§ 4.10 p.m.
§ THE MINISTER OF STATE, DEPARTMENT OF HEALTH AND SOCIAL SECURITY (BARONESS SEROTA)
My Lords, I will, with permission, now repeat a Statement which is being made by the Secretary of State for Social Services in the House of Commons about the Report of the Committee of Inquiry into the Ely Hospital, Cardiff, which has been presented to the House this afternoon as a White Paper, Cmnd. 3975. In doing so I must apologise for its length. The Statement is a follows:
"The Committee of Inquiry was set up in 1967 by the Welsh Hospital Board at the request of my right honourable friend, the then Minister of Health, to investigate allegations of ill-treatment of patients and of pilfering by staff which had been made by a nursing assistant employed at the hospital. The Committee was also asked to make their own examination of the situation in the hospital at the time of their inquiry.
"The Committee, under the chairmanship of Mr. Geoffrey Howe, Q.C., has done its work with a thoroughness fairmindedness and humanity which must command universal respect. This makes it all the more disturbing that the Report is highly critical and will, I am sure, cause as deep concern to Members as it does to me. It is for this reason and because I consider that it should be used at once as a basis for remedial action that I have decided to take the unusual course of publishing it in full, omitting only the names of individual patients and staff.
"The Committee finds, first, that most of the specific incidents alleged by the nursing assistant as examples of ill-treatment did occur. Secondly, the Committee finds that many members of staff in the wards made use of food supplied for patients, and that excessive quantities of meat were provided to 1385 nursing staff. These aspects of the Report have been referred to the Director of Public Prosecutions. Thirdly, the Committee finds that an atmosphere existed in which well-intentioned members of the nursing staff felt it hazardous to complain; two who did so had to leave the hospital.
"Responsibility for serious deficiences in standards of medical and nursing services and of administration is attributed to the senior staff of the hospital, to the Hospital Management Committee and to the Welsh Hospital Board. The Committee also criticises the present procedures for dealing with complaints in the hospital service as a whole. And finally the Committee recommends that a system of inspection of such hospitals is needed—the form of which it leaves me to consider.
"The House will, I am sure, wish to study the Report before coming to conclusions. Nevertheless I think honourable Members will expect me to say today what the Government's attitude to it is. As the Minister responsible I accept the Committee's findings and recommendations about Ely. I add, however, that it would be quite wrong to draw conclusions about the standard of care in long stay hospitals from these findings. I would remind the House that these findings do not apply to the whole of the hospital service or even to the whole of Ely Hospital: they apply only to four wards and one villa for children. To draw general conclusions from this limited evidence would be quite wrong. Indeed in the course of an extensive series of visits up and down the county I have myself been deeply impressed by the skilled and devoted service given by staff in long stay hospitals, who have all too often been working for many years under heartbreaking difficulties; and I am very much aware that if this Report were published without a firm assurance of strong remedial action, it could shake their morale. In expressing my confidence in them, therefore, I at once add this assurance to them and to the House. The conditions which have existed for so many years to which many of them have been calling attention for a long time and in which such grave deficiencies as have been revealed at Ely can far too easily breed, are fully 1386 and frankly recognised by my Department and I am already taking steps to ensure that they will be dealt with effectively by the Regional Hospital Boards.
"One of these conditions is professional isolation. The main recommendation of the Report is that a new system of regular visiting and inspection is needed. I agree. And while the details are being worked out I am setting up a small working party in my Department to analyse the knowledge already available on these hospitals, and to supplement this survey where necessary with their own investigation.
"Secondly I have already asked each Regional Hospital Board Chairman to reassess the situation in his region and to present a report to me at our next meeting in April.
"I hope the House will permit me one further general observation. We are in the midst of a medical revolution in the treatment of the diseases of old age and mental illness. As the span of life is extended long term, often permanent, hospitalisation which only 20 years ago was the norm for these patients, is being replaced by intensive treatment given in short spells in hospital. In planning the Health Service of the future, therefore, we are able to assume a massive reduction in the proportion of hospital beds—and of long-stay hospitals—requirel for geriatric and mentally ill patients.
"Unfortunately, this does not apply to anything like the same extent to the mentally subnormal. For the foreseeable future many thousands of them will need resident hospital care for very long periods and this means that there is no prospect of doing without this class of hospital which I am afraid still remains a deprived area within the Health Service as, indeed, it was long ago when the Service came into being. The advice issued by my Department in 1965 to stimulate improvements, which this Report commends, was a good beginning. It shows what can be done. These hospitals must be given their fair share of manpower and money even if this means (as it will mean) a reallocation of resources within the Health Service. I shall be considering with the Boards ways and 1387 means of starting this difficult operation as soon as possible."
§ LORD BROOKE OF CUMNOR
My Lords, this is a terrible story about Ely Hospital. I am sure the noble Baroness has found it as painful to have to make this Statement as the House has found it painful to hear it. I venture to suggest that until we have had time to read the findings of the Committee, the less any of us comments on what has actually happened at Ely Hospital the better it may be. May I be allowed, however, to say how strongly most of us would agree with what the noble Baroness said about not generalising from this lamentable case, but, instead, extending our support and appreciation to the devoted staff who work in many other long-stay hospitals—sometimes, I am sorry to say, under almost soul-destroying conditions.
As to what is wrong, the responsibility of Ministers is involved, as well as of Regional Hospital Boards and hospital management committees. Do the Government recognise that the whole of the hospital service is critically short of money and that, while hospitals for the mentally subnormal are in the greatest need of all if they are to satisfy modern requirements, their needs cannot be rightly made good by simply twisting more tightly still the financial screw on other hospitals?
§ LORD AMULREE
My Lords, I, too, should like to thank the noble Baroness for making this long and rather tragic statement. Like the noble Lord, Lord Brooke of Cumnor, I do not want to comment at this moment on the goings on at Ely Hospital and would rather wait until I have had time to study the Report. But I am very pleased that the Government have had the courage to publish this Report, even though it may be an unpleasant one to read. I should like to associate myself with what the noble Lord, Lord Brooke, said about the staff of these hospitals. Like him, I have had considerable experience of the conditions under which they work and of the marvellous work they manage to do under those deplorable conditions. One wants to pay the biggest tribute one can to the devotion to duty which they show.
There are three interesting matters to which I should like to refer. The first 1388 comment I would make (possibly it is unwise, but I should like to make it) is that it is the attitude of the senior staff that really lays down the attitude in the whole hospital, from the senior doctor down to the junior member of the ward staff. I am pleased to see that the Minister is to consider some way of changing the form of complaint, and possibly to introduce some form of inspection—I do not mean that in a pejorative way at all, but in a general, friendly and hopeful kind of way. I am a little worried about the assumption that there is going to be a large reduction in the number of beds taken for mental patients and geriatric patients. We were told that some time ago, and it proved to be sadly untrue. There may be some reduction but it will not be a very great one. I am very grateful indeed for the Statement.
§ 4.20 p.m.
§ LORD SEGAL
My Lords, if I may venture one or two comments from these Benches—and I do so with the greatest restraint—may I ask the Minister whether she realises the sense of relief that many people will feel that this Report has at last been published? These conditions have been known to exist for quite a long time in the past, and have given rise to an enormous amount of uneasiness. Also, may I say how much the statement made by the Minister, that the Government intend to take drastic action in this matter, will be generally welcomed? May I stress also the urgency for some action to be taken to remedy the appalling conditions which she has described?
In this connection I would emphasise the need for a special training for nurses who are on the staff of these institutions. Special recognition should be given to the difficult conditions under which they work, and, particularly, some adjustment should be made in the matter of their pay in order to recruit the proper type of nurse for these institutions. Furthermore, may I say how important it is that some proper channel should exist for the laying of complaints, when such complaints are known to exist, to see that they are not brushed aside in the future as they have been, most unfortunately, in the past?
BARONESS SUMMER SKILL
My Lords, I am afraid I cannot agree with my noble friend when she suggests that 1389 we might receive this Report without comment. I believe that every time an inquiry of this kind is made it is much better for the helpless individuals in these institutions to have people in both Houses of Parliament who are prepared to ask questions again and again. Therefore, may I ask—
§ LORD BROOKE OF CUMNOR
My Lords, in fairness to the noble Baroness, Lady Serota, may I say that it was not she who suggested there should be no comment? I suggested that we should withhold comment only until after we have had time to read the Report.
§ BARONESS SUMMERSKILL
My Lords, I agree, but some of us who have been in Parliament for many years have lived through this kind of moment, time after time. It is always suggested that we should read the Report and see what is in it. By the time we have read the Report other things are happening and people forget to ask questions at what I consider to be the relevant moment—now. What I want to ask my noble friend is this: is she aware that what she said just now applies to similar institutions throughout the country, in so far as the staff are intimidated? My noble friend said that two members of the staff were dismissed, or left, because they questioned the system: their questioning was unpopular, and therefore they were dismissed.
What I should like to know, in view of this Inquiry and of the Statement which has just been made, is what general inquiry is now going to be set afoot by her Department in order to see how far the conditions in this institution apply in others. Unless somebody from outside goes in, questions the management committees and generally makes a fuss, the conditions which she describes now and which have obviously been existing in this institution for years can go on in other institutions of which we have no knowledge. Therefore, my question to her is this—and I have faith in her Department, now that she is in this job, because she is a woman and has compassion. My noble friend at the back groans. I am afraid it is true that women have a little more compassion in these matters than, perhaps, some of the men. May I ask my noble friend whether she will see to it that her Department makes 1390 a general inquiry with regard to the administration of homes and institutions which are organised for the old and the sick? Because it is in these places that the patients are completely helpless.
§ LORD SHACKLETON
My Lords, I am bound to say that the House is getting seriously out of order at the moment. I realise that this is a matter of deep I concern. The House makes its own rules of order. In fact, we practically always break them on Ministerial Statements, but I would draw the attention of the House to the fact that questions for clarification may be asked upon such Statements but they should not be made the occasion for immediate debate. Before we go any further, I feel that this is a point of which we need to be reminded.
§ BARONESS SUMMERSKILL
My Lords, my noble friend having said that, may I ask him whether he will give us an assurance now that this matter will be debated in this House?
§ LORD SHACKLETON
My Lords, the noble Baroness, who is, as she reminded us, a very experienced Parliamentarian, knows that it is not for the Leader of the House to determine what noble Lords themselves may choose to debate. It is open to her to put down a Motion or an Unstarred Question at any tine. I may add that I think this is a matter of very grave concern, and obviously the House is rightly concerned. I would not disagree with my noble friend that this matter, along with other subjects, is one that could well be debated.
§ LORD OGMORE
My Lords, as the sole Welshman to speak on this matter—and it primarily concerns Wales—may I ask the noble Baroness whether she is aware that this Report will be regarded with the utmost seriousness in Wales, and that Welsh people will want to know that there are no other institutions where the same conditions might already apply? May I also ask her whether, when her right honourable friend has discussed the whole question of Ely Hospital with the Chairman of the Hospital Board, a further report or statement will be made to Parliament, conveying to Members the results of that interview between the two gentlemen concerned?
§ LORD SILKIN
My Lords, may I say (perhaps it is hardly necessary for me 1391 to say it) that I cordially agree with the noble Lord, Lord Brooke of Cumnor, and with the noble Lord the Leader of the House that, before we discuss this matter further, we ought to read the Report. I should like to put a question to the noble Baroness, and I put it because I was for many years both chairman and a member of a number of hospital management committees; and it seems to me inconceivable that a hospital management committee should not have known of what had been going on apparently for a long time. Certainly I should like to think that it could not have happened in the case of the hospitals with which I was concerned; and if a management committee is doing its job properly, it ought not to have happened in this case. May I ask the noble Baroness whether, in the Report, there is any reference to the activities of the Hospital Management Committee?
§ BARONESS HYLTON-FOSTER
My Lords, may I ask the noble Baroness whether Her Majesty's Government do not think that this is the moment to recommend that nurses should be moved around more? Because even with special training it needs superhuman patience to cope with some of the patients with whom they have to deal.
§ 4.27 p.m.
§ BARONESS SEROTA
My Lords, I thank all noble Lords who have spoken for their very balanced and restrained comments on a Statement which has clearly caused us all a great deal of distress. To my noble friend Lady Summerskill, whose comments were scarcely restrained, I can only say that I have very little doubt that if I were sitting in her place, and with her long Parliamentary experience, I should have reacted to a Statement of this kind in just the way that she has done to-day. It is a great support—and I know my right honourable friend the Secretary of State will share my feeling in this—to know that a Statement of this kind has been received in the way your Lordships have received it to-day. Of course, as the noble Lord, Lord Brooke of Cumnor, pointed out, the prime responsibility is that of my right honourable friend, and he and I will together, I hope, work through the recommendations of 1392 this Report and see the implementation of the proposals that I have put before your Lordships in the Statement to-day.
Of course, as again the noble Lord, Lord Brooke, pointed out, there is no superfluity of money in the National Health Service—I only wish there were. Nevertheless, I think it is the duty of the Ministers responsible to take cognisance of the fact that there are large differences between the amounts spent in hospitals such as this and in other kinds of hospitals within the National Health Service, although of course there are sometimes good reasons for those differences. We must also take note of the fact that there are large differences between what different regions spend on these hospitals. These are aspects which my right honourable friend will clearly want to investigate.
All noble Lords expressed some relief at the publication, and one or two asked specific questions. Here I would join with my noble friend the Leader of the House in asking them to read the Report; and I assure my noble friend Lord Silkin that there is mention in this Report of the activities of the Hospital Management Committee. With regard to the point made by the noble Baroness, Lady Hylton-Foster, about staff being moved around, as I indicated in the Statement that I read on behalf of my right honourable friend, the lesson of Ely is the need to avoid professional isolation in medical, nursing or in other grades of hospital staff. If noble Lords read the Report they will see that this aspect stands out clearly.
The noble Lord, Lord Ogmore, asked about the situation in Wales. I can assure him that my right honourable friend the Secretary of State for Wales (who will become responsible for Welsh hospitals on April 1) is fully aware of the situation; and from my conversations with him I know that he is taking action himself on the Ely Report.
Finally, my noble friend Lady Summerskill asked me two questions. She asked: What is being done to inquire into other hospitals? She joined with the noble Lord, Lord Ogmore, in asking whether the results of these inquiries will be reported. When, at leisure, your Lordships read the Statement that I have just repeated you will find that there is a two-fold answer to this question. In 1393 the first place, my right honourable friend is considering the setting up of a professional advisory system at regional and central levels so that by regular visiting we can raise standards in these hospitals as a whole. That is the long-term plan. In the short term the working party that my right honourable friend is setting up will have as its first task an assessment of the situation in other hospitals with a view to discussing with the regions what reallocations we need to make to improve standards.