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Ashworth Hospital
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:
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"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.
"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."
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
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
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
and may well be tackled with short-term crisis management, while the underlying issues at Ashworth and other special hospitals remain unresolved.
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