§ 4.36 p.m.
§ The Parliamentary Under-Secretary of State, Department of Health (Baroness Cumberlege)
My Lords, with the leave of the House, I should now like to repeat a Statement about the allegations concerning Ashworth Hospital in Merseyside which is being made in another place by my right honourable friend the Secretary of State for Health. The Statement is as follows:
"With permission, Madam Speaker, I wish to make a Statement about action being taken to address the allegations involving the Personality Disorder Unit at Ashworth Hospital in Merseyside. This unit comprises six wards, with 115 patients, within the total hospital population of 473 patients. Members will be aware that last Friday I instituted urgent action to address the very serious situation which 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 17th 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 28th January 1997 the Home Office received a letter from the honourable Member for Halifax enclosing a 60-page dossier which sets out the detail of Mr. Daggett's allegations. This dossier was passed to my department.
34 "On 31st January, police visited the home of a former Ashworth patient who had continued to be a frequent visitor to the hospital. Following this police action, a child has been taken into the care of the local authority under an emergency protection order.
"In the light of the allegations made by Mr. Daggett and of other evidence that has recently become available, I made three announcements on Friday. First, the hospital has suspended three members of staff, including the chief executive. An acting chief executive has been 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 that the hospital has today also suspended a member of the medical staff.
"Secondly, I have established 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 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. Its report will be published.
"The terms of reference for the inquiry will be published as soon as possible. They will make clear that since it is activities within the Personality Disorder Unit of the hospital which have given rise to recent concern, the inquiry should focus on the policies, management and clinical care provided by the unit. The inquiry will, however, also wish to follow up any wider questions which are necessary to the proper consideration of these issues.
"Thirdly, with regard to 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 which have been made about Ashworth Hospital are extremely serious. The public is 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."
My Lords, that concludes the Statement.
§ 4.41 p.m.
§ Baroness Jay of Paddington
My Lords, we are grateful to the Minister for repeating a Statement about a very serious and disturbing situation. We on these 35 Benches welcome the announcement of the inquiry and the fact that it has been quickly established. We have a concern as to whether its approach is broad enough. It is extremely sad that there is an urgent need for another inquiry at Ashworth only a few years after a similar investigation into serious incidents produced changes, including the appointment of the present chief executive who has now been suspended. I should like to ask a question about the suspension of senior staff. Can the noble Baroness add anything to her brief remarks about the suspension today of a medical member of staff? That matter was not referred to in the written version of the Statement that I was given.
The most serious questions that are raised today are probably those relating to the overall management and treatment of the so-called personality disordered—who used to be referred to as the psychopathic group of patients—in this one unit. All noble Lords recognise the extremely difficult and complex problems of combining care and security in this specialist field. On the whole, we welcome the move to the system of 24-hour care, where patients now have greater personal flexibility. For example, they hold the keys to their own rooms. Clearly, for that system to be acceptable and successful there is a need for highly skilled and effective management. Patients also need to be directly supervised by an adequate number of trained staff who are not intimidated or manipulated by the disordered and sometimes dangerous personalities in their charge.
The extremely disturbing situation at Ashworth that has been described suggests that security and supervision have been extremely lax and that there may even have been collusion between staff and patients. Obviously, the inquiry will look at the quality of management at the hospital as a top priority, but it will also need to establish whether there was implicit or explicit collusion about the pornographic and drug-taking activities that allegedly took place. Perhaps the Minister can assist us this afternoon by saying what, if any, evidence of such collusion has emerged. One knows that evidence of widespread drug abuse has been reported for more than a year by external supervisory organisations but has not been acted upon.
In addition, there is a statement by Mr. Daggett, a patient, to which the Minister referred, and a statement by Mr. Corrigan, an ex-nurse, which seem to have been ignored. I remind your Lordships that Mr. Corrigan had worked at the hospital for 10 years. It was he, among others, who reported the deplorable circumstances in which a young girl was smuggled into the unit and possibly molested.
Can the Minister explain why such various and authoritative reports were not acted upon more quickly? Were the mechanisms for reporting up through the system adequate? For example, how could these matters have been known locally without any reference to a regional authority or to the Department of Health? Are we seeing yet another serious example of the fragmentation of the NHS that leads to all of these matters being dealt with at such a local level that ministerial responsibility is difficult to carry out? For example, did any Minister know before the 28th January 36 reference to the dossier by the honourable Member in another place about what was happening, or was the Member of Parliament the first person at central government level to hear about it? Is the Minister concerned that the so-called gagging clauses which exist in NHS contracts have inhibited those members of staff who are still employed at the hospital from speaking more openly about their experiences?
Your Lordships will be aware that there are grave shortages of specialised staff across the whole spectrum of care for the mentally ill, particularly in the special hospitals. Can the Minister inform the House whether reports that staffing levels at Ashworth are at an all-time low are accurate? The reports say that there are shortages across the board, from forensic psychiatrists to ward orderlies. If they are true, what steps were being taken to improve the situation before these allegations became public? Can the noble Baroness speculate about the cause and effect of the staff shortages and the allegedly anarchic situation that the inquiry will investigate?
I said earlier that we welcomed the inquiry and the speed with which it had been set up. However, we are concerned that its terms of reference may not be sufficiently wide for it to consider some of the general issues about Ashworth and other special hospitals that need to be investigated. It is obvious that in the short term priority must be given to the alarming situation that has been revealed, but we on these Benches are anxious that the broader policy questions are also addressed. For example, for some time there has been discussion about the effectiveness or appropriateness of very large institutions and special hospitals like Ashworth, where many personality disordered patients are detained together. Noble Lords may recall that Sir Louis Blom-Cooper, who chaired the previous inquiry into events at Ashworth, described such organisations and institutions as inherently unmanageable. Will the inquiry be able to tackle that issue which is about both management and treatment?
There is an even broader clinical question about the psychiatric ability to treat personality disordered people. This is a subject that is much debated among psychiatrists, and potentially it has far-reaching consequences for the care and control of such patients. For example, has the Department of Health had time to discuss with the Home Office the possible impact of rethinking the questions about the treatability of these patients under the so-called hybrid orders for hospital and prison care that are proposed under the current crime Bill? It is important that these wider questions are inquired into and openly aired. There may well be a strong case for making this inquiry a public one so that at least the suspicions of cover-up and collusion can be seen to be examined. If the decision has been taken not to hold a public inquiry, perhaps the Minister can explain why that has been thought necessary. We all understand the importance of not compromising possible criminal proceedings.
Overall, we on these Benches would like to see both the specific problems and the general questions authoritatively and openly investigated; otherwise, we fear that in a few years' time another scandal will erupt 37 and may well he tackled with short-term crisis management, while the underlying issues at Ashworth and other special hospitals remain unresolved.
§ Lord McNally
My Lords, the noble Baroness, Lady Jay, has quite rightly drawn the attention of the Minister to the need for a proper balance between care and security at Ashworth. But I do not believe that Ministers should get away scot-free after the sheer disbelief and outrage of the general public at the catalogue of disasters that has been announced. Here we have child abuse and pornography—the worst nightmares of the public—associated with a secure unit for which there is direct ministerial responsibility. In an earlier age there would have been only one Statement made to either House; that is, a ministerial resignation. However, that belongs to an earlier age. Therefore, it is important that Ministers make it clear that there is a sense of urgency to match the public disquiet at what has been revealed at Ashworth. A one-year general inquiry—I echo the call of the noble Baroness, Lady Jay, for a public inquiry—may meet some of the concern.
There is need for immediate action. It is, again, unbelievable that this Statement is a product of the courage and publication by a patient. It has nothing to do with the lines of communication and command within the department but with a patient going public. We must have immediate assurances that there are already in place, ahead of any inquiry, proper and adequate machinery for inspections that breaks through what clearly is a successful wall of silence and collusion within these institutions. Without that assurance of external inspection, public disquiet will remain.
It is amazing that there have not already been any arrests or criminal prosecutions, given the range of evidence that has been acquired: 1,200 videos within a so-called secure unit suggests a range of knowledge and awareness which again makes the mind boggle.
I ask the Minister to comment upon the point made by the noble Baroness, which must awaken concern, about the size of these units. Earlier inquiries have drawn attention to the fact that units of this size are inherently unstable and unmanageable.
What lies at the heart of the Statement is its flabbiness and feebleness in the face of a scandal of such proportions. The actions are the usual ones—the judge is rolled out; a year of inquiry. But what the public want to know is that in this institution and parallel institutions immediate action is being taken to stop criminal activity by inmates, staff or visitors. I am not sure that that assurance comes from the Statement. Nor is there any sense of urgency about putting in place an independent inspectorate that can give the public the safety and the assurance they require.
§ Baroness Cumberlege
My Lords, first, I thank the noble Baroness, Lady Jay, for welcoming this inquiry. The noble Lord, Lord McNally, used the words, -Here we have" child abuse, child pornography, and so forth. We do not know whether it is, "Here we have".
38 These are allegations. That is why the inquiry is being set up. It would be wrong to jump to any conclusions before the outcome of the inquiry.
The noble Baroness asked about staff collusion, staffing levels, and why reports had not been acted upon earlier. Those are all matters for the inquiry, which is why we have set it up. My right honourable friend the Secretary of State only received these allegations at the end of last week. He acted within days to set up the inquiry to see whether or not the allegations have force behind them.
We should see this also in connection with the Health Advisory Service which reported in 1994 that things were improving at Ashworth. It said that there was a great deal more work to be done, but the Government acted upon all but one—the question of seclusion—of the recommendations of the Blom-Cooper Inquiry. The Health Advisory Service said that the changes were making an impact. It is hard for these institutions, whose whole nature is one of security, always to find out exactly what is going on.
The noble Baroness asked also whether the inquiry would look at much broader policies. We are doing that through the High Security Psychiatric Services Commissioning Board. It has already done a great deal on the general strategy for these secure services. It will be reporting its conclusions in due course.
The noble Baroness asked also whether the inquiry should be an open one. We have left that for decision by the chairman and the panel members. We shall publish the report, but we believe it important that we should get to the whole truth. One of the lessons we learnt from the Allitt Inquiry was that if the total inquiry is made public it does not always allow people the freedom to express their views about the situation they find working within these hospitals. It will be for the inquiry panel to determine whether it should be held in public or in private or, indeed, part private and part public. With the sensitivity of the issues and the need for patients to give evidence it may be that at least part of the evidence should be taken in private, but that would be a matter for the panel.
§ 4.56 p.m.
§ Lord Campbell of Alloway
My Lords, taking account of the fact, as my noble friend the Minister said, that these are but allegations, nonetheless they are very serious and disturbing allegations. I accept that my right honourable friend the Minister acted with dispatch, but I should like to know what supervisory system was set up in the wake of Sir Louis Blom-Cooper's report. Who was operating it? How often were visits made? What was found? If there were no visits or if nothing was found, why was that so? I do not think that this is the sort of situation—allegations; yes, but terrifying ones—which one can slough off in any way.
I heard what my noble friend said about there not being a public inquiry. I beg my noble friend to reconsider. I think it should be a public inquiry with evidence given on oath. This is a very serious matter. There may be difficulties with certain patients who may not necessarily understand the nature of the oaths, but 39 some of the staff presumably do. This should be treated with the utmost seriousness. I made a similar request when the Matrix Churchill matter was raised in your Lordships' House. There are two other aspects. Is this entirely within the remit, the responsibility, of the Secretary of State for Health? I do not know. Has not the Home Office—the noble Baroness raised the point—any responsibility? Is it not involved in the supervisory arrangements? Can this not be reconsidered? It is not a matter for Judge Fallon whom I know personally. He is a first rate man. It is not a matter for him. It is a matter for government. The responsibility lies with some ministry or two ministries. It is not for Judge Fallon really to make recommendations.
§ Baroness Cumberlege
My Lords, I thank my noble friend for some of those comments. Of course my right honourable friend and, indeed, all his Ministers share with him the view that this is a very disturbing set of allegations. It is serious, and that is why we have taken prompt action. My noble friend suggests that there should be another body to supervise these hospitals. That is something that the inquiry will clearly want to consider.
At the moment we have the Health Advisory Service and the Mental Health Act Commission. They are two bodies which have overall responsibility for looking at the clinical practice within these three special hospitals. I am not sure whether a third would do the trick. Perhaps one must look to different mechanisms and to different lines of accountability. The hospital authority board, which has a chairman and non-executive members, is in many respects set up like a hospital trust. The chairman has direct accountability to the Secretary of State. The commissioning board, which purchases the services for the National Health Service, is part of the NHS Executive. The chairman of that board also has direct responsibility to the Secretary of State. There is a clear line of accountability, but it is for the inquiry team to see whether it worked; if it did not, why; and how it can be improved.
§ Lord Harris of Greenwich
My Lords, is the Minister aware that many of share the view of the noble Lord, Lord Campbell of Alloway, that the inquiry should be in public? There is widespread public concern about the matter which will not be allayed by an inquiry taking place behind closed doors.
Will the Minister also tell us more about the report of the Health Advisory Service? I believe she said that in 1994 the report indicated that there had been an improvement. Is she aware that if there had been an improvement, heaven alone knows what the conditions were like previously?
Finally, what is the Minister's reply to the point made by my noble friend Lord McNally? Is it not already clear that there should be some external inspection of such hospitals; the kind which operates within the Home Office with the chief inspector of prisons? Is it not 40 obvious that if such an inspectorate had been in existence many of these shocking episodes would have been identified earlier?
§ Baroness Cumberlege
My Lords, the noble Lord asks what the Health Advisory Service found and if the situation had improved. The Health Advisory Service went in after the Blom-Cooper report in 1992. It found improvements but said that there was more work to be done. Perhaps I may put that into context. Before Sir Louis Blom-Cooper compiled his report allegations were made and evidence was found within Ashworth that it was a brutal system and a more therapeutic service should be provided. Sir Louis Blom-Cooper put forward about 25 recommendations. We have implemented all of those except for one which relates to seclusion.
The Health Advisory Service found that the situation had improved. It is for the inquiry to decide the matter, but it may be that one regime has been superseded by another and the swing has been too great. Clearly, the inquiry will wish to examine that matter.
I believe that I dealt with inspections when I replied to my noble friend Lord Campbell of Alloway. There are inspections by outside bodies and it will be for the inquiry team to decide whether a third body carrying out inspections will improve the standards or whether we should be using other mechanisms.
Lord Bruce of Donington
My Lords, I deeply sympathise with the Minister in the position in which she finds herself with regard to the allegations. Can any of the allegations to which she referred by regarded as criminal? If there are suggestions that criminal actions may have taken place it is difficult to understand why the police were not immediately called in. Can the Minister enlighten the House about that?
§ Baroness Cumberlege
My Lords, yes, the police are very much involved in these allegations. They are in the hospital at present, which is one of the reasons why we have some difficulty with the inquiry. Clearly, we must in no way obstruct what the Merseyside Police are doing at present.
I have been to Ashworth on two occasions and I have spoken to those responsible for the hospital. I know that in parts of the hospital extremely good work is being carried out. We are talking about one unit within the hospital, and that needs to be seen in context. The personality disorder unit contains people who, in the old jargon, were called psychopaths. They are very disturbed, violent people. I believe that they are the most challenging patients with whom we must deal anywhere in the health service and it is not surprising that on occasions we have difficulties.
§ Lord Merlyn-Rees
My Lords, perhaps I may return to the terms of reference. I finished today for publication next week an inquiry into allegations against the hospital trust in Leeds. Constantly, during the past three years I found that the people concerned had not read the terms of reference. The Minister referred to wider matters and my noble friend Lady Jay referred to more 41 general matters. Will the wider matters include resources and staffing of a wider nature than the narrower hut important issues that we have discussed today?
§ Baroness Cumberlege
My Lords, the terms of the inquiry will be focused on the clinical care, the policies and the procedures carried out within the unit. They will also take into account the security and management arrangements. To my knowledge there have been no problems regarding financial resources to the hospital. That has not been an issue. As regards whether the inquiry should look wider, my right honourable friend the Secretary of State said that he wants it to focus on the personality disorder unit of the hospital. However, if the inquiry wishes to follow up wider questions which are necessary to the proper consideration of these issues it has the freedom to do so.
§ Baroness Jay of Paddington
My Lords, as we have a little time, perhaps with the leave of the House I may return to a few questions which I asked in my original remarks. The Minister has not responded to them but I believe that they are important and are not covered by the terms of the inquiry which she says make them difficult to comment on. The first is the issue of staffing levels at Ashworth, which must have been known to the management and to people in the wider healthcare community before the allegations became public. If the suggestion of considerable under-staffing at Ashworth is true, what was being done about it before the allegations came to light?
My second question related specifically to the member of the medical staff who, the Minister said, was suspended today but whose suspension was not referred to in the Statement.
My third question related to the mechanisms for reporting upwards from the hospital through the health service. There appears to be a considerable lacuna between the reporting of individual members of staff and the Secretary of State, or the Minister who is responsible for the hospital. Although the Minister said that the hospital trust will report directly to the Secretary of State, my suspicion remains that we are seeing another example of the fragmentation of proper responsibility and accountability within the health service.
§ Baroness Cumberlege
My Lords, I am afraid that I cannot answer in detail the issues concerning the staffing levels at Ashworth. All I can say is that all such hospitals are both professionally and geographically isolated and find difficulty in attracting staff. As regards staff reporting, in this case it was not a member of staff who was reporting but a patient who was making allegations. I am sure that noble Lords who are aware of such institutions will know that frequently allegations are made by patients about their personal treatment.
§ Baroness Jay of Paddington
My Lords, I believe that there was also an ex-nurse who was very much 42 involved in those allegations, which were substantiated, it is true, by the patient. However, there was the involvement of that ex-nurse.
§ Baroness Cumberlege
My Lords, an ex-nurse was in charge of the patient Daggett, who absconded. He was subsequently dismissed by the board. I am in no position to judge the veracity of the allegations and, again, I am sure that that is something which the inquiry will wish to take up.
The accountability of this particular hospital is very clear. I explained it to my noble friend. It is as clear as it is with a trust or a health authority: it goes through the regional office of the NHS Executive to the Secretary of State. The noble Baroness is a member of a health authority and no doubt she knows the lines of management accountability as well as I do.
§ Lord Richard
My Lords, the Minister has told us for the first time that a member of the medical staff has been suspended. Can we have some more information about that? Who is the person and what position does he hold? What is his connection with the allegations?
§ Baroness Cumberlege
My Lords, I do not have the name of the member of staff. All I know is that allegations have been made about him. I do not know what those allegations are in the same way that I do not know any details about the two nurses who have been suspended and the allegations made about them. But they are all suspended pending the inquiry, as is the chief executive.