North Lakeland Healthcare NHS Trust

HC Deb 31 January 2001 vol 362 cc120-8WH

1 pm

Mr. Eric Martlew (Carlisle)

I welcome the opportunity to debate the findings of the first report of the Commission for Health Improvement. However, I very much regret that it is a report into a serious case of patient abuse in my constituency at the former Garlands psychiatric hospital, which was run by North Lakeland Healthcare NHS trust. I am pleased to say that this weekend I visited the site of the hospital; it has been closed, the demolition has started and the patients and the staff have been transferred over to the new Carleton clinic—an excellent facility.

In order to appreciate fully the scale of the problem, I shall have to outline some of the background details of the events and abuse that took place. In December 1998, two bank nurses from another hospital were working in the Garlands hospital, in Kielder House ward. They were so appalled by the abuse that they saw that they reported it to the senior managers. I would like to thank those two members of staff for taking that brave decision. I understand that they were heavily criticised by some of their colleagues, but whistleblowing has to happen in the NHS and they did the right thing.

I will briefly outline the sort of abuse that was taking place in Kielder House ward. In December 1998, two elderly patients in their night attire—not wearing their dressing gowns—were locked outside on a veranda in the cold. The staff refused to let them back in for a considerable period of time. Other incidents included patients being tied to commodes—a great indignity and against all the rules—and fed their meals at the same time. Other patients were sworn at and told they were past their sell-by date, that they should be in their box—in fact that they should be dead. They were subjected to verbal and physical abuse. One patient was struck in the testicles by a male nurse who was a judo expert. That was the level of abuse.

An internal inquiry looked into the matter and in March 1999 it reported with 33 recommendations to improve the situation in Kielder House and in the new clinic. I saw a copy of the Kielder House internal review in April 1999 and was appalled. I have been in public service since 1972 and have dealt with many difficult situations, but I was very angry when I read about the abuse that was taking place and lost sleep that night.

I had a meeting with Mary Styth, who was the chair of the trust. She expressed concern about the abuse and called for an external inquiry into what had happened in Kielder House ward. The inquiry was set up by the regional health authority. In August 1999 it discovered a previous report into abuse in the hospital in 1996.

The catalogue of abuse was very similar and it was then in ward 21, which was merged with Kielder House ward later. The 1996 report, which included complaints by student nurses, had been ignored and no real action had been taken. In fact, there was a cover-up in 1996. The chief executive of the trust said that he had not read the report for three years. In August, it was decided that he should be suspended.

In March 2000, the external inquiry reported. It found that a range of unprofessional and cruel practices took place in Kielder House, and severely criticised the 1996 investigation. Following the publication of the report, the chairman of the trust, Mary Styth, was summarily dismissed by the Secretary of State, and six members of staff were subject to disciplinary action.

I am sure that the 1996 and 1998 incidents were not isolated. Sadly, we must presume that abuse carried on throughout the period, if not longer. Later, I will mention the failure of various organisations to detect and stop the abuse, but I would like to make it clear now that none of the failures of the system absolves those who perpetrated that abuse. There was no excuse for it.

Following the external review and the large amount of publicity about the abuse and the sacking, the Government rightly called in the Commission for Health Improvement, and we are now considering its report. It said that the abuse was some of the worst involving elderly patients in recent years". It was highly critical of the management that investigated ward 21 and Kielder House, saying that there was a complete failure of effective management and a "whole systems failure". The report accused the trust of failing to respond to the early warnings of whistleblowers. Despite the evidence, the commission found a culture of denial among some staff, who did not believe that the abuse had taken place.

I shall move on to lessons to be learned and problems that were created. North Cumbria health authority failed to act following the complaint from Carlisle MIND about abuse at the hospital. Although the health authority's headquarters were only 10 minutes' drive away from Garlands hospital, it worries me that there was a remoteness between the two, as though they were 100 miles apart. I also felt that the non-executive members of the health authority were not informed of the problems at Garlands.

We are lucky in Carlisle to have an excellent community health council, which has been ably led for many years by its chief officer, Peter Canham. However, due to the nature of its visits, the CHC failed, in that it did not pick up the abuse. I repeat my belief that the abuse was systematic in the hospital, not occasional. Although we have a good CHC, and although I am not totally convinced that I support the Government 100 per cent. on the alternative to CHCs, the fact that they have structural problems was shown in this situation.

The only organisation to come out of the affair with any credit was Carlisle MIND. I have to declare an interest, as I am its vice-president and my office shares a building with it. It flagged up the fact that abuse was taking place at Garlands hospital, and it told the trust and the health authority. Unfortunately, it was ignored. The director, Ann Dawson, should be praised for her diligence and persistence. I am rather annoyed that when Carlisle MIND wrote to the health authority asking for funding for another five years to allow it to continue with its work, the health authority agreed to fund it for only one year. Whether we like it or not, an organisation with money for one year only that rocks the boat too much may not receive money for following years. I shall return to that subject later.

What issues, national and local, have resulted from the report? First, it is obvious that the trust had structural problems when was it was set up in 1994. It was a community and mental health trust. The majority of the effort and resources went into the community, and the hospital probably came second. I do not want to say too much about the new structure of health care in Cumbria because the Minister already knows my views. However, from 1 April, Cumbria will have a single mental health trust. I was initially worried about its size, but I believe that it will allow the trust to concentrate on giving the community a good mental health service, which is timely.

Another important factor is funding. We can blame various causes, but mental health has been underfunded for generations. Although we tend to concentrate on acute cases, it is time to ensure sufficient funding, nationally and locally, for mental health trusts. I hope that the Minister will take that on board.

Another important aspect is the way in which the Government treat non-executive members of trusts. The chair of the trust, Mary Styth, was summarily dismissed by the Secretary of State. The chief executive of the trust was suspended for more than a year, and was given the opportunity to plead his case. He underwent a disciplinary procedure and was rightly dismissed. However, I believe that non-executive and executive members of trusts should be treated equally and that both should have a right of appeal. I accept that members are appointed for a fixed term, but if they are dismissed they should have the opportunity to plead their case.

Next, I wish to mention the police. I make no bones about it: I would like to have seen the perpetrators of the abuse brought before the courts. However, my impression is that when we have problems in our hospitals, whether in Cumbria or elsewhere, the police adopt the unofficial national policy that such matters are better dealt with through internal disciplinary procedure than through the courts.

I greatly admire Cumbria police; I am sure that the Minister would agree that it is one of the best police forces in the world. Crime in Cumbria has been reduced by 21 per cent. in the past year. However, I am worried that no prosecutions were brought. I know that it is difficult, and that mentally ill people do not make good witnesses, but I believe that the two nurses who made the allegations and those who were disciplined were not interviewed. I do not know that for definite, but I have corresponded about the case with the chief constable. If the Association of Chief Police Office has a national policy of not getting involved in cases in hospitals and institutions, I suspect that the Minister should attend to it.

The future of the external reviews also needs thought. Will the new system set up by the Commission for Health Improvement supersede the external reviews such as the one at the Garlands hospital? A major flaw in the review was exposed by the commission's report. The first external review gives the impression that no consultants or doctors were involved in any of what happened at the Garlands hospital. Those conducting the review failed to interview the consultant concerned. I understand that he was off sick with a broken leg, but that should not have precluded his giving evidence. It was only when the commission looked into the matter that some responsibility was laid upon the consultant. Are external reviews now in the past, with that function to be taken over by the commission, or will they run parallel?

A general question that I want to raise is how organisations such as MIND in Carlisle can be funded so as to retain an independent voice when they want to criticise an authority. It is not fair for an institution to have to depend for money on an organisation that it monitors.

The report has highlighted several problems that, hopefully, will now be tackled by the agencies concerned, especially the trust. We must look in a positive way to the future and hope for the restoration of public confidence and the improvement of the hospital's reputation. The vast majority of staff who worked at Garlands and who now work at the Carleton clinic are professional and conscientious and look after their patients well. However, if the hospital is to have a clean bill of health, the commission should return to conduct an audit; I shudder to use the word Ofsted. I understand that improvements have already been made. The commission needs to establish that it is satisfied that the people of north Cumbria and Carlisle have the mental health service that they require.

1.17 pm

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

I warmly congratulate my hon. Friend the Member for Carlisle (Mr. Martlew) on initiating the debate and on his presentation of the arguments. I pay tribute to the work that he has done and continues to do to improve NHS services in his constituency. Carlisle has a powerful champion for the national health service in my hon. Friend.

The North Lakeland Healthcare NHS trust provides a range of mental health and community health services for a mainly rural area from a number of sites across north Cumbria. Last year 63,500 patients were treated by the trust, which provides a wide range of services from paediatrics and community midwifery to mental health services for all ages. I know that my hon. Friend is particularly concerned about those services.

I share my hon. Friend's concern about the findings of the various inquiries into the events at the North Lakeland Healthcare NHS trust. I appreciate his efforts in bringing those matters to the attention of Ministers. A clearly unacceptable state of affairs was allowed to develop in the trust. Standards of patient care and treatment fell seriously short of what we expect from the national health service. In addition, the trust failed to deal properly and effectively with abuses, which had been taking place over several years, as my hon. Friend made clear.

Allegations of abuse were first brought to the trust's attention in May 1996 by student nurses working in Garlands hospital. Those allegations were investigated by the trust's patient services manager and training manager. At that time, the internal trust inquiry concluded that the type of patient in this ward leads to a marked difference between theory and practice and that some of the difficulties encountered may have been created by the students' understanding of the relationship between theory and practice". That is totally unacceptable. No disciplinary action was taken and no report was made to the police. It was the failure at that stage to take effective action to deal with obvious evidence of unacceptable practices in the trust that lay at the heart of the subsequent events.

In December 1998, as my hon. Friend made clear, two bank nurses made further complaints about the treatment of patients in Kielder House ward in the same hospital. The complaints investigation uncovered other aspects of care that gave cause for serious concern. One member of staff was dismissed, one resigned and three were given warnings. I would like to express my gratitude and admiration to those two nurses. It was their actions that finally began the process that led to measures being taken to deal with the appalling treatment of NHS patients in the hospital. Those two nurses acted in the best traditions of the nursing profession.

The former chief executive of the trust met the police in January 1999 to appraise them of the draft report into the allegations, which could lead to suspensions and disciplinary action against staff. As a result of that discussion, the police concluded that it was not an issue for them as there was insufficient information to justify further investigation into the actions of any individual. As my hon. Friend is aware, the trust initiated a further internal investigation.

I understand that the police have now been sent copies of both internal investigations and are currently reviewing the evidence.

My hon. Friend was concerned that there was a national policy not to prosecute cases of alleged criminal behaviour by people in hospitals. I can assure him that no such national policy exists. Anybody who works in the NHS is subject—just like all of us—to the full operation of the criminal law, and that will continue to be the case.

My hon. Friend is also aware that, following that internal investigation, an independent external review was instigated by the Northern and Yorkshire NHS Executive regional office. The report of the independent external review found, in particular, an unacceptable culture of care, which allowed unprofessional, counter-therapeutic and degrading, even cruel, practices to take place. It also found that the governance of the trust was at risk through a significant blurring of roles and responsibilities between the chair and the chief executive, and that the trust lacked an atmosphere of openness and had no effective arrangements in place to ensure proper clinical governance.

The responsibility for the continuation of such a regime in any NHS trust must lie squarely and properly with the chairman of that trust. That is why we did not hesitate in removing her from her position. Chairs in the NHS are directly appointed by Ministers with the clear remit to deliver health services of the highest possible quality, which was not happening in the North Lakeland trust. The abuse and mismanagement on the scale experienced in North Lakeland meant that the chairman's position was not sustainable. Although the former chair was responsible for the overall management of the trust and must take responsibility for its failings, it was clear that senior management were also at fault. A number of disciplinary actions against senior managers have followed. To date, the chief executive and the director of personnel have been dismissed, and a range of serious disciplinary actions have been taken against six other members of staff at the trust.

We took the decision to send in the Commission for Health Improvement. The commission reviewed the previous reports and examined the management, provision and quality of care provided across the trust. It found that there was an almost complete absence of effective corporate management and clinical governance processes—in effect, a whole systems failure. The Government accept the commission's findings, and we expect the acting chief executive and chair to take on board the recommendations and to implement the action plan drawn up to address them. I have asked my Department's regional office to work closely with the trust and the health authority to ensure radical improvements to the management and the delivery of services at North Lakeland. It is important that the community served by the trust can draw a line under the appalling sequence of events to secure a future marked by the highest quality of care.

Action being taken now in the light of the CHI's report will be vital to achieving that. I am pleased that since publication of the commission's report a number of important developments have taken place. An action plan to address all the commission's recommendations has been implemented; a service staff skill mix review was started in December and a draft report is due to be produced by today; clinical governance training for all board members has taken place and further sessions have been held with senior managers and clinicians.

The trust is actively reviewing and re-defining its corporate values with patients, carers and staff. Discussions have been initiated with the local community health council and the local branch of MIND to establish a patients council, which will be useful. The Northern Centre for Mental Health is supporting the trust in reviewing the allocation and responsibilities for standards and quality across the trust.

A user-focused complaints policy was introduced in November. Complaints are now valued as opportunities to learn about and improve services. My hon. Friend will be aware that a comprehensive review of nursing standards across the trust is also being carried out.

We have reorganised management structures in the NHS in north Cumbria. The North Lakeland trust will be dissolved on 31 March, to be replaced by a districtwide dedicated mental health and learning disabilities trust. That will provide the opportunity to refashion a modern, efficient and effective mental health service appropriate to meeting the needs in my hon. Friend's constituency.

The action taken will help to ensure that these events do not happen again. I welcome the intention of the Commission for Health Improvement to review the new trusts in north Cumbria one year after its report on the North Lakeland trust. I hope that a very different picture will emerge. My hon. Friend asked me to ensure that we would revisit the trust, as it were, and I assure him that we will.

My hon. Friend also raised important points about checks and balances in the system, and about how groups representing patients and users can be heard effectively. I should make it clear that the Commission for Health Improvement found a whole systems failure. The trust was responsible for the appalling circumstances about which we have spoken. I praise the contribution of the local branch of MIND, which raised its concerns with the trust and the health authority. I congratulate my hon. Friend on his comments on MIND, as it stood up for patients at Garlands hospital.

The Government's reforms are helping to renew public confidence in the NHS through greater involvement than in the past of patients, carers and the public in the planning and the development of health services. The Government are determined to ensure that the voice of the patient is heard loudly and clearly in the new NHS. The NHS cannot operate behind closed doors and keep patients in the dark. New ways need to be found to take patients into its confidence. The NHS plan sets out how we intend to do that.

This week, my right hon. Friend the Secretary of State gave further details of our plans. We intend that every local trust should have its own independent statutory patients forum, run by patients. The forums will have rights to inspect standards of care and cleanliness. A patient will be appointed to serve on the local trust board so that patients' interests are at the heart of local decision making. I hope that my hon. Friend will welcome those reforms. In turn, the trust will have to demonstrate that it has responded to the concerns of the patients forum.

Other changes that we are making include ensuring that patients are regularly asked for their views on their care, and requiring trusts to publish a prospectus to set out how they intend to address patients' concerns. A new patient advocacy and liaison service will be established in every trust to give patients on-the-spot help with care and treatment problems. A new complaints system, more independent than the old one, and a new, independently commissioned and independent advocacy service will be available in every area when a patient needs specialist help with a complaint.

At health authority level, independent local advisory forums that will include patients will scrutinise the whole local health service. There will be more patients' representatives at every level in the health service. That will include existing organisations such as the General Medical Council, the National Institute for Clinical Excellence and the Commission for Health Improvement, and new organisations such as the new independent appointments commission and the independent reconfiguration panel. Patients will have seats at the top table.

The issues in the North Lakeland trust should not be considered in isolation. The Government are committed to delivering significant improvements to the NHS across north Cumbria. Year on year, we have increased the resources to the NHS in my hon. Friend's constituency. This year has seen a cash increase of more than £19 million, which is 6.4 per cent. above inflation, or a 9 per cent. increase in cash terms. Next year, we shall ensure a real terms increase of 6 per cent., which is more than £17 million in cash terms.

My hon. Friend was concerned about the financing of mental health services, and I agree with many of his comments about the inadequate funding that has dogged them for many years. That is why I hope that he shares our commitment to modernising, investing in and improving mental health services, as set out in the NHS plan published in the summer. I accept that much is to be done, but new, dedicated funding is coming on stream.

I am sure that my hon. Friend and I agree that the trust needs to move forward, and in so doing it must ensure that its patients and the whole community enjoy a relationship of full confidence and trust in the services that it provides. That is what every member of staff in the trust wants and is committed to achieving. It is what my hon. Friend and I both want to happen, and I look forward to working with him to ensure that it does.