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Single Regeneration Budget
11. Mr. Gordon Marsden (Blackpool, South): How the single regeneration budget fifth programme will be targeted on the areas of greatest need. [63575]
The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Mr. Alan Meale): Under round 5 of the single regeneration budget, about 80 per cent. of new SRB resources will support comprehensive regeneration schemes in the most deprived areas, based on the 1998 index of local deprivation. About 20 per cent. of the resources will tackle pockets of need elsewhere, including rural areas, coalfield areas and coastal towns.
Mr. Marsden: In welcoming my hon. Friend's answer, may I draw his attention to two matters? First, there is a need for the survey to be extremely specialised, given that, in seaside and coastal towns in particular, there are often pockets of deprivation in the centre of towns. Secondly, during that review, will he look especially favourably and sympathetically on those areas of public infrastructure in seaside and coastal towns that are not currently eligible for heritage or other forms of lottery grant?
Mr. Meale: First, I pay tribute to the amount of work that my hon. Friend has done since becoming a Member of Parliament at the last general election. The Government are well aware of the extent of the social deprivation occurring in many seaside and coastal towns. My right hon. Friend the Deputy Prime Minister has shown his awareness of it in his many speeches on regeneration and in the reshaped single regeneration budget, which was announced on 22 July 1998. We shall pay particular regard to the problem and focus on it in any future SRB bids and planning.
Capping Criteria
12. Mr. Andrew Lansley (South Cambridgeshire): If he will make a statement on the impact which his decision not to announce capping criteria will have on (a) transparency and (b) accountability. [63576]
The Minister for Local Government and Housing (Ms Hilary Armstrong): The accountability and transparency of local authority decision making will be improved. Local authorities will no longer be able simply
to take their capping limits as their budgets, and will instead have to consider carefully their needs and the funding they will receive when drawing up their spending plans.
Mr. Lansley: Does the Minister not understand that the absence of pre-signalling of capping criteria means that, to local authorities, the capping system this year, far from being transparent, is utterly opaque? Does she understand that it would be an unhappy situation if local authorities were to be capped with a small margin between their budget requirement and the capping limit? Will she give local authorities and the House two pledges: first, that an allowance will be made for very small differences between any capping criteria, so as not to require rebilling for small sums of money; and, secondly, that she will take particular account of the special circumstances of authorities that have a budget requirement that is close to their standard spending assessment?
Ms Armstrong: I am not able to tell the House today what the capping criteria will be. We are currently consulting on that matter; the consultation finishes tomorrow and we shall bring our proposals to the House. I do not accept that the system has been made more opaque. The fact is that the previous Administration introduced a system that meant that central Government determined everything. That gives local authorities little accountability to local people and little opportunity or responsibility to work with local people to achieve a budget that gets the best for local people at a price they are prepared to pay. I believe that the new system will lead to increased accountability and to greater clarity for local people.
Mr. Lindsay Hoyle (Chorley): I believe that transparency is something on which the Labour Government were elected. I asked a similar question about the criteria used for capping, but the answer I received was "No." That is not helpful to local government,
especially the council in Chorley which asked me to ask the question. Will the Minister reconsider the answer she gave and be more open and more transparent?
Ms Armstrong: We are fulfilling a manifesto commitment, and I understand that my hon. Friend was also elected on that manifesto. As long as central Government set the limits, although the system will be transparent at one level, at another it will remove all responsibility from local authorities. Local authorities should be more independent and more responsible to local taxpayers. My right hon. Friend the Deputy Prime Minister has made it clear that local authorities are charged with being responsible. If they are responsible, capping will not arise.
Dr. Evan Harris (Oxford, West and Abingdon): May I remind the Minister that the Labour manifesto promised to end universal capping; that the Oxfordshire Labour party manifesto for the 1997 county council elections said, "Vote Labour and end capping and the cuts to local services"; but that, on taking office, the Labour Government capped Oxfordshire's budget, jointly proposed by the Labour group? Does she accept that, by not publishing in advance the capping criteria, not only is there still universal capping, but there is now random universal capping? The people of Oxfordshire will not forgive the Government for the cuts in social services and education that flow from that outright negation of local democracy.
Ms Armstrong: I met Oxfordshire county council this morning. I am sorry that the hon. Gentleman was not part of that delegation, but I take his point as part of his representations and I am not criticising him. The manifesto commitment was to remove crude and universal capping. In the manifesto, we made it absolutely clear that we would retain reserve powers. There is a national interest and we are seeking to achieve a balance between the local and national interests.
Ashworth Special Hospital
3.30 pm
The Secretary of State for Health (Mr. Frank Dobson): Madam Speaker, I wish to make a statement on the report of the public inquiry into the Ashworth special hospital conducted by his honour Peter Fallon QC. That inquiry was established by my predecessor in February 1997 to investigate allegations by Mr. Steven Daggett, a former patient of Ashworth special hospital, that there was misuse of drugs, financial irregularities, possible child molesting and the circulation of pornographic material in the personality disorder unit at the hospital.
I also pay tribute to the work of my hon. Friend the Member for Halifax (Mrs. Mahon), who brought this matter to the attention of the Government. She subsequently received threatening telephone calls, which she believes came from people whose trade in pornographic videos was interrupted by her intervention.
In this short statement, it is difficult to do justice to the inquiry report, which is 473 pages long. The executive summary alone covers 44 pages. So, I will highlight the major points in the report. The inquiry sat for a total of 66 days, taking evidence from a wide range of witnesses involved in Ashworth hospital, both in the past and at present.
The report presents a shameful picture. The general allegations made by Mr. Daggett were largely true. There were financial irregularities, drug abuse, the circulation of pornography and a poor quality of patient care.
Mr. Daggett's main allegations referred to Lawrence ward in the personality disorder unit. A ward within a personality disorder unit, set inside a special hospital, had been repeatedly visited by a seven-year-old girl, who was allowed unsupervised contact with patients guilty of sex offences against children. Her father brought her into the unit and, without let or hindrance, gave her unsupervised access to one patient who had a history of molesting young girls, including indecent assault and attempted rape. She also visited another patient who was locked up in Ashworth because he had kidnapped, tortured, sexually assaulted, mutilated and eventually murdered a 13-year-old boy. I am glad to say that the inquiry report concludes that there was no proof that the girl was abused, but that she was being "groomed" for later abuse.
The inquiry asked how a young girl could have been allowed to visit such men. It was told that the Lawrence ward was special and that there were not many incidents. All the patients were allowed to roam round much of the hospital unaccompanied. For a time, routine searching did not take place. The inquiry was told that the ward espoused the philosophy of a "democratic community". I should emphasise that the inhabitants of that so-called democratic community had between them committed innumerable murders, manslaughters, indecent assaults, indecent assaults on children, assaults or woundings with intent and a host of other offences.
The inquiry concludes that a small group of patients, led by the child murderer, was intimidating patients and staff and had gained a grip on the ward. It also concludes that there was a drugs problem on Lawrence ward, that it was endemic throughout the hospital, but that there was no direct evidence that nursing staff were involved.
The financial irregularities arose from a shop on Lawrence ward, from the sale of pornographic materials including videos and from people conducting credit
card businesses. Judging by the report, Lawrence ward appears to be a veritable outpost of the enterprise culture. The father who brought his daughter into Ashworth hospital also supplied pornographic videos, which he was allowed to deliver by car to the ward without either him or the car being properly searched.
There was a shop on Lawrence ward that was supposed to sell confectionery and soft drinks. Its turnover started at £50 a month and soared to £14,000 between January and October 1996. The child murderer also ran an unofficial shop from his side ward.
Unknown to senior managers, several patients--including Mr. Daggett, the person who complained--had been allowed credit cards. Eventually, when managers decided to end this arrangement, patients were forced to cut up their cards, but they retained the numbers so that they could renew them or continue to use them in telephone transactions. Security was so slack that Mr. Daggett managed, while in the hospital, to change his name by deed poll, acquire a new passport and driving licence and use a credit card to take out a large sum of money, prior to absconding.
The inquiry found that security was so lax that neither patients and staff, nor visitors were properly searched. It confirms Mr. Daggett's claim that, on Lawrence ward, the patients' rooms were not properly searched. That was illustrated when a full-scale search in January 1997 revealed a stock of children's underwear in the room of the man who had molested girls, and male pornography in the room of the child murderer. Both patients had video cassette recorders, used for copying videos. A previous search of the boot room on the ward had revealed 41 pornographic videos.
The inquiry set out to find how that deplorable situation had come about and how it had been allowed to persist. What it found out is a shameful story of confusion, indecision, mismanagement and incompetence. Some of the professionals and managers failed to show a glimmer of common sense, let alone to live up to the standards of their professions. The whole thing was a mess from top to bottom.
In the past, Ashworth had operated a harsh and repressive regime. Following scandals in the early 1990s, the Blom-Cooper inquiry in 1992 recommended a more liberal approach. The Fallon inquiry concludes that those recommendations, which were mainly directed at therest of the hospital, were implemented without proper consideration of their differing impact on different patient groups. As a result, the patients with personality disorders enjoyed most personal freedom and reduced security. The report says that it was quite predictable that those failures could be abused by some of the patients.
What is clear is that, because of the failure of top management to lay down and enforce clear rules for both patients and staff, security became less and less important. As a result, more and more problems arose but nobody attended to them. As the report says,
The Fallon report concludes that the whole system was at fault. I am sure that that is right, but the report goes on to criticise individuals and I am sure that that is right too, because too many people at Ashworth failed to do properly the jobs that they were paid to do. The report criticises a number of people by name. Ashworth hospital authority has already taken disciplinary action against some people, and some others have left Ashworth.
In the case of any of those criticised in the report who are still employed by the NHS, whether at Ashworth or elsewhere, I expect their employers to initiate appropriate disciplinary proceedings in the light of the report. In at least one case, the report will be drawn to the attention of the General Medical Council and other professional regulatory bodies. The United Kingdom Central Council for Nursing, Midwifery and Health Visiting has already commenced disciplinary action in one case.
The report recommends that Mr. Paul Lever, chairman of Ashworth hospital authority, should step down. He has done so. Anne Marie Nelson, former chairman of the Special Hospitals Service Authority and present chairman of the High Security Psychiatric Services Commissioning Board has also resigned, in accordance with the principles of public accountability.
The running of Ashworth and the terrible incidents there were the subject in the 1990s of a succession of inquiries and reports. In 1990, one patient was murdered on Owen ward and another was murdered on Forster ward. In 1992, the director of security carried out security audits at Ashworth, Broadmoor and Rampton. Her recommendations for greater security at Ashworth were ignored. At about the same time, a task force that was implementing the Blom-Cooper report described Ashworth as "over custodial". The Fallon report describes the task force's policy as a recipe for disaster.
In 1993, an inquiry into the women's services at Ashworth, which are not part of the personality disorder unit, produced a damning report. In 1995, there was an internal investigation into a hostage-taking on Owen ward. The report was 59 pages long with appendices covering 385 pages. Again, it was a damning indictment of what went on, but staff were shown only a nine-page summary, and so was the official responsible for implementing its recommendations.
Neither the Owen ward report nor the Swan report was made available to the health advisory service before publication of its review of progress following the Blom-Cooper report in 1995. Also in 1995 and again in 1996, patients attacked members of staff with razors. Later that year, the discovery in mail addressed to a patient of a machine for embossing share certificates led to an inquiry which revealed security breaches, scams and money-making ventures in the personality disorder unit.
Reports were prepared on all the incidents, but no machinery was put in place to see that changes and improvements were made. Nor was anyone ever given the task. I am determined that the Fallon report will notsuffer the same fate. The report makes 58 detailed
recommendations. Some cover the operational procedures at Ashworth. I am giving the hospital authority four months to develop an action plan to implement the necessary changes within the hospital. I am appointing lan Pirnie to chair the authority during that process. Mr. Pirnie presently chairs the Morecambe Bay health authority. I hope and expect that he will bring to this task the leadership and management skills that he demonstrated as an admiral in the Royal Navy.
Other recommendations cover the general role and organisation of the special hospitals and their relationship with the rest of the national health service. Those will be the personal responsibility of Sir Alan Langlands, the chief executive of the NHS. I have given the task of ensuring progress on the more general recommendations which apply across government to Chris Kelly, the permanent secretary at the Department of Health. All three will report directly to me and all three will be expected to deliver.
The inquiry team gave final clearance to its report on Wednesday of last week. The printed edition arrived this morning; it is being published this afternoon. A detailed response to all its recommendations will be published as soon as possible. In the meantime, I can say that the Government broadly accept most of the recommendations and I can give an immediate response to some of those that will be of most concern.
The report recommends that security should be given a higher priority--that searches of patients and staff should be introduced, that no visitors should be allowed into Ashworth without being searched and that there should be regular searches of patients' rooms. The Government accept those recommendations. We give top priority to the safety of the public. We have already taken action. All aspects of security have already been tightened up. New rules have been introduced. Management is making sure that they are implemented for people entering and leaving the Ashworth site, within the site and on the wards.
Further investment in extra security staff is being made. An extra £1.5 million is being made available for all three special hospitals this year and a further £4.5 million is being made available for increased physical security measures at Ashworth. That will allow fully effective searches to be made of all visitors, staff, patients, goods and vehicles, including, where appropriate, the use of X-rays, metal detectors and sniffer dogs.
I have arranged for an independent review of all aspects of security, including the use of the post and telephones at all three special hospitals, which will report direct to Sir Alan Langlands. The social services inspectorate will conduct inquiries into the social work aspects of Ashworth, and subsequently the other two hospitals, and report directly to me.
On visits by children, we have already changedthe rules on child visitors and gone beyond the recommendations in the report. In September last year, we put a stop to child visits to ward areas and visits by children who are not close relatives of the patients. No visits are allowed unless they are judged to be in the best interests of the child. All visits by children must be off the wards and must be supervised. Any visits by a child must be by prior arrangement. The rules apply at all three hospitals, and I wish to make it clear that those who breach any of those rules can expect to be summarily dismissed from their job.
The report recommends a review of the whole system of accountability within the national health service and between the national health service, officials of the Department of Health and Ministers, particularly in relation to the special hospitals and more generally. I share some of the inquiry's concerns about the system that I have inherited from my predecessors. I have made clear to the House who is to have personal responsibility for dealing with the various aspects of the report and that, for the present, they will all report directly to me.
The health Bill, which we will be introducing shortly, will put in place stronger and clearer accountability arrangements for the whole of the national health service and will end the internal market that has clearly inhibited more active management by the national health service executive and regional offices. As recommended in the Fallon report, the commission for health improvement will cover the special hospitals.
In addition, the board of every hospital--including each special hospital--will have for the first time a statutory duty concerning the standards of treatment and care it provides, there will be clearer powers for the Secretary of State to issue directions, and new arrangements for commissioning specialised services. I am giving further consideration to the question of overall accountability in the light of the report's recommendations.
The inquiry was set up to consider the personality disorder unit, not the future of the whole hospital, and of its high-security psychiatric services. However, the inquiry team has recommended the closure of Ashworth hospital. The Government do not accept that recommendation.
In the policy document "Modernising Mental Health Services", on which I reported to the House on 8 December last year, we made it clear that we want to see a closer integration of the high-security services with the other secure services, and the reconstitution of the special hospitals as NHS trusts. For the foreseeable future, the three special hospitals must continue to be the main providers of high-security services. There is no practical alternative in the short term. To announce that the three special hospitals had no long-term future, but that they could not be replaced for a good many years would run the risk of making them even more difficult to manage than they are now.
In any case, I do not believe that the problem at Ashworth is one of bricks and mortar. The problem is management, and that is what we are determined to tackle. The personality disorder unit at Ashworth is not some decrepit Victorian dump: it was purpose-built. Work started on it in 1976 and was completed in 1984. Replacing it with smaller high-security units spread around the country would not guarantee better security, higher-quality treatment and care or more effective management. That would still have to be planned, organised and worked at.
The members of the inquiry team gave a great deal of thought to how best the legal, medical and penal systems should deal with people suffering from severe personality disorder, and they make a number of very useful recommendations for far-reaching changes. I welcome those ideas very much, and my right hon. Friend the Home Secretary and I will consider them very carefully
as we develop new and more effective ways of dealing with people suffering from severe personality disorder, whether they are currently in prison, hospital or in the outside world. Public security must be our main priority. The Government will also make sure that the recommendations in the Fallon report are made available to the teams reviewing the Mental Health Act 1983 and mental health services.
As a result, that may lead to changes in the role of the Ashworth personality disorder unit, the scale of its operations and how they are organised. It could mean breaking up the hospital into smaller physically segregated units, but we do not contemplate its closure. However, we agree with the inquiry team that a new form of reviewable detention is needed for those people with a severe personality disorder who are considered to pose a grave risk to the public. We therefore announced in December in our strategy document "Modernising Mental Health Services" that we would make proposals that ensure that the safety of the public is the prime concern and that a new regime is established for that difficult group of people.
Since the Fallon inquiry got under way there have been many changes at Ashworth. The process of change has not been without its problems, but progress is being made. The quality of the medical staff has improved substantially as a result of new appointments, management has improved and security has been tightened, but there is still a long way to go.
I should add that despite the catalogue of disasters accurately outlined in the Fallon report, many of the staff at Ashworth have been trying hard to do a good job. They work in very difficult circumstances. The patients in the personality disorder unit are often highly intelligent and manipulative as well as dangerous. They have to be looked after and checked on 24 hours of every day so that the rest of us can be secure. We owe it to the staff to make a fresh start at Ashworth and to encourage the good staff and management, partly by getting rid of the bad ones. The new arrangements and the new people should deliver a better performance all round.
"all too often the core principles of security were absent."
Nobody was seen to be in charge of the personality disorder unit. That was because nobody--with the possible exception of the patients--was really in charge. The senior management staff were out of touch, and psychiatrists seem to have been incapable of carrying out their proper professional functions. Management decisions, if known, were frequently ignored by both staff
and patients. The internal monitoring system did not work. The members of the board do not seem to have known what was going on. The external monitoring system did not work. Events within Ashworth were not reported to senior officials of the national health service or the Department of Health. Reports into serious incidents were suppressed.
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