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Mr. Simon Hughes (Southwark, North and Bermondsey): First, I join the Secretary of State in paying tribute to Judge Fallon and his team who, in the short time available, appear to have done an extremely thorough and comprehensive piece of work. I also pay tribute to the Secretary of State and his predecessor for the speed with which they set up the inquiry and published its conclusions.
It appears from the report that the management of Ashworth was nothing short of outrageous. To adopt a phrase from elsewhere, it appears to be truly a case of the most disordered patients being in charge of the hospital. That being so, an instinctive gut reaction would be that the place must close, but the Liberal Democrats are prepared to share the Secretary of State's view that to announce its closure would create as many problems as would keeping it open. However, it should be seen to be a hospital on licence rather than on probation or under sentence, because unless it gets its act together, it would clearly be inappropriate for it to have an extended life.
With proper management, accountability and scrutiny, the hospital should be able to do the job, but will the Secretary of State accept the following suggestions? First, there should be a move within the hospital to management within smaller units. In particular, thought should be given to separating those who are convicted from those who are not convicted.
Secondly, will the Secretary of State and the Home Secretary, when considering their responses--as my right hon. Friend the Member for Berwick-upon-Tweed (Mr. Beith) and I will as we consider the matter in more detail--bear in mind the great benefit of following the report's recommendation to bring the medical staff in the Prison Service under the Department of Health, so that psychiatrists and psychiatric nurses can be moved between prisons and special hospitals? There would then not be the culture of closed wards, which we now have in special hospitals, where such people basically stay for life. Instead they would enjoy career development and progress, which might also allow us to recruit the psychiatrists and psychiatric nurses now in short supply.
Lastly, given that this is exactly the sort of subject where public interest demands that we get security and the method of coping with severely disabled people right, I offer the services of Liberal Democrats, with, I hope, those of Conservative Members, in reaching an all-party agreement on the way forward, which I hope will result in a secure and safe system, with a tough and effective inspectorate, so that such a scandalous outrage never happens again.
Mr. Dobson:
I thank the hon. Gentleman for his welcome for the report and statement, and for his acceptance of our view that we cannot close Ashworth.
One of the problems with a probationary period, or the sword of Damocles hanging over Ashworth, is that, if Ashworth is to work, those working there will have to show a real commitment to the hospital, and they are only likely to show such commitment if they feel that the Government share that commitment. What is good for them is good for us.
We have already contemplated breaking the hospital up into smaller units. We must clearly improve security within the hospital. The hospital has many vulnerable patients suffering from mental illness, and it is clear that a militant force of people from the personality disorder unit dominates everything, including the bodies which are supposed to represent all the patients and many of the staff. We want to stop that domination by breaking the hospital up into smaller, more easily controlled units.
However, if we are to have a proper regime which will look after the mental health interests of all the patients, security is crucial. It is impossible to deliver a decent therapeutic service without security, including security for the staff, some of whom have been stabbed while others have been held to ransom.
We are contemplating what to do about the prison health service, which always poses problems. I certainly welcome any commitment from the Liberal party, or anyone else, to ensure that this time we get it right, because in the past we got it wrong every time.
Audrey Wise (Preston):
Does my right hon. Friend agree that the structure of what he described as the semi-autonomous trusts that he inherited makes his job more difficult, and that it is ironic that the Opposition should call for firm action from him when, as he has made clear, not all the levers are in his hands? However, does he agree that, because of Ashworth's troubled history, special attention should have been paid to it by structures within the national health service, such as the regional offices? Will he assure me that he will examine the role--or lack of it--of the regional offices to make quite sure that they, too, had their priorities right?
Although I agree completely that the staff at lower levels and the local management should be firmly held to account, dereliction of duty, neglect, or failure to have the right priorities at a higher level should not go unrecognised and unremarked.
Mr. Dobson:
I sympathise with my hon. and well informed Friend's view. We live in a country where--as in this case--it is characteristic that, as far as I am aware, the first person to be sacked outright was an unqualified nurse, whereas other people, earning large sums, have been suspended on full pay or have gone to other well-paid jobs. I am determined to trace the responsibility, wherever it lies. In fairness to those who work in the regional offices of the national health service, until we came to power, they were being told to keep their noses out of virtually everything and merely to provide a service if it was asked for.
Mr. Dale Campbell-Savours (Workington):
By whom?
Mr. Dobson:
By the previous Government and by the very competitive internal market which they had established. We are moving towards giving a much bigger and more positive role to the regional offices. We believe that to be necessary, not only in this sphere, but in matters such as the maintenance of proper surveillance and monitoring of the cervical and breast cancer screening system, where there was none until we gave that role to the regional offices.
Mrs. Virginia Bottomley (South-West Surrey):
I thank the right hon. Gentleman for his consideration in allowing me to see a copy of the report earlier this
Anne Marie Nelson was totally dedicated, absolutely committed and determined to get the right balance between security and treatment. It did not work, and she has rightly stepped down, but I wish to place that point on record. When the hospital staff are mentioned--the right hon. Gentleman has referred to them--it is hard to distinguish between those who were at the heart of deplorable and unacceptable practices and those who were bravely and courageously trying to improve standards of care, with precious little support from their colleagues or superiors. A judgment has therefore to be made.
I am concerned about the distinction between the comments in the Fallon report--essentially endorsed, I think, by the Secretary of State--and the comments of the Home Secretary in the aftermath of the Michael Stone case. The Fallon report suggests, if anything, a shift towards pressure on the Prison Service to take more responsibility, or keep more offenders, whereas the Home Secretary appeared to be critical of the health service for not doing more for these troublesome, intractable and, frankly, costly patients, or offenders--call them what you wish.
I would appreciate some guidance from the Secretary of State. In which direction does he see the policy moving? How does he see the tension between security and care, and the distinction between patients and prisoners?
Mr. Dobson:
In a sense, I do not think that there is a tension between security and care, because without security there will be no care. That has been one of the problems at Ashworth. I think that the relaxations introduced as a result of the Blom-Cooper report have been harmful. They may have produced benefits for some, but I do not believe that they produced benefits for many.
As for hospital staff and the whole system of responsibility, even after a reading of the Fallon report it is difficult to know who was responsible for any of these matters in the past. It is not clear which Ministers, which senior staff in the health service and which officials at the Department of Health were responsible, how those in the regional office, those in the commissioning body and those "on the ground" at Ashworth were involved, who was responsible for security, who was responsible for therapy or who was responsible for running the wards. The whole thing was a systematic shambles from top to bottom, and it must be sorted out.
I do not think that my right hon. Friend the Home Secretary was criticising the national health service when he said what he did after the Michael Stone case. He was, in fact, mounting a legitimate criticism of the attitude of some parts of the psychiatric profession. If someone has a personality disorder and commits a crime, that person will, we hope, be caught, prosecuted and imprisoned; but
there is another category of people who are dangerous, and who psychiatrists feel can be treated in hospital. Under the law, such people are entitled to go into hospital and be treated.
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