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Laura Moffatt (Crawley): I suspect that those who have been described today as being dedicated to the work of caring for the most difficult members of the community will be extremely sad, especially those who work at Ashford. They will feel that they have been tarred with the same brush as others, and will say, "If anyone mentions Ashworth, I shall be ashamed to say that I worked there." What building work can we do to reinvigorate those people--they are committed to the most difficult people in our society, to healing them, to getting to grips with their recovery and to getting them into communities--to try to ensure that they can be proud of the work that they do, even though they have been severely let down by others?
Mr. Dobson: Given my hon. Friend's professional knowledge, I would respond to her by saying that I am concerned to show a firm commitment by the Government to Ashworth hospital, so that staff there feel that it will be reasonable for them to retain their commitment to the hospital, the patients and what the hospital is trying to do. Unless we have that commitment and put better people on the board and in management, the staff will become more and more disillusioned; but I have gone out of my way in the statement and in response to questions to make it clear that many people there do a difficult job on our behalf and get little credit for it. I want to ensure that they can do their jobs properly and are properly rewarded for that in every sense of the word.
Mr. Michael Jack (Fylde): The report is a frightening account of professional and managerial failure. In his statement, the Secretary of State said that he was referring the report's contents to various professional bodies in the health care sector. May I first seek an undertaking that he will make public the replies that he receives from those bodies, as their commentary on the sorry tale of Ashworth would be interesting?
Secondly, the Secretary of State mentioned the other special hospitals: Rampton and Broadmoor. May I seek his assurance that the Government's response to the report will include a section to say that the Secretary of State has checked against current procedures at Broadmoor and
Rampton to ensure that none of the failures that are outlined by the report are in any way possible or incorporated into managerial or professional structures at those two other hospitals?
Mr. Dobson:
The right hon. Gentleman has raised two points. The first is about the responses of the professional bodies. Unless I am advised by my officials that I am breaking the law, I am prepared to publish them; in fact, whatever their advice, I will publish them. In relation to his second point, we need to take great care in dealing with all these matters. If it would help the right hon. Gentleman, I will think about the point that he has made and write to him in due course.
Ms Hazel Blears (Salford):
I am sure that, like most hon. Members, I have listened to the Secretary of State's statement with an increasing sense of horror and disbelief at the catalogue of events at Ashworth, but I am aware that Dr. Peter Clarke, the acting chief executive, who was seconded from Salford's mental health services, is trying tremendously hard with his management team to make improvements, although he personally acknowledges that there is a long way to go.
Will the Secretary of State reassure us and confirm that we will move as swiftly as we can to implement the ideas that are set out in our White Paper "Modernising Mental Health Services", to ensure that special hospitals can become full national health service trusts and part of the NHS family? In that way, we can put the values of the health service--openness, accountability, transparency, the caring ethos of the NHS--into those institutions. They need to be opened up and made fully a part of the NHS family. I would welcome his reassurance that we will move in that direction.
Mr. Dobson:
I can confirm that it is our intention to change the law in the health Bill that we will introduce to do just what my hon. Friend says. For several reasons, I am concerned about the way in which senior executive appointments are made in the NHS. If we ask someone, in effect as a favour, to take over the management of a very difficult place such as Ashworth, I would like to be in a position to tell them at the start, "If you do a good job for two or three years, we will be able to guarantee that you will move on to some other job, possibly a better paid job, as a reward for doing a good job in the one that we are asking you to do now." Under the present arrangements I cannot do that. There is something lacking in the system because we need to reward people who do a really good job, whether they are nurses on the wards or chief executives of hospitals.
Mr. A. J. Beith (Berwick-upon-Tweed):
May I ask the Secretary of State and the Home Secretary to recognise that it will not do simply to castigate psychiatrists for not classifying as mentally ill and treatable highly dangerous people who are not mentally ill and do not appear to be treatable? Since the report makes it clear that there is such a category of people, and since there are some such people now in custody who might be released because they are not considered to be treatable, there is some urgencyabout the Secretary of State's discussions with the
Mr. Dobson:
I recognise that some people with personality disorders cannot be treated. The problem is that the psychiatrists have changed the boundaries, and there is such a thing as psychiatric fashion just as there is fashion about removing people's tonsils. One of the problems that has arisen is that, recently, the psychiatrists have decided that far fewer people can be treated and it just so happens that that means they do not have to deal with them.
Helen Jones (Warrington, North):
I wholeheartedly agree with the Secretary of State that the problems at Ashworth are problems not of bricks and mortar but of management. Anyone who has had any contact with that hospital over the years knows that only too well. May I suggest to my right hon. Friend and other Back-Bench Members who have not yet had an opportunity to read the full report that two steps need to be taken? First, the concept of 24-hour care, which was introduced afterthe Blom-Cooper report, worked disastrously in the personality disorder unit because, in practice, it meant patients wandering around in the middle of the night.
Steps must be taken to ensure that patients, particularly those with personality disorders, co-operate with their agreed care plans and face sanctions if they do not. Secondly, while there are many good staff at Ashworth hospital, an inward-looking culture has developed in that institution over the years, and we must move away from that. Although we can look at the future of the prison health service with the NHS, there are other steps that need to be taken immediately to ensure that Ashworth forges links with other parts of the NHS such as mental health trusts and regional secure units. That would help to provide continuity of care and better career paths for staff, which in turn would help us to attract good staff to work in Ashworth. I would appreciate my right hon. Friend's comments on those two points.
Mr. Dobson:
I know that my hon. Friend has had both professional and local involvement with people in Ashworth and she has made a valid point. For hon. Members who do not know, generally speaking, in the past if one lived in Ashworth hospital, one was expected to go to bed at night like most other people. Under the 24-hour care arrangement, people in the personality disorder unit can sleep when they like and walk around when they like, which imposes what can only be described as a massive burden. It means that the staffing at night sometimes has to approach the intensity that applies during the day in order to keep an eye on people. That is absurd and it needs to be changed.
It will however be very hard for the staff to carry out that process of change with such a difficult group of patients, and I will not promise any precipitate changes because I will not be the person who risks being knifed in the back at 3 o'clock in the morning. I agree with my hon. Friend that we need to ensure that there is a more positive approach. I hope that, in committing ourselves to the future of the hospital we will enable the staff to provide the more positive approach that most of them want to provide.
Mr. Colin Pickthall (West Lancashire):
I welcome the Fallon report and my right hon. Friend's attitude towards it.
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