§ 3.50 p.m.
THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (LORD ARERDARE)My Lords, with your Lordships' permission, and with apologies to the noble Lord, Lord Byers, perhaps this may be a 31 convenient moment for me to repeat a Statement which my right honourable friend the Secretary of State for Social Services is making in another place on the Report of the Inquiry into Whittingham Hospital. The Statement is as follows:
"Allegations of ill-treatment of patients, fraud and maladministration at Whittingham were made in confidence to my predecessor in 1969. These were followed by a special audit investigation and inquiries by the police. Shortly after the police inquiries were completed a nurse was tried and convicted of manslaughter of a patient. As soon as I was free to do so after these proceedings I set up the Committee of Inquiry, which made its report to me early in November. Publication of the Report has been delayed while charges against two other nurses, on which they were both acquitted, were before the courts.
"The Report is very disturbing. It is highly critical of standards of medical and nursing services in some parts of the hospital, particularly for longer-stay patients, and of the management. It also criticises the Manchester Regional Hospital Board, and to some extent my Department also. With a few qualifications, which are not however central to the main issues, I accept the conclusions and recommendations.
"The Report assesses Whittingham as a hospital of wide contrasts and an extreme example of a hospital which has failed to keep up with the times. Side by side with some good modern services, it found in the long-stay wards evidence of old-fashioned methods, inadequate treatment and rehabilitation, poor buildings and insufficient medical and nursing staff. The Report severely criticises the medical and nursing administration, the management structure and the way these worked; it describes the result as a hospital with day-to-day tactics but no overall strategy. The Committee of Inquiry believe that in these conditions there have been instances of ill-treatment and large-scale pilfering by some members of the staff and the further evil of suppression of complaints about such practices when made by junior staff.
32 "As the House knows, I have set up a Committee to review the procedures for dealing with complaints in hospitals and I have arranged for this most distressing aspect of the Whittingham Report to be brought to their attention.
"The Report apportions a share of the blame for the general state of affairs at Whittingham to the Regional Hospital Board who, while pioneering the establishment of psychiatric units in general hospitals, did not adequately recognise the needs of elderly long-stay patients, which led to dual standards of care. I accept that my own Department, as well as others, may not have been sufficiently alive to this danger in earlier years. Our present policies take full account of it.
"The Report recommends that all members of the Whittingham Hospital Management Committee should be invited to resign and the Committee reconstituted. It also recommends complete operational integration of the medical and nursing services at Whittingham with those of the psychiatric unit at Preston. Such integration is undoubtedly most desirable, but in my view it is doubtful whether it can he achieved satisfactorily without amalgamating under a single Hospital Management Committee the hospitals at present in the Whittingham and in the Preston and Chorley groups. The Board have already started local consultations on proposals for amalgamation. The Chairman of the Whining-ham Committee resigned in December on grounds of ill-health, and four other members have resigned in the course of discussions of the proposed amalgamation. With my endorsement the Chairman of the Board is inviting the remaining members to resign so that a reconstituted Committee can be appointed with amalgamation with the Preston and Chorley group of hospitals in mind at an early date. The new Committee will need to consider the many detailed recommendations in the Report for improvements at Whittingham itself. There have already been important staff changes.
"This Report highlights two of the most important problems facing the Hospital Service to-day: the proper 33 care and treatment of longer-stay and elderly patients in large isolated mental hospitals, and the proper planning of the transition from services based on such hospitals to services based on departments in general hospitals. I have asked all Boards to review their services for longer-stay mentally ill patients, looking particularly at outmoded attitudes, allocation of staff, and at management policies and organisation. Each Board is also now working out and discussing with my Department plans for the restructuring of their services for the mentally ill; these will provide for a properly organised transition to services based in general hospitals, and improved standards in the old mental hospitals until they eventually close.
"It would be wrong to jump to general conclusions from the indictment in this Report of some parts of one hospital. There have been enormous improvements in the last twenty years in nearly all psychiatric hospitals. The great majority of staff, at Winningham as well as elsewhere, work with patience and devotion, often in difficult and unsatisfactory conditions, which we are now making great efforts to remedy.
"I have referred in this Statement to the main points which arise from the Report. The Command Paper includes a Foreword I have written which contains similar comments and also refers in more detail to the recommendations addressed to my Department and to the Regional Hospital Board; action on most of these has already been taken or is under way.
"The House will, I am sure, be grateful, as I am, to Sir Robert Payne and the other members of the Committee for the time and effort they devoted to their Inquiry and to producing this forthright and constructive Report. Ever since I have been in office I have been continuing the theme of my predecessor in concentrating on improvements in this and related fields where they are most needed. The House can be sure that the lessons of this Report will not be forgotten."
My Lords, that is the end of the Statement.
§ 3.56 p.m.
§ BARONESS SEROTAMy Lords, may I first thank the noble Lord for repeating the Statement made by his right honourable friend in another place, especially as I am only too conscious that this was neither an easy nor a pleasant task in view of the very grave and extremely disturbing nature of the findings of the Payne Report. Clearly, your Lordships will wish to read and study this Report in some detail and with very great care. The 14 allegations of ill-treatment and dishonesty listed in paragraph 41 of the Report which were found to be largely justified by the evidence are such that all must agree that a very serious position has been revealed in this particular hospital.
I will at this moment of time confine myself to asking the noble Lord, Lord Aberdare, two or three questions on the Statement he has just made. First, may I ask him if he is in a position now to tell the House the long-awaited out come of the protracted discussions his right honourable friend has been having on the appointment of a Health Commissioner? May I again remind him of the recommendations of the Committee which inquired into the events at Farleigh Hospital about which I reminded him only last November in our debate on the reorganisation of the Health Service; namely, that
a Health Commissioner, given the widest possible powers, should be appointed to meet public anxiety about the investigation of complaints in the Health Service".This anxiety—and I think I can speak for all of us here—is certainly not lessened by this latest Report. The matter is now extremely urgent. I appreciate that in paragraph 5 of the Statement the Secretary of State refers to the Committee he has set up to review procedures for dealing with complaints in hospitals. But this is quite a separate matter. We know that the complaints procedures need to be speedy, effective and efficient; but the additional need for an independent Health Commissioner to investigate complaints is of prime urgency and importance.The second question I should like to ask the noble Lord is about this very real problem of pocket money. The Report finds that there was abuse of patients' pocket money—"pilfering if not 35 more organised corruption". I should like to ask the noble Lord what progress his Department has made with the proposal that I put to him last April: that patients in long-stay hospitals who are eligible as of right for pocket money should be paid this direct through the Supplementary Benefits Commission's procedures in the same way as is done for all other eligible patients in general hospitals. I believe that the time has come to remove this long-standing and unjust anomaly. At that time the noble Lord assured me that his right honourable friend was giving serious consideration to the question and I suggested to him that schemes of this kind should be progressively introduced. The noble Lord, Lord Amulree, supported me in this. May I ask, if this proposal has been taken seriously, what progress is being made; and could it be applied to the situation at the Whittingham Hospital where there was gross abuse of patients' pocket money entitlement?
Finally, the noble Lord has given us to understand through the Statement that his right honourable friend accepts in full the recommendations of the Report of the Payne Committee. May I suggest that consideration should be given to inviting the Hospital Advisory Service to assist the new Hospital Management Committee which is now to be appointed to implement the recommendations of the Payne Committee as quickly as possible.
§ 4.0 p.m.
§ LORD AMULREEMy Lords, I should like to thank the noble Lord for making this very disquieting Statement. I do not want to say a great deal about it, but I will study the report. It makes one wonder once again whether conditions rather like these may exist in some of the other large mental hospitals in the country, particularly those taking care of the elderly who are there for a very long time. One has been told in the past that it will be possible to shut down these hospitals and to treat the patients in the community or elsewhere, but that is going to take a very long time.
I associate myself with the two questions which the noble Baroness has asked about the appointment of a Health Commissioner and about some kind of 36 inquiry regarding the pocket money which these mentally disturbed patients are allowed. I know what an enormous amount of very good work is done by all members of the staff in these very overcrowded, uncomfortable, inconvenient hospitals, and one would not like an occasion such as this to pass without saying some kind word about those who work in the psychiatric world.
§ 4.1 p.m.
§ LORD ABERDAREMy Lords, I am grateful to the noble Baroness, Lady Serota, and the noble Lord, Lord Amulree, for the way in which they have received this rather long Statement. May I say to the noble Baroness, Lady Serota, that I am afraid I cannot at the moment relieve her anxieties about a Health Commissioner. I do not think she would expect me to do so as a result of this Statement. I can, however, assure her that this matter is under the most careful and detailed consideration at the moment. As my right honourable friend has said, he is consulting with the medical profession. On the question of pocket money, I can only repeat that we took full account of what the noble Baroness said in our debate here, and we are also looking at this matter. This was an unfortunate occurrence in this hospital. One might wonder how it could have occurred; but auditors have not in the past been expected to examine the control of cash in the wards where much depends on the relations between the medical and nursing staff and patients and on a judgment which an auditor cannot make of the capacity of the patient to manage his own affairs. The whole question is under review. The noble Baroness also asked me to draw the attention of the Hospital Advisory Service to this matter. I will certainly do so although, as she knows only too well, they are an independent advisory body and make their own decisions.
I thank the noble Lord, Lord Amulree, particularly for the kind words he said about the staff who work in these hospitals. This was mentioned in my right honourable friend's Statement. We do appreciate the valuable work which the vast majority of them do.
BARONESS SUMMER SKILLMy Lords, in view of the fact that this is not 37 the first time that there have been complaints of scandalous conditions in some of these long-stay hospitals and on investigation the complaints have been fully justified, does not the noble Lord think that the time has arrived when we should have a national survey of these hospitals and not wait, as we have been doing, for complaints to reach such a pitch that the Government have to step in and investigate the conditions and then, as now, find them fully justified? Everyone, including the noble Lord, Lord Amulree, knows that these old places invite all kinds of abuses. One knows about them; one realises that the appalling conditions of nursing and so on do not necessarily attract the best people to do the work. Will not the noble Lord therefore seriously consider having all these complaints investigated and so anticipate any further complaints of this character?
§ LORD ABERDAREMy Lords, I am grateful for the suggestion of the noble Baroness, but we must not forget that we are dealing here with matters and conditions that operated some time ago. As a result of the initiative taken both by the previous Secretary of State and the present one I think that the conditions are now very much improved in these long stay hospitals. The other effective instrument now available is the hospital advisory service, which to some extent is the kind of thing the noble Baroness is asking for, a body of independent people to report directly to the Secretary of State on conditions in mental hospitals, and now also hospitals dealing with old people.
LORD GRENFELLMy Lords, I feel I should say one word on this very tragic occasion. With the noble Lord, Lord Amulree—and I know that my noble friend Lord Aberdare would agree—may I say that the great majority of nurses and all who work in hospitals give the greatest wonderful loving care to their patients, and I should not like it to be thought that I should sit in this House without paying that tribute. I have not yet had a chance to read the report, but may I ask my noble friend whether there was by any chance—and I do not mean this in a difficult way at all—any criticism of the medical side in this one hospital? There would appear to be no mention of that but a good deal about the nursing. I think this is important. Perhaps my 38 noble friend could just say whether there was any such criticism.
§ LORD ABERDAREMy Lords, I am grateful to my noble friend. Perhaps it would be best if he reads the report. Indeed there was criticism of both medical and nursing administration.
§ LORD SEGALMy Lords, I would also take the opportunity of that king the noble Lord for reputing this Statement and paying tribute to the devotion of the vast majority of the nurses engaged in the care of long stay mental patients, and adding a word of tribute to the energy with which his right honourable friend seems to have followed up the publication of this report. Since the Manchester Regional Hospital Board bears some degree of blame for the existing conditions in this hospital, may I ask whether any changes have taken place or are contemplated in the personnel of the Manchester Regional Hospital Board? The local hospital management committee have been invited to retire as whole. Have any individual members of the Regional Hospital Board been invited to retire or is it intended to inject some more active members into this Hospital Board who will concern themselves with the state of affairs in this and other longstay mental hospitals? Would it not allay local uneasiness to some extent if something of this nature were done?
§ LORD ABERDAREMy Lords, I would advise the noble Lord to lead the report. The recommendation of the Committee was that the hospital management committee should be asked to resign, and although certain criticism was made of the Regional Hospital Board I do not think it would be appropriate to go so far as the noble Lord was Suggesting, to replace anybody.
§ LORD AUCKLANDMy Lords, although I have not had time to read the report there are two questions I should like to put to my noble friend on one aspect which I have studied. First of all, has any action been taken with regard to visiting hours? The report of the restrictions on visiting hours se ms to me to be a particularly disturbing aspect. If nothing has been done could something be done quickly? Secondly, there is mention made of a recommendation to sell some of the market gardens. Many of these hospitals do not possess such 39 valuable assets. Can my noble friend say anything about what is being done or is contemplated on this score?
§ LORD ABERDAREMy Lords, I am grateful to my noble friend. I cannot give him a straight answer on either of those questions. They would be matters for the new hospital committee, who I am sure will pay due attention to the recommendations of the Committee.