§ The Secretary of State for Health (Mr. Stephen Dorrell)
With permission, I should like to make a statement about action being taken to address the allegations involving the personality disorder unit at Ashworth hospital in Merseyside. The unit comprises six wards, with 115 patients, within the total population of Ashworth hospital of 473 patients.
Hon. Members will be aware that last Friday I instituted urgent action to address the very serious situation that had been brought to my attention in the preceding few days. In October last year, Stephen Daggett, a patient at Ashworth hospital, made a number of allegations, including the misuse of drugs and alcohol, financial irregularities, the availability of pornographic material, and possible paedophile activity involving a child visitor within the personality disorder unit.
I am advised that the hospital began investigations at that time and that a subsequent ward search on 17 January found a large amount of pornographic material. Despite the availability of this evidence and of Mr. Daggett's allegations, the hospital continued to maintain that press reports of unacceptable and possibly unlawful activity within the personality disorder unit were unfounded.
On 28 January, the Home Office received a letter from the hon. Member for Halifax (Mrs. Mahon) enclosing a 60-page dossier setting out the detail of Mr. Daggett's allegations. The dossier was passed by the Home Office to my Department.
On 31 January, police visited the home of a former Ashworth patient who had continued to be a frequent visitor to the hospital. Following that action, a child has been taken into the care of the local authority under an emergency protection order.
In light of the allegations made by Mr. Daggett and of other evidence that has recently become available, I made three announcements on Friday of last week. First, the hospital has suspended three members of staff, including the chief executive. An acting chief executive was appointed with immediate effect. He is Mr. Erville Millar, chief executive of Lambeth Health Care NHS trust, who has a strong background in mental health services. I can further inform the House this afternoon that the hospital has today suspended a member of its medical staff.
Secondly, I established on Friday a statutory inquiry under section 84 of the National Health Service Act 1977 to review the clinical policies and the management of the personality disorder unit at Ashworth hospital. The inquiry will be led by His Honour Judge Peter Fallon QC, a recently retired senior circuit judge. A section 84 inquiry has the power to summon witnesses and to take evidence on oath. The inquiry will determine how and on what terms it takes evidence. It will also be for the inquiry to ensure that its work does not compromise continuing police investigations or possible criminal proceedings, but I would expect it to report within a year. That report will be published.
The terms of reference for the inquiry will be published as soon as possible. They will make it clear that, as it is activities within the hospital's personality disorder unit that have caused recent concern, the inquiry should focus on the policies, management and clinical care provided by 22 that unit. The inquiry will, however, also wish to follow up any wider questions that are necessary to the proper consideration of the issues.
The third announcement I made on Friday was on the alleged involvement of a child. The chief inspector of social services, Sir Herbert Laming, has asked the local authority concerned for a full report on the handling of the case by its social services department. I will decide, in the light of that report, whether further action needs to be taken.
The allegations that have been made about Ashworth hospital are extremely serious, and the public are entitled to reassurance on two counts. First, Ashworth hospital must be properly managed and must provide a high level of security for the benefit both of patients and of the public at large. Secondly, the hospital must also ensure that its patients receive a high standard of clinical care. The action that I announced on Friday is directed at the achievement of both those objectives.
§ Ms Tessa Jowell (Dulwich)
I welcome the Secretary of State's statement, and his action in setting up the inquiry under Mr. Fallon. I should also like to pay tribute to my hon. Friend the Member for Halifax (Mrs. Mahon) for her action, on behalf of her constituents, in ensuring that the terrible allegations were brought to light and investigated.
The revelations are shocking. Equally disturbing, however, is the fact that the alleged pornography trade and paedophile activity could have gone on undiscovered in a hospital that has recently already been subject to a fundamental and far-reaching inquiry, under the chairmanship of Sir Louis Blom-Cooper. That inquiry was to have led to the introduction of a new complaints procedure, 24-hour nursing across the hospital, and an independent patients' advocacy service. I understand that Ministers were also to monitor the hospital's performance in acting on the inquiry's recommendations, through the so-called "accountability review process". The new allegations illuminate the failure of any effective accountability in the hospital.
Will the Secretary of State tell the House when allegations related to this inquiry were first made to any party? Were the allegations—or allegations on related matters to do with Ashworth hospital—reported at any earlier time, before 28 January, to the Secretary of State, to his predecessor or to any Minister; or to the High Security Psychiatric Services Commissioning Board, to the Ashworth hospital board or to the Mental Health Act Commission? If so, what action was taken in each case?
What visits were paid to the hospital by Ministers or by any of the bodies I have mentioned between October, when the allegations were first made by Mr. Daggett, and receipt of the dossier submitted by my hon. Friend the Member for Halifax to the Secretary of State? What conclusions, if any, were drawn from those earlier visits? Were unannounced visits made to the hospital by the commissioning board in the second half of last year? If not, why not, given Ashworth's history? Does the right hon. Gentleman not accept that the allegations expose the dreadful inadequacy of the monitoring systems which are supposed to ensure safety at high-security hospitals?
As for the future, we welcome the inquiry, but we hope that it will be held in public. Will the Secretary of State assure the House that the inquiry will deal with the 23 hospital's chronic staff shortage—which has come to light only because of the dreadful allegations? Does he accept that the gagging of staff, which was introduced by the Government, has made it more difficult for such allegations to come to light? Will he now join Labour in a commitment to end the gagging of staff in the national health service?
After yet more allegations about abuse and depravity in a special hospital, will the Secretary of State also establish an additional and separate inquiry to examine the appropriate treatment and custodial arrangements for people suffering from personality disorder, as part of the wider review called for by Sir Louis Blom-Cooper and Dr. John Reed into the future of the three large special hospitals as appropriate institutions for the care of dangerously mentally ill people?
We do not doubt the seriousness with which the Secretary of State has taken these allegations since they were brought to his attention by my hon. Friend the Member for Halifax, but perhaps he needs to be reminded that the people of Britain want a Secretary of State for Health working on health and not devolution, fighting for patients and not the Tory party leadership.
§ Mr. Dorrell
The Blom-Cooper inquiry made a number of recommendations, all of which except one were implemented. I was on a radio programme with Sir Louis on Saturday morning when he was good enough to acknowledge that, as a consequence of the recommendations that he had made, there had been substantial changes in the regime at Ashworth, changes that he welcomed and which he said reflected the burden of his report.
The only recommendation of the Blom-Cooper report that we did not implement was that we should put an end to the use of seclusion in special hospitals. We stated at the time that we did not intend to accept that recommendation because we felt that it was not possible to run hospitals of that nature while eschewing ever the use of seclusion. Every one of the other recommendations of the Blom-Cooper report was implemented. I shall return to this, because there is an important lesson in the fact that we implemented all but one of Blom-Cooper's recommendations, which we should keep in mind now.
The hon. Member for Dulwich (Ms Jowell) asked when the allegations were first made. The answer is that they started to circulate in the press in the autumn of last year. It is precisely because the advice and information relating to the allegations and coming to the Department of Health from the hospital now appears to suggest that adequate knowledge was not then being passed on to the Department that we have made the changes that I announced on Friday—the suspension of the manager and the establishment of the inquiry to ascertain exactly what happened, what should be happening and, more important, what should happen in the future.
The hon. Lady also asked whether the inquiry would take place in public. I was careful to say in my statement that that was a matter for the inquiry itself. Therein lies one of the lessons of the Blom-Cooper process. That inquiry was held wholly in public. One of the lessons that we should draw from the Blom-Cooper process is that it did not resolve all the issues for the future of Ashworth. 24 More recent inquiries, especially that surrounding the events of the Beverley Allitt case, suggest that it is easier for independent inquiries of this nature—I stress the words "independent inquiries"—to get to the bottom of what exactly happens in these very difficult cases if at least some of the evidence is taken in private.
That specific provision was included in the announcement that I made on Friday so that Mr. Fallon should have that option open to him if he wishes to take it. It is a matter for him and his inquiry. The inquiry report will of course be published.
I reject what the hon. Lady said about what she calls gagging clauses. The only provision that we have made in contracts for staff of the health service is that, where there is a disagreement between members of staff and their employing authority, the staff should first take their disagreements to the authority. We have never sought to prevent members of staff taking their disagreements outside the authority if they fail to get satisfaction. With respect, it is not members of staff who have been the key to the changes that I announced on Friday.
The hon. Lady is right about the treatment of personality disorders. One of the difficulties surrounding the treatment of mentally ill and disturbed patients is knowing how to deal with those suffering from long-term personality disorders. That question is currently the subject of discussion with the psychiatric profession and is, I suggest, best dealt with in that context, as it is the clinicians who ultimately have to make the decisions about the treatment of individuals.
The commissioning board is part of the Department of Health. It is conducting a review of the future of special hospital provision and high-security psychiatric care. That is one of the issues that Sir Louis Blom-Cooper feels that we should consider in the light of the history of the special hospitals. That is why the commissioning board is reviewing it.
§ Mrs. Mahon
I welcome the Secretary of State's decision to set up the inquiry. Will it investigate the treatment meted out to Stephen Daggett, who went to extraordinary lengths to get the inquiry under way, including absconding and, when he was moved to Rampton against his will, going on hunger strike? Can I have an assurance that his case will be looked into? Will the Secretary of State also give other whistleblowers, such as staff who might want to speak out, some protection? I share the anxiety about gagging clauses expressed by my hon. Friend the Member for Dulwich (Ms Jowell).
Is the Secretary of State aware that the chief executive of Rampton had Stephen Daggett's report on 25 November? Did she call the police, inform the Department of Health or the Home Office, or—as I am led to believe—simply photocopy it and send it back to Ashworth, saying to Mr. Daggett, "This is an Ashworth question, not ours"? If she did, will her behaviour be included in the investigation?
25 When did the visits to Lawrence ward by the little girl mentioned in the report stop? Does the Secretary of State agree that, if they were allowed to continue after early October, many people who should have known better left her unnecessarily exposed to danger?
§ Mr. Dorrell
I am grateful to the hon. Lady for the way in which she has responded to the announcements that I made on Friday. I should also have said that I am grateful to the hon. Member for Dulwich for the way in which she and her hon. Friend the shadow Secretary of State for Health have responded. To the extent that examining the background to Mr. Daggett's care is relevant to the wider inquiry on the way in which Lawrence ward has been run—it is clearly one of the central issues—of course the inquiry will look into the nature of the care that he received and where it went wrong.
It is perfectly true that the dossier that Mr. Daggett provided to the manager of Rampton was sent, on my understanding, on the Monday following its receipt to the manager of Ashworth, but, as I said in my original statement and repeated this afternoon, that dossier was not made available to officials or Ministers in my Department until the hon. Member for Halifax sent it to me.
I do not seek to give an authoritative answer to the hon. Lady's question about the last day on which the girl who is now in care visited the ward, because it is one of the issues that the inquiry will consider in great detail. It will look into whether such visits took place, on what terms and how often, and when they came to an end. Those alleged visits are at the centre of the concerns that have been expressed about the case.
§ Sir Roger Sims (Chislehurst)
I thank my right hon. Friend for his statement and for the prompt action that he took as soon as he was alerted to the situation. The apparent lack of supervision at Ashworth is worrying. The suggestion of paedophilia and child abuse is horrifying and appalling.
My right hon. Friend referred to wider issues. Do those include the way in which such institutions are run? Anyone who needs medical treatment should surely receive it, but the people in Ashworth are there, first, because they have committed serious offences, and, secondly, because they need medical treatment. Should not security and supervision in such institutions be just as rigorous as in conventional prisons? Is it not self-evident that that was not the case at Ashworth?
§ Mr. Dorrell
I am grateful for my hon. Friend's welcome for the prompt action that was taken. I entirely agree with him about the pre-eminent need for security in hospitals of this nature, although he is not entirely right in saying that every patient in a special hospital is an offender. People can be sent to such hospitals if they suffer from dangerous disorders, without having committed an offence. They are there because both they and the rest of society need the protection that a highly secure environment can provide. Hospitals are failing if they do not provide that security: they are failing their patients, and the wider public. My hon. Friend is right to emphasise that that is one of the prime responsibilities of such institutions.
26 As for the broader question of the long-term future of high-security psychiatric care, that—as I said in answer to an earlier question—is one of the issues that the commissioning board is now actively reviewing.
§ Mr. Simon Hughes (Southwark and Bermondsey)
I thank the Secretary of State for his statement, and for the prompt action that has been taken. Like him, I pay tribute to the hon. Member for Halifax (Mrs. Mahan).
May I put it to the right hon. Gentleman, however, that the answers that he has given today have not dealt with one issue? I refer to the fear that quasi-independent national health service trusts, and the management of the three special hospitals—Ashworth, Broadmoor and Rampton—are able to be semi-autonomous, and that no one checks that they carry out their activities in the interests of patients and the wider public, rather than in their own interests and with a view to their own managerial self-preservation.
May I suggest that the way forward—I should be grateful if the right hon. Gentleman would give it serious consideration—is the establishment of a standing inspectorate of health and social care that can inspect any trust, hospital or other health service facility at any time, at the instigation of patient, member of staff or friend or relative? We need to ensure that there is someone outside the premises who can check on what is going on. In this instance, the concern is that, although the allegations were made, for internal reasons people decided not to take them seriously or to do anything. That is a very worrying state of affairs.
§ Mr. Dorrell
I entirely agree with the hon. Gentleman's diagnosis. The problem is that such institutions are too tightly held, and that information that should properly be available to the accountability chain—including, ultimately, me as Secretary of State—apparently was not available. I have set up the inquiry to establish why it was not.
The hon. Gentleman asked for a separate agency or inspectorate to examine such issues. With all respect, that is not the solution that immediately suggests itself to me, given that we already have two agencies dealing specifically with mental health. The Health Advisory Service actually went to Ashworth in 1995, and delivered a report that suggested that the situation there was improving. That agency—an agency of the precise kind that the hon. Gentleman suggests—delivered a report which, although not devoid of criticism, was generally encouraging following that visit, which was not very long ago. Detained, restricted and sectioned patients also already have the protection of the Mental Health Act Commission. So, in the specific field of high-security psychiatric services, we already have two bodies of the kind that the hon. Gentleman is considering.
§ Mr. Dorrell
Indeed. That is why I do not think that we should leap to the conclusion that another of those agencies is the answer. We should be considering why information did not flow, at the time when it should have, to the people who were accountable for what went on in the hospital.
§ Mrs. Jane Kennedy (Liverpool, Broadgreen)
The Secretary of State suggests that the information was in the 27 public domain because it was being discussed in the media—in the press. Is it not a shocking indictment of the commissioning boards that no one appears to have made an unannounced visit to Ashworth, given the history of that unit? Will the Secretary of State accept ministerial responsibility for the commissioning boards—and for the failure of those boards—if it is shown that they are failing us to such an extent, given that they were set up such a short time ago by his Government?
§ Mr. Dorrell
I have never sought to avoid ministerial responsibility for what goes on in any part of the health service, including special hospitals. That is why I took the action I did on Friday, when it was clear to me that questions had been asked, and that charges and allegations—serious allegations—had been made and had not been adequately examined by those in the front line. The question whether unannounced visits should take place is no doubt one of the questions that Mr. Fallon will examine.
However, with respect, I do not think that that can be the whole answer. I do think that there needs to be in place a management structure that observes the protocol between the Department of Health and individual special hospitals. That protocol makes it crystal clear that, where such allegations are made about treatment in the hospital, they should be reported. The advice available to me at present suggests that they were not.
§ Mr. David Alton (Liverpool, Mossley Hill)
Does the Secretary of State accept that, over a long period, there has been succession of inquiries, including by journalists—particularly the local newspaper editor, for instance, who suffered as a result of gagging restraints being placed on him because of speaking out about what was happening at Ashworth? That has all militated against bringing out into the open what takes place in the hospital.
Does the Secretary of State accept that the greatest public concern at present involves the presence of a child on those premises? Will he now tell the House which local authority that child is in the care of, and undertake that nothing will be done to impede the flow of any information that may come out of the inquiry to the Merseyside police, particularly in connection with their inquiry, which is already under way, into paedophile and child abuse activities in the region?
§ Mr. Dorrell
I can give the absolute assurance that nothing will be done to impede the flow of information. I do not propose to reveal which local authority is responsible for the social services department, for the fairly obvious reason that it would be quite hard to preserve confidentiality in relation to the child if we narrowed it down to one local authority and an ex-Ashworth patient with a young child. That would severely jeopardise the ability to maintain that confidentiality.
§ Mr. Dennis Skinner (Bolsover)
Is the Secretary of State aware that there is evidence that, some time ago, trade unionists who worked at the hospital received representations about the allegations, and that, in some cases, they were warned that, if they opened their mouths too wide, the union would be de-recognised? Is he aware that one of the features of this Government is that, more and 28 more, trade union free collective bargaining is prevented in these institutions, including in nursing homes? His Government encourage such activity.
The Secretary of State and the Government should be aware of the fact that trade unions are not just about wages; they are about conditions, and they act as watchdogs to alert the management to practices. It is high time that more attention was paid to such people, who have to work for a living, so that they can alert the authorities to some of the abuses that have taken place at Ashworth and elsewhere.
§ Mr. Dorrell
The suggestion that any part of the health service has threatened to remove recognition from a trade union that has raised such a concern is, frankly, ridiculous. One of the features of the hon. Gentleman's contributions to the House's debates is that they get further and further removed from anything that resembles the sort of world in which the rest of the House lives.
§ Mr. David Winnick (Walsall, North)
I pay tribute to my hon. Friend the Member for Halifax (Mrs. Mahon), who carried out her parliamentary duties in the most conscientious way. A tribute should certainly be paid to her for so doing.
Is the Secretary of State aware that the large majority of people believe that he should have enough on his plate as Secretary of State for Health without delving into Scottish nationalism, devolution or developments in the European Union? Is it not unfortunate that he finds plenty of opportunities for such headline work, trying to promote himself in the Tory party, and not doing the job for which he was appointed in the first place?
§ Mr. Dorrell
I notice that, when the opportunity arises to make a contribution to one of the most difficult aspects of the health service, all the hon. Gentleman can think of is an opportunity to make silly party political points. I think that the House and the country will draw their own conclusions from his action.
§ Mr. D. N. Campbell-Savours (Workington)
If it is true that some information about these matters, in particular Mr. Daggett' s comments, was being reported in the press in late autumn, is it not fair to say that the Minister's private office would have been aware of that? If it was aware of it, why did it not carry out inquiries as early as that, instead of the inquiry being set up today?
§ Mr. Dorrell
The answer is that questions were asked on behalf of Ministers, and answers were given that suggested that there was not a problem. It is precisely that failure to pass on the information central to proper accountability that is the focus of the inquiry that I have set up.
§ Mr. Andrew Faulds (Warley, East)
Should not the whole question of the grouping together of so many people with the medical condition that leads to this sort of perverse conduct be re-examined? Is it really advisable that so many people should be congregated together who are only too likely to indulge themselves in this sort of improper performance and conduct? Should this not be a matter that is looked at in this investigation?
§ Mr. Dorrell
The hon. Gentleman raises an important point. Incidentally, it would be wrong to imagine that every 29 patient in the personality disorder unit is there because of sexual offences, as that is not the case. Personality disorder has a wider meaning than that.
However, there is a serious question about the proper provision for people with severe personality disorders. I suggest that lay Members of this House should approach this question by taking the advice of trained psychiatrists, who have a proper understanding of what is and is not possible with modern psychiatric science. Having said that, I believe that the hon. Gentleman is quite right to say that there are important questions about clinical judgment concerning the treatment of such patients, and that is exactly what the commissioning board is examining.
§ Mr. Paul Flynn (Newport, West)
Why is it that everything that goes right in government is the result of the work of Ministers, and everything that goes wrong is the fault of civil servants?
§ Mr. Dorrell
Whenever I speak about the work of the NHS, I am careful to say that its successes are the result not of political insight but of the dedication and professionalism of the professional staff who work in the health service day after day. I find it rather difficult to stomach the slighting of their work that sometimes comes from Opposition Members.
§ Mr. John Gunnell (Morley and Leeds, South)
The Blom-Cooper report—all but one of whose recommendations have been followed—recommended that there should be an internal inquiry into the dissemination of what it described as "unacceptable literature". It is clear from what the Secretary of State has said that that inquiry has been held. What recommendations were made as a result of that inquiry? From what he has said and what has been reported today, it seems that the recommendations were not effective. When was the inquiry held? What system of accountability currently exists? At what point do he and his office become aware that the system is breaking down?
§ Mr. Dorrell
I inherited the regime that was introduced following the report. The hon. Gentleman asked how I deal with the implementation of recommendations. The answer is that I make individuals responsible for them, and I set time scales for reports on the implementation of the proposals. I am advised, and am satisfied, that all the recommendations in the Blom-Cooper report, with the exception of the one concerning seclusion, were implemented. I do not know precisely what regime was set up to enforce accountability for the implementation.
§ Mr. Tam Dalyell (Linlithgow)
Pursuant to the Secretary of State's answer to my hon. Friend the Member for Workington (Mr. Campbell-Savours), what questions were asked, and what answers to those questions suggested that there was not a problem? It seems as if the Department's officials were deceived by the answers. Is that the case, or were the wrong questions asked?
Did any Minister or official go to or contact this hospital between September and January? As a former parliamentary private secretary to one of the Secretary of State's predecessors who had to deal with Ely, Farley and South Ockenden, I know how difficult questions relating to psychiatric hospitals are. However, I repeat: what questions were asked, and what answers led to the suggestion that there was no problem?
§ Mr. Dorrell
The Under-Secretary of State for Health, my hon. Friend the Member for Chelmsford (Mr. Burns), visited the hospital last autumn. He discussed the issues with the hospital management when he was there. I refer the hon. Gentleman and the House to the paragraph in my statement in which I said:Despite the availability of this evidence and of Mr. Daggett's allegations, the hospital continued to maintain that press reports of unacceptable and possibly unlawful activity within the … unit were unfounded.The hon. Gentleman asked what questions were asked. The questions asked were the obvious ones, given the nature of the reports that were circulating: we asked, "May we please have advice about the nature of the allegations and what is being done to follow them up?" I do not propose to be drawn further on the advice that was given, beyond saying that the advice received by Ministers and officials in the Department of Health from the hospital made it clear that the hospital did not believe that there was a problem. That is one of the issues that will be at the centre of the inquiry that Mr. Fallon will lead.
§ Mr. Peter Thurnham (Bolton, North-East)
Further to the previous question, how often do Ministers visit such hospitals? Should not those hospitals be inspected regularly by official bodies, as my hon. Friend the Member for Southwark and Bermondsey (Mr. Hughes) suggested, and by Ministers, in order to build a culture that encourages visits rather than a culture of neglect?
§ Mr. Dorrell
The answer to the hon. Gentleman's first question is illustrated by the fact that my hon. Friend with direct responsibility for the special hospitals has visited all three in the four months that he has been responsible for them. In the period that I carried that responsibility, I visited two of the three. Those hospitals are regularly visited by Ministers, but anybody who believes that a ministerial visit is the means of discovering whether serious abuse is taking place on an individual ward has not carried out any ministerial visits.