§ 5.45 p.m.
§ Baroness Macleod of Borve rose to ask Her Majesty's Government whether they are aware of the morale at Rampton Psychiatric Hospital and whether they will give a date before which the police presence in the hospital will be removed.
§ The noble Baroness said: My Lords, I hope noble Lords will forgive me if I thank in anticipation all those on all sides of the House who are taking part in this debate. I understand that I shall not have the right to thank them afterwards, so I am doing so now.
§ Like many Members of this House, I have many other outside interests, and two of them are pertinent to my Question this evening. For over 25 years I have been a magistrate and for an equal length of time I have worked with leagues of hospital friends, and it was in that capacity that I was invited to visit Rampton again some 18 months ago and I have been there on several occasions recently. On 22nd May 1979, Yorkshire Television showed a programme about Rampton Hospital which was to have three important repercussions; first, the police were at once put into the hospital, and they are still there; secondly, the Boynton Committee was set up; and thirdly, confidence in the hospital at all levels was shattered and a trail of havoc has followed. At no time did the people making the film go into the hospital.
§ Rampton is one of four special hospitals. It is an austere building set in austere countryside in Nottinghamshire. In 1961 there were 975 patients.366
§ Today there are 662, 497 male and 165 female; 42.6 per cent. suffer from mental illness, 22.8 per cent. from psychopathic disorder, 18 per cent. from subnormality and 16.6 per cent. from severe subnormality; 265 patients are unrestricted and 397 are restricted and therefore cannot he discharged without the consent of the Home Secretary; 81 per cent. of males come from courts following convictions, 34 per cent. of women are from the courts and only 26 per cent. are restricted. At the beginning of this month there were 1,037 members of staff, of whom 683 were nursing staff, 447 males and 236 females. Nearly all the staff are members of the Prison Officers' Association.
§ The criteria for admittance to a special hospital is that a patient is dangerous, violent or has criminal propensities. When their treatment is finished they are transferred to National Health hospitals or hostels. Unfortunately, at this time 111 patients are awaiting places. I am told that recidivism is very low, which is a comforting thought.
§ The Boynton Committee was set up in the autumn of 1979. As a result of very hard detailed work while living in the hospital, the report contained over 200 recommendations. It also contained specific references to the dedication and care of the nursing staff and the help given by the voluntary leagues of hospital friends. The report was also of the opinion that the school of nursing should be maintained.
§ Recommendations already implemented include the appointment of the Rampton review board of six members, who are making a big impact in the life of the hospital, and the setting up of the hospital medical team, who have day to day responsibilities; that came into operation in June 1981. There was also the appointment of a medical director, who took up his post last spring, as well as other medical appointments. Improvements for the patients include provision of their own lockers and the making available of interview rooms on 13 wards to date, with the hope of more to come. Transistor radios apparently were very important, and patients are allowed to use them in bed. Ties do not have to be worn, except on the admission ward. Auto-shavers are in use, and, to hide the bare walls, pictures, peg boards and posters have been put up. Those are only a few of the very many improvements which have recently been made. The League of Friends gives considerable help by visiting and by arranging coaches for visitors from long distances, and it is now arranging very well-publicised horse-riding lessons. These are very much appreciated.
§ As I have said, Boynton also made a point of the retention of the school of nursing. Therefore the morale of the nursing staff was recently lowered again when they were told by the General Nursing Council that the school must close. I am told that the intake to the school is unusual, in that mature people often join, perhaps after early retirement in the social fields, and they find a rewarding vocation in nursing the mentally ill. I hope that the Minister will use his considerable influence and powers of persuasion to see that the unit is retained.
§ In one of my semi-judicial capacities I was able to meet eminent psychiatrists. I have written to several of them, and they have been kind enough to give me their professional opinions. I asked whether they thought that patients' evidence of alleged incidents that may 367 have happened up to 21 years ago could be relied upon. The replies from all but one ranged from, "Probably not", to "No". One said that he thought possibly an incident could be remembered. One doctor gave the view that six years was the maximum period of memory retention. However, all agreed—which is very rare with psychiatrists—that, because of the nature of the illness, patients are prone to exaggeration, suffer from delusions, often go out of their way to make trouble, and can frequently be vicious.
§ We know of course that even the non-violent patients assault nursing staff. When I visit wards I am aware that I am closely guarded in case of an attack. Although attempts have been made in the past to institute a code of practice for nursing in the special hospitals, so far it has not been found possible to formulate one which covers every contingency at Rampton. That might be one reason why nurses have been charged by the police, and indeed have even had to stand trial.
§ Of course as a magistrate I agree that offenders must pay the price for their offences. I am also aware that there might be a substandard apple in a barrel. But, my Lords, in my submission it is not possible for a police officer, who is not trained in psychiatry, who does not have the day to day responsibility of coping with, treating, and trying to cure patients—who often are very sick and violent—to differentiate between what might happen in the streets outside and what occasionally can happen when dealing with patients. For instance, the problems of stopping a violent street brawl and stopping violent patients from fighting must be similar, but the difference is that the police officer is not likely to be charged with assault, while the nursing officer might well be charged. It was because of—and only because of—the lack of a code of practice that nurses recently withdrew escort duties, but the review board, with all the interested parties, is now working on this matter and normal duties have been resumed.
§ The police have been in the hospital for over three years. The net result to date is that there have been charged with offences 21 nurses, six of whom retired or resigned before trial. Charges have been of ill-treatment of patients under Section 126 of the Mental Health Act 1959, and a small number of charges have been preferred under Sections 18 and 47 of the 1861 Act, which are for offences against the person. All charges relate to alleged incidents between 1961–22 years ago—and 1979. Four nurses were found not guilty at Crown Court. Two were found not guilty at magistrates' courts, and two charges were dropped by the department of the Director of Public Prosecutions.
§ Last Friday at Nottingham the learned judge dismissed most of the charges against four of the nurses, saying that there was insufficient evidence and that the alleged offences were too long ago. Three other nurses were convicted by a jury, and the learned judge awarded nine months, suspended for two years, against two of them and three years, suspended for 18 months, against the other. All six nurses earlier found not guilty have been reinstated at the hospital.
§ Meanwhile, the nurses are carrying on their very difficult duties with care and devotion, but they are ever mindful that each one of them may receive a summons to attend Worksop police station to answer 368 a charge relating to an incident that is alleged to have happened many years ago. Meanwhile, also, some of the patients are taunting the nurses with threats of "telling on" them to the police. No one can go on working under those conditions of considerable tension. Staff are now weary, deeply disillusioned, frustrated and tired of the endless stress.
§ I am glad to know that the Secretary of State and my noble friend the Minister on the Front Bench have recently been to Rampton. I should like to say, for what it is worth, that I have enormous admiration for everyone working at the hospital. In asking the Minister to use his good offices in the right quarters to withdraw the police from the hospital. I am sure that a new spirit, a new hope, a new confidence in a new challenge will make Rampton Hospital the great place of care and healing that it has always been.
§ 5.58 p.m.
My Lords, I am mindful of the fact that this is not a short debate, but an Unstarred Question, and therefore it behoves me not to make a speech, but merely to elaborate a little upon the noble Baroness's Question, and perhaps add one or two questions of my own. I thank the noble Baroness for drawing the attention of your Lordships' House to this matter of vital public importance—and it is a matter of public importance, not of importance merely to those at Rampton.
In thanking the noble Baroness for her initiative in seeing that this very important matter is noticed and is discussed in your Lordships' House, perhaps it would be appropriate if I also make clear that though the noble Baroness and I are at one on this particular Question, we do not necessarily see eye to eye on all the various matters involved in the history of the events. Indeed, I would say that I differ a little from the noble Baroness in my attitude to the original film by Yorkshire Television—I think it was entitled "The Secret Hospital"—shown in May 1979. I do not for a moment say that everything that was said or suggested in that programme was true. Indeed, we now know that a great deal that was said and suggested was not true. But in my view events and public opinion at that time were such that it was perhaps necessary for somebody to draw attention to the whole matter—and Yorkshire Television did that.
Following that, as the noble Baroness has said, we then had the Boynton Inquiry. I welcomed the Boynton Inquiry, and indeed I warmly welcomed many of the matters in the report. Here, perhaps I might take the liberty of reminding the noble Lord the Minister who is presently to reply of two very brief sentences in the Boynton Report which seemed to me to be very important. They are brief, and I will quote them. In the report (Cmnd. 8073) on page 22, paragraph 5.12, we see this stated by the Boynton Inquiry:We think that Rampton operates too much as a closed and secretive institution".We also see, if we look at the detailed recommendations at the end of the report—and the noble Baroness has referred to these—that Recommendation 203, on page 152, says this:Less emphasis can and should be placed at Rampton on the provisions of the Official Secrets Act".My Lords, I should merely like to ask the noble Lord 369 who is to reply whether progress has in fact been made since those days on those matters, because I share the view of the Boynton Report that it really is very important indeed that institutions such as Rampton, Broadmoor and so on should be exposed to public scrutiny as much as is possible, bearing in mind the need for the staff to be able to get on with their work.
So I hope that progess has been made with opening up these institutions to public scrutiny, but I would go on to say that doing those things—and I think it is necessary to do those things—certainly does not in my view require a permanent police presence. As the noble Baroness has rightly reminded the House, the events into which the police were very properly and correctly inquiring took place a very long time ago, and very few of the present staff at Rampton were in any way concerned in those events. Indeed, many of the present staff at Rampton were not working in the hospital at all.
Perhaps I could go on to say that it seems t o me that the police have more urgent and pressing matters to get on with than merely living permanently in Rampton Hospital. They have very important work to do. Indeed, I might suggest, if this is not digressing too much, in relation to the deplorable events which took place at a public meeting of the police with the Home Secretary and the Metropolitan Commissioner of Police in London recently, that to my mind the behaviour of the police then was not really related to resentment about low pay. I think it was related in many ways to the tact that the police as a whole are desperately overworked; and while they are desperately overworked I think it is very important to see that numbers of policemen, from whatever force they may come, should not be tied up indefinitely in continuing an operation such as that which has been going on for so very long at Rampton.
Indeed, too, the situation and the climate of opinion have changed. I think, as I said before, it was right that the police went in and carried out a thorough investigation. But they have had long enough to complete that, and I take very much the point that was made by the noble Baroness: it is not helpful to members of staff doing a highly difficult job in extremely difficult circumstances to have the constant feeling of a police presence somewhere looking over their shoulders and looking over their work. I repeat that I think it is necessary that these places should be open to public scrutiny; but, of course, that is going on now. We shall be dealing with another measure in your Lordships' House in a day or two, the Mental Health (Amendment) Bill, which sets up a mental health commission and sets up machinery whereby hospitals will be under continuing scrutiny from the point of view of public interest.
Therefore, I think there are a number of developments which have taken place since those days in 1979 which surely make it important that the police presence in Rampton should be removed at the earliest possible moment. I hope that in replying the noble Lord the Minister will be able to tell us why it is that after such a long time they are still there; and I hope that he will, perhaps, tell us that it will be possible for that police presence to be ended very soon. And if that is as a result of the initiative which the noble Baroness has taken today, then I would join with so 370 many other noble Lords in your Lordships' House in thanking her for having done what she has done.
§ 6.5 p.m.
§ Lord Renton
My Lords, we should he grateful to my noble friend Lady Macleod for initiating this debate. Quite apart from the merits of the debate, it is, so far as I know, the first debate in which as many Peeresses will be taking part as noble Lords. That is a fine demonstration of sympathetic sex equality in your Lordships' House. My Lords, I was chairman of MENCAP at the time, 3½ years ago, when this matter came to light, and we were extremely worried because, in addition to the psychopaths, some of them very violent, and the mentally ill at Rampton, there are a number of people there who are simply mentally handicapped to various degrees. Indeed, quite a number of our parent members have or have had mentally handicapped sons and daughters there, including our founder member.
My Lords, it became abundantly plain, when investigations were started after Yorkshire Television did their rather sensational filming of this, that the problem arose through a minority of the staff who were in charge of the most violent patients perhaps exceeding the force that was necessary. It is not for me to question, and I do not question, the action taken by the Director of Public Prosecutions and the results of the cases in the courts. I was most relieved, however, to hear my noble friend Lady Macleod say what has happened in the case (which we should not discuss any further) so far as discharges from certain charges are concerned.
My Lords, Rampton has a very wide range of people there for treatment. Some, as I say, are suffering from various degrees of mental handicap, and you go right through various degrees of mental illness to the truly violent psychopaths. It has seemed to us at MENCAP that perhaps not enough care has been taken to separate those three categories, and I suggest that all the information which has come out points at the real necessity for a complete separation of those three categories of people—the mentally handicapped, the mentally ill and those with violent criminal tendencies. I do not think that that is a counsel of perfection. I would have thought that as a practical matter it was something which needed to be done. Perhaps by now it been done—we do not know; we may hear this evening. But it is certainly something which should be done, and which, if it has not yet been done, then I hope it soon will be.
So far as the police are concerned, whatever the original complaints against the minority of staff in the 1970s, there can be no justification, in my opinion, for keeping the police there indefinitely. I hope I am not being emotive when I say that it cannot help the staff in this very difficult and demanding work indefinitely to have the police breathing down their necks. Unless it is really necessary, it should not happen; and I cannot believe that it is necessary any longer, after all that has happened in the last three years. So I hope that we shall hear from my noble friend Lord Trefgarne this evening that the suggestions made by my noble friend Lady Macleod have been heeded by the Government and by those responsible for the administration of our criminal law, for whom I have such 371 admiration. I hope we can call this a closed chapter before long.
§ 6.10 p.m.
The Countess of Loudoun
My Lords, it is now over three years since I visited Rampton with the All-Party Parliamentary Mental Health Group, since which time the staff there have been coping with the difficulties caused by the continuing police inquiries and the court cases, some still in progress. Rampton has an enormously difficult and demanding task to fulfil. It has to deal with a population that almost all other institutions and services have failed. On June 1st 1982, there were still 106 people on the "approved for transfer" list at Rampton, despite there having been a more positive response from local hospitals recently, 174 patients having left the hospital in 1981. Rampton has its Eastdale unit for rehabilitation which could offer eleven more places were the funds available but there is no similar unit at all for female patients and the other special hospitals have none either, to my knowledge.
May I ask the Government what the present situation is with regard to the interim secure units? These units were planned to relieve the pressure on the special hospitals but to do this effectively more of these secure units need to he established. Without these, the ordinary psychiatric hospitals will continue to evade their responsibilities for dealing with difficult or unlikeable patients under the Mental Health Act. Since the establishment of a new hospital management at Rampton with the appointment of a medical director, Dr. Alfred Minto, and a review hoard with management responsibility for the hospital, a distinct mental handicap division of approximately 250 men and women has been set up under the care of three newly-appointed consultant psychiatrists who are responsible for both medical and psychiatric care.
Now, Rampton Hospital wants very much to get on with its job. Its medical director, Dr. Alfred Minto, is very keen to bring Rampton into the mainstream of current psychiatric thought and progress and is actively organising seminars, lectures and such to further this purpose. The hospital needs help to reduce its sense of isolation and, with this in view, useful links with neighbouring universities have been established, such as with the School of Social Work at Leicester University. I understand from Mr. Herschel Prins, the director of this school, that they now have various joint activities with Rampton including the placement of social work students. This training and education programme could be extended into the post-qualifying field to include the utilisation of Rampton's facilities; but to do this adequately it needs a continuing injection of funds. This is crucial. Let us not dwell on the past with all its mistakes but look to the future—a brighter one, I trust. I should like to pay tribute to all the dedicated officers and staff at Rampton and I wish them well.
§ 6.13 p.m.
§ Baroness Lane-Fox
My Lords, as I am sure your Lordships will agree, to perform many tasks in the nursing profession calls for the very finest qualities. Psychiatric nursing in particular makes huge demands and asks for almost superhuman strength of character.
372 Any one of us who has seen the quiet and patient concern and understanding shown by those psychiatric nurses who really find a vocation in such hospitals is left inspired and admiring. Obviously, it would be impractically idealistic to expect all nurses to reach this standard of dedication, but the unselfishness displayed really does deserve the best support of those of us lucky enough to be neither patients nor nurses in those hospitals.
Many of us have felt very disturbed about the difficult conditions for staff at Rampton; so now we are deeply indebted to my noble friend Lady Macleod for giving us this chance to talk about it and for her fact-filled speech. In addition, I should like to back up the remarks made by my noble friend Lord Renton as to categorisation of patients. For a long time I have felt that categorisation of schizophrenic patients alone is something that has not been attended to nearly enough. I hope his appeal today will be heard in wider circles.
In all our thoughts must be anxiety about the morale of nurses working in such taxing circumstances. It seems quite astonishing that so few nurses have thrown in the sponge and left the hospital for good. Nevertheless, it is interesting to know how many of those who have been involved in court cases have later been reinstated. Undoubtedly the morale of the staff at Rampton deserves to he well and truly boosted. These people are carrying out duties that few of the rest of us could claim to have the care and compassion to do. Therefore, the least that we can do is to back up my noble friend lady Macleod in her requests to the Minister.
§ 6.17 p.m.
My Lords, I must thank the noble Baroness, Lady Macleod, for asking this Unstarred Question today, but I have to ask the indulgence of your Lordships because I cannot speak directly to the Motion as it is now eight years since I went to Rampton. But, having said that, four patients to whom I was social worker came to see me within the last few months and I am in touch with them. They are now all, except for one, out in the community and working. I think that that is a tribute to the work done at Rampton.
That is not to say that they have not got some complaints. It would be quite unnatural if they had not; but the complaints were something quite different. The complaints concerned the siting of the hospital. Oxford to Retford and on to Rampton is a terribly difficult journey and the great complaint of the patients with whom I was in personal touch was that they were losing touch with their families. Their families could not visit, their families could not afford to visit and, when they did visit, it had very often to be with one of us social workers because often that was the only way that the family could get to Rampton. If patients are unable to be in touch with their families, they become more disturbed than they are already. I think that we have not looked closely enough at what it is that really disturbs the patients at Rampton. They are disturbed. But not to be in touch with your family, to be miles away from your family, and not to be visited by them, causes great concern. Very often it is only to their families that they will tell 373 anything that they are deeply worried about. Therefore, my Lords, my question to the Minister, alongside the Unstarred Question which the noble Baroness has asked, is this: Is there any possibility that there could be regionalisation of the special hospitals, particularly Rampton? As the noble Baroness has said, we have four hospitals in this country; but Rampton is particularly and peculiarly difficult to get to.
The noble Baroness spoke with warmth of the League of Hospital Friends, and I support her tribute to them. Canon Mason, the chairman, arranges outings for the patients and, where possible, he arranges for patients' families to come along. But this cannot be very often. At Broadmoor there are 800 visitors visiting patients who have no family to visit them. There are three such visitors at Rampton. The reason why there are three of these visitors at Rampton is because of its remoteness and the fact that it is right out in the country. Despite the points made by the noble Countess, Lady Loudoun, who told us of the interest taken by the universities, university people come and go. What is needed is consistency, and what is needed is the same person visiting year after year. So my question to the Minister—and I repeat it—is this: Is there any hope of setting up smaller hospitals in different parts of the country and regionalising the special hospitals? This would be an asset not only to the patients whose families could keep in touch with them, but to the staff and thus to the running of the hospital.
§ 6.21 p.m.
§ Lady Kinloss
My Lords, it is just over three years since I visited Rampton in October 1979, but it was an unforgettable experience. The distressful state of mind of many of the patients was equalled only by one's admiration for the devotion and skill of the staff. It is because of this that it is most fitting that the noble Baroness, Lady Macleod of Borve, should have asked this Question this evening.
For more than three years publicity has been directed against certain members of the staff who may or may not have felt or displayed temper under extreme provocation. Some have paid the penalties of the law for it—others have a cloud hanging over them. Surely it is high time that this was brought to a conclusion for the sake of both nurses and patients. It is to be expected that mentally ill or mentally handicapped patients will have delusions about ill-treatment on the part of the staff and then forget what they have said. Is it possible that the memories of mentally ill or mentally handicapped patients can be relied upon over a short period, let alone a long one? We all know how difficult it often appears to be for details to be remembered by apparently sane witnesses.
What has happened to the code of practice for Rampton? Why has it not yet been formulated? I believe it is under urgent discussion, but could not the medical director promulgate a set of draft guidelines with the proviso that they could be modified or disused after the final code of practice has been agreed? The reason why the nurses recently withdrew from their escort duties but have since continued those duties was because of a lack of a code. One has to remember that nurses have from time to time to deal with violent patients and must be allowed to use such force as is 374 necessary to restrain them, to protect not only themselves but others, and to prevent the unfortunate patients from hurting themselves.
I am glad to know that the review board proposed by Sir John Boynton in his report on Rampton has been set up and is operating. I was also glad to hear the noble Baroness, Lady Macleod, say that it is giving great help. Could the Minister say whether it is likely to continue after its three years (I think that is the period) are up? Could the Minister when he replies also say whether nursing auxiliaries are or can he employed at Rampton? It seems to me to be wholly reasonable that no nurse should ever be alone with violent patients in view of the danger both of possible violence and of unfounded allegations. It is here perhaps that nursing auxiliaries could be of real help, where the highest degree of nursing skill is not involved.
My Lords, I should like to ask the Minister who is to reply what opportunities the staff have for transfer to other institutions. After several years nurses might well feel that they would benefit from a change of scene within their profession. Every week one reads in the newspapers of the posting of members of the armed services and others. Such changes could perhaps be beneficial to both the nurses and the patients, and maybe a grant or payment to help them with the move would be possible.
In The Times of last Saturday, 23rd October, there was a report about Rampton. Three nurses were acquitted of the charges. The offences were alleged to have taken place in 1961 and one nurse is now stated to be 71 years old. The judge said:There was no supporting evidence for the allegations, and since the events were said to have taken place 21 years ago, recollections could be dimmed.Would the Minister say whether there are many such cases outstanding of stale charges? If there are, is it not time that there should be an end to it? How can there he peace at Rampton if nurses continue to be kept in suspense and under suspicion? How can the nurses under these circumstances be expected to impart a sense of security and confidence to the patients who are at Rampton precisely because they need those things?
§ 6.16 p.m.
§ Lord Auckland
My Lords, although this is a very important Question directed towards a relatively narrow point and has been asked by my noble friend Lady Macleod with her usual sensitivity and compassion, this particular very disturbing Question raises wider issues, although I do not propose to go into that situation this evening.
I have not visited Rampton or any of the other special hospitals; but obviously, anybody who has served on the committee of a mental hospital will take a very deep interest in the situation at Rampton Hospital. One of the great problems of this hospital—and although I have not visited Rampton I am reasonably familiar with some of the territory around that area—is that it is six miles from Retford, which is the nearest main line station. The weekend services to Retford, particularly the Sunday rail services, are not particularly frequent. That means that people coming from the London area, for example, or from the South of England who may have 375 relatives and friends at Rampton, find it difficult for weekend visiting. I understand from the admirable Boynton Report that Monday is the other day for official visits. This may be somewhat more convenient for travelling, but obviously it is not so for those who have other jobs to perform.
A few weeks ago there was a very disturbing series of television programmes on the women's prison at Styal in Cheshire. I only mention this because two of the women in this programme, who were looked after with great devotion by the wardresses of that hospital—and there was no question of any ill-treatment there—were, certainly so far as I could tell, confirmed psychopaths who should certainly be in an institution such as Rampton. But as my noble friend has already stated, there are a number of inmates or patients in Rampton already waiting to be transferred to other establishments. Here is the very difficult anomaly which must face any mental health tribunal, review board or indeed Her Majesty's Government. I should like to ask my noble friend: what consideration has been given to this point?
Two hundred and two recommendations were made in the outstandingly clear report from Sir John Boynton. Obviously, in an Unstarred Question, one cannot go into details about these, but one concerns the matter of night duty. I accept that many of these recommendations have been acted upon or are, hopefully, in course of being acted upon. I should like to ask: what is the present situation regarding night duty? Twenty years of consistent night duty, which is stated as having taken place so far as some nurses are concerned, seems to be an inordinately long time, particularly with such disturbed patients.
The League of Friends at Rampton and elsewhere perform the most marvellous job. Indeed, one wonders how any hospital, be it a general hospital, a psychiatric hospital or a special hospital of any kind, could function at all so far as the welfare of patients is concerned without the League of Friends; and so I should like to pay a real tribute to them.
Finally, I should like to ask my noble friend the Minister whether he can to tell your Lordships how many of the 202 recommendations regarding Rampton Hospital, as instanced in the Boynton Report, have been acted upon or are in the process of being acted upon. My noble friend, happily, has mentioned some of the more important points, such as transistor sets in rooms and improvements in bus transport and so on. I would hope that facilities will be made available for more of your Lordships and Members of the other place who have not yet visited these places to do so, because I believe that Members of both Houses of Parliament have a duty, and particularly those of us who are interested in this question of mental health at whatever level, to make ourselves acquainted with these establishments where very hardworking and hard-pressed nursing staffs are looking after extremely difficult patients who are frequently violent through no fault of their own.
§ 6.34 p.m.
Lord Wallace of Coslany
My Lords, first may I say that the noble Baroness, Lady Macleod, in thanking her supporters, as she expected, in advance, has 376 certainly got the results she asked for. Because so many Members have spoken, giving very briefly their expertise, my job from these Benches is to speak as briefly as possible in order to give the noble Lord as much time as he needs and deserves to reply.
Let us face it, the noble Baroness, Lady Macleod, has painted a serious and worrying picture which must give cause for concern, and in raising this issue for us tonight she has done a good service. I would particularly agree with her that it is a mistake to close or to envisage closing the school of nursing. This does have an effect on the morale of the nursing profession because a school of nursing does confer prestige on a hospital, and nurses are naturally very proud and conscious of the prestige of their profession. I also agree with the noble Lord, Lord Winstanley, that surely something could be evolved without having to call in the police.
I would also agree with the noble Baroness, Lady Faithfull—and how right she is—and also with the noble Lord, Lord Auckland, that the lack of visitors and distance from family can cause worry and unrest in addition to other things, and this does not help the patient's condition. That, of course, applies not only to Rampton, but to Her Majesty's prisons as well, as your Lordships will realise.
I should like to take this opportunity of paying tribute to the mental hospital staffs and particularly to the nurses, not only at Rampton, but generally throughout the country, because we must recognise that theirs is a very difficult job calling for extreme patience and skill. I recollect some years ago visiting a Durham hospital and going through the women's section (where a male has to be closely escorted) with a matron. It was very touching indeed to see some women touch the matron's cloak and give every sign of happiness in so doing. That impressed me so much that I cannot forget that particular picture.
Let us also recognise that some patients, because of their illness, can be unpredictable in behaviour and sudden violence may arise which puts the nurse at risk. This is something they always have to be prepared to face as part of their job in the course of their duties. I well remember many years ago having to help a male nurse whose skull had been fractured by a patient suddenly hitting him over the head with a chair. So it is not only a question of patient care; it is a matter of looking after the staff as well. In special hospitals, such as Rampton, obviously the risk of patients becoming violent is even greater, because of the special category of patients.
As has already been indicated, there is at present no code of practice and I agree that it would be extremely difficult to formulate such a code: but some nurses have to work in difficult conditions and at greater risk than their colleagues in other mental hospitals. As we are to evolve a code of practice generally for our mental hospitals, I am wondering whether it would not be possible in the proposals in the Bill which is still before Parliament to extend it to special hospitals, because in this case a different code of practice would need to be evolved.
I should like to ask the Minister for some reassurance on another point. Although I am open to correction on this, I understand that tribunals which will be set up under the new Bill would not apply to special hospitals, I hope I am wrong here, but if they 377 can be brought forward for special hospitals I think it would ease the present position. I think that such tribunals, in the case of special hospitals, would have to be separately staffed in order to deal with the problems they would face. I would say in passing that it seems incredible that witnesses should be asked for evidence of incidents going back some 20 years. It looks as though there is some lag on tribunals in this case, which would he eased if we brought in special tribunals for the future.
Patients have rights, and legislation which is before Parliament will advance them. I refer specifically, of course, to the new Bill; but we must not overlook the fact that staff have rights too, and protection must also be extended to them. Perhaps the noble Lord, Lord Trefgarne, will be able to indicate the present position and say what steps, if any, the Government are prepared to take to improve the matters which have been so well outlined by the noble Baroness.
§ 6.40 p.m.
§ Lord Trefgarne
My Lords, I must, of course, start by thanking my noble friend for bringing this Question to the attention of your Lordships. I should like, before responding to the debate, to pay tribute to the valuable work which she does as national Chairman of the Leagues of Hospital Friends, but particularly for the interest she has shown in Rampton Hospital and the encouragement which she has given to the staff working in the hospital during a very difficult period. The League of Friends of Rampton Hospital, under the chairmanship of Canon Mason, have given considerable support over the years to patients at the hospital, to patients' visitors and to the staff, and I gladly include them in this tribute. I know something of the great lengths to which my noble friend has gone in giving her personal support to Canon Mason and his colleagues and to all at the hospital.
Since I took up my present ministerial appointment, in which I have a particular concern with mental health services, I have visited a large number of hospitals and other units, to get a first-hand impression of the work which they are doing. I have a particular concern with the special hospitals and I did, in fact, visit Rampton Hospital, as part of my preparation for this debate, on Friday, 15th October. This provided me with a most valuable opportunity to meet the local managers of the hospital, and staff representatives, and to visit many of the wards and departments where I was able to talk to a large number of patients and individual members of the staff.
I think I should first make some general comments about the special hospital service as a whole, before moving to the particular situation at Rampton Hospital. There are four special hospitals, the others being Broadmoor Hospital in Berkshire—probably the best known—and two hospitals situated just north of Liverpool, which I have also visited recently. These are Moss Side Hospital, which has been in use since the 1930s, and the completely new Park Lane Hospital, which is still being built, although it already accommodates some 200 patients in facilities which I believe are as good as could be found anywhere in the world. The buildings at the other special hospitals obviously do not compare with these, but the care provided in them is, of course, of an equally high standard.
378 The four special hospitals are provided in accordance with Section 4 of the National Health Service Act 1977, which places on the Secretary of State for Social Services a duty,to provide and maintain establishments for persons subject to detention under the Mental Health Act 1959 who, in his opinion, require treatment under conditions of special security on account of their dangerous, violent or criminal propensities".Since the point is sometimes misunderstood, I think I should emphasise that this is the only basis upon which people are admitted to special hospitals. Most of the patients have been sent there from the courts, but the special hospitals are places of treatment and not in any sense of punishment. In fact, nearly 25 per cent. of all the patients in these hospitals were not admitted in connection with any offence, but were transferred from other psychiatric hospitals or admitted direct from the community.
There are hundreds of thousands of people who at any one time are suffering from some form of mental disorder. Seven thousand people are compulsorily detained under the Mental health Act. Of these, only 1,750 are in the special hospitals. We are thus concerned with a tiny minority of mental patients who, for some time at least, require to be treated under conditions of special security. Unlike all other hospitals in the National Health Service, these four hospitals are the direct responsibility of my department, and the 2,800 staff who work in them are employees of my department. The hospitals are, as I have said, provided under the terms of the National Health Service Act, and the care and treatment given in them is part of the total spectrum of health care which the National Health Service provides.
I turn now to Rampton Hospital. This hospital is situated in a rural area near Retford in Nottinghamshire. My noble friend described it as austere countryside. But I must say that I thought it was rather beautiful when I visited the district the other day. Originally opened in 1912, the hospital was responsible from 1920 onwards for the care of mentally handicapped people under secure conditions, when it operated under the direction of the former Board of Control. Since 1959, the hospital has been the direct responsibility of my department. The number of patients in the hospital has fallen significantly in recent years. At the present time, as my noble friend said, there are about 650 patients—three-quarters of them male and one-quarter female. There has also been a substantial shift in the types of patient in the hospital; less than half of the total are now suffering from mental handicap. I will deal with the point raised by my noble friend Lord Renton in a moment.
At Rampton Hospital, as in all the special hospitals, a full range of therapeutic treatment is provided and there is a variety of industrial and other occupations. Care is provided by a number of disciplines, including doctors, nurses, psychologists and social workers. In total, there are about 1,000 staff employed at the hospital, some 670 of whom are nursing staff. I think it may be helpful to quote these figures—some 650 patients cared for by 1,000 staff—to indicate to your Lordships the scale of the task which is undertaken in this hospital.
On 22nd May, 1979, as my noble friend reminded your Lordships, a film about Rampton Hospital was 379 shown on independent television. The film, which was entitled "The Secret Hospital", included many serious allegations of ill-treatment of patients by members of the staff at the hospital. The then Secretary of State, my right honourable friend Mr. Patrick Jenkin, referred these allegations to the Director of Public Prosecutions, who arranged for the allegations to be investigated by the Nottinghamshire police. It is the protracted nature of these inquiries which has given rise to the concern expressed by my noble friend and other noble Lords and Baronesses who have spoken this evening.
Mr. Jenkin also announced his intention to institute a thorough review of the organisation and facilities at the hospital. A review team was subsequently appointed under the chairmanship of Sir John Boynton. In October 1980, the review team produced a comprehensive report, which was published in full and which included more than 200 separate recommendations. If your Lordships will allow me, I will deal with some of those recommendations in a moment. But, for now, may I just refer to the central one, which was the establishment of a special health authority, to be known as the Rampton Hospital Review Board, to take over responsibility for the local management of the hospital and to ensure the implementation of the Boynton team's recommendations.
The review board assumed its responsibility in September 1981. The chairman of the board, who devotes two day a week—as well as a lot of other time—to the management of the hospital, is Mr. Leslie Teeman, a leading businessman in the East Midlands. Mr. Teeman and his colleagues on the board, originally five and now six, undertook a challenging task when they accepted their appointments. Changes were needed at the hospital, but it was not a case of starting from scratch. As the Boynton team had acknowledged, and as the members of the review board came to recognise, there was already much that was good about Rampton Hospital, a fact which has received all too little recognition in the various public comments. The staff of the hospital were providing dedicated care for some of the most seriously mentally disordered patients in the country. All of those staff had been bruised by the general accusations which were then flying about. Rampton Hospital is a human institution and it is not surprising that the morale of many staff in the hospital had been undermined, initially by the sensational accusations being made, and subsequently by the extensive, but entirely necessary, police inquiries at the hospital.
Thus, the task facing the review board was to help restore confidence and morale; to build on what was good—and, as I have said, there was much that was good in this hospital—and to seek to make changes where needed in the light of the Boynton recommendations. This task called for high qualities—of patience and understanding, as well as imagination, vigour and determination. I am very glad to acknowledge the sympathetic and enthusiastic manner in which the members of the board have set about their task. One of the national characteristics, from which we so greatly benefit in this country, is the willingness 380 of able people to undertake public service often in difficult circumstances. The service which the members of the Rampton Hospital Review Board are giving typifies so much of what is best in our society and all of us owe them a debt of gratitude and the assurance of our full encouragement.
My noble friend has drawn the attention of your Lordships to the effect on staff morale at Rampton Hospital of the protracted police inquiries. I can assure her that my colleagues and I are fully aware of the problems which have arisen. Both we and the chairman of the review board, while recognising the difficult task facing those responsible for conducting the investigations, have drawn the attention of the prosecuting authorities to the effects of the protracted inquiries on staff morale and thus on the effective management of the hospital, and the consequent need to complete the investigations as soon as this could properly be done. My right honourable and learned friend the Attorney-General acknowledged this problem when he replied to an adjournment debate in another place on this subject on 2nd March this year.
I think it is important, however, while recognising the difficulties, that we should take great care to avoid saying anything which might have a further adverse effect upon morale. The review board members are seeking to restore both the morale and the confidence of the staff of the hospital. I believe, from what I saw on my recent visit, that they have achieved a great deal and I hope that I, too, was able to make a modest contribution when I was there. We must give them positive encouragement in this important aspect of their work.
My noble friend referred particularly to the effect on morale of the loss of the hospital's status as a nurse training school. The noble Lord, Lord Wallace of Coslany, mentioned this, and at least one other noble Lord or noble Baroness. The decision to withdraw approval from the school was taken by the General Nursing Council, which is, of course, an independent professional body with statutory responsibility for such matters. I am aware of the background to the GNC decision, which I do not, of course, question. I do, however, agree very much with my noble friend's view that the existence of an approved nurse training school in a hospital is an important influence for good; and there is no doubt that the withdrawal of approval from the school was a further severe blow to management and to staff at Rampton Hospital.
A great deal of work has been done at the hospital since the approval was withdrawn to deal with the various matters which have given rise to criticism. I understand that the nursing management of the hospital will shortly be submitting an application for reinstatement of the school's approval. This is a matter entirely for the GNC to decide but I wish to say in plain terms that all of us concerned with the management of the special hospitals very much hope that in the light of the new circumstances the application will be successful and that basic nurse training approval will be restored at Rampton Hospital just as soon as possible.
I turn now from the particular concern of my own department with its responsibility for the management of the special hospitals to the question of police presence in Rampton Hospital. The special police inquiry team which has been carrying out the inquiry 381 into allegations against some members and former members of the staff at the hospital was set up following the request to the Director of Public Prosecutions in May 1979 to which I have already referred. I am aware that my noble friend has been in correspondence about these matters with my right honourable and learned friend the Attorney-General, and I have of course consulted my right honourable and learned friend about the response which I should make on this aspect of my noble friend's Question.
Let me first make clear the Government's attitude to abuse or neglect of patients. We are aware that in the special hospitals and in mental hospitals in the National Health Service an enormous amount of care and treatment of the highest standard is given to patients by the dedicated staff who work in those hospitals. But we also know that mistreatment or neglect can occasionally occur, and I say unequivocally that where there is any evidence of such mistreatment or neglect it will not be tolerated.
It is also sometimes alleged that some members of staff cover up the misdeeds of colleagues out of a misdirected sense of loyalty, or bring pressure on others not to complain if they see any wrongdoing. Our position on this also is absolutely clear. I can do no better than to quote the words of my right honourable friend Mr. Jenkin when, as Secretary of State for Social Services, he addressed an international psychiatric nursing conference in September 1980. He said then:Management must support those who complain; there must be thorough investigations; and victimisation or intimidation of those who are doing their duty must be ruthlessly stamped on.I am sure that all of your Lordships would endorse those sentiments.
So our attitude to any wrongdoing against patients is clear. It is totally unacceptable and must be rooted out wherever it occurs. But we recognise that the kind of exhaustive inquiries which may he needed to establish the truth regarding allegations of wrongdoing can have a depressive effect on the hospital concerned, not only for those against whom allegations might lie but for the general body of the hospital's staff who have to carry on the daily business of caring for patients against a background of suspicion and often ill-informed comment. It is this problem to which my noble friend has drawn the attention of your Lordships in the case of Rampton Hospital.
The position at Rampton Hospital is that, following the reference of this question to the DPP and the setting up of the special police inquiry team, more than a thousand separate allegations were received. The police team was thus faced with a mammoth task of investigation to enable the prosecuting authorities to decide whether there were cases in which the evidence required prosecutions to be brought. The allegations made were of many different kinds. All of them had to be looked into. Some were very serious, others trivial. The vast majority of the allegations received have not been substantiated, or were of a character which could not have given rise to any question of prosecution. But in some instances the prosecuting authorities were satisfied that the evidence did justify charges. This is not the occasion to comment on the nature of particular allegations. That 382 would be quite wrong, especially as some trials are still to take place, but your Lordships will wish to know that, of the cases so far concluded, one person has been convicted of the single charge made against him, three people have each been convicted of one or more of the charges made against them, and are currently seeking leave to appeal; nine people have been acquitted of all the charges against them (three of these were involved in the recent case in which the judge, after hearing the prosecution evidence, directed the jury to acquit the defendants); and the charges against two people have been dropped.
My noble friend, who has taken a close interest in these matters, now asks explicitly for a date after which there will be no more police presence at the hospital. I understand completely why she seeks that undertaking, but I am afraid I must tell her that an undertaking cannot be given in that form. There are two main reasons for this. First, so long as criminal proceedings are continuing—and it may be some time before the remaining charges now outstanding will have all been finally disposed of—the police may have to visit the hospital to obtain information required by those responsible for conducting the prosecutions in connection with the charges which have already been brought.
Thus we must expect that the police inquiry team set up to investigate the allegations at Rampton Hospital will continue in existence until the last of the outstanding charges has been disposed of I should emphasise that responsibility for the inquiry team rests, as it must do, with the Chief Constable of Nottinghamshire who has been responsible for conducting these investigations on behalf of the Director of Public Prosecutions. It will be for the chief constable to decide if and when the inquiry team should be disbanded. But I can inform your Lordships that the inquiry team which, at the peak of the investigations, included 20 police officers has now been reduced to six, with two supervisory officers. This is a clear indication that, as we would all hope, this matter is now nearing its end. Thus, the first reason why I cannot give the undertaking which my noble friend seeks is the essentially practical one, that the work which this police inquiry team is doing is not yet completed and will not be completed before the outstanding charges have all been disposed of.
The second reason why I cannot give the undertaking is more fundamental and is a matter of principle. The assurance being sought is that beyond a certain date the police will pay no more visits to the hospital in relation to the matters which the special inquiry team was set up to investigate, except possibly for some limited purpose. I am told by my right honourable and learned friend the Attorney General that some allegations are still being made. Generally, these are not revealing any fresh matters of substance. But if some matter should be brought to notice which indicated that a serious offence might have been committed, clearly the police must be free to investigate it. We have no grounds for supposing that any such matter remains uninvestigated or undiscovered; but it would be quite wrong in principle to give an undertaking in terms which could be seen as preventing the police from properly investigating any serious allegation which might arise either at Rampton Hospital or elsewhere, no matter how unlikely the 383 possibility of any such allegation might seem at present. There could be no question of Ministers seeking to interfere with the actions of the police in such a matter.
I hope the House and my noble friend will recognise that I have chosen my words with care and that there are sound reasons why I cannot, on behalf of the Government, give the undertaking which she seeks. I hope, however, that the explanation which I have given her will serve as some reassurance both to her and to the management and staff at Rampton Hospital that we have now reached a stage where we would expect that any continuing police presence in the hospital is likely to be limited to inquiries relating to charges which have already been brought or to any fresh matter of substance that might be brought to notice. I believe that goes a very long way towards meeting my noble friend's point. But I am, in fact, able to go even further—and I am very glad to be able to do so.
My noble friend is probably aware that the police inquiry team recently questioned, under caution, five more members of the staff at Rampton Hospital. Four of them have since been told that they are to be charged and the fifth has been told he will not be. I am now able to tell my noble friend and your Lordships, on the authority of my right honourable and learned friend the Attorney-General, that those charges are the last which are to be brought as a result of the information obtained by the police inquiry team over the last three and a half years. No further charges are to be preferred as a result of those investigations. As I have indicated, if any new matters of substance should be brought to notice, they must be properly investigated, but I am sure that my noble friend will have been glad to receive the information I have just given. It will. I know, be widely welcomed by the management and staff at Rampton Hospital.
I have already spoken at some length and I hope that your Lordships will forgive me if I do not deal with individual points which have been raised in this debate. But I will certainly write to noble Lords who have raised them with a full response. The end of the ordeal which the hospital has now been suffering for more than three years really is, at last, in sight. As I said earlier. I have recently met and talked to many people in the hospital. I have seen clear evidence of the valuable work undertaken by staff in the hospital, often under very difficult circumstances—work which few of us would want to share. The tribute which I wish to pay to them is in no sense rhetoric or formality. Society asks these people to undertake on its behalf one of the most difficult jobs that anyone can be asked to do. We rarely show any recognition of the value of this work, usually preferring to sensationalise or criticise; but my colleagues and I certainly do recognise its value. We wish to give to staff and management the support they deserve and to encourage them to look to the future with a positive resolve to continue to care for their patients with commitment and dedication and at the same time to keep fully abreast of new developments in treatment and care.
Before I end, I want also to repeat my tribute to Mr. Teeman and his review board. They took on their task at a time of great difficulty for the hospital and have rendered a considerable service, not least to the 384 patients. We are indeed most grateful to them. I have sought to make the most of the timely opportunity provided by my noble friend to deal with the understandable anxieties prevalent at Rampton Hospital. I have been able to give some new assurances which I hope will be widely read—not least at the hospital itself.