complaint by a Consultant Psychiatrist was superficial and inaccurate. Who in this House has not been guilty of a little superficiality here and a little inaccuracy there? The very fact that these charges could seriously be put forward as grounds for sacking someone shows that the Department of Health and Social Security's district health authority's management leaves so much to be desired that the Minister has a responsibility on this occasion to stand up for the individual against the bumbling bureaucratic management which the Government came to office to suppress.

Charge No. 18 said: In January 1982 you allowed your staff, down to the most junior, to read the confidential Watt-Killen Report. That is the type of nonsense that the so-called East Berkshire health authority uses as material to dismiss a junior nurse while keeping all his seniors in post. That is the type of management that the Minister will defend from the Dispatch Box. That will not wash in any way. This is not the Paul Walsh affair, as theNursingTimes called it last week. It is an affair which is central to the whole future of nursing.

I should like to quote a paragraph from an excellent article in theNursing Timeslast week which was written by me: The professional, multidisciplinary road implies, at the end of the day, the right of professionals to refuse to take action which they see as unprofessional. In this area no set of professions can be more equal than others. If we are going multidisciplinary, it is necessary to go truly multidisciplinary. If we are going hierarchical, let us say that we are going hierarchical and stop prating about a multidisciplinary approach. In my article I stated: No one challenges this right in doctors". No doctor, nurse or occupational therapist would dream of saying to a doctor 'I demand that you take this action". No one challenges .doctors in that way, and I believe that the same right should be accorded to nurses. That is what being a professional is all about. Either the Government believe in the multidisciplinary approach, which means allowing professionals to withhold action when they feel it unprofessional, or they should cast it aside and say that they want hospitals to be run with doctors telling other professionals what they should do.

This conscience clause is central to the future of the nursing profession. I plead with the Minister to take it seriously and not merely to read out a departmental brief that defends the doctors and rubbishes Paul Walsh, which would be so simple to do. I do not defend every action that he takes, but far more important than what has happened at Wexham Park is whether the nursing profession is allowed to be a profession rather than a group of paramedicals at the beck and call of the doctors. It is essential that the House passes the new clause to show its faith in not only the medical profession but the nursing profession.

Mr. Tim Smith (Beaconsfield)

I had hoped that it might not be necessary for me to contribute to the debate. In the light of what has been said I consider it necessary to do so to restore some balance. It is clear that the new clause is largely, if not wholly, inspired by one incident which occurred at Wexham Park hospital psychiatric unit, which is in my constituency.

I have taken no part previously in the discussions on the Bill and I do not claim to be an expert on the matters under discussion. However, I read the article to which the hon. Member for Lewisham, West (Mr. Price) has referred in theNursing Timesof 13-19 October and I listened to his speech. It is clear that the clause and the hon. Gentleman's views are based on one incident, and it is extremely dangerous to generalise on one incident. We might be forgiven for thinking that this was a debate, not on the hon. Gentleman's clause, but on the events at the hospital's psychiatric unit over the past few months.

The hon. Gentleman has made a number of allegations and I do not wish to delay the House by dealing with them all. As I have said, it is always extremely dangerous to generalise on the particular, and perhaps there can be no clearer an example than this instance. As the hon. Gentleman said, the events that occurred have been the subject of a full inquiry by the Oxford regional health authority. He attempted to malign the chairman of the inquiry, which was rather unfortunate. As well as being a lawyer, he happens to be the chairman of a neighbouring health authority. The report has been accepted by both the regional health authority and by the East Berks health authority.

Whether one likes it or not, the man at the centre of the inquiry, whichever way one considers it, is Mr. Walsh, who was formerly the senior nursing officer. The report makes incredibly depressing reading. A tragic series of events took place. It is not fair to blame the management or the nursing staff exclusively. Had reasonable people been employed at the unit on both sides, the events that occurred would probably have never taken place.

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However, the fact is that, although relations at the unit were not particularly good before Mr. Walsh arrived, after his arrival they deteriorated rapidly. The House should be aware of Mr. Walsh's attitude to doctors. It is best exemplified by a statement that he made, and which he admits having made, to the effect that the unit at which he was employed could manage perfectly well without doctors. He made that statement to other nurses on a so-called study day.

Mr. Walsh also told the inquiry that the only difference between himself and a psychologist was that a psychologist was paid more than he was. That is interesting. The report states: Much of Mr. Walsh's evidence and conduct led us to believe that he harbours a strong resentment of doctors. His observation that the unit could manage without them appeared to represent a fundamental tenet of his beliefs. During his evidence, he spoke in disparaging terms of nearly all the doctors in the unit. He told us quite seriously, on what he admitted was hearsay evidence, of one consultant who was said to admit private patients to the unit and who had been seen with a suitcase full of banknotes, said to belong to a rich Arab. We dismissed this as nonsense. Quite right, too.

Nurses, on the other hand, according to Mr. Walsh, possess all sorts of special skills—hypnotherapy, marital therapy, group therapy and various other therapies. Above all, apart from doctors and nurses, Mr. Walsh has a particularly high opinion of his own abilities. The report states: Both in his evidence and in another context altogether, he described his post"— that was a former post— as a nurse in research methods at the University Department of Psychiatry—a perfectly respectable and well thought-of position—as a 'research fellowship in Oxford'. This should be contrasted with the reality of nearly eight years' registration as a student at the University of Surrey without having obtained a degree. I congratulate anyone who can study at university for eight years without obtaining a degree. Unfortunately, following the departure of Mr. Walsh, the unit has been in the most ghastly situation. There has been rapid deterioration. Ordinary working relationships are virtually non-existent. However, there is no way in which outside intervention, apart from the help that ACAS is already giving, will achieve anything. Those matters must be sorted out at local level. That is where they started. I understand that some progress is being made in that direction.

The incident that led to Mr. Walsh's suspension was described to me in a letter, the only letter that I have received from a constituent about this matter. It states: Paul Walsh was suspended for refusing to order his staff to forcibly inject a female patient with Depixol (a long acting tranquillising injection.) This lady was being detained under section 26 of the 1959 Mental Health Act.

Mr. Christopher Price

The hon. Gentleman has spent a long time trying to denigrate an individual. Will he confirm that that lady, when she went before the mental health review tribunal, was released from hospital and declared not to be suffering from mental illness?

Mr. Smith

I have not sought to deny any of the facts that have been put before the House by the hon. Gentleman. I said that I believed that this terrible situation had arisen because of faults on both sides at the unit. The hon. Gentleman concentrated on the management. All I was trying to do was to rectify the balance. All the parties are at fault. It is ridiculous to suppose that this situation arose only because the management was weak or the nursing staff was particularly unco-operative.

The hon. Member for Lewisham, West says that it is a test case for multidisciplinary procedures. I doubt whether it is a test case for anything. It is a ghastly episode, but I doubt whether one can draw any conclusions from it.

I agree that nursing is a noble profession, but what should a nurse do if he or she disagrees strongly with proposed treatment? What does a multidisciplinary approach mean? A management team in whatever sphere will comprise members of varying professions, but at the end of the day someone must make a decision. I recognise that nurses spend much more time with individual patients than consultants do. There should be prior discussion about treatment, but team members cannot opt out at the time when it is important for everyone to co-operate. That is a complete breakdown of the management relationship.

I accept that the new clause is put forward with the utmost good will, but I do not believe that such a provision would have helped in the particular situation. Mr. Walsh was given the chance not to participate in the treatment, but he continued to participate, so one is bound to question his motives. The example cannot lead to a general conclusion and we should not accept the new clause.

Mr. Charles Irving

I have a great deal of sympathy with many of the points made by the hon. Member for Lewisham, West (Mr. Price). To a more modest extent I share the views of my hon. Friend the Member for Beaconsfield (Mr. Smith), but he has laboured the situation of Mr. Walsh. In my previous speech I mentioned the grave anxiety about the serious injustices that might arise if the matter is not looked into yet again.

The climax of the horror story of Wexham Park involves not only Mr. Walsh and the problems of 16 nurses being suspended. A nursing officer is a senior member of the multidisciplinary or management team. One senior nursing officer has been sacked; another attended a disciplinary hearing on Friday and the result is not yet known. Mr. Walsh had nothing to gain and everything to lose. He took what he believed to be the correct professional attitude when he was given instructions that he felt were dreadfully wrong.

It is important to consider the whole story. There is a grave injustice. Much of the blame and all the punishment has been inflicted on one person. At the end of the day, management must accept responsibility. The senior management have a grave responsibility. The report that the East Berkshire authority has promised to implement states that inexperienced junior officers were breaking the Mental Health Act by signing forms in advance to prevent patients leaving the hospital and that a member of staff was appointed contrary to the Department of Health and Social Security guidelines in national circulars. These were grave breakdowns in management and cannot be blamed on Mr. Walsh. There were also inadequate or incomplete procedures for the admission of patients, the treatment of violent patients, the use of secure accommodation to lock up patients and the treatment of mother and baby. There was grave mismanagement at the top. Yet, Mr. Walsh is the only victim to date. The inquiry, under a learned lawyer, suggested that there was inadequate or nonexistent guidance to staff on how they should interpret the Mental Health Act 1959, with the result that nurses and doctors were unsure of how to treat patients.

In my previous speech I referred to a scandalous catalogue but did not give details. I hoped that that would not be necessary and that the matter would be picked up by the Department. But I cannot sit down and allow one person to be put in the pillory and stuck in the stocks when, by no means, does he carry the responsibility for all the serious breaks of regulations and misdemeanours that occurred in the East Berkshire authority in the management of the psychiatric unit.

At the end of the day, what has happened? The unit has been closed and boarded up. I was informed of that indirectly. The way that the operation was carried out was absolutely disgraceful—rather similar to an SAS attack as though there was a war to be fought. Not one nurse—not even the sister in charge of the psychiatric ward—was informed that the ward would be shut the following day. They knew nothing until the district management team arrived, together with the police, and patients were manhandled into wheelchairs. That was wholly scandalous.

Sixty beds, now empty, could be occupied and serviced by trained, caring and compassionate nursing staff. The average cost of caring for a patient is about £400 per week. I have been told, although it has not been confirmed, that some patients are being catered for in private mental institutions. The cost of the breakdown in the system of management at Wexham Park will be many hundreds of thousands of pounds. I appreciate that there are always two sides to every question, but when I read the report and a number of other papers, I felt ashamed that such a position should have arisen. In view of the comments from both sides of the House, it should be made absolutely clear that we are here not to pillory anyone, but to try to ensure that some semblance of justice is done. In my view, and that of many others, the nurses and the senior nursing officer have had a raw deal. They have seen senior people escaping the responsibility for which they are paid far more money than those who have been placed in the dock.

Mr. Kenneth Clarke

The debate on new clause 12 has turned largely, but quite properly as the choice of the three hon. Members concerned, into a debate about a series of unhappy incidents at Wexham Park, which have been used to illustrate the need for the new clause.

Although I shall deal with the problems raised in relation to Wexham Park, I wish to begin by reminding the House about the new clause, and the broad and general principles of legislation upon which the whole House has agreed until this point.

We agree that the Mental Health Act 1959 is unsatisfactory and unfair in many respects in the guidance that it gives to doctors, nurses and other professionals. One of the principal achievements of the Bill will be to codify clearly such important and difficult matters as when it is right to give treatment to a detained patient without consent. The Bill directly bears on problems such as those. Throughout the Bill we have accepted the principle—

Mr. Christopher Pricerose—

Mr. Clarke

I do not accept that Wexham Park is entirely determined by this one issue, which has been chosen by those campaigning in this debate.

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Mr. Christopher Price

Under the Bill, is it or is it not the duty of a nurse in any circumstance at all to obey a doctor if restraint is needed?

Mr. Clarke

The Bill allows one to give a legal answer, and good management and practice allows one to come to a common sense conclusion as well.

That brings me to the whole question of multidisciplinary working and co-operation between a team of professionals. I said earlier that absolutely rigid rules of law cannot make different professional people work together if they will not listen to each other, have no respect for each other and are in personal conflict. Wexham Park is a perfect illustration of that. If people cannot stand the sight of each other and are devoting most of their time to undermining the professional position of their rivals, drawing up a code of practice will be difficult. Regulations drawn up by the Secretary of State specifying the way in which they consult each other will be of no use whatever. I fear that a conscience clause of this kind will not have much bearing either.

The new clause is technically defective, but I would not dream of arguing on those grounds. It would give rise to great difficulties in practice. I do not believe that the new clause will solve the problem. I believe that it has been chosen to debate the general principle and draw lessons and conclusions from Wexham Park.

I have followed events at Wexham Park closely since the matter first arose and began to cause problems. I have kept in close touch with events. I am quite satisfied that the East Berkshire district health authority management team has acted properly throughout in the impossible situation that it inherited in part from the previous area health authority. I have only had a word with the chairman of the authority, Dr. MacWilliams, and assured him that so far he has my support. I am satisfied that the team is doing everything possible to re-open the unit in more satisfactory circumstances.

Having looked at the Camp report and listened to the speeches this evening, it is obvious that a sad state of affairs existed in this psychiatric unit before matters came to a head and Mr. Camp was appointed to carry out the inquiry. I accept that few people connected with the unit emerge with complete credit. There were failings on several sides—by the medical staff, some of the management, and the nurses. The report reinforces the belief that multi-disciplinary co-operation is essential to a good psychiatric unit and the good care of patients.

It is clear that Wexham Park should not be taken as a test case of multidisciplinary working, because most things that could go wrong appear to have gone wrong. Having said that, I do not believe that the Camp report makes any attempt to whitewash everyone across the board. It makes many recommendations and contains much criticism. In public debate, it has been turned into an issue about the personal position of Mr. Paul Walsh. Before the inquiry Mr. Walsh's counsel referred to it as the Walsh inquiry. Mr. Walsh appears to regard it as turning upon him and his position. Mr. Walsh's position was one of the matters upon which Mr. Camp came to clear conclusions but it was only one part of the whole picture at Wexham Park.

Although I feel less restrained now than when the debate started, I am in some difficulty because I am not sure how far I am at liberty to quote from the Camp report of which I and my hon. Friend the Member for Beaconsfield (Mr. Smith) have a copy. If my hon. Friend the Member for Cheltenham (Mr. Irving) does not have a copy, he may have one. My copy is clearly labelled "Confidential" and it is an extensive document. It contains many direct strictures aimed at many people and some clear conclusions about many incidents.

I do not want to dip into the report too far, but I would quote one passage which does not go to anybody's personal position. Paragraph 6 of part Eon page 75 shows the conclusions of Mr. Camp and his colleagues about multidisciplinary co-operation and the position of the doctor within it. He says: Finally, although we have studiously and perhaps with excessive detachment avoided expressing a view about 'medical primacy' in general terms, we must observe that a true understanding of the consultant's role is essential to any multidisciplinary clinical team. It is the consultant who is ultimately charged with responsibility for the care and treatment of patients in hospital. This does not mean that he is entitled to be autocratic or unreasonable or to disregard the opinions of other professionals. Indeed, it confers upon him an obligation to consider those opinions with the greatest care, to be responsive and to keep himself well-informed. Nor does it mean that the consultant is always right. It should, however, entail a realisation by other professionals that the deliberate obstruction or countermanding of the consultant's proposals for treatment is to arrogate to themselves a responsibility for patient care of a kind which they do not have in law or in practice. I commend that to the House as a good and balanced description of how a multi-disciplinary team can work. It is not written by someone who conducted an inquiry taking the view that the consultant is almost always right. It does obviously commend the consultant to take into account the opinions of other professionals. However, in the end responsibility for medical treatment has to be the responsibility of the medical man.

What we are talking about in the other amendments and throughout the Bill is the extent to which, although the psychiatrist must have the ultimate responsibility for the medical treatment of a patient, because he is the only man qualified to give that medical judgment, he should nevertheless co-operate with the other professionals and draw upon their distinctive skills in a way which works to the advantage of the patients. However, the other professionals must accept that the prime medical responsibility is that of the consultant.

As my hon. Friend the Member for Beaconsfield said, on the evidence in this case Mr. Walsh plainly held quite different and extreme views. He did not even think that doctors were necessary in the unit at all.

Mr. Christopher Price

Leaving aside the hon. and learned Gentleman's last comment, which I understand is a piece of obiter dicta overheard in a lecture from Mr. Walsh, is it the Minister's view that, although it is the duty of other professionals not deliberately to obstruct or countermand the consultant's proposals, it is perfectly all right for the consultant to deliberately obstruct and countermand the proposals of other professionals? Is that the Minister's view of the multi-disciplinary approach?

Mr. Clarke

My tentative answer to that question would be that neither group of professionals should seek to overrule the other in their own special area; the specialty of the psychiatrist being medical treatment and clinical judgment and the specialty of the nurses being specialised nursing care, which, again, is a matter over which high professional standards must be maintained. The two should co-operate. Obviously, we trust that in the best psychiatric units they co-operate and respect each other's opinions.

I have only given that quotation to show that the Camp report was written by people who took a sensible and balanced view of what a multi-disciplinary team should be. There are 19 recommendations, of which only one is that Mr. Paul Walsh should be immediately suspended from duty and dealt with in accordance with the disciplinary policy operated by East Berkshire health authority in cases of serious misconduct. To go into the full details of Mr. Paul Walsh is to build up his position out of all proportion and to bring up the question of his dismissal, which has properly been resolved by the disciplinary procedures of the authority, subject, I understand to a further stage of appeal.

Given what has been said by the hon. Member for Lewisham, West (Mr. Price) and by my hon. Friend the Member for Cheltenham on behalf of Mr. Walsh, it should be pointed out that Mr. Camp and his colleagues—and I do not want to quote him, as there are difficulties—spent the equivalent of five full days hearing Mr. Walsh and his evidence. Therefore, they had ample time in which to judge him and to reach many conclusions. Those who have read the report will know that the issue did not turn on one incident of holding down a person receiving treatment, but that a stream of matters were investigated. Many complaints were examined. Mr. Walsh's views, and those of witnesses critical of him, were given.

I do not wish to quote from the report, but I can, without departing from it, say that Mr. Camp and his colleagues were satisfied that Mr. Walsh deeply resented the position of doctors, and adopted a thoroughly unhelpful attitude towards those with whom he was involved. He also claimed expertise, experience and qualifications that he apparently did not possess and his whole style of conducting himself was obviously drawn on heavily by Mr. Camp and his colleagues in reaching their conclusions. Their conclusions about Mr. Walsh are copious. They are not confined to one incident and a long series of issues are cited. The breakdown of relations in Wexham Park and the difficulties that built up from 1981 began when Mr. Walsh appeared on the scene and took up his post of senior nursing officer.

A great deal has been said on behalf of Mr. Walsh. I have said something in defence of the authority. I am sure that the authority's first desire is to reopen the unit so that it is functioning as it should be. In that, it has my full support. Obviously, everyone wants the beds to be brought back into use and wants to see better practice followed. In saying that better practice should be followed, I entirely agree with my hon. Friend the Member for Cheltenham, who expressed his views about presigned forms being used by the doctors. That disgraceful procedure should not be pursued and plainly would be illegal under the Bill. All those things must be stopped. The unit must return to proper functioning. The authority is acting on the basis of an independent report, commissioned by the region. It is following the disciplinary procedures laid down for individuals and I am confident that the main aim is to get the unit working properly as soon as possible.

Therefore, such general conclusions should not be drawn from Wexham Park. It does not illustrate anything good about multi-disciplinary working. I hope that what was bad about Wexham Park will be corrected by the authority when it regains control of the situation. It is extremely unfortunate that while it attempts to do so, injunctions have to be obtained to prevent some people from returning to the premises. Constant attempts are made to reopen the case and to turn the whole thing around the work and position of one individual who is only one part of the whole picture.

The Bill will apply to the generality of hospitals and will assist the East Berkshire health authority and other health authorities. It represents a codification and an improvement in the law as it affects the treatment of patients and their detention and care in hospital. It also provides for the Mental Health Act Commission, and the code of practice which will give strong professional guidance to everyone in our hospitals, to ensure that the best practices are widely spread.

The new clause is defective, as well as being based on false premises drawn from Wexham Park. The hon. Member for Lewisham, West has made one of his typical campaigning speeches. He is a classic civil rights campaigner, and an effective and informed one, but civil rights campaigning does not always depend on a balanced view of incidents. The hon. Gentleman occasionally draws on incidents to dramatise a point that he wishes to make. However, Wexham Park, and the point that he has made about it, is not an adequate case for new clause 12. I hope that, having aired the matters that so concern him, the hon. Gentleman will withdraw the new clause.

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Mr. Christopher Price

It is often said that hard cases make bad law, but the truth is that the House legislates on few issues that do not arise from single issues such as Wexham Park. We would not have children's committees in any local authority were it not for a single incident in Worcestershire in 1948. The Mountbatten report on prisons stemmed from the escape of George Blake from Wormwood Scrubs. The Butler committee on mentally retarded and disordered offenders stemmed from a single issue that stirred Parliament to press the Government to set up the committee. The House legislates only when there is a breakdown in a system that is meant to work properly. This is how the House has operated for two centuries. If hon. Members do not understand that, they do not understand anything.

It is the tradition of the House, when an incident of this kind occurs, to Lse it to raise an issue. I realise that the new clause may not be accepted by the House tonight, but I predict that Wexham Park, far from being dismissed as a breakdown of no importance to legislation, as the Minister described it, will be a step on the road to a true multidisciplinary approach where a number of professionals start to respect each other as equals and not look upon themselves as all equal except one primary medical profession, in the way that Minister spelt out when he supported Mr. Camp's view.

I thank the Minister for his speech, because he covered the ground. He might have been a little more even handed, because the Government are meant to be in favour of management and the buck stopping at the top instead of half-way down die system. That is what has happened in this case, as everybody knows. We know that Wexham Park has produced a scapegoat so that some people who are paid a great deal of money—much more than Members of Parliament—can wash their hands, say that it was not their fault, thank God that they have sacked a nurse, and everything will be all right in future. It will not be all right in future until all the professions in the Health Service run a system in which each respects the other.

It is for that reason that I should like to advise the House, as many hon. Members as I can persuade, to support the new clause.

Question put, That the clause be read a Second time:— —

The House divided: Ayes 52, Noes 113.

Division No. 306] [11.50 pm
AYES
Alton, David Lofthouse, Geoffrey
Beith, A. J. McCartney, Hugh
Bennett, Andrew(St'kp't N) McWilliam, John
Booth, Rt Hon Albert Marshall, D(G'gow S'ton)
Campbell-Savours, Dale Morris, Rt Hon A.(W'shawe)
Cocks, Rt Hon M(B'stol S) Morris, Rt Hon C.(O'shaw)
Cowans, Harry Pavitt, Laurie
Cryer, Bob Penhaligon, David
Dalyell, Tam Pitt, William Henry
Davidson, Arthur Powell, Raymond(Ogmore)
Davis, Terry(B'ham, Stechf'd) Price, C.(Lewisham W)
Dean, Joseph(Leeds West) Ross, Ernest(Dundee West)
Dixon, Donald Sever, John
Dormand, Jack Skinner, Dennis
Eastham, Ken Spearing, Nigel
Ellis, R.(NE D'bysh're) Steel, Rt Hon David
Ennals, Rt Hon David Thomas, Dafydd(Merioneth)
Evans, loan(Aberdare) Thorne, Stan(Preston South)
Evans, John(Newton) Wainwright, E.(Dearne V)
Foster, Derek Weetch, Ken
Freeson, Rt Hon Reginald Welsh, Michael
George, Bruce Whitehead, Phillip
Hardy, Peter Winnick, David
Harrison, Rt Hon Walter Young, David(Bolton E)
Haynes, Frank
Homewood, William Tellers for the Ayes:
Howells, Geraint Mr. Allen McKay and
Johnston, Russell(Inverness) Mr. George Morton.
NOES
Alexander, Richard Marlow, Antony
Alison, Rt Hon Michael Mather, Carol
Ancram, Michael Maude, Rt Hon Sir Angus
Aspinwall, Jack Maxwell-Hyslop, Robin
Atkinson, David(B'm'th,E) Mayhew, Patrick
Baker, Nicholas(N Dorset) Mellor, David
Bendall, Vivian Meyer, Sir Anthony
Benyon, Thomas(A'don) Mills, lain(Meriden)
Berry, Hon Anthony Moate, Roger
Best, Keith Morrison, Hon C.(Devizes)
Biggs-Davison, Sir John Murphy, Christopher
Blackburn, John Neale, Gerrard
Boscawen, Hon Robert Needham, Richard
Bottomley, Peter(W'wich W) Neubert, Michael
Bright, Graham Newton, Tony
Brinton, Tim Osborn, John
Brown, Michael(Brigg & Sc'n) Page, John(Harrow, West)
Bruce-Gardyne, John Page, Richard(SW Herts)
Bulmer, Esmond Pattie, Geoffrey
Carlisle, John(Luton West) Percival, Sir Ian
Chalker, Mrs. Lynda Price, Sir David(Eastleigh)
Chapman, Sydney Proctor, K. Harvey
Clark, Hon A.(Plym'th, S'n) Raison, Rt Hon Timothy
Clarke, Kenneth(Rushcliffe) Renton, Tim
Cockeram, Eric Rhys Williams, Sir Brandon
Cope, John Ridsdale, Sir Julian
Costain, Sir Albert Roberts, M.(Cardiff NW)
Cranborne, Viscount Rossi, Hugh
Crouch, David Rumbold, Mrs A. C. R.
Dickens, Geoffrey Shaw, Giles(Pudsey)
Dover, Denshore Shaw, Sir Michael(Scarb')
Dunn, Robert(Dartford) Shepherd, Colin(Hereford)
Faith, Mrs Sheila Smith, Tim(Beaconsfield)
Finsberg, Geoffrey Speed, Keith
Goodhart, Sir Philip Speller, Tony
Goodhew, Sir Victor Spicer, Jim(West Dorset)
Gow, Ian Spicer, Michael(S Worcs)
Griffiths, Peter(Portsm'th N) Stanbrook, Ivor
Grist, Ian Stevens, Martin
Hamilton, Hon A. Stradling Thomas, J.
Hampson, Dr Keith Taylor, Teddy(S'end E)
Heddle, John Temple-Morris, Peter
Henderson, Barry Thompson, Donald
Hooson, Tom Thorne, Neil(IIford South)
Hunt, David(Wirral) Trippier, David
Jessel, Toby van Straubenzee, Sir W.
Jopling, Rt Hon Michael Viggers, Peter
Lang, Ian Waddington, David
Lester, Jim(Beeston) Waller, Gary
Lloyd, Peter(Fareham) Watson, John
Lyell, Nicholas Wells, Bowen
McCrindle, Robert Wheeler, John
Macfarlane, Neil Wickenden, Keith
MacKay, John(Argyll) Wolfson, Mark
Macmillan, Rt Hon M.
McNair-Wilson, M.(N'bury) Tellers for the Noes:
Madel, David Mr. Tristan Garel-Jones and
Major, John Mr. Peter Brooke.

Question accordingly negatived.

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