Skip to main content

Hospital Facilities (North West Region)

Volume 892: debated on Monday 12 May 1975

The text on this page has been created from Hansard archive content, it may contain typographical errors.

11.28 p.m.

I am grateful for the opportunity of introducing this important matter on the Adjournment.

The findings of the committee of inquiry set up by the North West Regional Health Authority following the deaths of a number of elderly patients not long after their transfer from Fairfield Hospital to Rossendale General Hospital on 27th December 1973 show a combination of circumstances including inadequate planning and preparation, which meant that the decision to transfer patients was ill advised.

The particular conclusions of the committee, that the deaths of three patients were as a matter of probability contributed to by the transfer and/or the deficiencies of the reception area at Musberry House, Rossendale, and that the probability cannot be excluded of the deaths of two other patients being contributed to by the transfer and/or the deficiencies of the reception area, unfortunately confirmed my concern. Sadly, therefore, I wish to express my sincere sympathy for any of the patients involved and their families who may have suffered adversely as a result of these events.

I find that the report is on the whole a full, fair and forthright account of the committee's independent investigation. I know that the Department of Health and Social Security has already begun urgent consideration of it, particularly the general recommendations relating to policy in this sector, on which the regional health authority is now seeking advice in order to concentrate more of the available resources where they are most needed.

To avoid a recurrence of such a tragic event, I should like to draw attention to certain aspects of the committee's report. The first relates to Dr. Grimshaw. He is a member of what I consider to be the Cinderella specialities, which are psychiatry, geriatrics and mental handicap. These specialities are poorly endowed in prestige and finance, yet he made the National Health Service work his speciality despite poor buildings, a heavy workload and nursing and medical staff problems.

Dr. Grimshaw ran a wholly district hospital-based psychiatric service and was—I stress this—the sole consultant psychiatrist for a population of 210,000 people. On current norms there should be at least three consultants for such a population and many, including the Royal College of Psychiatrists, would hold that even this ratio is not high enough. In these circumstances, in my estimation Dr. Grimshaw deserves praise and credit for maintaining a service at all times.

Over the years Dr. Grimshaw had suffered—he accepts that he is not alone in this—what he regarded as the shortcomings of departmental and regional policy in terms of money, staff and facilities in psychiatry.

In November 1973, as a result of the economic crisis, there had been a general deferment of all capital schemes for a period of three months, which meant a loss for the hospitals in Bury of £80,000 for hospital improvements. It was only in May 1973, however, that a visiting medical team regarded one of the hospital buildings in these terms:
"It would appear impossible for us to believe that anything but a complete demolition could in any way make this accommodation better."
About the other buildings the report said:
"The windows were very poorly fitted, with significant and in some cases visible cracks permitting the ingress of uncontrolled air"—
and, I might add, during the December period, very cold air.
"Some attempts had been made over the years to seal off the cracks with adhesive tape—but this was temporary and unreliable!".
I regard that as the understatement of the year. It is a credit to the nurses who tried to fill the gaps and cracks with what sheets and blankets they could while the old ladies were in the hospital. These windows, however, had been reported as being in need of repair since 1960. Fourteen years later they were in part responsible for the deaths of the old ladies.

Therefore, can Dr. Grimshaw be held responsible for the cut of £80,000? Can he be held responsible for the condition of a hospital which was built in 1870?

The other aspect which filled the committee with dismay and great concern was the need to rely heavily on junior psychiatric staff who, in Dr. Grimshaw's reckoning, were generally very poor over the years. He had no choice of junior staff. He would be fortunate to get one applicant for an advertised post. As the committee reported,
"We refer to the near catastrophic difficulty"—
I repeat that, "the near catastrophic difficulty"—
"of recruiting staff, which is common to all non-teaching psychiatric units."
Most of the junior doctors seemed to be transient birds of passage in the field of psychiatry, and of late everyone has come from overseas—although Dr. Grimshaw emphasised that not all junior staff were unsatisfactory. Indeed, some were exemplary.

As regards the two junior doctors in post in January 1974, Dr. Grimshaw described them as being fairly characteristic of the staff which came to his unit. The committee, however, reported that
"these two doctors filled them with dismay",
and yet they were characteristic of what Dr. Grimshaw was getting over the years. One had been in psychiatry for about nine years, though not as yet with any success in postgraduate qualifications.

It was clear from many witnesses that in no sense did that doctor participate in the life of the ward. He never did regular ward rounds on his own, and the nurses at all levels complained that it was difficult to get him to come to the wards when needed by the patients. Accordingly, without adequate medical support from the teaching hospitals, Dr. Grimshaw attempted to remedy these inherent difficulties by undertaking, in addition to acting in his own consultant capacity, much of the work of the junior doctor's day-to-day routine work in caring for the many patients.

The regional officer of the Confederation of Health Service Employees, Mr. Eddie Lawson, who, I may add, represented his nurses magnificently during the inquiry, has related to me how numerous members of the nursing staff have expressed their appreciation of Dr. Grimshaw's work. As Mr. Lawson put it to me, the nurses said:
"We like him and we are proud"—
note the word "proud"—
"to work under Dr. Grimshaw's dedicated direction."
As Mr. Lawson said,
"What a tribute to a fine doctor."
Having regard to the fact that no individual is held wholly responsible by the committee of inquiry, I say to the Minister that there should be an urgent reconsideration of the position and that Dr. Grimshaw should not be reprimanded.

If the committee's experience from the evidence is of more than local significance, the problems of staffing psychiatric units outside teaching centres seem to have reached serious crisis proportions. The committee was told that in non-teaching psychiatric units in the North-West Region about five-sixths of the senior house officers and three-quarters of the registrars were overseas doctors. This is obviously a matter of concern to the public who may be treated by overseas doctors and to overseas practitioners themselves whose effectiveness as doctors may be reduced by doubts about the value of their qualifications.

The most convincing evidence of a different and lower standard of doctors from certain overseas countries than from home-trained doctors is shown in the performance of candidates attempting the Royal College's examinations. The college's figures for its membership examinations 1972 to 1974 relating to doctors from the United Kingdom show a pass rate was 82 per cent., while the pass rate for overseas doctors was 21 per cent.

The figures for examination results generally show a disturbing indication of the quality of overseas doctors entering general practice, and even more so in the geriatric service. The importance of this topic is best demonstrated by stating that there are about 13,000 overseas doctors in the National Health Service. Therefore it is the General Medical Council's prime duty to ensure that no doctor is placed upon the register who fails the minimum standard.

The only possible posture for the GMC over the registration of overseas doctors is that of ensuring that they have reached standards of competence at least equivalent to the minimum standards for the registration of doctors trained in the United Kingdom. Anything else is a disservice to the foreign doctors themselves, whose contribution to the working of the NHS is immense.

The North West Regional Health Authority has inherited a large proportion of old hospital buildings, many of them old workhouses built in the last century, like those at Bury and Rossendale, which are completely inadequate and inefficient, requiring proportionately more resources, both of revenue and of capital, because they consume more in maintenance, staffing, upgrading and extensions. Most of these former workhouses tragically form the present geriatric accommodation. Hospitals built before 1850—in Florence Nightingale's time—accommodate 14 per cent. of the geriatric patients. Those built between 1850 and 1899 accommodate 20 per cent., those built between 1900 and 1918, 26 per cent., and those built between 1919 and 1948, 28 per cent. These Florence Nightingale hospitals are a scandal and a blot on the nation's conscience. Yet estimated capital expenditure per head on these facilities for 1974–75 is £8·29 in Oxford and £4·65 in the North-West, compared with a national average of £5·29. That is just not good enough.

There is, therefore, a serious situation in respect of accommodation and facilities for psycho-geriatric patients for which there is a North-West Region requirement, based on the norm of three beds per thousand patients aged 65 and over, of 1,750 beds and a similar number of day places. Despite those figures, however, only 165 beds and 17 day places are designated for this purpose. The result of the shortage of hospital accommodation for the elderly is that in one North-West Region hospital for geriatric patients—again, a former workhouse—the number of patients dying in 1964 while awaiting admission was 80. In 1965 it was 115; in 1971, 185; and in 1973, 236. Last year, the total of people who died while awaiting admission to this one hospital had risen to 283. How many times can that figure be multiplied throughout the hospitals of the North-West and England?

If the measure of a civilised society is the care of its aged and infirm, the way in which we in Britain take care of them is seriously wanting when we consider that 49·25 per cent.—almost half—of the accommodation for our old people is in old poor law hospitals, in other words ex-workhouses. We have pushed the old people away to the tops of mountains, as at Rossendale, 700 feet above sea level. Only 4 per cent. are in new hospitals.

If this tragedy is never to be repeated, a colossal amount will have to be injected into this area of care. In the North-West alone it is estimated that upwards of £50 million is needed, and that could be a low estimate. There should also be a strengthening of the powers of the standing advisory bodies to remedy poor communication between hospitals and university teaching hospitals. Also, perhaps the formation of a body of Her Majesty's inspectors of hospitals is long overdue.

Everyone is aware of the gaps in our National Health Service. On the non-acute side, the services for the disabled, the elderly and the mentally ill have failed to attract the attention and resources that they need. All the more credit is due, therefore, to staff like those at Bury and Rossendale, who have toiled tirelessly for their patients, despite the difficulties.

For the imbalances and gaps successive Governments must take their share of responsibility. The shortcomings were not rational. They did not result from a calculation of the best way to deploy scarce resources. They just happened. Yet the health service depends crucially on humane planning and the provision of adequate services, with effective and understanding collaboration between regional health authorities, teaching hospitals and ordinary hospitals to see that arrangements are evolved under which a more coherent and smoothly interlocking range of services can be provided to meet the needs of the population.

11.45 p.m.

My hon. Friend the Member for Middleton and Prestwich (Mr. Callaghan) has raised a serious issue, and I start by paying tribute to the close, sustained, informed and very responsible attitude which he has adopted throughout in this difficult situation. He talked about this Cinderella speciality, and I can only say to him, as I have said often to the House before, that I wish we as a nation spent more of our time worrying about the Cinderella areas of the National Health Service. If we had done so over the years and had been prepared to divert resources, both of money and of skilled manpower and womanpower, into these areas, some of the tragedies we are discussing today and which have occurred in other areas might never have occurred.

My hon. Friend referred to the catastrophic difficulty of recruiting staff into these areas. I was glad that when criticising the quality of some staff he paid tribute to the considerable dedication of many of the staff who work in these appallingly difficult circumstances. My hon. Friend singled out the contribution that is being made by nurses and doctors from overseas, and this needs to be constantly stressed. They often shoulder some of the most difficult burdens in the National Health Service. I am glad my hon. Friend said that.

On 27th December 1973, 15 elderly, confused female patients were transferred from the psychiatric unit, Ward 17, Fairfield Hospital, Bury, to the Rossendale Hospital about eight miles away in Rawtenstall. Over a period following the move a number of the patients died. Complaints were made by relatives of two of the patients to the Bury and Rossendale Hospital Management Committee—which was then responsible for administration of both of the hospitals involved—and representations, including those of my hon. Friend, were made to my right hon. Friend and the former Manchester Regional Hospital Board requesting an investigation.

After inquiries into the complaints, the North Western Regional Health Authority, which succeeded the Manchester Regional Hospital Board on 1st April 1974, decided to appoint a formal independent committee of inquiry into all aspects of the transfer on or about 27th December 1973 of patients from Fairfield Hospital to Rossendale Hospital and related matters. I was assured that all the members of the inquiry would be drawn from outside the region concerned and I arranged to be consulted about the proposed terms of reference.

I recognised the gravity of the matter and approved the intentions of the RHA to appoint a committee of inquiry. I was satisfied that the inquiry would be as independent and objective as we would all want. I made clear our view that inquiries such as these should publish a report at the completion of their work so that justice was not only done but was seen to be done. I am very grateful that my hon. Friend said that in his judgment it was a full, fair and forthright account.

The inquiry, under the chairmanship of Mr. David McNeill, QC, was held during October and November 1974. Its report has been considered by representatives of the regional health authority and of the Lancashire and Bury Area Health Authorities and has been published by the regional health authority in its entirety, save for the names of patients, staff and others and the appendices listing names and documents which were omitted.

There has also been considerable comment in the Press, which I welcome. Issues of this sort should be discussed frankly and should be discussed in the area or region in which the circumstances arise. There are many issues of a national character on which we can learn from the report.

The committee concluded as a result of its investigation that the deaths of three patients were as a matter of probability contributed to by the transfer and/or the deficiencies of the reception area at Musberry House, Rossendale; and that the probability that the deaths of two other patients were contributed to by the transfer and/or the deficiencies of the reception area at Musberry House, Rossendale, could not be excluded. The committee also concluded that it was unlikely that the transfer or the deficiencies of the reception area at Rossendale had any effect on the death or continued life of one other patient. It found that no conclusion could be safely reached about the death of another patient and that neither the transfer nor the deficiency of the reception area at Rossendale had any significant effect on the death of two patients or any patient transferred on 27th December 1973 who died after them.

The decision to accommodate the patients from Ward 17, Fairfield Hospital, in Musberry was, in the committee's view, wrong in principle and premature when made. The decision to transfer the patients on 27th December 1973 was also wrong, the committee believed. It found that the reception area at Rossendale was not on that date suitable for accommodation of the patients because of badly fitting windows and skirting boards, uncontrolled ventilation and draughts affecting the heating of the area, inadequate furnishing and equipping of the area for patients, insufficient qualified medical and nursing staff covering the reception area and insufficient preparation of staff on Ward 17, Fairfield Hospital, and of the patients for the transfer.

Faults in the system of medical care and the co-ordination of the planning and preparation for the transfer were found. For the faults of planning and preparation and the consequences to the patients, the report indicates that the senior administrative, nursing and medical officers concerned must each bear responsibility within their respective fields of activity. Overriding responsibility vicariously for its staff and directly in respect of its own decison to transfer the patients is placed by the report on the former hospital management committee.

Patients in our hospitals occasionally need to be moved, individually or in groups, from one ward to another, from one unit to another or, indeed, from one hospital to another. Whatever the reasons--and there can be many—the patients' welfare must always be a paramount consideration by those involved and responsible for the management of patient care. This report has shown that things can go seriously wrong and has focused a spotlight on the dangers of inadequate co-ordination of and lack of adequate participation by all appropriate professional and other staff in the decision processes affecting patients and the planning for implementation of such decisions.

The decision to transfer patients in this instance seemed to have stemmed from a need, which the committee of inquiry accepted, for additional geriatric accommodation at Fairfield Hospital and the decision to take Ward 17 for this purpose was considered by the committee on balance justified. However, the consequences for the Ward 17 patients were not, the committee found, given sufficient thought, and in this connection the committee referred to the problems of group definition of the type of patients involved in the transfer, and its recommendations touch on these as well as other matters arising from its investigation.

My right hon. Friend, who has a particular interest in this area, and I are, therefore, intent on ensuring that all possible action is taken in the light of the committee of inquiry's recommendations to avoid, so far as is humanly possible, risks of similar occurrences happening again. The regional and area health authorities concerned have already indicated that they have no reservations about accepting the main burden of the conclusions and recommendations of the committee of inquiry.

I noted what my hon. Friend said about many of the staff and the points raised about Dr. Grimshaw. I shall draw the attention of the RHA to his remarks with the quotations which he made on the subject.

The committee's recommendations were made under general and local heads, and I think it would be worth while if I were to indicate the lines of action taken, but I thought it right to summarise the report because I believe that these issues should be brought clearly before the House.

On the recommendations directed to matters of local concern, the regional and area health authorities have agreed with the two recommendations on the importance of establishing for the category of elderly patient described in the report defined wards at both Fairfield and Rossendale Hospitals recognised as an entity of their own with facilities and staff tailored for the purpose. The area health authorities will consider how best such wards can be established. Arrangements have been made for written guidance for ward doctors and staff to be given by the consultant as recommended by the committee, and assurances sought from the consultant have stressed the need for acceptance of training responsibilities.

The committee referred to difficulties in an arrangement whereby one consultant runs a service based in effect on two hospital units now in two different area health authority areas and recommended that, with the appointment of a second consultant and any further consultants, ways should be explored of making a more rational and unambiguous division of responsibility.

The regional and area medical officers are to investigate these problems particularly in relation to Fairfield, Rossendale and associated hospitals, where there are now two consultants in post. The suggestion for integration of the medical cover rota for psychiatric staff with resident staff in other specialties will be examined and action has already been taken to issue guidance documents for medical and nursing staff prescribing and administering drugs, as recommended by the committee. The question of instruction in procedures relating to certification of death has been pursued throughout the region, and areas are being asked to ensure that laid-down procedures are regularly brought to the attention of all medical staff. In addition, although the committee did not specifically make any recommendation on this, the area health authorities concerned are taking steps to improve the standard of patients' case notes.

My Department is giving detailed consideration to the general recommendations of the committee of inquiry.

Before I deal with that I should deal with the local problems of finance. The figures quoted by my hon. Friend are extremely revealing. I would only say that we have tried to get into this region, first, more money globally than has been allocated in the past and, secondly, more money for the specific capital allocations for geriatric services and services for elderly patients with severe dementia. The North-Western Region is now receiving the second largest allocation in 1975–76, as it had in 1974–75, of £1,610,000. The only region with more is Birmingham with £1,620,000.

These global figures in the region can still hide disparities within a region, and it is well known to the House that I believe that one of the major problems facing the National Health Service is to redress the inequalities and to be able to direct resources, particularly when they are stretched and inadequate, selectively to the areas of greatest need. We also need far better information so that we can channel resources more effectively.

We have already done a great deal in the last year to try to ensure the allocation of resources, not just equably across the 14 different regional health authorities but discriminating positively in an attempt to right some of the inequalities and redress the lack of spending in many areas. That responsibility I take on as being an overall central Government responsibility.

The committee's first recommendation was for the issue of guidance relating to transfers of groups of patients in the form both of a general check-list and of specific guidance on the transfer of psycho-geriatric patients. I would not necessarily agree that transfers of groups of patients are likely to become more common. It is not intended as a general rule that elderly confused patients should be moved from their familiar surroundings. Nevertheless, where transfers of groups of patients become necessary, adequate well-planned arrangements must be made. The King's Fund has already published a check list, and my Department is looking urgently at the need to back this up with guidance of its own.

The committee's second recommendation concerned the need for statistics of elderly mentally ill patients—

The Question having been proposed 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 two minutes to Twelve o'clock.