§ The Secretary of State for Health (Mr. Frank Dobson)
Madam Speaker, I wish to make a statement on the report of the public inquiry into the Ashworth special hospital conducted by his honour Peter Fallon QC. That inquiry was established by my predecessor in February 1997 to investigate allegations by Mr. Steven Daggett, a former patient of Ashworth special hospital, that there was misuse of drugs, financial irregularities, possible child molesting and the circulation of pornographic material in the personality disorder unit at the hospital.
I also pay tribute to the work of my hon. Friend the Member for Halifax (Mrs. Mahon), who brought this matter to the attention of the Government. She subsequently received threatening telephone calls, which she believes came from people whose trade in pornographic videos was interrupted by her intervention.
In this short statement, it is difficult to do justice to the inquiry report, which is 473 pages long. The executive summary alone covers 44 pages. So, I will highlight the major points in the report. The inquiry sat for a total of 66 days, taking evidence from a wide range of witnesses involved in Ashworth hospital, both in the past and at present.
The report presents a shameful picture. The general allegations made by Mr. Daggett were largely true. There were financial irregularities, drug abuse, the circulation of pornography and a poor quality of patient care.
Mr. Daggett's main allegations referred to Lawrence ward in the personality disorder unit. A ward within a personality disorder unit, set inside a special hospital, had been repeatedly visited by a seven-year-old girl, who was allowed unsupervised contact with patients guilty of sex offences against children. Her father brought her into the unit and, without let or hindrance, gave her unsupervised access to one patient who had a history of molesting young girls, including indecent assault and attempted rape. She also visited another patient who was locked up in Ashworth because he had kidnapped, tortured, sexually assaulted, mutilated and eventually murdered a 13-year-old boy. I am glad to say that the inquiry report concludes that there was no proof that the girl was abused, but that she was being "groomed" for later abuse.
The inquiry asked how a young girl could have been allowed to visit such men. It was told that the Lawrence ward was special and that there were not many incidents. All the patients were allowed to roam round much of the hospital unaccompanied. For a time, routine searching did not take place. The inquiry was told that the ward espoused the philosophy of a "democratic community". I should emphasise that the inhabitants of that so-called democratic community had between them committed innumerable murders, manslaughters, indecent assaults, indecent assaults on children, assaults or woundings with intent and a host of other offences.
The inquiry concludes that a small group of patients, led by the child murderer, was intimidating patients and staff and had gained a grip on the ward. It also concludes that there was a drugs problem on Lawrence ward, that it was endemic throughout the hospital, but that there was no direct evidence that nursing staff were involved.
The financial irregularities arose from a shop on Lawrence ward, from the sale of pornographic materials including videos and from people conducting credit 108 card businesses. Judging by the report, Lawrence ward appears to be a veritable outpost of the enterprise culture. The father who brought his daughter into Ashworth hospital also supplied pornographic videos, which he was allowed to deliver by car to the ward without either him or the car being properly searched.
There was a shop on Lawrence ward that was supposed to sell confectionery and soft drinks. Its turnover started at £50 a month and soared to £14,000 between January and October 1996. The child murderer also ran an unofficial shop from his side ward.
Unknown to senior managers, several patients—including Mr. Daggett, the person who complained—had been allowed credit cards. Eventually, when managers decided to end this arrangement, patients were forced to cut up their cards, but they retained the numbers so that they could renew them or continue to use them in telephone transactions. Security was so slack that Mr. Daggett managed, while in the hospital, to change his name by deed poll, acquire a new passport and driving licence and use a credit card to take out a large sum of money, prior to absconding.
The inquiry found that security was so lax that neither patients and staff, nor visitors were properly searched. It confirms Mr. Daggett's claim that, on Lawrence ward, the patients' rooms were not properly searched. That was illustrated when a full-scale search in January 1997 revealed a stock of children's underwear in the room of the man who had molested girls, and male pornography in the room of the child murderer. Both patients had video cassette recorders, used for copying videos. A previous search of the boot room on the ward had revealed 41 pornographic videos.
The inquiry set out to find how that deplorable situation had come about and how it had been allowed to persist. What it found out is a shameful story of confusion, indecision, mismanagement and incompetence. Some of the professionals and managers failed to show a glimmer of common sense, let alone to live up to the standards of their professions. The whole thing was a mess from top to bottom.
In the past, Ashworth had operated a harsh and repressive regime. Following scandals in the early 1990s, the Blom-Cooper inquiry in 1992 recommended a more liberal approach. The Fallon inquiry concludes that those recommendations, which were mainly directed at the rest of the hospital, were implemented without proper consideration of their differing impact on different patient groups. As a result, the patients with personality disorders enjoyed most personal freedom and reduced security. The report says that it was quite predictable that those failures could be abused by some of the patients.
What is clear is that, because of the failure of top management to lay down and enforce clear rules for both patients and staff, security became less and less important. As a result, more and more problems arose but nobody attended to them. As the report says,all too often the core principles of security were absent.
Nobody was seen to be in charge of the personality disorder unit. That was because nobody—with the possible exception of the patients—was really in charge. The senior management staff were out of touch, and psychiatrists seem to have been incapable of carrying out their proper professional functions. Management decisions, if known, were frequently ignored by both staff 109 and patients. The internal monitoring system did not work. The members of the board do not seem to have known what was going on. The external monitoring system did not work. Events within Ashworth were not reported to senior officials of the national health service or the Department of Health. Reports into serious incidents were suppressed.
The Fallon report concludes that the whole system was at fault. I am sure that that is right, but the report goes on to criticise individuals and I am sure that that is right too, because too many people at Ashworth failed to do properly the jobs that they were paid to do. The report criticises a number of people by name. Ashworth hospital authority has already taken disciplinary action against some people, and some others have left Ashworth.
In the case of any of those criticised in the report who are still employed by the NHS, whether at Ashworth or elsewhere, I expect their employers to initiate appropriate disciplinary proceedings in the light of the report. In at least one case, the report will be drawn to the attention of the General Medical Council and other professional regulatory bodies. The United Kingdom Central Council for Nursing, Midwifery and Health Visiting has already commenced disciplinary action in one case.
The report recommends that Mr. Paul Lever, chairman of Ashworth hospital authority, should step down. He has done so. Anne Marie Nelson, former chairman of the Special Hospitals Service Authority and present chairman of the High Security Psychiatric Services Commissioning Board has also resigned, in accordance with the principles of public accountability.
The running of Ashworth and the terrible incidents there were the subject in the 1990s of a succession of inquiries and reports. In 1990, one patient was murdered on Owen ward and another was murdered on Forster ward. In 1992, the director of security carried out security audits at Ashworth, Broadmoor and Rampton. Her recommendations for greater security at Ashworth were ignored. At about the same time, a task force that was implementing the Blom-Cooper report described Ashworth as "over custodial". The Fallon report describes the task force's policy as a recipe for disaster.
In 1993, an inquiry into the women's services at Ashworth, which are not part of the personality disorder unit, produced a damning report. In 1995, there was an internal investigation into a hostage-taking on Owen ward. The report was 59 pages long with appendices covering 385 pages. Again, it was a damning indictment of what went on, but staff were shown only a nine-page summary, and so was the official responsible for implementing its recommendations.
Neither the Owen ward report nor the Swan report was made available to the health advisory service before publication of its review of progress following the Blom-Cooper report in 1995. Also in 1995 and again in 1996, patients attacked members of staff with razors. Later that year, the discovery in mail addressed to a patient of a machine for embossing share certificates led to an inquiry which revealed security breaches, scams and money-making ventures in the personality disorder unit.
Reports were prepared on all the incidents, but no machinery was put in place to see that changes and improvements were made. Nor was anyone ever given the task. I am determined that the Fallon report will not suffer the same fate. The report makes 58 detailed 110 recommendations. Some cover the operational procedures at Ashworth. I am giving the hospital authority four months to develop an action plan to implement the necessary changes within the hospital. I am appointing lan Pirnie to chair the authority during that process. Mr. Pirnie presently chairs the Morecambe Bay health authority. I hope and expect that he will bring to this task the leadership and management skills that he demonstrated as an admiral in the Royal Navy.
Other recommendations cover the general role and organisation of the special hospitals and their relationship with the rest of the national health service. Those will be the personal responsibility of Sir Alan Langlands, the chief executive of the NHS. I have given the task of ensuring progress on the more general recommendations which apply across government to Chris Kelly, the permanent secretary at the Department of Health. All three will report directly to me and all three will be expected to deliver.
The inquiry team gave final clearance to its report on Wednesday of last week. The printed edition arrived this morning; it is being published this afternoon. A detailed response to all its recommendations will be published as soon as possible. In the meantime, I can say that the Government broadly accept most of the recommendations and I can give an immediate response to some of those that will be of most concern.
The report recommends that security should be given a higher priority—that searches of patients and staff should be introduced, that no visitors should be allowed into Ashworth without being searched and that there should be regular searches of patients' rooms. The Government accept those recommendations. We give top priority to the safety of the public. We have already taken action. All aspects of security have already been tightened up. New rules have been introduced. Management is making sure that they are implemented for people entering and leaving the Ashworth site, within the site and on the wards.
Further investment in extra security staff is being made. An extra £1.5 million is being made available for all three special hospitals this year and a further £4.5 million is being made available for increased physical security measures at Ashworth. That will allow fully effective searches to be made of all visitors, staff, patients, goods and vehicles, including, where appropriate, the use of X-rays, metal detectors and sniffer dogs.
I have arranged for an independent review of all aspects of security, including the use of the post and telephones at all three special hospitals, which will report direct to Sir Alan Langlands. The social services inspectorate will conduct inquiries into the social work aspects of Ashworth, and subsequently the other two hospitals, and report directly to me.
On visits by children, we have already changed the rules on child visitors and gone beyond the recommendations in the report. In September last year, we put a stop to child visits to ward areas and visits by children who are not close relatives of the patients. No visits are allowed unless they are judged to be in the best interests of the child. All visits by children must be off the wards and must be supervised. Any visits by a child must be by prior arrangement. The rules apply at all three hospitals, and I wish to make it clear that those who breach any of those rules can expect to be summarily dismissed from their job.
111 The report recommends a review of the whole system of accountability within the national health service and between the national health service, officials of the Department of Health and Ministers, particularly in relation to the special hospitals and more generally. I share some of the inquiry's concerns about the system that I have inherited from my predecessors. I have made clear to the House who is to have personal responsibility for dealing with the various aspects of the report and that, for the present, they will all report directly to me.
The health Bill, which we will be introducing shortly, will put in place stronger and clearer accountability arrangements for the whole of the national health service and will end the internal market that has clearly inhibited more active management by the national health service executive and regional offices. As recommended in the Fallon report, the commission for health improvement will cover the special hospitals.
In addition, the board of every hospital—including each special hospital—will have for the first time a statutory duty concerning the standards of treatment and care it provides, there will be clearer powers for the Secretary of State to issue directions, and new arrangements for commissioning specialised services. I am giving further consideration to the question of overall accountability in the light of the report's recommendations.
The inquiry was set up to consider the personality disorder unit, not the future of the whole hospital, and of its high-security psychiatric services. However, the inquiry team has recommended the closure of Ashworth hospital. The Government do not accept that recommendation.
In the policy document "Modernising Mental Health Services", on which I reported to the House on 8 December last year, we made it clear that we want to see a closer integration of the high-security services with the other secure services, and the reconstitution of the special hospitals as NHS trusts. For the foreseeable future, the three special hospitals must continue to be the main providers of high-security services. There is no practical alternative in the short term. To announce that the three special hospitals had no long-term future, but that they could not be replaced for a good many years would run the risk of making them even more difficult to manage than they are now.
In any case, I do not believe that the problem at Ashworth is one of bricks and mortar. The problem is management, and that is what we are determined to tackle. The personality disorder unit at Ashworth is not some decrepit Victorian dump: it was purpose-built. Work started on it in 1976 and was completed in 1984. Replacing it with smaller high-security units spread around the country would not guarantee better security, higher-quality treatment and care or more effective management. That would still have to be planned, organised and worked at.
The members of the inquiry team gave a great deal of thought to how best the legal, medical and penal systems should deal with people suffering from severe personality disorder, and they make a number of very useful recommendations for far-reaching changes. I welcome those ideas very much, and my right hon. Friend the Home Secretary and I will consider them very carefully 112 as we develop new and more effective ways of dealing with people suffering from severe personality disorder, whether they are currently in prison, hospital or in the outside world. Public security must be our main priority. The Government will also make sure that the recommendations in the Fallon report are made available to the teams reviewing the Mental Health Act 1983 and mental health services.
As a result, that may lead to changes in the role of the Ashworth personality disorder unit, the scale of its operations and how they are organised. It could mean breaking up the hospital into smaller physically segregated units, but we do not contemplate its closure. However, we agree with the inquiry team that a new form of reviewable detention is needed for those people with a severe personality disorder who are considered to pose a grave risk to the public. We therefore announced in December in our strategy document "Modernising Mental Health Services" that we would make proposals that ensure that the safety of the public is the prime concern and that a new regime is established for that difficult group of people.
Since the Fallon inquiry got under way there have been many changes at Ashworth. The process of change has not been without its problems, but progress is being made. The quality of the medical staff has improved substantially as a result of new appointments, management has improved and security has been tightened, but there is still a long way to go.
I should add that despite the catalogue of disasters accurately outlined in the Fallon report, many of the staff at Ashworth have been trying hard to do a good job. They work in very difficult circumstances. The patients in the personality disorder unit are often highly intelligent and manipulative as well as dangerous. They have to be looked after and checked on 24 hours of every day so that the rest of us can be secure. We owe it to the staff to make a fresh start at Ashworth and to encourage the good staff and management, partly by getting rid of the bad ones. The new arrangements and the new people should deliver a better performance all round.
A natural question that will arise in the minds of most decent people is, "How is the little girl getting on?" I have checked. She seems to be doing pretty well. She is living a settled life and under a court order, her father has no contact with her. She was being exploited by the adult world. I am determined to ensure that from now on the adult world looks after her instead. I hope that all will respect her privacy. At my instigation, a court order is being sought to prohibit disclosure of her name, address or school or any other information that might identify her. I hope that that will be respected.
Finally, I thank his honour Peter Fallon, the other members of the inquiry team and their secretariat for the thorough way in which they have gone about their business and the report that they have produced. They have done their job. It is now up to us to do ours.
§ Mr. Philip Hammond (Runnymede and Weybridge)
I thank the Secretary of State for that important statement and for making available to me a little earlier a copy of the substantial report. I express the Opposition's support for his action this morning in seeking to protect the identity of the little girl involved through an application to the court for an appropriate order.
113 As the Secretary of State has said, the management problems at Ashworth hospital go back a long way. They are in many respects linked to a wider question about the appropriate approach to dealing with the most dangerous mentally ill offenders. The provision of a regime that is at once therapeutic and secure, thus achieving the twin imperatives of treatment for the patient and ensuring, as a paramount concern, the safety of the public, poses enormous challenges. Many changes in practice have been introduced since the early 1990s and major steps have been taken towards integrating the special hospitals into the mainstream structure of the NHS. The Opposition support the Government in seeking to continue that process. There has been a good deal of constructive collaboration in the past, and the Opposition hope that that approach will continue.
Even with the benefit of 20:20 hindsight, I believe that my right hon. Friend the Member for Charnwood (Mr. Dorrell) and, before him, my right hon. Friend the Member for South-West Surrey (Mrs. Bottomley) acted promptly and appropriately when these matters came to light.
The Fallon inquiry was established by the previous Government to investigate the operation of the personality disorder unit within the hospital and to make recommendations to ensure that there could be no recurrence of such activities as those revealed by the evidence of Steven Daggett in early 1997.
The Secretary of State has already made it clear that what he has said today is but an initial response to a massive and detailed report. The House and the Secretary of State will appreciate that we have had even less time than he has to digest the details of the report, but I welcome his initial response that he will accept the bulk of its recommendations.
The Secretary of State has said that he will publish a detailed response in due course. Will he give an undertaking that he will make a statement when that response is published and the hospital management's detailed proposals are available? Will he otherwise make arrangements to ensure further discussion of matters once we have all had the chance to consider and digest the report?
The report's central recommendation to close the hospital completely has been rejected by the Secretary of State. In doing so, he is taking on a heavy burden of responsibility. It is his duty to ensure the safety of the public and of patients in the hospital. In rejecting the report's recommendation to close the personality disorder unit at Ashworth, he must be absolutely confident that the action that he has taken and is proposing to take will safeguard both the public and patients.
The House, too, will want to be reassured that the Secretary of State's action will be effective in addressing the long-running and intolerable problems at Ashworth. Will he therefore undertake to review the situation at Ashworth in 18 months, and make a further statement at that time on the effectiveness of the measures which are to be implemented in lieu of the recommended closure of Ashworth hospital?
What measures will the Secretary of State take to oversee the implementation of the recommendations that the Government have accepted, bearing in mind the report's criticism of the implementation task force, which was set 114 up to oversee implementation of the Blom-Cooper report recommendations? Will he assure the House that outsiders will be involved in that oversight process?
Does the Secretary of State envisage that continuing down the route of regionalisation and providing regional high-security units will eventually lead to the closure of the three special hospitals? Will he confirm that, in the meantime, no offender convicted of a serious offence will be transferred from high-security to medium-secure facilities? Will he further confirm that there will be no reduction in the number of high-security beds that deal with the throughput from the courts?
I noted that the Secretary of State expressed the hope that the relevant employers will take appropriate action in respect of any persons named in the report who are still employed in the national health service. Will he assure the House that he will follow up that expression of hope with action to ensure that, if such people are still employed in the NHS, they will be immediately suspended from their duties while the relevant employers investigate matters more fully?
The Secretary of State acknowledged the failure of management at Ashworth over many years. Given that there have been two changes of chief executive since this Government came to power, does he have full confidence in the hospital's current management and its ability to implement the report's recommendations?
§ Mr. Dobson
First, may I report to the House—I think that all hon. Members will be pleased to hear this—that I have just received a note saying that the High Court has granted the order to protect the confidentiality of the child.
We shall certainly be producing a detailed response. Whether that will be given on the Floor of the House and whether there will be an opportunity for debate is a matter not for me but for my right hon. Friends the Leader of the House and the Chief Whip. We shall have to leave it in their hands.
I have never tried to get out of responsibility for any decision that I have taken. Security of the public and of people in the hospital must be the paramount consideration. Some advocates of breaking large hospitals into many smaller units seem to think, in a Pollyanna way, that everything will therefore be all right. There is no guarantee that a collection of small units would be more secure than one large and highly secure unit. I want to ensure that these people are securely locked up and that security is guaranteed in the hospital. I think that I am taking the option that is likely to prove the most secure.
With regard to implementation, I have spelt out who will have responsibility, at least in the short run, for the immediate implementation of the major recommendations. They will report to me and I will ultimately report to the House.
On the eventual closure of Ashworth or the other hospitals, I cannot speculate too far ahead, but I do not envisage any of the three being wholly closed.
With reference to high-security beds, there are people who are moved from high-security units to medium-secure units because the psychiatrists and others responsible believe that they will be safe there. Some of those people are allowed out because the psychiatrists believe that they have changed as a result of treatment, have improved and will be safe. The number of beds therefore varies, and we should not get into a great party political spat about that.
115 I am fairly confident that it will be possible to mount successful disciplinary proceedings against people employed by the Ashworth authority for something that they did wrong or failed to do at Ashworth. The situation is more complicated if they have moved to other jobs in the national health service. As I said earlier, I share some of the concerns of the Fallon inquiry about accountability in the NHS. I cannot instruct a health authority or a trust to dismiss anyone under the present powers available to me or the powers that previous Ministers used to have.
I have confidence in the arrangements that I am making and the changes that we are making at Ashworth. As I said in my initial statement, I do not suggest that it will be plain sailing. There have been difficulties. One chief executive at Ashworth lost the confidence of the doctors and had to be removed. She has been replaced, and I hope that the replacement will do a good job. He certainly seems to be doing a good job, and it is my job to try to help him and the others to do their jobs.
§ Mr. David Hinchliffe (Wakefield)
I echo my right hon. Friend's tribute to my hon. Friend the Member for Halifax (Mrs. Mahon) for her role in exposing this sad affair. I am sorry that she cannot be present today, but I am sure that she would welcome many of the steps taken by my right hon. Friend, particularly those relating to the little girl.
Is it not a fact that the special hospital system has been a shambles for years and is one of the great unresolved policy issues of the previous Administration? Will my right hon. Friend confirm that the internal review commissioned by the previous Government, chaired by Dr. John Reed, recommended the closure of Ashworth and the other two special hospitals, and strongly recommended moving in the direction of regional secure units at a localised level?
Does my right hon. Friend accept that the failure of the previous Government to act along those lines has led to serious difficulties in the prison system? Prisons such as Wakefield in my constituency are accommodating vast numbers of seriously mentally ill people who ought to be receiving psychiatric care, rather than prison care. Does he agree that in the longer term, the only way to avoid problems such as those at Ashworth is to move in the direction set out by John Reed?
§ Mr. Dobson
I have great respect for the views of my hon. Friend the Member for Wakefield (Mr. Hinchliffe), as he well knows, but I am not sure that I agree with him in this matter. My right hon. Friend the Home Secretary and I are giving consideration to various categories of people suffering from personality disorder: the people in the hospitals who, in theory, are treatable but many of whom are not actually treatable; the people in the prisons who are suffering from personality disorder, are not getting the attention that they deserve and are a real nuisance to the prison system; and the people outside with personality disorder, who are dangerous but have not committed an offence, who the psychiatrists believe cannot be treated and who therefore have no place either in a prison or a hospital.
We are considering all sorts of alternatives for dealing with that, including a reviewable detention for all three 116 categories and the possibility of establishing a separate service to deal specifically with that minority. That may be the best way forward.
§ Mr. Simon Hughes (Southwark, North and Bermondsey)
First, I join the Secretary of State in paying tribute to Judge Fallon and his team who, in the short time available, appear to have done an extremely thorough and comprehensive piece of work. I also pay tribute to the Secretary of State and his predecessor for the speed with which they set up the inquiry and published its conclusions.
It appears from the report that the management of Ashworth was nothing short of outrageous. To adopt a phrase from elsewhere, it appears to be truly a case of the most disordered patients being in charge of the hospital. That being so, an instinctive gut reaction would be that the place must close, but the Liberal Democrats are prepared to share the Secretary of State's view that to announce its closure would create as many problems as would keeping it open. However, it should be seen to be a hospital on licence rather than on probation or under sentence, because unless it gets its act together, it would clearly be inappropriate for it to have an extended life.
With proper management, accountability and scrutiny, the hospital should be able to do the job, but will the Secretary of State accept the following suggestions? First, there should be a move within the hospital to management within smaller units. In particular, thought should be given to separating those who are convicted from those who are not convicted.
Secondly, will the Secretary of State and the Home Secretary, when considering their responses—as my right hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith) and I will as we consider the matter in more detail—bear in mind the great benefit of following the report's recommendation to bring the medical staff in the Prison Service under the Department of Health, so that psychiatrists and psychiatric nurses can be moved between prisons and special hospitals? There would then not be the culture of closed wards, which we now have in special hospitals, where such people basically stay for life. Instead they would enjoy career development and progress, which might also allow us to recruit the psychiatrists and psychiatric nurses now in short supply.
Lastly, given that this is exactly the sort of subject where public interest demands that we get security and the method of coping with severely disabled people right, I offer the services of Liberal Democrats, with, I hope, those of Conservative Members, in reaching an all-party agreement on the way forward, which I hope will result in a secure and safe system, with a tough and effective inspectorate, so that such a scandalous outrage never happens again.
§ Mr. Dobson
I thank the hon. Gentleman for his welcome for the report and statement, and for his acceptance of our view that we cannot close Ashworth.
One of the problems with a probationary period, or the sword of Damocles hanging over Ashworth, is that, if Ashworth is to work, those working there will have to show a real commitment to the hospital, and they are only likely to show such commitment if they feel that the Government share that commitment. What is good for them is good for us.
117 We have already contemplated breaking the hospital up into smaller units. We must clearly improve security within the hospital. The hospital has many vulnerable patients suffering from mental illness, and it is clear that a militant force of people from the personality disorder unit dominates everything, including the bodies which are supposed to represent all the patients and many of the staff. We want to stop that domination by breaking the hospital up into smaller, more easily controlled units.
However, if we are to have a proper regime which will look after the mental health interests of all the patients, security is crucial. It is impossible to deliver a decent therapeutic service without security, including security for the staff, some of whom have been stabbed while others have been held to ransom.
We are contemplating what to do about the prison health service, which always poses problems. I certainly welcome any commitment from the Liberal party, or anyone else, to ensure that this time we get it right, because in the past we got it wrong every time.
§ Audrey Wise (Preston)
Does my right hon. Friend agree that the structure of what he described as the semi-autonomous trusts that he inherited makes his job more difficult, and that it is ironic that the Opposition should call for firm action from him when, as he has made clear, not all the levers are in his hands? However, does he agree that, because of Ashworth's troubled history, special attention should have been paid to it by structures within the national health service, such as the regional offices? Will he assure me that he will examine the role—or lack of it—of the regional offices to make quite sure that they, too, had their priorities right?
Although I agree completely that the staff at lower levels and the local management should be firmly held to account, dereliction of duty, neglect, or failure to have the right priorities at a higher level should not go unrecognised and unremarked.
§ Mr. Dobson
I sympathise with my hon. and well informed Friend's view. We live in a country where—as in this case—it is characteristic that, as far as I am aware, the first person to be sacked outright was an unqualified nurse, whereas other people, earning large sums, have been suspended on full pay or have gone to other well-paid jobs. I am determined to trace the responsibility, wherever it lies. In fairness to those who work in the regional offices of the national health service, until we came to power, they were being told to keep their noses out of virtually everything and merely to provide a service if it was asked for.
§ Mr. Dobson
By the previous Government and by the very competitive internal market which they had established. We are moving towards giving a much bigger and more positive role to the regional offices. We believe that to be necessary, not only in this sphere, but in matters such as the maintenance of proper surveillance and monitoring of the cervical and breast cancer screening system, where there was none until we gave that role to the regional offices.
§ Mrs. Virginia Bottomley (South-West Surrey)
I thank the right hon. Gentleman for his consideration in allowing me to see a copy of the report earlier this 118 afternoon. Undoubtedly, it sets out a most odious and appalling set of circumstances. I recall a similar sense of shock when I read the Blom-Cooper report about six years ago. I regret that Mr. Fallon accuses me of being over-zealous, if anything, in implementing the Blom-Cooper recommendations, but the right hon. Gentleman, in reading the report before us, will share my sense that such a state of affairs cannot be allowed to continue. I believe that there were seven suspensions then; he has identified a number of people who the report suggests should also be held responsible.
Anne Marie Nelson was totally dedicated, absolutely committed and determined to get the right balance between security and treatment. It did not work, and she has rightly stepped down, but I wish to place that point on record. When the hospital staff are mentioned—the right hon. Gentleman has referred to them—it is hard to distinguish between those who were at the heart of deplorable and unacceptable practices and those who were bravely and courageously trying to improve standards of care, with precious little support from their colleagues or superiors. A judgment has therefore to be made.
I am concerned about the distinction between the comments in the Fallon report—essentially endorsed, I think, by the Secretary of State—and the comments of the Home Secretary in the aftermath of the Michael Stone case. The Fallon report suggests, if anything, a shift towards pressure on the Prison Service to take more responsibility, or keep more offenders, whereas the Home Secretary appeared to be critical of the health service for not doing more for these troublesome, intractable and, frankly, costly patients, or offenders—call them what you wish.
I would appreciate some guidance from the Secretary of State. In which direction does he see the policy moving? How does he see the tension between security and care, and the distinction between patients and prisoners?
§ Mr. Dobson
In a sense, I do not think that there is a tension between security and care, because without security there will be no care. That has been one of the problems at Ashworth. I think that the relaxations introduced as a result of the Blom-Cooper report have been harmful. They may have produced benefits for some, but I do not believe that they produced benefits for many.
As for hospital staff and the whole system of responsibility, even after a reading of the Fallon report it is difficult to know who was responsible for any of these matters in the past. It is not clear which Ministers, which senior staff in the health service and which officials at the Department of Health were responsible, how those in the regional office, those in the commissioning body and those "on the ground" at Ashworth were involved, who was responsible for security, who was responsible for therapy or who was responsible for running the wards. The whole thing was a systematic shambles from top to bottom, and it must be sorted out.
I do not think that my right hon. Friend the Home Secretary was criticising the national health service when he said what he did after the Michael Stone case. He was, in fact, mounting a legitimate criticism of the attitude of some parts of the psychiatric profession. If someone has a personality disorder and commits a crime, that person will, we hope, be caught, prosecuted and imprisoned; but 119 there is another category of people who are dangerous, and who psychiatrists feel can be treated in hospital. Under the law, such people are entitled to go into hospital and be treated.
There is another category, of people with severe personality disorders who have not committed an offence, and who would clearly not benefit from treatment. At present, the system provides nowhere for those people to go. The problem created by the psychiatric profession—or some members of it—is the reduction of the proportion of people whom the psychiatrists considered capable of being treated in hospital. That extended the number who were not being dealt with by the system. I think that my right hon. Friend's criticism was perfectly legitimate, which is why we are trying to deal with the problem.
Generally speaking, it seems that the further down the hierarchy hospital staff were, the more committed they were to the hospital, to patients, to security and to doing a good job; conversely, the further up the hierarchy they were, the less committed they were.
§ Laura Moffatt (Crawley)
I suspect that those who have been described today as being dedicated to the work of caring for the most difficult members of the community will be extremely sad, especially those who work at Ashford. They will feel that they have been tarred with the same brush as others, and will say, "If anyone mentions Ashworth, I shall be ashamed to say that I worked there." What building work can we do to reinvigorate those people—they are committed to the most difficult people in our society, to healing them, to getting to grips with their recovery and to getting them into communities—to try to ensure that they can be proud of the work that they do, even though they have been severely let down by others?
§ Mr. Dobson
Given my hon. Friend's professional knowledge, I would respond to her by saying that I am concerned to show a firm commitment by the Government to Ashworth hospital, so that staff there feel that it will be reasonable for them to retain their commitment to the hospital, the patients and what the hospital is trying to do. Unless we have that commitment and put better people on the board and in management, the staff will become more and more disillusioned; but I have gone out of my way in the statement and in response to questions to make it clear that many people there do a difficult job on our behalf and get little credit for it. I want to ensure that they can do their jobs properly and are properly rewarded for that in every sense of the word.
§ Mr. Michael Jack (Fylde)
The report is a frightening account of professional and managerial failure. In his statement, the Secretary of State said that he was referring the report's contents to various professional bodies in the health care sector. May I first seek an undertaking that he will make public the replies that he receives from those bodies, as their commentary on the sorry tale of Ashworth would be interesting?
Secondly, the Secretary of State mentioned the other special hospitals: Rampton and Broadmoor. May I seek his assurance that the Government's response to the report will include a section to say that the Secretary of State has checked against current procedures at Broadmoor and 120 Rampton to ensure that none of the failures that are outlined by the report are in any way possible or incorporated into managerial or professional structures at those two other hospitals?
§ Mr. Dobson
The right hon. Gentleman has raised two points. The first is about the responses of the professional bodies. Unless I am advised by my officials that I am breaking the law, I am prepared to publish them; in fact, whatever their advice, I will publish them. In relation to his second point, we need to take great care in dealing with all these matters. If it would help the right hon. Gentleman, I will think about the point that he has made and write to him in due course.
§ Ms Hazel Blears (Salford)
I am sure that, like most hon. Members, I have listened to the Secretary of State's statement with an increasing sense of horror and disbelief at the catalogue of events at Ashworth, but I am aware that Dr. Peter Clarke, the acting chief executive, who was seconded from Salford's mental health services, is trying tremendously hard with his management team to make improvements, although he personally acknowledges that there is a long way to go.
Will the Secretary of State reassure us and confirm that we will move as swiftly as we can to implement the ideas that are set out in our White Paper "Modernising Mental Health Services", to ensure that special hospitals can become full national health service trusts and part of the NHS family? In that way, we can put the values of the health service—openness, accountability, transparency, the caring ethos of the NHS—into those institutions. They need to be opened up and made fully a part of the NHS family. I would welcome his reassurance that we will move in that direction.
§ Mr. Dobson
I can confirm that it is our intention to change the law in the health Bill that we will introduce to do just what my hon. Friend says. For several reasons, I am concerned about the way in which senior executive appointments are made in the NHS. If we ask someone, in effect as a favour, to take over the management of a very difficult place such as Ashworth, I would like to be in a position to tell them at the start, "If you do a good job for two or three years, we will be able to guarantee that you will move on to some other job, possibly a better paid job, as a reward for doing a good job in the one that we are asking you to do now." Under the present arrangements I cannot do that. There is something lacking in the system because we need to reward people who do a really good job, whether they are nurses on the wards or chief executives of hospitals.
§ Mr. A. J. Beith (Berwick-upon-Tweed)
May I ask the Secretary of State and the Home Secretary to recognise that it will not do simply to castigate psychiatrists for not classifying as mentally ill and treatable highly dangerous people who are not mentally ill and do not appear to be treatable? Since the report makes it clear that there is such a category of people, and since there are some such people now in custody who might be released because they are not considered to be treatable, there is some urgency about the Secretary of State's discussions with the 121 Home Secretary and a need to develop something along the lines of the reviewable sentence, which is recommended in the report.
§ Mr. Dobson
I recognise that some people with personality disorders cannot be treated. The problem is that the psychiatrists have changed the boundaries, and there is such a thing as psychiatric fashion just as there is fashion about removing people's tonsils. One of the problems that has arisen is that, recently, the psychiatrists have decided that far fewer people can be treated and it just so happens that that means they do not have to deal with them.
§ Helen Jones (Warrington, North)
I wholeheartedly agree with the Secretary of State that the problems at Ashworth are problems not of bricks and mortar but of management. Anyone who has had any contact with that hospital over the years knows that only too well. May I suggest to my right hon. Friend and other Back-Bench Members who have not yet had an opportunity to read the full report that two steps need to be taken? First, the concept of 24-hour care, which was introduced after the Blom-Cooper report, worked disastrously in the personality disorder unit because, in practice, it meant patients wandering around in the middle of the night.
Steps must be taken to ensure that patients, particularly those with personality disorders, co-operate with their agreed care plans and face sanctions if they do not. Secondly, while there are many good staff at Ashworth hospital, an inward-looking culture has developed in that institution over the years, and we must move away from that. Although we can look at the future of the prison health service with the NHS, there are other steps that need to be taken immediately to ensure that Ashworth forges links with other parts of the NHS such as mental health trusts and regional secure units. That would help to provide continuity of care and better career paths for staff, which in turn would help us to attract good staff to work in Ashworth. I would appreciate my right hon. Friend's comments on those two points.
§ Mr. Dobson
I know that my hon. Friend has had both professional and local involvement with people in Ashworth and she has made a valid point. For hon. Members who do not know, generally speaking, in the past if one lived in Ashworth hospital, one was expected to go to bed at night like most other people. Under the 24-hour care arrangement, people in the personality disorder unit can sleep when they like and walk around when they like, which imposes what can only be described as a massive burden. It means that the staffing at night sometimes has to approach the intensity that applies during the day in order to keep an eye on people. That is absurd and it needs to be changed.
It will however be very hard for the staff to carry out that process of change with such a difficult group of patients, and I will not promise any precipitate changes because I will not be the person who risks being knifed in the back at 3 o'clock in the morning. I agree with my hon. Friend that we need to ensure that there is a more positive approach. I hope that, in committing ourselves to the future of the hospital we will enable the staff to provide the more positive approach that most of them want to provide.
§ Mr. Colin Pickthall (West Lancashire)
I welcome the Fallon report and my right hon. Friend's attitude towards it. 122 I agree with him about not acceding to the recommendation in the report to close the hospital down. In my view that would be plain silly. There is nothing wrong with the physical security or facilities at Ashworth. I live about a mile and a half from it and have a vested interest in knowing that to be true.
We have had investigation after investigation and report after report over the years, but no one has ever been given the power and authority to sort the mess out. The choice of chairman will be important. My right hon. Friend must select the right person for the job in the medium and longer term.
I hope that my right hon. Friend will bear it in mind that, although many people in Ashworth have a lot to answer for, many brave people have worked—and still work—there. Some whistleblowers lost their jobs, including my constituent Sue Machin, who was forced out of her job as a psychiatrist there because she tried to expose what was going on. She eventually won her case at an industrial tribunal after undergoing years of terrible stress. There are heroes there as well as villains.
§ Mr. Dobson
I am sure that that is true. I last went to Ashworth before it was Ashworth. My hon. Friend will understand what I mean—such places have their names changed. Some of the people who work in some of the medium-secure units that I have visited are heroes just for working there in very difficult circumstances. I want to try to ensure that the people who work there feel that they are getting the credit, the attention and the help that they deserve.
From my brief acquaintance with him, I am confident that the new chairman of the authority has the necessary drive, skill and management capacity to take on the task of at least getting the first response from Ashworth. I have told him that I should like him to take on the task for four or five months and if he wants to stay after that he is welcome. However, I have agreed that if it is so demanding that he wants to return to Morecambe bay, he can.
§ Mr. Campbell-Savours
Whom can the public blame at the top for what has happened over the past six years? Let us have names. Which Ministers were responsible?
§ Mr. Campbell-Savours
Oh yes. The right hon. Lady did not get to the Dispatch Box because she was so frightened about her image. I am sorry to raise this controversial issue. Who is to blame for what happened during the regime of relaxation? Why was there no monitoring by Ministers at the Department of Health in the early 1990s to ensure that the changes that were being introduced would not be abused as they have been? People need a politician to blame for what has happened.
§ Mr. Dobson
As my hon. Friend knows, I am the last to go round blaming people—with the exception of a few Conservatives. The previous Government implemented the Blom-Cooper report when the right hon. Member for South-West Surrey (Mrs. Bottomley) was Secretary of State for Health. In view of the infinite capacity of the civil service and the national health service to take 123 donkeys' years to do anything, as I have discovered over the past 18 months, I have some sympathy with the right hon. Lady's attempts to get things done quickly, even if that has had ill consequences.
The almost universal application of the liberalisation after the Blom-Cooper report, which was directed not at the personality disorder unit but at the rest of the hospital, was effected pretty thoughtlessly by whoever was responsible on the ground. It was predictable—common sense must have suggested—that a group of highly intelligent, manipulative people would be better able to exploit reduced security and greater freedom than the average person suffering from mental illness in another part of the hospital. Quite frankly, in respect of some of the management and professional staff involved, it is as though the words "Abandon common sense all ye who enter here" were written over the doorway of Ashworth.