HC Deb 09 February 1999 vol 325 cc227-34

Motion made, and Question proposed, That this House do now adjourn.—[Mrs. McGuire.]

Mr. Deputy Speaker (Mr. Michael Lord)

I call Dr. Julian Lewis.

Hon. Members

Hear, hear.

10.15 pm
Dr. Julian Lewis (New Forest, East)

I am grateful to my colleagues for giving me such a warm send-off on my debate, although start-up might be a more appropriate term.

Let me start with a quotation: Patients charter offers Hobson's choice on mixed-sex wards. Government not even attempting to collect figures on patients denied beds in single-sex wards. Those are not my words, or those of any Conservative Member, but the words of the then shadow Secretary of State for Health, the right hon. Member for Islington, South and Finsbury (Mr. Smith), in a Labour party press release dated 20 November 1996. At the outset, I state that I am not, and have never held myself out to be, a medical expert—[Interruption.]

Mr. Edward Leigh (Gainsborough)

On a point of order, Mr. Deputy Speaker. May we have some order in the Chamber, so that we can listen to this important debate?

Mr. Deputy Speaker

That is a matter for the occupant of the Chair to decide.

Dr. Lewis

Thank you, Mr. Deputy Speaker.

I have come to the topic by a gradual process, though my involvement with people who have experience as professionals, as designers of mental health hospitals and units, as psychiatric experts and even as users of psychiatric services. I hope to explain why I felt it necessary to apply for this debate, by taking hon. Members through the process of the problem's gradual emergence in my awareness.

I return to the position in November 1996, when the Labour party was, rightly, protesting about the continuing problem of mixed-sex wards. I shall quote the right hon. Member for Islington, South and Finsbury further, because I totally agree with him. He said: The last Patients' Charter…said that patients could expect single-sex washing and toilet facilities; and that their wishes to be treated in single-sex wards 'will be respected wherever possible'. Note the words "and that", for they mean that it is not enough to give patients single-sex washing and toilet facilities and then to say that single-sex wards have been achieved. As the right hon. Gentleman went on to say: These two promises sound good on paper. But a report from the Patients' Association yesterday revealed that segregated washing and toilet facilities are far from being the norm; while patients all over the country commonly report that if they do express a preference to be treated in a single-sex ward, as the Charter encourages them to do, they are suddenly told that in fact their wait for treatment will be far longer as a result. Let us look at the relevant section of the patients charter, which states: You have the right to be told before you go into hospital whether it is planned to care for you in a mixed ward for men and women. (It may not be possible to tell you this if you are admitted to hospital in an emergency.) In all cases, you can expect single washing and toilet facilities. If you would prefer to be cared for in single sex accommodation (either a single sex ward or 'bay' area within a larger ward which offers equal privacy) your wish will be respected wherever possible. There may be some cases, particularly emergencies, where a hospital cannot provide single sex accommodation. Labour was saying that that was a dead letter.

Mr. Leigh

Does my hon. Friend remember that the Labour party manifesto said that it would take steps to abolish mixed-sex wards in the NHS? What has happened to that commitment?

Dr. Lewis

I shall explain the developments. I am happy to acknowledge that some steps in that direction have been taken, but by no means enough has been done. I am concerned that, having taken a few steps in the right direction, which the manifesto commitment outlined, the Government are almost trying to say that the battle is won, the deed is done, the problem is solved. That is not so. Since I first took an interest in this subject some months ago, some worrying developments have made me realise the need to bring the matter more closely to the House's attention.

I remind the House that, on 12 December 1997, I proposed that the provision of single-sex ward areas be made a statutory commitment under the Mental Health (Amendment) Bill, which I moved after being fortunate enough to draw second place in the ballot for private Members' Bills. Sadly, the Government saw fit to amass a combination of Back Benchers and Front Benchers to waste five hours of parliamentary time and talk out the Bill.

Subsequently, there have been some more encouraging developments. In particular, I was tipped off about a development of a mixed-sex ward in a new psychiatric unit at Charing Cross hospital. I raised the issue with the Secretary of State, who gave a characteristically forthright response. He said, "It's news to me if any new mixed-sex wards are being constructed, and if they are, I will put a stop to it." As far as I can see, in this case, he did so.

At that point, the plot began to thicken. As a result of the Secretary of State rightly instructing Charing Cross hospital to revise its plans to create a new mixed-sex ward, the Goodmayes hospital—which was concerned that its proposals for its psychiatric unit would fall foul of the Secretary of State's determination to abolish mixed-sex wards—wrote to the NHS executive.

Mr. Philip Hammond (Runnymede and Weybridge)

Does my hon. Friend agree that, in view of the express determination of the Secretary of State to end mixed-sex wards in psychiatric hospitals, it is very odd and surprising that the recently published mental health code of practice makes no reference to such a management objective?

Dr. Lewis

I agree with my hon. Friend; indeed, I am about to explain why I think that may be. I much welcomed his reference to this omission in the code, when he considered it in Committee in January.

The Goodmayes hospital received a reply on 3 August 1998 from a lady called Judith Guest of the patients charter unit at NHS executive headquarters. It was sent to the consultant psychiatrist and clinical director of Goodmayes hospital, Mr. Andrew Margo, and said: Patients have a right to feel safe in hospital and it is recognised that there are special circumstances in mental health wards that have to be addressed to make patients feel secure. There should be separate sleeping and washing areas for men and women and those should be accessible to people when needed and suitable arrangements put in place to ensure that the area is safe. But completely segregating services would not be acceptable, as there are good clinical reasons to provide an environment in hospitals which, as closely as it can, prepares people for their return to their own accommodation". I am very concerned about that advice. Indeed, I have raised it in correspondence with and questions to the Secretary of State. Nor will it come as any surprise to the Under-Secretary, because I have done my level best to inform his office of my entire line of argument, in the hope that that would assist him in addressing specifically the points which concern me so much.

Mrs. Angela Browning (Tiverton and Honiton)

In considering what would be the norm in the community, under what circumstances can my hon. Friend imagine, for example, that women would find it the norm to have men whom they did not know in the same sleeping accommodation, and vice versa?

Dr. Lewis

I am most grateful to my hon. Friend, as I am always am when she brings the searchlight of her intellect and her specialised knowledge to bear on these topics. She anticipates a point that I intended to make later, but I shall deal with it now because it is precisely what the group of users from the Maudsley hospital has emphasised to me in my two meetings with its members.

I take the opportunity to pay tribute to Jolie Goodman, Cath Collins, Lynne Clayton and Denise McKenna for the campaign that they have been running. They have collected a number of deeply worrying examples of what is entailed for a woman who finds herself an in-patient on an acute ward. First, they contrast two quotations to make the point that my hon. Friend has just emphasised. They quote a pilot wing manager from the Charing Cross development as saying: Sexual harassment is a fact of life in mental health wards…We feel that single-sex services themselves are not suitable here because we're trying to create a normal environment. The campaigners' response states: Mixed wards don't reflect a 'normal' society. They are full of a completely mixed bag of strangers in extreme distress who are forced to live in intimate circumstances with each other. We can all anticipate the extreme examples of abuse that might occur in such an artificial environment. I shall give only two examples that the campaign group has drawn to my attention. These are the experiences of people who have written to the group. The first concerns a female user who, in 1998, wrote: In 1995 I was a patient in"— I shall not name the hospital— and a woman on my ward was raped by a male patient who followed her into the female bathroom. I interject that all too often what is lacking is a proper definition of what is meant by a ward. The term "bay" is particularly misleading because it refers to corridors: a male corridor opens off in one direction and a female corridor opens off in the other, but there is nothing apart from the vigilance of the staff to stop people going from one to the other.

The second example concerns a 17-year-old woman who, in 1998, wrote: I, too, have been sexually assaulted by two male patients on my ward in July of this year. This experience was so traumatic and dreadful that it stopped any progress I was making for several months. As I said, we could all imagine those extreme cases, and I had already thought of what might be entailed by those terrible circumstances; but what came as a revelation to me in the first-hand testimonies of the campaign group were the examples of more everyday occurrences with which female in-patients have to contend. I make no apology for reading out one or two that some people might find rather disgusting. The first states: On entering the games room, a female patient tripped over the legs of a male patient who was lying flat on his back on the floor masturbating. When she complained to a nurse, she was told, 'He's very ill, you know,' and nothing was done. The funny thing—funny peculiar or funny ironic, but not funny in any other sense—is that that patient was ill, and indeed it was not his fault, but he should not have been where she could stumble across him in that way, or vice versa.

Another example concerns a woman who found herself surrounded by half-dressed men asking whether she wanted a boy friend as she queued for breakfast. It has been explained to me that queueing is a key part of life as an in-patient. One queues for meals and one queues for medication. What does a female do if she is being groped or interfered with in a queue? What does she do if someone starts to bully her for her food or benefits? Another example concerns a frail lady who was bullied by a young male patient into handing him her benefit money.

Then there are the cases caused by proximity and geography. The men's toilets are sometimes at the beginning of the corridor leading to the dining room, and the doors are frequently left open while the toilets are in use. That is not the fault of the mentally ill people who leave them open, but it should not be visible to women.

What can I say in the short time that remains? There is a risk that the pendulum will swing too far. This keeps happening in mental health. At one time, the pendulum swung too far in the direction of institutionalisation: anyone who had anything wrong with them was put away for years—for the better part of their lives, sometimes for ever. That injustice was recognised. Then the pendulum swung the other way, with care in the community, and hardly anyone was admitted as an in-patient.

A compromise has now been reached in distinguishing between those who need to be long-term in-patients and those who can do well in the community. That is good, but I was disturbed to hear the Secretary of State say some time ago in a statement on mental health that community care had failed. No; part of it failed, and part of it succeeded. Now we are trying to get the balance right.

I appeal to the Minister to come out from behind the obfuscation of official language. He cannot have it both ways. Either the Government believe in the principle of single-sex wards, or they believe in the philosophy of a "normalising" environment—in which the single-sex wards that he is talking about relate only to very basic functions, and there is nowhere for women to be during the day without the intrusion of men. If the Minister's concern is genuine, he must say once and for all tonight that the idea of creating a "normal" environment by putting sick men with sick women, in circumstances in which they cannot be held responsible for their actions, is fatally flawed, is unacceptable, and will finally be rejected.

10.32 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Hutton)

I thank the hon. Member for New Forest, East (Dr. Lewis) for giving me notice of some of the points that he has made. I congratulate him on raising such an important subject tonight. I know that he has a long-standing interest in it: indeed, I believe that he is one of only a few hon. Members to have displayed such a continuing interest. I am grateful to him for giving me the opportunity to set out the Government's intentions in relation to mixed-sex accommodation in psychiatric units.

We should see the issue in the wider context of the Government's plans to modernise mental health services, which we outlined at the end of last year in the strategy document "Modernising Mental Health Services". In that document, we tried to make it clear that we wanted services to be safe, sound and supportive—safe to protect the public, patients and staff, providing effective care for those with mental illness at the time when they need it; sound to ensure that patients are given the best and most appropriate care and treatment in the right settings, and have access to the full range of services; and supportive through work with patients, carers and local communities to help people to lead lives that are as independent as possible.

Effective responses to mental health problems require three elements to be in balance: resources and the systems to make the best use of them, legislative powers, and the processes of care. Deficiencies in one area cannot be compensated for by change in another. Increasing resources—which we are doing—will not be cost-effective unless the necessary care processes are in place; strengthening legislative powers cannot overcome the problems of inadequate resourcing. We recognise that reform in all three areas is needed to modernise mental health services.

Our plans for mental health services, taken with our proposals for modernising health and social care, add up to a comprehensive set of policies that will provide a new vision for mental health services. Our new vision is underpinned by new investment—the hon. Gentleman did not refer to it, but I am sure he will not mind if I do—of £700 million over the next three years. That sum represents the largest single increase in investment in mental health services since the NHS was established in 1948. It will be supported by the development of a new mental health national service framework, which will set new service models, and by a review of the current legislation.

In planning for high-quality mental health and social care, we do not, unfortunately, start with a blank sheet of paper. Instead, we inherit a complex legacy of problems in policy, planning and the patterns of service delivery. All those need to be addressed. That will take time, but the plans set out in "Modernising Mental Health Services" make clear the direction that we intend to take, with a clear set of objectives and a focus on new investment. "Modernising Mental Health Services" marks a new beginning for mental health provision in England.

On the situation regarding mixed-sex accommodation that we inherited from the previous Administration, it is worth pointing out to the hon. Gentleman, as I know that he has a balanced and sensible approach to these matters, that many of the problems that he rightly identified did not date from 1 May 1997. He will probably want to join me in regretting the fact that the previous Administration, whom he strongly supported, made such poor progress in eliminating mixed-sex accommodation in the NHS.

I am acutely aware of the concerns that have been raised about the safety of patients in psychiatric units. Like the hon. Gentleman, I have had meetings with former patients. I recently met four women who have at various times been patients in the Maudsley hospital. They expressed to me their serious concerns about harassment and serious assaults on acute psychiatric wards. I was extremely concerned by what those women told me of their own experiences. As we have done on previous occasions, I made it clear to them, and I do so again today, that we are committed to getting rid of mixed-sex accommodation in the NHS.

The hon. Gentleman developed his arguments in his comments. It might be helpful to him, and to all the other hon. Members who are present and who are clearly interested in the subject, if we start to define some of our terms. By "single-sex accommodation" we mean clearly defined, separate sleeping areas, separate day rooms and social areas, and separate toilets and washing facilities. Guidance will be issued that will state clearly that male and female toilets and bathing facilities should be located in separate areas, close to respective male and female sleeping areas.

The word "accommodation", about which the hon. Gentleman was concerned, means the whole range of buildings and types of living space used by patients in the NHS. It would be wrong for the hon. Gentleman to suggest that using the word "accommodation" is in any way a narrowing of our manifesto commitment to ensure the safety of women patients who use the NHS. We made a clear promise in our manifesto and we will keep it. I cannot make myself any clearer than that.

I was intrigued by some of the hon. Gentleman's comments. I have read the speech that he made when he introduced his Bill. He might be interested to reflect on some of the words that he used in that debate. Introducing clause 2, he said that it dealt with mixed-sex areas, not wards. He said: I am not talking about big open spaces with male patients at one end of the room and female patients at the other, but all wards should have an area reserved for women if they want that. It would be a refuge room not unlike the ladies waiting rooms provided at some railway stations for women who want to wait in a women-only environment."—[Official Report, 12 December 1997; Vol. 302, c. 1267.] I was rather surprised by the tone of some of the hon. Gentleman's remarks today expressing his concern about the use of the word "accommodation," which I do not think can be justified by what we have said.

I repeat that we will not tolerate violence against women anywhere in the NHS. We are determined that all women in mental health units should be assured of conditions that are safe and free from harassment and abuse. However, we cannot overnight repair the damage of many years' neglect and under-resourcing. The previous Government spoke much about safety, but we are determined to take action to make improvements to protect patients. We inherited a national health service badly in need of modernising, and that is particularly true of mental health services. We also need to bring about a change in culture. Outdated attitudes and practices have no part in the revitalised services that we want to bring about.

What action are we taking? We are taking action on several fronts. We have set the national health service objectives to implement our commitment to the elimination of mixed-sex accommodation. We are monitoring its performance in achieving those objectives and we are to issue further guidance on mixed-sex accommodation. We are investing in staff training and we will ensure that variations across the country are reduced through the implementation of the mental health national service framework, which, in turn, will be monitored and enforced by the Commission for Health Improvement.

I want to say a little more about each of those areas to show that a substantial amount of work is taking place to deliver our commitment to getting rid of mixed-sex accommodation. First, the NHS has been given three key objectives: to ensure that appropriate organisational arrangements are in place to secure good standards of privacy and dignity for all hospital patients; to achieve fully the patients charter standard for segregated washing and toilet facilities across the NHS; and to provide safe facilities for patients in hospital who are mentally ill which safeguard their privacy and their dignity.[Interruption.]

We have made it clear—I say this in response to the sedentary intervention from the hon. Member for Rutland and Melton (Mr. Duncan)—that we expect 95 per cent. of health authorities to have met those objectives by the end of 2002.

Last August, we issued a monitoring tool to ascertain the progress of the NHS towards achieving those objectives. That contained a checklist to assist health authorities in monitoring the processes in place to deliver good physical segregation of the sexes in hospital. It also included additional arrangements for mental health in-patient facilities.

The NHS executive has monitored progress in achieving the objectives that have been laid down and the Government have already published two reports, which show health authorities' progress in this area. A further monitoring report will be published in the spring. We continue to keep this issue high on the NHS agenda, through the performance management systems that we are introducing, and to check hospitals' capital plans to ensure that the money that they have been given contributes towards the elimination of mixed-sex accommodation. As a clear signal of our commitment in that area, £70 million has been earmarked specifically for that purpose from the NHS capital allocation for next year.

The monitoring checklist produced by the NHS executive included specific points to check that the safety of patients in mental health units is maintained, but we want to go beyond that by producing more detailed guidance that specifically addresses the issues for vulnerable, mentally ill people in hospital. Although there are constraints on the ability of NHS trusts to maintain the best standards in their existing stock of buildings, they must do what they can, within the constraints of the accommodation, to protect patients' privacy and dignity.

We have made it clear that new developments must achieve best practice standards in providing separate accommodation for the sexes. Each of the new schemes is being scrutinised by the regional offices to ensure that they eliminate problems and that they comply fully with the patients charter requirements.

When I addressed a conference of hospital designers and service providers last month, I announced that we would be issuing further guidance for mental health units in the late spring. That guidance will help to inform discussion locally about how to achieve the targets of privacy and dignity. It will also contain examples of good building design and solutions to varying ward layouts and requirements for operational policies that ensure the safety, privacy and dignity of all patients within the NHS.

We want to ensure that trusts have proper management policies in place and protocols to prevent assaults. The guidance will also give advice on what to do, both at trust management level and at individual ward level. It will cover such issues as the assessment of each individual's needs and the risks that they may present; speedy, robust arrangements to deal effectively with staff, or patients, who sexually abuse or harass patients; and monitoring of complaints to enable identification of problems over the care and treatment of women patients.

The guidance will also make it clear that each ward should have a written policy relating to the safety of women and that a designated officer at senior level in the trust should have overall responsibility for the safety of women. I could say more, but we will shortly run out of time.

All those requirements will be reflected in the mental health national service framework, which will specifically address unacceptable variations in services across England. It will set national standards for health and social care and establish performance indicators to measure the progress made by those services.

I can assure the hon. Member for New Forest, East that the NHS will not be complacent about the safety of women. There is no place in the health service for discrimination, sexual harassment or assault—at all. Women must feel safe in mental health services. That is our objective and that is what we will deliver.

Question put and agreed to.

Adjourned accordingly at fifteen minutes to Eleven o'clock.