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Lord McNally: My Lords, the noble Baroness, Lady Jay, has quite rightly drawn the attention of the Minister to the need for a proper balance between care and security at Ashworth. But I do not believe that Ministers should get away scot-free after the sheer disbelief and outrage of the general public at the catalogue of disasters that has been announced. Here we have child abuse and pornography--the worst nightmares of the public--associated with a secure unit for which there is direct ministerial responsibility. In an earlier age there would have been only one Statement made to either House; that is, a ministerial resignation. However, that belongs to an earlier age. Therefore, it is important that Ministers make it clear that there is a sense of urgency to match the public disquiet at what has been revealed at Ashworth. A one-year general inquiry--I echo the call of the noble Baroness, Lady Jay, for a public inquiry--may meet some of the concern.

There is need for immediate action. It is, again, unbelievable that this Statement is a product of the courage and publication by a patient. It has nothing to do with the lines of communication and command within the department but with a patient going public. We must have immediate assurances that there are already in place, ahead of any inquiry, proper and adequate machinery for inspections that breaks through what clearly is a successful wall of silence and collusion within these institutions. Without that assurance of external inspection, public disquiet will remain.

It is amazing that there have not already been any arrests or criminal prosecutions, given the range of evidence that has been acquired: 1,200 videos within a so-called secure unit suggests a range of knowledge and awareness which again makes the mind boggle.

I ask the Minister to comment upon the point made by the noble Baroness, which must awaken concern, about the size of these units. Earlier inquiries have drawn attention to the fact that units of this size are inherently unstable and unmanageable.

What lies at the heart of the Statement is its flabbiness and feebleness in the face of a scandal of such proportions. The actions are the usual ones--the judge is rolled out; a year of inquiry. But what the public want to know is that in this institution and parallel institutions immediate action is being taken to stop criminal activity by inmates, staff or visitors. I am not sure that that assurance comes from the Statement. Nor is there any sense of urgency about putting in place an independent inspectorate that can give the public the safety and the assurance they require.

Baroness Cumberlege: My Lords, first, I thank the noble Baroness, Lady Jay, for welcoming this inquiry. The noble Lord, Lord McNally, used the words, "Here we have" child abuse, child pornography, and so forth. We do not know whether it is, "Here we have".

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These are allegations. That is why the inquiry is being set up. It would be wrong to jump to any conclusions before the outcome of the inquiry.

The noble Baroness asked about staff collusion, staffing levels, and why reports had not been acted upon earlier. Those are all matters for the inquiry, which is why we have set it up. My right honourable friend the Secretary of State only received these allegations at the end of last week. He acted within days to set up the inquiry to see whether or not the allegations have force behind them.

We should see this also in connection with the Health Advisory Service which reported in 1994 that things were improving at Ashworth. It said that there was a great deal more work to be done, but the Government acted upon all but one--the question of seclusion--of the recommendations of the Blom-Cooper Inquiry. The Health Advisory Service said that the changes were making an impact. It is hard for these institutions, whose whole nature is one of security, always to find out exactly what is going on.

The noble Baroness asked also whether the inquiry would look at much broader policies. We are doing that through the High Security Psychiatric Services Commissioning Board. It has already done a great deal on the general strategy for these secure services. It will be reporting its conclusions in due course.

The noble Baroness asked also whether the inquiry should be an open one. We have left that for decision by the chairman and the panel members. We shall publish the report, but we believe it important that we should get to the whole truth. One of the lessons we learnt from the Allitt Inquiry was that if the total inquiry is made public it does not always allow people the freedom to express their views about the situation they find working within these hospitals. It will be for the inquiry panel to determine whether it should be held in public or in private or, indeed, part private and part public. With the sensitivity of the issues and the need for patients to give evidence it may be that at least part of the evidence should be taken in private, but that would be a matter for the panel.

4.56 p.m.

Lord Campbell of Alloway: My Lords, taking account of the fact, as my noble friend the Minister said, that these are but allegations, nonetheless they are very serious and disturbing allegations. I accept that my right honourable friend the Minister acted with dispatch, but I should like to know what supervisory system was set up in the wake of Sir Louis Blom-Cooper's report. Who was operating it? How often were visits made? What was found? If there were no visits or if nothing was found, why was that so? I do not think that this is the sort of situation--allegations; yes, but terrifying ones--which one can slough off in any way.

I heard what my noble friend said about there not being a public inquiry. I beg my noble friend to reconsider. I think it should be a public inquiry with evidence given on oath. This is a very serious matter. There may be difficulties with certain patients who may not necessarily understand the nature of the oaths, but

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some of the staff presumably do. This should be treated with the utmost seriousness. I made a similar request when the Matrix Churchill matter was raised in your Lordships' House. There are two other aspects. Is this entirely within the remit, the responsibility, of the Secretary of State for Health? I do not know. Has not the Home Office--the noble Baroness raised the point--any responsibility? Is it not involved in the supervisory arrangements? Can this not be reconsidered? It is not a matter for Judge Fallon whom I know personally. He is a first rate man. It is not a matter for him. It is a matter for government. The responsibility lies with some ministry or two ministries. It is not for Judge Fallon really to make recommendations.

Baroness Miller of Hendon: My Lords, we are dealing with questions to the Minister.

Baroness Cumberlege: My Lords, I thank my noble friend for some of those comments. Of course my right honourable friend and, indeed, all his Ministers share with him the view that this is a very disturbing set of allegations. It is serious, and that is why we have taken prompt action. My noble friend suggests that there should be another body to supervise these hospitals. That is something that the inquiry will clearly want to consider.

At the moment we have the Health Advisory Service and the Mental Health Act Commission. They are two bodies which have overall responsibility for looking at the clinical practice within these three special hospitals. I am not sure whether a third would do the trick. Perhaps one must look to different mechanisms and to different lines of accountability. The hospital authority board, which has a chairman and non-executive members, is in many respects set up like a hospital trust. The chairman has direct accountability to the Secretary of State. The commissioning board, which purchases the services for the National Health Service, is part of the NHS Executive. The chairman of that board also has direct responsibility to the Secretary of State. There is a clear line of accountability, but it is for the inquiry team to see whether it worked; if it did not, why; and how it can be improved.

Lord Harris of Greenwich: My Lords, is the Minister aware that many of share the view of the noble Lord, Lord Campbell of Alloway, that the inquiry should be in public? There is widespread public concern about the matter which will not be allayed by an inquiry taking place behind closed doors.

Will the Minister also tell us more about the report of the Health Advisory Service? I believe she said that in 1994 the report indicated that there had been an improvement. Is she aware that if there had been an improvement, heaven alone knows what the conditions were like previously?

Finally, what is the Minister's reply to the point made by my noble friend Lord McNally? Is it not already clear that there should be some external inspection of such hospitals; the kind which operates within the Home Office with the chief inspector of prisons? Is it not

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obvious that if such an inspectorate had been in existence many of these shocking episodes would have been identified earlier?

Baroness Cumberlege: My Lords, the noble Lord asks what the Health Advisory Service found and if the situation had improved. The Health Advisory Service went in after the Blom-Cooper report in 1992. It found improvements but said that there was more work to be done. Perhaps I may put that into context. Before Sir Louis Blom-Cooper compiled his report allegations were made and evidence was found within Ashworth that it was a brutal system and a more therapeutic service should be provided. Sir Louis Blom-Cooper put forward about 25 recommendations. We have implemented all of those except for one which relates to seclusion.

The Health Advisory Service found that the situation had improved. It is for the inquiry to decide the matter, but it may be that one regime has been superseded by another and the swing has been too great. Clearly, the inquiry will wish to examine that matter.

I believe that I dealt with inspections when I replied to my noble friend Lord Campbell of Alloway. There are inspections by outside bodies and it will be for the inquiry team to decide whether a third body carrying out inspections will improve the standards or whether we should be using other mechanisms.

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