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12.5 am
The Minister of State, Department of Health (Mr. John Hutton): I congratulate my hon. Friend the Member for Barnsley, Central (Mr. Illsley) on securing this Adjournment debate. He raises several specific concerns on behalf of his constituent Roy Cotton, currently a patient in Ashworth high-security hospital. In the light of those concerns, I have made further inquiries about Mr. Cotton's case to gauge progress since my hon. Friend and I last corresponded on the subject. He referred to a number of issues raised by Mr. Cotton and I would like to deal with each of them in turn.
Mr. Cotton has expressed concern over the cancellation of several leaves of absence. Ideally, it should not be necessary to cancel visiting arrangements on financial grounds, and the regional director of mental health has asked the chair and chief executive of the hospital for a report in relation to Mr. Cotton.
I can tell my hon. Friend that Ashworth received an additional £2 million during the current financial year--as indeed it did during 1999-2000. That is over and above the substantial extra resources to support high-security hospital services and is in recognition of the cost pressures faced by the hospital and to allow it to deal with shortages of staff. In addition, the regional office has, by recently appointing a dedicated regional director of mental health, acknowledged the importance of more closely monitoring the performance of service delivered by Ashworth hospital.
I can advise my hon. Friend that Mr. Cotton's desire to move to a medium-secure placement was recently reconsidered by the mental health review tribunal--the appropriate body to make this decision, because all the relevant facts are available to it. I understand that the tribunal has made no recommendation about his transfer to a less secure unit--as my hon. Friend may already be aware.
Mr. Cotton expressed disappointment at the removal of a photograph album from his room. My hon. Friend drew attention to some of Mr. Cotton's concerns about that. It seems that the album was categorised as a book and, as such, counts as one of the 10 books that he is allowed to have in his room at any given time. The patient was permitted to keep the photos, but not the album itself. I shall cover that part of the safety and security directions in more depth later in my remarks.
I am advised, however, that Mr. Cotton does have access to stationery--I can assure my hon. Friend about that. All Mr. Cotton's mail is checked, with the exception of privileged mail--for example, his letters to and from his MP and his solicitor--in view of his clinical presentation. Privileged mail is treated in accordance with the provisions of the Mental Health Act 1983.
Under the safety and security directions, patients' telephone calls may be recorded. Patients have access to two privileged telephone numbers; in practice, they are
usually the advocacy service and a legal representative. Patients are entitled to register 10 other numbers and there is a newly recorded message on the Ashworth telephone system, explaining which calls will not be recorded.All food and tobacco brought in by visitors has been banned from the hospital as part of the new safety and security directions, which came into effect on 30 November. The directions apply to all patients; Mr. Cotton has not been singled out in any way.
My hon. Friend rightly drew attention to the recommendations of the Fallon inquiry--established in February 1997 to investigate allegations of the misuse of drugs and alcohol, financial irregularities, possible paedophile activity and the availability of pornography within the personality disorder unit at Ashworth special hospital. The ward on which Mr. Cotton is cared for is part of that personality disorder service.
The inquiry reported on 12 January 1999. It severely criticised the management and security arrangements at Ashworth. The Government accepted the recommendations and allocated some £22.5 million to enable the three special hospitals to improve staffing levels, enhance safety and security, modernise services and implement the necessary change.
Each of the three high-security hospitals drew up action plans to address the issues raised in the Fallon inquiry. In May last year, Ashworth published its action plan to address the inquiry's recommendations.
Recommendation 7 of the Fallon report stipulated that an independent review of all aspects of physical security at Ashworth hospital should take place and be repeated at regular intervals. The scope of the independent review was extended to cover all three high-security hospitals.
Sir Richard Tilt, a former Director General of the Prison Service, was commissioned to undertake that review. Sir Richard's final report contained 86 separate recommendations. It was published on Monday 22 May 2000. The Government accepted the report's recommendations in full.
Two of the recommendations contained in Sir Richard's report are particularly relevant to tonight's debate. The first recommendation was that additional funding of £25 million should be provided to facilitate the movement of patients no longer needing high-security care. The Government are making the £25 million available to facilitate the movement out of high-security care of those patients who are inappropriately placed in high-security hospitals.
The need for the transfer to appropriate levels of security of 400 people who no longer require high- security care and the creation of new places by 2004 for the assessment and treatment of dangerous people with severe personality disorder was also a recommendation in the national health service plan.
Secondly, Sir Richard recommended that the safety and security directions be revised and extended. The original safety and security directions were issued to the high-security hospitals on 28 June 1999. The subjects covered by the original set of directions included the searching of patients, staff and visitors; limits on the extent of patients' possessions; and the monitoring of patients' post and telephone calls.
The revised set of safety and security directions were issued on 30 November 2000. In addition they cover, for example, the introduction of procedures for listening to
and recording patients' telephone calls; the introduction of restrictions on food and tobacco being brought in or sent into the hospitals for patients' consumption; and leave of absence arrangements, which my hon. Friend mentioned, for patients.I am aware, as my hon. Friend has drawn my attention to it tonight and in previous correspondence, that his constituent is unhappy with the directions and finds it unreasonable that there is a limit on his personal possessions. However, there are very good reasons for these restrictions. There is a need to ensure, as Sir Richard emphasised, that possessions in patients' rooms are kept to a level and type that are compatible with the facilitation of searching, the maintenance of security and the reduction of fire hazards.
The guidance contained in the Mental Health Act code of practice is that all detained patients are entitled to maintain contact with, and be visited by, anyone that they wish to see, subject only to some carefully defined exceptions. The code states that any decision to prohibit a visit by a person whom the patient has asked to visit him, or whom he has agreed to see, should be regarded as a serious interference with the rights of that patient and should be taken in exceptional circumstances only.
I can tell my hon. Friend that the code refers to two principal situations in which the exclusion of visitors may be justified. First, it may be justified on clinical grounds--for example, where a visit is considered to be anti- therapeutic for the patient. Secondly, it may be justified on security grounds--for example, if a particular visitor has been disruptive in the past, perhaps having brought or attempted to bring illicit items into the hospital.
None of Mr. Cotton's visitors have been prevented from seeing him, although clinical concerns did lead a nurse and a social worker to discuss with one of his visitors their reservations about what my hon. Friend refers to as "grooming" during the course of her meetings with the patient.
All patients' visits are, rightly, subject to the safety and security directions. The directions apply to all patients, in all the high-security hospitals. Enforcement of the procedures concerning visitors is designed to ensure that visiting occurs in an environment that is safe for patients, visitors and staff alike.
My hon. Friend knows that I am aware of difficulties with response times to complaints at Ashworth. Ashworth's complaints procedures have been developed to conform with the national NHS complaints procedures. Ashworth patients have the same rights as any other NHS patient.
The Ashworth board requested an independent review of its complaints policy and the complaints department last December, because of concerns about how long it was taking to respond to complaints. The national target is that complaints should be responded to within 20 working days. At Ashworth hospital, unfortunately, only 16 per cent. were meeting that target; the report of the review was presented to the Ashworth board in May 2000 and a detailed action plan was developed and presented to the board in September.
I can tell my hon. Friend that additional staff have now been employed in the complaints department at Ashworth hospital. A new computer system is in place and training for front-line staff is under way to help them to deal with complaints more effectively.
Ashworth has set a target of responding to 50 per cent. of all complaints within 20 working days. I am advised that Ashworth will hit the target of responding to all complaints by the end of the next quarter. Unfortunately, that still falls short of the national average which is 62.5 per cent., so the NHS executive will be monitoring Ashworth's performance on a monthly basis. Ashworth is expected to hit the national average for responding to complaints within six months.
All complaints are dealt with through the formal complaint process. However, the patient ultimately has the right to have his case referred to the health service commissioner for England, who is independent of the Department of Health and the Government. I can tell my hon. Friend that from my inquiries I have ascertained that all his constituent's complaints have now received a response, with the exception of one received by the complaints department less than 20 days ago.
The purpose of high-security hospitals is to provide care for those mentally disordered people who have the most complex care needs. There is a need for patients to have leave of absence outside of hospital as part of their rehabilitation programme. Clearly, patient, public and staff safety is a key matter of concern when making judgments about the suitability for proceeding with a leave of absence.
The Tilt report recommended that leaves of absence for quality of life reasons should be discontinued. Since the Fallon inquiry, therefore, the number of leaves of absence
occurring within the personality disorder service has been reduced. In 1999, there were a total of 218 such absences; up to 15 December this year, there had been 173. Mr. Cotton has had two leaves of absence scheduled this year, both of which went ahead.It is worth reminding ourselves that some of the most challenging patients in the country are cared for in Ashworth. Leaves of absence are occasionally cancelled because of adverse patient behaviour and, on a few occasions, because of staff not being available at short notice. Regrettably, it is therefore inevitable that some leaves of absence will be cancelled, for reasons that may be outside the hospital's control.
I am aware that my hon. Friend has been in extended correspondence with the chair of Ashworth for some months about issues relating to Mr. Cotton. As I am sure he will appreciate, this is a complex individual case, although I can understand his frustration that matters have not moved at the pace he would have wished.
I note that arrangements are in hand for the chair of Ashworth to meet my hon. Friend at the earliest possible date. I trust that that will allow the concerns that he has raised on behalf of his constituent to be dealt with satisfactorily. I am grateful to him for bringing those matters to my attention, and can confirm that Ashworth hospital will--
The motion having been made after Ten o'clock, and the debate having continued for half an hour, Mr. Deputy Speaker adjourned the House without Question put, pursuant to the Standing Order.
Adjourned at seventeen minutes past Twelve midnight.
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