HC Deb 20 December 2000 vol 360 cc494-502

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

11.47 pm
Mr. Eric Illsley (Barnsley, Central)

I am grateful for the opportunity to raise this issue on the Adjournment. I hope that I shall not detain my hon. Friend the Minister for too long as I understand that he has a very busy day tomorrow.

I wish to raise the circumstances of my former constituent Mr. Roy Cotton who is currently detained at Ashworth special hospital under sections 37 to 41 of the Mental Health Act 1983.

I begin by clearing up the issue of whether I have the required consent of Mr. Cotton to release his details this evening as I understand that, perhaps rightly, Ashworth was somewhat reluctant to disclose information without that consent. First, consent has never been an issue in the correspondence that I have exchanged with Ashworth special hospital. Secondly, and perhaps more important, I have arranged for Mr. Cotton's express consent to be obtained and this afternoon he gave his express consent to his information being released as part of this evening's debate. Thirdly, I find the hospital's concern for Mr. Cotton's privacy somewhat touching, bearing in mind the way in which he has been treated over the past couple of years. I shall return to that later in my speech.

Having said that, I appreciate that confidentiality remains an issue and I understand that my hon. Friend will be constrained in his response. However, I hope that he will be able to address some of my concerns. I shall be asking him to look again at Mr. Cotton's rights in relation to his privileges in Ashworth special hospital and, perhaps more important, to look closely at whether Mr. Cotton should remain at Ashworth and whether he is receiving appropriate treatment there. When I talk about Mr. Cotton's rights. I refer to whether he has suffered some form of harassment or victimisation.

Sadly, Mr. Cotton has a history of offending for various crimes. He was imprisoned in 1970, in 1977 and in 1979. In 1980, he was made subject to a restraining order and detained in Ashworth following a charge of attempted rape. In 1986, after successful treatment, Mr. Cotton was conditionally discharged. He remained in Liverpool, but unfortunately in 1987 he was subject to a further restraining order, which is the basis of his current detention. Apart from the conditional discharge period of approximately one year, Mr. Cotton has been in Ashworth for 20 years.

The issues I wish to raise fall into two categories. The first is the lack of treatment, as he describes it, to rehabilitate him and to try to bring him back into society. He should be given appropriate therapy and courses to allow his transfer to a medium-secure unit. Secondly, there is the restriction of his rights that I have already touched on, which Mr. Cotton and his solicitor feel borders on harassment.

As Mr. Cotton has been in Ashworth for 20 years, there is a danger that he is likely to become institutionalised. He has undergone courses and therapy to assist him, notably on anger management and alcohol abuse. In March this year, he appeared before a mental health review tribunal. It found that Mr. Cotton still suffered from a psychopathic disorder that required his detention, but it concluded: We are of the opinion, given the length of Roy Cotton's stay at Ashworth, his eligibility for escorted visits and his possession of a community card, that serious consideration should now be given to a move to conditions of long-term medium security and to the question of whether the necessary therapy and treatment for Roy Cotton could now be provided in such conditions, whether or not a RSU might be his ultimate destination. That conclusion mentions "the necessary therapy" and a move to conditions of long-term medium security. Unfortunately, little has happened between that hearing in March and his most recent hearing on 14 December.

Mr. Cotton has had three different doctors in the past three months. His regular doctor retired and was replaced by another doctor, who was in charge of him for two months. He is now under the care of another doctor. He feels that that is symptomatic of how he is regarded at Ashworth and the lack of suitable care available to him. He thinks that he is regarded as part of the furniture and will not be treated.

There is a suggestion that Mr. Cotton is disliked and perhaps victimised by some of the staff, and that that dislike extends to his care team and social workers, who have consistently opposed his move, despite the recommendations of the tribunal and some of the psychiatrists, doctors and social workers who have provided reports in support of Mr. Cotton when he has appeared before the various tribunals.

I understand that Dr. Coorey, who was one of the doctors who treated Mr. Cotton and was in charge of his care for only two months, commented to him that the issue was not whether he should be moved to a medium-secure unit, or whether he should receive treatment or therapy, but that he should be given a better quality of life. That suggested that Mr. Cotton would have a longer stay in Ashworth, that he was unlikely to be moved and that things would remain the same. Even if it was intended to give him a better quality of life, what has happened to him over the past few months has significantly diminished the quality of his life.

I want to ask my hon. Friend whether the issue is one of finance. Cannot the hospital afford to provide the necessary treatment for Mr. Cotton? Are resources constrained? As a result, is he allowed to remain at Ashworth without any proper programme of therapy for his rehabilitation?

Most of the recent reports on Mr. Cotton stated that he should be considered for a move. The tribunal made the point that he has a community card and is able to make escorted visits when they are availalb1e; some have been denied him. Yet his social workers at Ashworth repeatedly maintain that he should not be moved. His social worker from the Barnsley area, who provides reports to the mental health review tribunal, maintained on the past few occasions that Mr. Cotton would perhaps benefit from a move, if it could be secured. I understand the point that the chairman of Ashworth made to me about a lack of appropriate accommodation because medium-secure units are usually for short-term rather than long-term care, which Mr. Cotton would perhaps continue to require. However, medical advisers consistently refer to the fact that he might improve more quickly with a change of institution.

I am worried that one of the social workers who is in charge of Mr. Cotton's care generates some ill-feeling in him and his visitors. Some personality conflicts may be developing between Mr. Cotton and the people who care for him. They have perhaps led to some of the unfortunate circumstances that have arisen in the past few months. If that is the case, perhaps my hon. Friend could tell me whether the care team or the medical team in charge of Mr. Cotton could be changed to try to alleviate those problems.

I want to consider Mr. Cotton's rights. After the Fallon inquiry, security at Ashworth has been tightened. I fully support that. We all remember the horrendous reports of incidents at Ashworth that led to the inquiry and its results. That increased security must apply to Mr. Cotton as it applies to all other patients at Ashworth, but it sometimes applies to him to the extent of becoming almost farcical. There is a fear, which I consider significant, that Mr. Cotton is being prevented from complaining to me as his Member of Parliament and to his solicitors because staff at Ashworth resent the fact that he complains freely to his solicitors and to me.

I was first contacted about the matter in November 1999 after Mr. Cotton had been denied a leave of absence. In 1998, his case conference decided that he should have four leaves of absence a year. For various reasons, he got no leaves of absence in 1999: they were cancelled at short notice, or transport or staff were unavailable to cope with the visits. I intervened on Mr. Cotton's behalf and, with the help of my hon. Friend and the management at Ashworth, the cancelled leave was reinstated. It appeared that the programme of leaves of absence would continue. However, Mr. Cotton has now been told that he is entitled to only two such leaves. Even they are in question because his mother visits him regularly, so Ashworth claims that there is no need for him to make visits.

Surely such visits are part of the therapy that I mentioned earlier. Mr. Cotton was able to go to South Yorkshire, usually to a shopping mall called Meadowhall, where he spent the day with his mother. That gave him a change of scenery, got him out of Ashworth and contributed to his rehabilitation. When I pressed the matter, Ashworth claimed that the visits cost £1,200. I felt that I had to question that figure because it seemed excessive for trips of such a short distance and involving so few staff.

In March, I was told that Mr. Cotton was to be prevented from receiving letters from a penfriend in Germany. That is another example of rights being taken away from him. Mr. Cotton's social worker—the same social worker is involved all the way through, unfortunately—complained that Mr. Cotton was making too many phone calls from Ashworth. At the time, Mr. Cotton alleged that his calls were being recorded or monitored. I took this up with the chairman of Ashworth, who wrote: I understand that Mr. Cotton's telephone calls were not being recorded, although he had heard a clicking noise which he understood to be a recording. Staff do ensure that all patients use their own pin number for using the telephone and the number called and length of call are recorded. That letter was dated 30 November; the same date as when the new guide to patients was issued from Ashworth. The guide states that all calls are recorded and/or monitored, so Mr. Cotton might have had a point there.

I asked about Mr. Cotton's mail being intercepted, lost or sent back to the senders. I was told that this had been looked into. The chairman said: I understand that a limited number of staff are authorised to handle mail, but that on Lawrence Ward— Mr. Cotton's ward— that has been increased to minimise any delay. I have asked that the issues of deprivation and tampering with mail should be looked into closely. Even before the new guidelines, Mr. Cotton was able to receive mail only from seven nominated people; all of that mail was opened and intercepted. On occasions, it was lost, delivered to him late or sent back to the sender. Letters from his solicitor have been intercepted in a similar manner. I understand that those should have been treated as privileged communications.

In the latest guide from Ashworth, mail for patients is not even mentioned. That problem might solve itself because, on 1 October this year, Mr. Cotton's stationery and stamps were confiscated; it was alleged that he should not have been in possession of them. I can only assume that, once again, because he has complained to his solicitors and to me about his treatment at Ashworth, the staff have decided to make it more difficult for him to make those complaints. That is of great concern to me. Having said that, the chairman of Ashworth has told me that, under paragraph 134 of the Mental Health Act 1983, Mr. Cotton has the absolute right to contact his Member of Parliament.

Other petty actions have been taken against Mr. Cotton. An illuminated magnifying glass which has been in his possession for seven years has now been confiscated. His Christmas presents—which his mother delivered a week ago and which amounted to three boxes of chocolates, toiletries and another box of sweets—were confiscated because the chocolates were regarded as food items. Under the latest guidelines, food and tobacco items are no longer allowed in Ashworth. It seems petty to confiscate boxes of chocolates.

I have had a letter from Ashworth today, posted on 14 December, which has suggested that food items will be available for sale on the premises of Ashworth, alleviating the problem for visitors who wish to buy food items such as confectionery for patients. That problem might have been resolved.

Mr. Cotton is allowed 10 books, and in his room he had that number and a photograph album. Ashworth decided that the photograph album was a book and that has now been confiscated. Again, I feel that that is rather petty. More seriously, a female visitor who Mr. Cotton has known for thirty years—a woman who was the partner of his cousin until he died and who has been visiting Mr. Cotton for 18 years—has been told that she will not be allowed to visit any longer. She has been interviewed by the staff of Ashworth and a staff member made the point that she could no longer visit on the grounds that Mr. Cotton was "grooming her". The quote comes directly from the Fallon inquiry; it is an emotive quote, which was subsequently withdrawn. That action was inappropriate and the prevention of visits by long-term visitors should not have taken place. Again, it gives the impression that Mr. Cotton has been harassed.

On 30 November, Ashworth issued its guidelines to patients. In my view, some of those guidelines contravene the European convention on human rights, which the Government made great play of implementing. Mr. Cotton's rights have been considerably interfered with.

Will my hon. Friend look into the petty harassment or victimisation of Mr. Cotton? Is he receiving the treatment to which he is entitled?

12.5 am

The Minister of State, Department of Health (Mr. John Hutton)

I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on securing this Adjournment debate. He raises several specific concerns on behalf of his constituent Roy Cotton, currently a patient in Ashworth high-security hospital. In the light of those concerns, I have made further inquiries about Mr. Cotton's case to gauge progress since my hon. Friend and I last corresponded on the subject. He referred to a number of issues raised by Mr. Cotton and I would like to deal with each of them in turn.

Mr. Cotton has expressed concern over the cancellation of several leaves of absence. Ideally, it should not be necessary to cancel visiting arrangements on financial grounds, and the regional director of mental health has asked the chair and chief executive of the hospital for a report in relation to Mr. Cotton.

I can tell my hon. Friend that Ashworth received an additional £2 million during the current financial year—as indeed it did during 1999–2000. That is over and above the substantial extra resources to support high-security hospital services and is in recognition of the cost pressures faced by the hospital and to allow it to deal with shortages of staff. In addition, the regional office has, by recently appointing a dedicated regional director of mental health, acknowledged the importance of more closely monitoring the performance of service delivered by Ashworth hospital.

I can advise my hon. Friend that Mr. Cotton's desire to move to a medium-secure placement was recently reconsidered by the mental health review tribunal—the appropriate body to make this decision, because all the relevant facts are available to it. I understand that the tribunal has made no recommendation about his transfer to a less secure unit—as my hon. Friend may already be aware.

Mr. Cotton expressed disappointment at the removal of a photograph album from his room. My hon. Friend drew attention to some of Mr. Cotton's concerns about that. It seems that the album was categorised as a book and, as such, counts as one of the 10 books that he is allowed to have in his room at any given time. The patient was permitted to keep the photos, but not the album itself. I shall cover that part of the safety and security directions in more depth later in my remarks.

I am advised, however, that Mr. Cotton does have access to stationery—I can assure my hon. Friend about that. All Mr. Cotton's mail is checked, with the exception of privileged mail—for example, his letters to and from his MP and his solicitor—in view of his clinical presentation. Privileged mail is treated in accordance with the provisions of the Mental Health Act 1983.

Under the safety and security directions, patients' telephone calls may be recorded. Patients have access to two privileged telephone numbers; in practice, they are usually the advocacy service and a legal representative. Patients are entitled to register 10 other numbers and there is a newly recorded message on the Ashworth telephone system, explaining which calls will not be recorded.

All food and tobacco brought in by visitors has been banned from the hospital as part of the new safety and security directions, which came into effect on 30 November. The directions apply to all patients; Mr. Cotton has not been singled out in any way.

My hon. Friend rightly drew attention to the recommendations of the Fallon inquiry—established in February 1997 to investigate allegations of the misuse of drugs and alcohol, financial irregularities, possible paedophile activity and the availability of pornography within the personality disorder unit at Ashworth special hospital. The ward on which Mr. Cotton is cared for is part of that personality disorder service.

The inquiry reported on 12 January 1999. It severely criticised the management and security arrangements at Ashworth. The Government accepted the recommendations and allocated some £22.5 million to enable the three special hospitals to improve staffing levels, enhance safety and security, modernise services and implement the necessary change.

Each of the three high-security hospitals drew up action plans to address the issues raised in the Fallon inquiry. In May last year, Ashworth published its action plan to address the inquiry's recommendations.

Recommendation 7 of the Fallon report stipulated that an independent review of all aspects of physical security at Ashworth hospital should take place and be repeated at regular intervals. The scope of the independent review was extended to cover all three high-security hospitals.

Sir Richard Tilt, a former Director General of the Prison Service, was commissioned to undertake that review. Sir Richard's final report contained 86 separate recommendations. It was published on Monday 22 May 2000. The Government accepted the report's recommendations in full.

Two of the recommendations contained in Sir Richard's report are particularly relevant to tonight's debate. The first recommendation was that additional funding of £25 million should be provided to facilitate the movement of patients no longer needing high-security care. The Government are making the £25 million available to facilitate the movement out of high-security care of those patients who are inappropriately placed in high-security hospitals.

The need for the transfer to appropriate levels of security of 400 people who no longer require high-security care and the creation of new places by 2004 for the assessment and treatment of dangerous people with severe personality disorder was also a recommendation in the national health service plan.

Secondly, Sir Richard recommended that the safety and security directions be revised and extended. The original safety and security directions were issued to the high-security hospitals on 28 June 1999. The subjects covered by the original set of directions included the searching of patients, staff and visitors; limits on the extent of patients' possessions; and the monitoring of patients' post and telephone calls.

The revised set of safety and security directions were issued on 30 November 2000. In addition they cover, for example, the introduction of procedures for listening to and recording patients' telephone calls; the introduction of restrictions on food and tobacco being brought in or sent into the hospitals for patients' consumption; and leave of absence arrangements, which my hon. Friend mentioned, for patients.

I am aware, as my hon. Friend has drawn my attention to it tonight and in previous correspondence, that his constituent is unhappy with the directions and finds it unreasonable that there is a limit on his personal possessions. However, there are very good reasons for these restrictions. There is a need to ensure, as Sir Richard emphasised, that possessions in patients' rooms are kept to a level and type that are compatible with the facilitation of searching, the maintenance of security and the reduction of fire hazards.

The guidance contained in the Mental Health Act code of practice is that all detained patients are entitled to maintain contact with, and be visited by, anyone that they wish to see, subject only to some carefully defined exceptions. The code states that any decision to prohibit a visit by a person whom the patient has asked to visit him, or whom he has agreed to see, should be regarded as a serious interference with the rights of that patient and should be taken in exceptional circumstances only.

I can tell my hon. Friend that the code refers to two principal situations in which the exclusion of visitors may be justified. First, it may be justified on clinical grounds—for example, where a visit is considered to be anti-therapeutic for the patient. Secondly, it may be justified on security grounds—for example, if a particular visitor has been disruptive in the past, perhaps having brought or attempted to bring illicit items into the hospital.

None of Mr. Cotton's visitors have been prevented from seeing him, although clinical concerns did lead a nurse and a social worker to discuss with one of his visitors their reservations about what my hon. Friend refers to as "grooming" during the course of her meetings with the patient.

All patients' visits are, rightly, subject to the safety and security directions. The directions apply to all patients, in all the high-security hospitals. Enforcement of the procedures concerning visitors is designed to ensure that visiting occurs in an environment that is safe for patients, visitors and staff alike.

My hon. Friend knows that I am aware of difficulties with response times to complaints at Ashworth. Ashworth's complaints procedures have been developed to conform with the national NHS complaints procedures. Ashworth patients have the same rights as any other NHS patient.

The Ashworth board requested an independent review of its complaints policy and the complaints department last December, because of concerns about how long it was taking to respond to complaints. The national target is that complaints should be responded to within 20 working days. At Ashworth hospital, unfortunately, only 16 per cent. were meeting that target; the report of the review was presented to the Ashworth board in May 2000 and a detailed action plan was developed and presented to the board in September.

I can tell my hon. Friend that additional staff have now been employed in the complaints department at Ashworth hospital. A new computer system is in place and training for front-line staff is under way to help them to deal with complaints more effectively.

Ashworth has set a target of responding to 50 per cent. of all complaints within 20 working days. I am advised that Ashworth will hit the target of responding to all complaints by the end of the next quarter. Unfortunately, that still falls short of the national average which is 62.5 per cent., so the NHS executive will be monitoring Ashworth's performance on a monthly basis. Ashworth is expected to hit the national average for responding to complaints within six months.

All complaints are dealt with through the formal complaint process. However, the patient ultimately has the right to have his case referred to the health service commissioner for England, who is independent of the Department of Health and the Government. I can tell my hon. Friend that from my inquiries I have ascertained that all his constituent's complaints have now received a response, with the exception of one received by the complaints department less than 20 days ago.

The purpose of high-security hospitals is to provide care for those mentally disordered people who have the most complex care needs. There is a need for patients to have leave of absence outside of hospital as part of their rehabilitation programme. Clearly, patient, public and staff safety is a key matter of concern when making judgments about the suitability for proceeding with a leave of absence.

The Tilt report recommended that leaves of absence for quality of life reasons should be discontinued. Since the Fallon inquiry, therefore, the number of leaves of absence occurring within the personality disorder service has been reduced. In 1999, there were a total of 218 such absences; up to 15 December this year, there had been 173. Mr. Cotton has had two leaves of absence scheduled this year, both of which went ahead.

It is worth reminding ourselves that some of the most challenging patients in the country are cared for in Ashworth. Leaves of absence are occasionally cancelled because of adverse patient behaviour and, on a few occasions, because of staff not being available at short notice. Regrettably,it is therefore inevitable that some leaves of absence will be cancelled, for reasons that may be outside the hospital's control.

I am aware that my hon. Friend has been in extended correspondence with the chair of Ashworth for some months about issues relating to Mr. Cotton. As I am sure he will appreciate, this is a complex individual case, although I can understand his frustration that matters have not moved at the pace he would have wished.

I note that arrangements are in hand for the chair of Ashworth to meet my hon. Friend at the earliest possible date. I trust that that will allow the concerns that he has raised on behalf of his constituent to be dealt with satisfactorily. I am grateful to him for bringing those matters to my attention, and can confirm that Ashworth hospital will—

The motion having been made after Ten o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at seventeen minutes past Twelve midnight.