The scandal of Ashworth Special Hospital, on Merseyside, UK, where a state of anarchy allowed mentally disordered patients to participate in a regime of drug abuse and pornography, ranks as one of the worst failures of the NHS, concluded a two year official inquiry published last week.
Parliament was shocked by the catalogue of problems noted in the personality disorder unit at Ashworth—such as a 7 year old girl being groomed for paedophile purposes during regular visits to patients—which the health secretary, Frank Dobson, described as a mess from top to bottom.
Doctors working at Ashworth were singled out for particular criticism by the inquiry chairman, Judge Peter Fallon. At one point in Ashworth’s recent history, only three of 11 doctors in post were judged to be competent. The report stated: “If such levels of incompetency and poor performance had occurred in another specialty, such as general surgery, immediate and decisive action would have had to be taken.”
The Fallon inquiry acknowledged problems in staffing high security hospitals, but stated that a self perpetuating circle of unattractive posts and inadequate training had developed, making the hospitals even less attractive places to work. A fact finding assessment commissioned by the inquiry found that there were only two medical officers devoted to the personality disorder unit, although five or six were needed.
The inquiry concluded that the personality disorder unit was unsustainable in the long term. The wards were too big, the mix of patients was wrong, and there was no credible medical leadership. The inquiry was convinced that the hospital was too corrupted ever to provide a satisfactory quality of service and that it should be closed.
The report conceded that the principal villain at Ashworth was “the system.” It did not blame individuals, who may have been doing their best in a system that was flawed. But it judged that Dr Ian Strickland, former clinical manager of the personality disorder unit and a consultant forensic psychiatrist, failed to balance security and treatment and had little idea of what was happening on the wards. The report suggested that his professional competence fell well below the minimum required of a hospital consultant. A referral to the General Medical Council would seem appropriate in Dr Strickland’s case, the report stated.
Health officials, including the former health secretary Virginia Bottomley and ministers at the Department of Health, were also criticised by the inquiry. It was suggested that the changes initiated by ministers in an attempt to move from a custodial to a liberal regime at Ashworth and to change the culture of therapeutic pessimism were deeply flawed. The pendulum swung too far: patients were “empowered over staff” and the essential principles of security were undermined. Illicit activities expanded as a small group of patients “gained a grip.” A ward shop became a cover for selling pornographic videos and dealing drugs, with a turnover of £14000 ($22400) in 10 months.
Mr Dobson told the House of Commons that it was a shameful story of confusion, indecision, mismanagement, and incompetence. “Some of the professionals and managers failed to show a glimmer of common sense, let alone live up to the standards of their professions.” He has appointed a former admiral, Ian Pirnie, to chair the hospital authority, with orders to produce an action plan within four months. Security has now been tightened and visits by children to wards have been prohibited. Rejecting the inquiry’s proposal to close Ashworth, Mr Dobson said that the problem lay in management, not in the bricks and mortar, and argued that there was no practical alternative in the short term to the three special hospitals in the United Kingdom: Ashworth, Rampton, and Broadmoor.
The inquiry made 58 recommendations about the hospital, its security, and the wider problems of dealing with violent criminals with personality disorders. It suggested that the personality disorder unit, where the activities took place, must be managed in smaller units of no more than eight to 12 patients. It recommended that the Department of Health and the Home Office develop new, regional special units for people with severe personality disorders. The report also called for a change to the Mental Health Act 1983 which would remove the classification “psychopathic disorder” and replace it with “personality disorder.”
Mr Dobson supported the inquiry team’s call for a “new form of reviewable detention” for people with severe personality disorders. Steps were proposed to end the “professional isolation” of the psychiatrists. Urgent action was also called for to improve teaching in the diagnosis and treatment of personality disorder at undergraduate and professional levels.
Peter Snowden, chairman of the forensic psychiatry faculty of the Royal College of Psychiatrists and consultant forensic psychiatrist at Salford Mental Health Trust, commented: “Dealing with offenders with serious personality disorders has to be one of the most difficult areas in the whole of psychiatry.” He said that the findings of the inquiry will be considered in a document that the college is developing on the treatment of personality disorder, which is due out in the next few weeks. (See pp 206, 271)
The full inquiry report on Ashworth hospital is available from the Stationery Office, price £36. An executive summary costs £8.35. Copies are available on the internet at www.doh.gov.uk/fallon.htm
Figure.
The inquiry into Ashworth Special Hospital has called for smaller units