Allegations Concerning the Care of Elderly Patients in Certain Hospitals

Presented to Parliament by the Minister of Health by Command of Her Majesty July 1968

LONDON HER MAJESTY’S STATIONERY OFFICE

7s. 6d. net Cmnd. 3687

FOREWORD

In Section 1 of the book “Sans Everything” (published in June, 1967, on behalf of the Association for the Elderly in Government Institutions) a number of contributors gave their views on the conditions under which elderly patients are cared for in some National Health Service hospitals. In her Preface to the book, the Chairman of AEGIS indicated that the descriptions were applicable to a small minority of hospitals. Nevertheless, they gave rise to much public concern, and were of a nature which clearly called for investigation.

At the request of the Minister of Health, the Hospital Boards within whose responsibility the hospitals concerned lie appointed independent Committees of Enquiry to investigate the allegations made in Chapters 3, 5 and 6 of “Sans Everything”, and also to enquire into the present state of affairs at these hospitals. Seven hospitals were involved, in six hospital regions. One Committee of Enquiry was also asked to investigate allegations of ill-treatment of patients in one of these hospitals which were reported in the Press at about the same time.

The Chairmen of these Committees were Queen’s Counsel whose names had been suggested by the Lord Chancellor at the request of the Minister of Health; the other members of each Committee were a doctor, a nurse and one or more persons not professionally qualified in medicine or nursing but experienced in the administration of hospitals or other public concerns. None of the Chairmen or members of any Committee had any connection with any hospital authority in the Region in which the hospital with which his Committee was concerned is situated.

The findings and recommendations of these Committees of Enquiry are reproduced in the following pages in accordance with the undertaking given to Parliament on behalf of the Government in the Debate of llth July, 1967, on the Care of the Elderly. As in the book, the identity of the authors of the allegations and other persons is concealed by the use of pseudonyms. In the book the hospitals were also referred to by pseudonyms but their names are now given at the head of the relevant Report.

BANSTEAD HOSPITAL

Terms of Reference

1. We were appointed by the South West Metropolitan Regional Hospital Board: —

(a) ” To investigate as far as the available evidence permits the allegations on pages 13, 14 and 17 of ‘ Sans Everything’ in relation to conditions in Banstead Hospital in the period “.

We were informed that the allegations on these pages might refer to the Banstead Hospital and, if so, probably to the period 1958 to 1961. The allegations on pages 13 and 17 concerned instances of alleged ill-treatment of patients and those at the bottom of page 13 and on page 14 to the improper sale by hospital staff to patients of tea and bread and butter.

On 13th October, 1967, the Secretary of the Committee received from the Secretary of the Regional Board correspondence from the Ministry of Health relating to an allegation of ill-treatment of a patient in or about June, 1967. After reference back to the Regional Board, the Committee agreed that their terms of reference should, if necessary, be enlarged to allow them to consider all complaints drawn to their attention referable to any date up to the date of the appointment of the Committee. It appeared that it was the intention that such matters should be covered by (b) below and that our instructions were to be widely interpreted.

(b) ” To examine the situation in the geriatric/psychiatric wards (defined by the Minister as those wards in the hospital which are occupied by elderly patients) in the hospital at the present time”.

We were instructed that this examination was “to take account of anything drawn to the Committee’s attention by other persons or anything observed by the Committee themselves at the hospital whether satisfactory or unsatisfactory”. We were informed that the Minister of Health hoped that the Committee would “report upon their own impressions of the general state of affairs in the relevant parts of the hospital at die present time”.

Procedure

2. The Committee first met on 28th September, 1967, in the Chairman’s chambers in the Temple but before this certain action had been taken. Letters were sent to a wide range of organisations and individuals associated with the hospital in the form of Appendix A and a summary of replies received is included later in the report. A notice in the form of Appendix B was displayed in all wards and public areas of the hospital. At the first meeting of the Committee it was decided that a further notice in the form of Appendix C should be displayed throughout the hospital alongside that in Appendix B in order to explain more fully the purpose and procedure of the Committee and to allay certain misgivings on the part of the hospital staff. At the same meeting it was decided that it was neither desirable nor necessary to increase the circulation of the letter in Appendix A to include all past patients who might have been discharged over the last ten years or so, not only because of the administrative burden and because so many would be likely to have changed their addresses or died, but also because some might not wish it to become known to others through receipt of a letter that they had been patients at Banstead, which is generally known as a mental hospital. (the appendices are not reproduced)

3. Before the first visits of the Committee to the hospital, a substantial number of replies had been received to the letter set out in Appendix A. These are shortly summarised below and the general picture obtained therefrom was not altered by replies received subsequently.

(a) Nursing Staff at Present Employed at Banstead Hospital

Twenty-five replies were received and all stated that they had no knowledge of ill-treatment or wilful neglect of patients, or the improper sale of beverages by hospital staff. Many mentioned the great improvements made during recent years, particularly with regard to patients’ comforts, clothing, social functions, diets, medical services, television, and trips to the seaside. The only criticisms appeared to stem from shortage of staff and difficulties arising from the employment in the wards of foreigners who could scarcely speak English. One charge nurse expressed a desire to give evidence before the Committee and we refer to some of the matters that he raised when he did so later in this report.

(b) Nursing Staff in Post 1958-1961

Sixteen replies were received and all stated that they had no knowledge of ill-treatment or wilful neglect of patients, or the improper sale of beverages by hospital staff during or since that period. In general, as in (a) above, the implication that there were any grounds for any enquiry was resented and although mention was made of a lack of interest and enthusiasm, which was attributed to lack of sufficient support, and encouragement from heads of departments as well, presumably, as to the staff shortage and hospital buildings themselves, mention was also made of the happy staff/patient relationship and progress to modern treatment.

Fifteen replies were received. None had any knowledge relating to any of the allegations in the period concerned and, indeed, only one mentioned any complaint by a patient of ill-treatment and this had been enquired into and dealt with by the Medical Superintendent. Although a number mentioned the high standard of nursing care one doctor, who was only at Banstead for a matter of months in 1961, mentioned a general despondency and apathy and resigned acceptance of make-shift arrangements. He added that there was then very little stimulus or constructive planning for the future and felt that an impression that the policy was to “run down” the hospital with a view to closure in about ten years was necessarily detrimental to the interests and welfare of staff and patients alike. Another doctor with long experience of the hospital felt that the service given at present was as good as it could be under existing conditions, but emphasised that an increase in nursing staff would enable more individual attention to be given to the patients and their surroundings.

(d) Members and ex-Members of the Hospital Management Committee since 1958

Nineteen replies were received. None had any knowledge of the allegations and one pointed out that the patients had plenty of opportunity to complain if they wished. The same points were taken about shortage of staff which, for instance, had been reported at every Committee meeting during the years 1958 to1961.

(e) Official Bodies, Social Organisations, etc.

Out of twelve replies received none had any knowledge of the allegations and most emphasised that they were favourably impressed by the friendliness shown to patients and amenities provided for them. One regular visitor mentioned an alleged incident to which his attention had been drawn, as a result of which we arranged for him to give evidence before us. After hearing what he had to say we found that the allegation was not substantiated. He added that, apart from this one complaint by a patient whom he described as very confused, resentful and troublesome, he had been visiting about 40 patients at Banstead for some 15 years and that, in his view, they had all been “very nicely looked after”.

(f) Chaplains

None of the five Chaplains who replied had any knowledge of any of the allegations and many favourable comments were made about the hospital and staff.

(g) Senior Administrative Staff

An ex Group Secretary was sure that the allegations were untrue and a Senior Administrative Officer spoke of his close contacts, particularly with the relatives of deceased patients and of the frequency with which they expressed their appreciation of the care given to the patient.

(h) Letters from Patients and Relatives

Except for two letters from in-patients with very minor criticisms, such letters as we received from patients, ex patients and relatives were full of warm appreciation for the medical and nursing staff.

4. The Committee visited the hospital and inspected the wards and ancillary buildings, spoke to staff and patients and heard evidence in private on llth, 12th and 27th October, 1967, and on 22nd February, 1968.

4 FINDINGS

5. (d) On 27th October, 1967, we heard evidence in relation to the alleged incident in June, 1967, and after due enquiry were not satisfied that it occurred as alleged or at all. At that date no allegations of ill-treatment or wilful neglect of patients or of improper behaviour by the hospital staff had been substantiated but we had to postpone preparation of our report when we received a communication from the legal representative of the relevant contributor to Sans Everything to the effect that the latter wished to give evidence before the Committee. We therefore delayed the preparation of this report until he had done so.

After failure to secure his attendance at either of two hearings provisionally fixed for November, 1967, and January, 1968, he appeared before us, accompanied by his legal adviser, on 22nd February, 1968. He did not disclose his real name and told us that he did not wish to identify any individuals or wards, adding that these things happened a long time ago and that, in spite of his criticisms, most of those with whom he had worked at Banstead were people for whom he had a high personal regard. He said that some of the staff who had been very kind to him when he was a student nurse were now either retired or dead, but he commented that a number were not very good nurses. He called no witnesses to corroborate anything that he said. The Committee were, therefore, unable to investigate the truth of his allegations, although we had no reason to doubt his good faith and were in the circumstances unable to find anything proved. We think it desirable to mention that the allegations were made only in the most general terms and no allegation was made of any specific instance of ill-treatment as described in Sans Everything or otherwise. Further, we desire to say that as a result of other evidence called before us we satisfied ourselves that none of the matters to which the witness referred and all of which related to a period of between 7 and 10 years ago need give any cause for concern today.

(b) We have examined the situation in the wards today and found that they are being managed and the patients are being treated as well as the conditions set by Banstead’s heritage will allow. We were impressed by the great improvements made over the past ten years caused by the change of attitude towards patients as the medical and nursing staff alike have departed further and further from the old Victorian approach of keeping mental patients in custody and deliberately isolated from the outside world to the modern appreciation that all patients, whatever their age are admitted primarily for treatment with a view to cure and discharge at the earliest opportunity. The removal of bars and the unlocking of doors are signs of the change which has seen the development of, for instance, the large Industrial Training Organisation, the Mother and Baby Unit, the Social Club, the development of outside contacts and the introduction of many new medical policies and treatments.

6. In conclusion, we desire to record our appreciation for the courteous and helpful efficiency which Mr. Darby has shown as our Secretary.