1. The book “Sans Everything” was published on behalf of A.E.G.I.S. (Aid for the Elderly in Government Institutions) on 30th June, 1967. An advance extract of the book appeared in the Sunday Times on 4th June, 1967. The book contained serious allegations of ill-treatment of elderly patients in Government Hospitals, and these aroused considerable public anxiety and concern which found expression in the press, on radio and television, and in a debate on the Care of the Elderly in the House of Commons on llth July, 1967. Following the publication of the book the Minister of Health made it known that, if the authors would identify to him the hospitals referred to in the book, he would institute Enquiries to ascertain the truth of such allegations. One of thet hospitals subsequently identified to the Minister as being referred to on pages 37 to 43 of the book was St. Lawrence’s Hospital, Bodmsin, Cornwall.
Constitution of the Committee and Terms of Reference
2. On 4th September, 1967, at the request of the Minister of Health the South Western Regional Hospital Board appointed an independent Committee of Enquiry into allegations concerning St. Lawrence’s Hospital, Bodmin. The Committee was composed as follows: —
- Legal Chairman: M. George Poison, Esq., Q.C., Recorder of Exeter and Chairman of the Isle of Wight Quarter Sessions.
- Medical Member: Professor T. Ferguson Rodger, C.B.E., M.B., F.R.C.P.(Edin. & Glas.), Department of Psychological Medicine at the University of Glasgow, Consultant Psychiatrist to the Southern General Hospital, Glasgow.
- Nursing Member: Miss D. Hall, M.B.E., S.R.N., S.C.M., D.N.(Lond.), formerly Regional Officer of the Birmingham Regional Hospital Board.
- Lay Member: E. W. Renwick, Esq., B.Sc.(Econ.), F.C.C.S., President of the Corporation of Secretaries, formerly Secretary of the Wiggins Teape Group of Companies.
The terms of reference of the Committee were as follows: —
(a) To investigate as far as the available evidence permitted, allegations in “Sans Everything”, in relation to conditions at St. Lawrence’s Hospital, Bodmin, during the period September, 1964, to May, 1965.
(b) To examine the situation in the geriatric/psychiatric wards in the hospital at the present time, and in so doing to consider anything drawn to attention by other persons, or observed by the Committee at the hospital; and to report our general impressions of the state of affairs in the relevant parts of the hospital at the present time.
3.Because the allegations in the book were of a general nature and madeunder the cloak of anonymity it was considered proper to conduct the Enquiry in private. This facilitated a full and frank disclosure of all material facts and witnesses, both staff and patients, were thus able to give evidence in complete confidence and without fear of the consequences. We had no power to summon witnesses or require witnesses to give evidence on oath.
4.The main witness concerning the allegations against this Hospital who we were most anxious to hear was the author of the article ” No-one Smiles here” which appears on pages 37-43 of ” Sans Everything” under the pseudonym “Nurse Adeline Craythorne “. Her identity was not known to the Hospital Management Committee at the commencement of the Enquiry save by inference only. She was thought to be a Mrs. X who had been employed as a part-time Nursing Assistant during part of the relevant time.
5.On the assumption that she was “Nurse Craythorne”, the Chairman wrote to Mrs. X some time before the first sitting of the Committee and invited her to give oral evidence to the Committee concerning the allegations she had made. She expressed her willingness to do so, but she was not prepared to appear before our Committee until she had been advised that it was right for her to do so. As we had no assurance from Mrs. X that she would in fact appear to give evidence, and as we had to proceed with the Enquiry, we notified Mrs. X that the Enquiry would commence on Monday, 25th September, 1967, and that we would hear her evidence at any time as soon as she informed us that she was ready to attend.
6.The hearing of evidence and inspection of hospital accommodation occupied a period of seventeen days held in three sessions during the period 25th September, 1967, to 25th November, 1967, at which time evidence was taken from 76 witnesses, numerous discussions held with patients, members of staff and amongst the Committee, and a large number of contemporaneous Records, Books, and Reports examined.
7.Applications for legal representations were granted as follows: —
- R. Birkett, Esq Solicitor (of Messrs. Bevan Hancock & Co., Bristol) appeared on behalf of the Hospital Management Committee.
- P. Stephens, Esq. Solicitor (of Messrs. Stephens & Scown, St. Austell) appeared on behalf of the Confederation of Health Service Employees.
- Counsel (instructed by Messrs. Hempsons) appeared on behalf of the Medical Defence Union.
- Counsel (instructed by Messrs. Le Brasseur & Oakley) appeared on behalf of the Medical Protection Society.
- Solicitor (of Messrs. Coodes, Hubbard, French & Follett, St. Austell) appeared on behalf of “Nurse Adeline Craythorne”.
8. Mrs. X attended and gave evidence at the Enquiry on Wednesday, 1st November, 1967. She was represented by a Solicitor, Mr. J. A. Coode of St. Austell. She confirmed that she was “Nurse Craythorne” the writer of the article concerning St. Lawrence’s Hospital in “Sans Everything”, and we shall hereafter refer to her as Nurse Craythorne.
9.We had heard some forty witnesses before we heard Nurse Craythorne’s evidence, but the majority of these witnesses had given evidence concerning matters which formed the subject of an Interim Report and which were not concerned with the allegations in the book. However, we informed Nurse Craythorne and her Solicitor that where these witnesses had given evidence generally concerning the matters referred to in Nurse Craythorne’s article the transcripts of evidence of these witnesses would be made available to them, so that Nurse Craythorne could make any comment upon such evidence as she may wish.
” Nurse Adeline Craythorne “
10.Nurse Craythorne obtained work as a part-time Nursing Assistant at St. Lawrence’s Hospital, Bodmin, in November, 1964, not September, 1964 as stated in the book. She had no previous nursing training or experience, and she had little if any nurse training during her brief spell at the hospital.
11.Nurse Craythorne told us that she had resigned her employment at the Hospital in May, 1965. On 10th November, 1965, she wrote in reply to a letter which appeared in The Times newspaper signed by Lord Strabolgi and others and about a month later she received a letter from Mrs. Robb of A.E.G.I.S. Thereafter, over a period of some months—the evidence suggested the period December 1965 to May 1966—she wrote about half a dozen letters to Mrs. Robb in which she described her experiences at St. Lawrence’s Hospital. She had kept no notes or diary, but the letters which she wrote from her recollection of her experiences were edited by Mrs.Robb and in this way her article came to appear in the book.
The Article on Pages 37-43 of ” Sans Everything “
12. In order to relate the evidence to particular allegations in the book, the whole article was divided into small paragraphs which were dealt with seriatim.
Paragraphs A, B & C.
” The Paper covers 5 wards of a big Mental Hospital in the South of England “.
” The worst of these was the Geriatric Ward, with seventy-plus patients “.
” Date, September, 1964 to May, 1965 “.
The hospital records disclose that taking into account absences for leave and sickness, Nurse Craythorne actually worked less than 100 days, normally from 7 a.m. to 2 p.m. Mondays to Fridays with an occasional Saturday or Sunday. The total hours worked compared with the 42 hour week of full-time nursing staff showed that Nurse Craythorne in the period 30th November, 1964 to 10th May, 1965, had the equivalent of 14 weeks full-time service. This was the sum total of her nursing experience.
Records show that Nurse Craythorne worked on 5 wards as follows: —
- Valency (Ward 13) (Long-stay patients) for most of her time ;
- Loveny (Ward 8) (Geriatric patients) on 4 days only ;
- Tresillian (Ford House) (Geriatric patients) on 1 day only ;
- Luxulyan (Ward 10) (Geriatric patients) on 1 day only ;
- Kensey (Ward 6) occasionally for short periods.
When it was pointed out to her that her statement “The paper covers five Wards . . . dated September 1964 to May 1965 ” could be misleading, when in fact she had spent only part of one day on two wards and part of four days on another ward, Nurse Craythorne agreed, but stated that she only needed one day to form her judgment on the things she had seen and heard. The following is an extract from the cross-examination of Nurse Craythorne dealing with this point: —
” Q. Bearing in mind that you had never had previous experience of nursing until you came in to the mental hospital do you think you were in a position to pass judgment on the staff, or the organisation or anything else concerned with the hospital when you had one day in a Ward?
A. I do.
Q. You do?
A. Yes, I do. I stand by that.”
“In September 1964 I was engaged to work as an auxiliary nurse in a large mental hospital in the South of England. When I was new on my ward, and not been issued with a uniform, one old lady said to me ‘ You aren’t a nurse, dear; you can’t be. You don’t hit us or shout at us’. Another said ‘No-one smiles here. We are no good in here; useless, bloody wets’ The patient who said that became a friend, and used to come with me to sort clothing. She proved capable of doing what seemed to me excellent sketching.”
The date—September, 1964—is admittedly wrong. The patient who is said to have become a friend was identified as Miss A., whose condition in the hospital records was described as “Not able to converse. Disorientated. Confusional state”. The evidence was that the Sister in charge of this ward had introduced a rehabilitation programme of occupation for patients and had encouraged Miss A. with her art sketching before Nurse Craythorne appeared on the scene.
There was no evidence that such expressions as those referred to above were ever used by the Nursing Staff. Deputy Ward Sister B. described how in his first job in a mental hospital he was horrified by the language but “I gradually became accustomed to it and occasionally regret that I swear myself “. “Bloody” was a word used, and “wet ” was a hospital word for incontinence, but he had never heard a patient referred to as “a bloody wet”.
Sometimes, he said, female staff would call a patient ” a bitch” and occasionally, though not often, ” a bloody bitch”.
“A very depressed old lady might say ‘Nobody smiles here’, not because it is true, but because of her mental state.”
” When I had been working for a few weeks, the (male) assistant matron asked me if 1 was happy. I told him that I was most unhappy and felt as if I was in a punishment ward. He shrugged his shoulders and said ‘ I know “. But it still goes on!’
The male assistant matron referred to was a Mr. C. who was a Senior Assistant Superintendent of Nursing and as such was responsible to the Superintendent of Nursing, for the supervision of staff and of nursing services on some of the female wards of the hospital. He would, therefore, have had contact with Nurse Craythorne as a newly appointed Nursing Assistant on morning duty in Valency Ward.
When new staff, and particularly untrained staff are appointed it is the practice of Mr. C. to enquire of them if they are “settling in”, “if they are happy” or “have any special problems”. He does not remember this Nurse in particular, but admits that he would be the male assistant matron referred to. He refuted the statement that if a nurse told him she was unhappy and felt as if she was in a punishment ward that he would simply shrug his shoulders and say “I know”. He kept a record of any complaints made to him of this kind, and he would certainly have taken further action if any complaint of this nature had been made to him.
Mr. C. impressed us as a witness of truth. In particular we were satisfied from the manner in which he kept his records, and was readily able to produce to us such records as we required, that if any such complaint had been made to him it would have been recorded, and action would have been taken on it.
” The staff were always showing me healed fractures—to fingers, arms, etc. They warned me to be very careful; and yet in eight months no patient either attempted to hit me or was even unpleasant. After a time I was regularly ‘phoned for to help to give treatment and medicine on the refractory ward, and to be there while the doctor did his round.”
In examination Nurse Craythorne admitted that a Sister was the only “staff” she could recollect having shown her on one occasion “broken fingers or broken bones in her arm”. The Sister recalled an occasion when she showed Nurse Craythorne “an unsightly break” in one finger. This was not done in the context of warning Nurse Craythorne to be careful, nor did she give her any such warning. The refractory ward was identified and Nurse Craythorne was asked what treatment and medicine she would help to give on these occasions.
” Q. I appreciate that you were ‘phoned, but what treatment did you give? ….What did you do?
A. Well, several of our patients actually went down, or two or three of our patients went down, to that Ward and I used to be sent down to look after them when they were there and bring them back. They used to sleep down there, some of our patients and I used to go down and bath and dress them, and bring them back and give them tablets and so forth.
Q. That is what you mean by giving them treatment and medicine?
” But working on a strange ward at weekends, there was likely to be the horror of seeing feeble old people flinch, and of hearing them plead: ‘Don’t hit me, will you, Nurse. Don’t drag me.’ ”
According to the hospital records, Nurse Craythorne worked on this ward on four occasions only. She was unable to identify by name or description any nurse whom she had seen dragging a patient, or any patient whom she had seen flinch from nursing staff. Patients, she said, had said these things when they were being bathed, or being prepared for their meals. Nursing staff questioned about this allegation commented as follows: —
One nurse agreed there was a patient “who says this kind of thing all the time. It is just a saying of hers. I do not think there is any meaning at all . . . she continually says ‘ Don’t hurt me, don’t hit me’ when there is no reason for saying it”.
Another told us that he had heard patients speak in this way who were rather confused. He had heard similar remarks in a context where there was no suggestion of any ill-treatment “probably when the patient was being given treatment or a bath and this was not uncommon”.
This view was confirmed by the testimony of a number of trained and experienced nursing witnesses.
In the course of our visits to the wards, a number of patients were seen who blurted out and repeated remarks which were quite meaningless and which were obviously caused by their mental condition.
“Little things mean so much to these patients. To the annoyance of some of the other nurses (it made a little more work for us) I asked for scented soap, toothbrushes—there were none in the ward—and hairbrushes. The mute patients’ joy in scented soap in the bath had to be seen to be believed. All those things are still in use now.”
There was evidence that lightly scented toilet soap, toothbrushes and hairbrushes had been available on requisition at least 5 years before Nurse Craythorne appeared. Additional toilet requisites were available for purchase by patients from the hospital shop and canteen through the comforts fund at the Ward Sisters’ discretion. There was no evidence to support the inference that Nurse Craythorne was instrumental in introducing comforts and it was found that nursing staff were only too anxious to obtain anything to add to the care and comfort of their patients.
“Bath mornings took place twice a week. Forty-four patients had to be bathed, and this was a nightmare. The sister in charge showed me how it was to be done. I had always at least eight patients stripped naked. One was put into each bath, while the others jostled one another. The incontinent patients often wetted the piles of clean towels and clothes on the urine-saturated floor. When left to manage on my own I took only two patients at a time and was finished just as quickly, with everyone happy and enjoying it.”
The bathing procedure on this ward was explained to us by the Sister in charge and confirmed by all the other nursing staff who had worked on the ward during Nurse Craythome’s period of service. It involved routine bathing of patients twice weekly and more frequent bathing of incontinent patients and with limited space and limited time and few staff to cope with 44 patients the whole process had to be carried through without delay and there would be occasions when two patients were drying and the next two were getting undressed ready to bath. Normally there would be no more than 4 patients in or near the bathroom, although there would be times when some patients had to be restrained from undressing or crowding into the bathroom out of turn. In a bathroom of 14 ft. x 10 ft. it would have been almost impossible to have accommodated 8 patients and staff at any one time. Part of the bathing procedure was that nurses should record, in the bath book, patients’ names and report in that book and the ward casualty book any bruises, rash or unusual marks seen on the patient’s body. Investigation of such bruises would follow.
Apart from one ward, no smell of urine was detected in any of the ward bathrooms and there was no evidence that the floor in the ward to which the allegation refers was ever “urine-saturated” or that incontinent patients wetted clean towels or clothes. Normally clean towels and clothes were placed on a rack in the bathroom.
While Nurse Craythorne told the Committee she could bath all 44 patients within 2 ½ hours, evidence from the Ward Sister and two members of the nursing staff was’ that Nurse Craythome had to be rebuked because she spent too much time with patients in the bathroom.
We noted the help afforded nurses in bathing heavy patients by the use of the Ambulift machines and their use, or use of similar machines, is recommended so far as is practicable.
We also noted with satisfaction that in the upgrading of ward accommodation undertaken in recent years, baths in most of the ward bathrooms have been curtained off to emphasise the need for privacy in bathing procedure.
“I had to complain of seeing bowls of water thrown over nervous patients’ heads and of patients locked in the lavatory to keep them out of the way. Yet every one of them would respond to ordinary human understanding. After several months work with them, one day when I unlocked the dormitory door and went in switching on the light, the greeting was so warm that it felt like arms holding me.”
In the absence of proper facilities for hair washing on the ward, it was the practice to wash patients’ hair in the bath and to rinse off by pouring a small bowl or jug of water over the patient’s head.
When closely questioned about the allegation, Nurse Craythorne stated that on one occasion only she had seen two small bowls of water poured over the head of a patient whose hair was being rinsed after it had been washed in the bath. This patient is a severely mentally sub-normal woman who dislikes having her hair washed at all and who was no doubt apprehensive of the procedure of having her hair rinsed in this way. We are quite satisfied that there was nothing vicious or harsh or unkind in the way in which these duties were carried out. In our view this is an example where the writer in places distorts a particular incident which has an element of truth in it by exaggerating it, by converting singulars into plurals and by making an isolated incident appear as though it were a regular occurrence and putting a slant upon it making it appear as though it were inhuman conduct by the nursing staff.
On the general point of humanity and understanding in the treatment of patients by nurses, we relied on the evidence of a nurse of considerable experience who said, “I feel this way—that understanding of the patients comes from experience. When you are very new you do not always understand the patients. I find that it is the older people and the people that know them that the patients come to with their little troubles and their little grievances. I think over a period of time the patients develop trust in the people they have known longest”.
“I was astonished and horrified by the way in which trained staff discussed the patients in front of them, as if they were stone deaf as well as confused. I saw one woman called up to the sister’s table in the day room and made to pull up her clothes to show that she had wet her knickers. This in front of a male cleaner, who, poor lad, was most embarrassed. The patient put out her hand touched the sister’s white apron and said, ‘You may be white on top, sister, but not underneath ‘ The sister told me to ‘Take your filthy friend and bath her”.
The male cleaner employed on the ward during Nurse Craythorne’s service (although no longer in the Hospital Service), gave evidence that he had no recollection of any such incident and that he was sure he would have remembered it had it occurred. All staff who worked with Nurse Craythorne on the ward were questioned, but no one had any knowledge of such an incident.
While nursing staff did discuss patients as people in front of them with other nurses and medical staff this was not undertaken maliciously or in a derogatory way, “The patients are there as people and they like to hear what you are saying.”
” One of the mutes in this ward neighs like a horse when frustrated and she is referred to, before her face, as the ‘bucking bronco’. Yet this woman, a clergyman’s daughter, is not deaf, because she would come with me when I was bed-making and I would sing to her, and she could show me, by her facial expression and by touching me, which songs she liked best. The rest of the day she sat slumped in a chair.”
“All these things when written down may sound trivial; but they build up an atmosphere which is Dickensian.”
The patient was identified. She is not a clergyman’s daughter and no other witness had heard her described as the “bucking bronco”.
Nurse Craythorne clearly had a deep interest in and sympathy for the patients and she would have been happier if she could have spent more of her time playing with and entertaining them, but one of the most frequent criticisms of her by other experienced staff, who worked with her, was that she never applied herself to learning elementary nursing duties. At the end of her employment we were told, she could not make a bed properly. She failed completely to understand that in a situation where staff were in short supply and where nursing duties pressed heavily on those involved, the disciplined nurse who got on with her job expeditiously and efficiently was making a greater contribution to the care and welfare of the patients than the sentimental but inefficient and untrained member of staff who wished to spend her time singing to and playing with the patients.
” I believe the male section of the hospital is administered in a far more humane manner. There is now a male nurse on my ward”
Some facts which we felt threw light on this statement are as follows:
(i) This hospital has 781 female beds and 492 male beds, and there is much less overcrowding and pressure of work on the male side.
(ii) Over recent years there has been a movement to introduce male nurses into female wards in an effort to improve the staffing position on the female wards.
(iii) On 16th March, 1965 Mr. D. was appointed Deputy Ward Sister on the ward, where Nurse Craythorne was also employed. He had previously assisted with a rehabilitation programme on the male side, and the intention was that he should co-operate in a similar programme which had commenced on this ward.
(iv) Nurse Craythorne may have gained the impression that with more staff dealing with fewer patients on the male side, the male side was better off than the female side.
“I could not see patients slapped across their naked breasts and kicked— the sister’s excuse being that she was short-tempered and anyway it was all that the b . . .s understood. So I left, as do many others who go there, as I had done, partly because they must earn a living and partly because they feel the need to do work crying out to be done.”
Nurse Craythorne told us that she had seen Sister E. slap patients across their naked breasts and kick them out of bed, and that she left her employment because she could not bear to witness this kind of behaviour. Nurse Craythorne could not identify any patient who had been ill treated in this way, nor could she identify anyone else who had witnessed such behaviour.
She was questioned about it. ”
Q. . . . Who did it?
A. The Sister, and I made a complaint about it.
Q. To whom?
A. To Miss F.
Q. How often did you see patients struck across their naked breasts and kicked?
A. On several occasions and kicked out of bed.
Q. By Sister?
Q. Do you mean literally kicked out of bed?
A. Literally kicked out of bed.
Q. How did she do it then?
A. Dragged off the bed clothes and would push the woman and push her and kick her out of bed.
Q. But how could she get her leg up and kick the patient out of bed? I find some difficulty in understanding this.
A. She did not seem to find any difficulty in doing it….”
Miss F. is an Assistant Superintendent of Nursing and she supervises the female wards under the direction of Mr. C. She is a very experienced Senior Nursing Officer and seemed to us a woman of high integrity. Nurse Craythorne recognised Miss F. as the person to whom she alleged she complained about Sister E.’s behaviour, and Miss F. recognised and remembered Nurse Craythorne as a part-time Nursing Assistant on Valency Ward. When questioned about the alleged complaint, Miss F. said: —
” Q. . . . what is being said is that she (Nurse Craythorne) reported to you specific acts of cruelty by Sister E.?
Q. She has told in evidence yesterday about a number of incidents— one when Sister E. slapped a patient who recoiled and fell to the ground.
A. … I do not know anything about that.
Q. She said she complained to you about that very incident.
Q. … and the incident ‘ I could not see patients slapped across their naked breasts and kicked. . . .’
A. No. I can truthfully say that if I had a matter of this nature reported to me I would have reported to my Senior Officers.”
We are quite satisfied on the evidence that Nurse Craythorne never did complain to Miss F. about these matters.
The Senior Nurse on Valency Ward under Sister E. was Nurse G. She had never seen any incidents of the kind alleged in this paragraph, nor had Mr. D., the Deputy Ward Sister, Nursing Assistants H. or I. Mr. C. had never received any complaints of this nature concerning Sister E. or any other staff.
Nurse J. who impresses us as a very frank witness, when asked about this paragraph described it as a lot of nonsense.
We have examined the Ward Casualty books, and the bath books, for any entries of ” bruises or injuries ” to patients, or of patients falling down, during the whole period covered by Nurse Craythorne’s employment, and we can find no records of any such injuries.
Sister E. vigorously denied these allegations and could not understand how they came to be made. The allegations were unsupported by any other evidence and were contradicted by all those witnesses who would normally have had some knowledge of the matters alleged.
Further, we found Nurse Craythorne’s evidence about this matter wholly unreliable. She told us that the reason for leaving her employment at the hospital was “I could no longer work in these conditions, it made me unhappy and it made me ill”. On further investigation we find that the true facts as to her leaving her employment are as follows :—
(i) When she was about to leave Nurse Craythorne told Mr. D. that her reason for doing so had something to do with her sons who wanted her at home to cook their dinner.
(ii)When questioned about her real reason for leaving, Nurse Craythorne denied that she had ever put her reasons into writing.
(iii)There was then produced to Nurse Craythorne a letter dated 5/5/65, which she had written to the Superintendent of Nursing stating ” Owing to a change of arrangements, I am needed at home. I wish to leave the hospital next week . . .”.
Nurse Craythorne then admitted that she had written this letter and that she had completely forgotten that she had written it. Nevertheless, she persisted in her statement that she left her employment because of the ill-treatment of patients such as she has referred to in this paragraph.
When nine months after leaving her employment at the hospital, Nurse Craythorne wrote the letters which form the subject matter of this article, she may have associated in her mind the fact of leaving with cruelty to patients which she says she witnessed, but we are quite satisfied on the evidence that she never told the Superintendent of Nursing or anyone else at the time that her reason for leaving had anything to do with these allegations.
” There were seventy-odd old and frail patients in the geriatric ward of this hospital. The majority of them were mentally confused and some were paralysed. The ward was on the ground floor and in winter there were two open fires. The more agile patients sat near these and would fight off others who tried to take their seats.’
The ward referred to was identified to us, and contained 64 patients.
There were two open fires in this ward and it is more than likely that problems would arise when the more agile and ambulant patients wanted places near the fires, but the picture of patients fighting off others in the context of the Dickensian atmosphere, while graphically descriptive, is wholly untrue. Nursing staff try to put the frailer patients where they will get the most warmth, in the areas near the fires.
“The food was adequate and quite well cooked, but always cold when served. Many of the staff smoked when serving it, dropping ash into it. They argued that, as the patients had filthy habits, this did not matter.”
“1 only worked on this ward in times of stress—e.g., an outbreak of scabies. Consequently I did not know the patients’ names; and many of them were too confused to remember their own. When I was told to fetch the patients due for bathing, I asked if someone could help me to find out which patients owned the names on the list of those whose turn it was for attention. I was told by a sister to “smell the b s’, and then I would know who had been bathed and who had not.”
Over recent years there has been a considerable improvement in the system of getting food from the kitchens to the wards. During the period of Nurse Craythorne’s service, it can well be understood that under the old system food was often cold by the time rectangular food containers which did not retain heat had been carried to upstairs wards.
Smoking by staff on wards was generally forbidden and smoking during the service of meals would have been the subject of disciplinary action. The names of 15 nurses who would have been on duty at some time or other with Nurse Craythorne were read out to her and either she did not recall their names, or remember them, or she stated she had not seen any of them smoke on the wards at meal times. All these witnesses denied the allegation and told us they had never seen this happen. There was no evidence before us that it ever did happen. We are quite satisfied that the Ward Sister at the relevant time would not have used the remark “smell the b s and then you will know who has been bathed and who has not”.
” The majority of these patients had urine rash. Some had sore breasts and navels. This was because they were not wiped dry after bathing. There was such a mad rush to bath so many in just an hour. This led to nurses who were rather slow workers signing their names in the bath book beside the names of patients whom they had not bathed.”
” I have seen nurses pull up old women s dresses and spray them with aerosol that was intended for sweetening the lavatories—between their already red, raw legs.”
As previously stated Nurse Craythorne was employed on this ward on four mornings only. Some patients were treated for scabies at this time and it would be surprising if some patients were not suffering from urine rash from time to time. In our view it is a gross exaggeration to say that “the majority of these patients had urine rash”
An examination of the ward bath book indicates that during the 4 days Nurse Craythorne spent on the ward, 3 patients only were bathed, so that there does not appear to have been any “mad rush to bath so many patients”. There were no reports of any excessive soreness or rashes and we are sure that the Ward Sister would not have tolerated such a situation.
Nurse Craythorne could not name or identify any nurses who had signed the bath book beside the names of patients who had not been bathed.
As to the alleged spraying of patients’ legs with lavatory aerosol, Nurse Craythorne told us that she had seen this happen on two occasions only on the same day, by two different nurses with two different patients. She was unable to name or otherwise to identify either of the nurses or the patients concerned. Again we find this remarkable if indeed, any such incident as this did take place. No other witness had ever seen anything like this occur and we are satisfied that Sister K. and the other nursing staff on the Ward would have been horrified at the thought of such behaviour.
We were told that there were three types of aerosol sprays in use on the Ward, namely an air freshener, an insecticide and a medicated spray for use on wounds. We can only think that Nurse Craythorne had seen the latter being used for spraying on a raw area and that in her own mind she has wrongly associated this with the kind of behaviour alleged in this paragraph. We can find no other basis for such an allegation.
“Many patients in this ward moaned and wrung their hands. Sometimes they vomited their food and the vomit was often eaten by other, very confused patients. The general air of cringing sadness and weeping was beyond bearing. Frequently nurses, seeing their names on the notice board for weekend duty on the geriatric ward, would stay away.”
During the relevant period this ward contained 64 frail and mentally confused patients, the majority of whom were over 65 years of age. There is no doubt that Nurse Craythorne did see patients in this ward who “moaned and wrung their hands”. When questioned about the paragraph a Staff Nurse said, “Of course they wring their hands. They are agitated and depressed. That is why they are here. The only time you know they are not well is when they stop wringing their hands”. Another trained and experienced nurse on this ward expressed it as follows: “Patients in this ward were old people and possibly you do get this business of wringing their hands and saying, Oh, I must go home to Mother’ and such things. This confusion you do get with old people”.
A sentimental and sensitive person like Nurse Craythorne, untrained and inexperienced in mental nursing, may have been more sensitive to atmosphere than the trained and experienced staff, but we are satisfied that it is a gross exaggeration to describe the atmosphere in this ward as “a general air of cringing sadness and weeping “.
No other witness had seen vomit of one patient eaten by another, but trained staff admitted that with certain types of mentally confused patients this kind of thing could happen. All witnesses described the statement, “the vomit was often eaten by other patients” as an example of the kind of exaggeration found in the article.
Frequent failure of nursing staff to report for night duty on this ward was another example of exaggeration. One Ward Sister said, “I felt like it many a time, but by God, you came in to your work and went home dead tired. … I think you have shirkers in any profession, but I do not think they would stay long “.
“I cannot describe the smell. There were many contributory factors, including the urine-soaked floor-boards, and the filthy dented and scaly metal chamber-pots. The patients’ slippers too reeked of stale urine. Surely some firm could make cheap slippers that might be burned when they have become foul! 1 had to walk three miles to the hospital through woodland and country lanes. After the sweet air, the smell in the ward made me retch!’
There was no evidence of urine-soaked floor-boards in this ward, but there was some evidence to suggest that the conditions described could have applied to another part of the hospital at this time. Both wards have since been modernised and renovated and apart from one ward, we found no evidence in our inspection of the hospital of the smell of urine. Chamberpots were in use at the time, but have since been withdrawn and commodes substituted. Plastic slippers are now in use and when fouled are replaced with new ones.
” The ward where 1 normally worked had only some forty patients, about half of whom were manic-depressives. There were several mutes, and the rest were mental defectives. Most were under fifty years of age. The sister in charge was particularly brutal in her treatment and handling of the patients. But when she went on leave for three weeks, she was replaced by a male charge nurse. He was keenly interested in the patients’ welfare, and we worked together without bothering about extra hours of unpaid work”
Part of the trouble seems to have been due to a clash of personalities between the sister in charge and Nurse Craythorne. The former was an efficient and experienced nurse having a powerful voice and a bustling and somewhat brusque manner, but a person with a high sense of her vocation and utterly devoted to the care and welfare of her patients. She would not maliciously or intentionally harm any one of these, and in our view there are few who would have done more than she did for her patients, often at much cost to herself in time and money.
On the other hand, Nurse Craythorne was extremely sensitive, sincerely concerned about people, but untrained ahd inexperienced in nursing and incapable of doing a nurse’s job. In our unanimous opinion, there is no foundation for the allegations levelled against the sister.
Enquiry from the Senior Nursing Officer concerned, revealed no record or recollection of Nurse Craythorne having made any such complaint regarding the alleged “brutal treatment” of patients.
As mentioned under paragraph 10 a rehabilitation programme was being implemented during the period November, 1964, to May, 1965, arising out of which improvements were made in patient’s dress and individual lockers. Face flannels and other items were provided as a regular issue to all wards. Far from working together with Nurse Craythorne as this paragraph suggests, the male nurse was severely critical of her and described the article as full of exaggerations, distortions and untruths. He described this particular paragraph as nonsense and said, ” I never took much notice of Nurse Craythorne because I considered her a bit silly”.
“I felt that something should be done about the heavy growths of facial hair which disfigured many of the patients. He agreed with me, and together we tidied them up. 1 brought in lipsticks and other make-up. We spent our breakfast breaks and lunch hours ironing their dresses, and trying to find shoes in the storeroom that would fit them. Two of the patients were compulsive walkers — one so bad that I could only keep her still long enough to feed her by taking her on my knee. Until now they had continually walked around the ward in clonking, lace-up boots. We put them into soft-soled shoes.”
The impression given in this paragraph that the improvements came about through the instigation of Nurse Craythorne is entirely contrary to the evidence. The Staff Nurse who worked on this ward with Nurse Craythorne told us that it had been the practice for over 18 years for the hairdresser to visit the ward regularly and to remove facial hair growth when necessary. Some wards had recently been provided with electric shavers and these were readily available to all wards on requisition.
“The results of all this were amazing. One woman reputed to be very fierce (I had been warned never to speak to her) ran out of the bathroom where the charge nurse had removed her black beard with an electric shaver borrowed from one of the male wards. She flung her arms around my neck and said “Nurse, darling, 1 look lovely!’ In all the five or six months that I have been at the hospital, these were the first words that I had ever heard her speak.”
Deputy Sister described this and the preceding paragraph as “a gross exaggeration . . . this is the sort of thing this woman has said . . . she would emphasise the good and the bad—she has exaggerated both ways”.
He told the Committee that the patient in question “is incapable of doing this. She would not do it”.
” We found that patients who had been doubly incontinent became clean and dry when we took away the hideous strong dresses and gave them ordinary hospital clothes. The same thing applied to the heavy, uncomfortable, strong sheets on the beds: there was much less incontinence when we provided ordinary sheets. The doctors became interested and said, ‘It makes you think’.”
We inspected one of the dresses: they were made of nylon material, Terylene, the seams of which were double turned and stitched with nylon thread, fastened at the back to prevent tearing and removal by restless patients.
About 6-8 patients wore these dresses at the time, and there was one patient in the ward who was in strong sheets. She had been put to sleep in these sheets, because she compulsively tore up all other sheets and blankets.
When Deputy Sister D. was asked about the statement in this paragraph concerning ” doubly incontinent patients becoming clean and dry ” he said:
” Q. What about paragraph 18?
A. Well again this is silly—anyone who has had experience of mental Hospitals knows it does not work like this. It takes a long time, it does not happen overnight.
Q. Have you any reason for her saying that taking away the strong dresses and strong sheets had an effect on the continence or otherwise of the patient?
” When the sister returned all this was stopped. She suggested, in the patients’ hearing, that the charge nurse had ‘prettied them up’ because he had sexual designs on them.”
“So we were back to square one again.”” I heard the crudest remarks in the bathrooms from members of the staff to patients about their habits of masturbation. In many cases these were distressing and embarrassing to the unfortunate patient.”
While there were differences of a minor character between the Ward Sister and Deputy Sister regarding the practical means of carrying out the rehabilitation programme, there was no real conflict regarding the rehabilitation programme itself. After careful enquiry we found no shred of evidence to support the allegations against Sister or any other member of the nursing staff regarding ” having sexual designs on the patients”. The very suggestion was grotesque. The sister agreed that she might have said jocularly, “I see nurse has made you look very pretty” or words to such effect (she was here referring to the male nurse who had been in charge during her absence). Similarly, we are satisfied that the nursing staff had never heard the crude remark alleged in the bathroom. One patient on the ward practised masturbation frequently. In dealing with this patient Sister would often say, ” Now come along, don’t be dirty. You must stop this ” and so forth. It was rather like dealing with the bad habits of a child. Nurse Craythorne may well have overhead Sister speak to this patient about this practice and it may have shocked her rather sensitive nature.
Nurse Craythorne told us in her evidence that her original draft of the article had contained these words ” Don’t talk to me about ministering angels. Many of them were dirty minded brutes”. Although these words do not appear in the article in the book, Nurse Craythorne told us that they represented her views of Sister E. and some four or five other nurses with whom she worked at the hospital, though she could not name or otherwise identify them. In our view there is not a shred of evidence to support such an allegation against Sister E. or any other member of the nursing staff, but it reveals the state of mind in which Nurse Craythorne has written this whole article.
“1 managed to have a piano brought into the ward. Several of the patients could play and sometimes, when I was off duty, I would go back on the ward and play and sing, or sit with them and help them to write and draw. I was told that this was ‘ lowering’ myself sitting with a collection of b.. s who wet themselves. But I have pages of drawings and writings, some of them the work of people who had not done anything but sit about for thirty years. There is still so much that I could tell you. 1 look forward very much to meeting you.”
The evidence does not support the inference that it was Nurse Craythorne who was instrumental in bringing a piano on to the ward or initially encouraged patients to draw or write. When Sister took over the ward sometime before Nurse Craythorne joined the staff, she arranged for books and a piano to be provided as part of the rehabilitation programme. Having an interest in art, Sister encouraged patients, two in particular, with their writing and drawing before Nurse Craythorne arrived, although it is true that Nurse Craythorne continued to encourage the patients to pursue their musical and artistic interests.
In our opinion this paragraph is another example in the article of the slant which Nurse Craythorne gives to the general attitude of other nurses whose behaviour and attitude she seeks to condemn.
” Thank you so much for your letter, and for returning Jane’s drawings. The verse on the piece of cardboard was an Easter card for me from her last Easter. Of all the patients in my ward, her appearance troubled me most— she had such a haunted, anxious look. Her incontinence troubled her terribly. The first day that 1 worked at the hospital, I went and talked to her as she stood wringing her hands and dragging at her straggly hair. When I moved away the sister shouted for all the ward to hear, ‘ I hope you have had an elevating conversation with that bloody wet. After weeks of trying to establish contact with Jane, the day came when she suddenly smiled at me and put her head on my shoulder, saying, ‘Life is hard, dear, for us both’.”
The evidence was that Sister was particularly fond of this patient. She had potential artistic ability which Sister had always encouraged. Sister denied ever referring to this patient as “a bloody wet”.
” As I have already said, the small things mean so much to these middle-aged women, some of whom have been in institutions since schooldays. One of them liked to carry in her apron pocket a postcard sent each week to her by her old mother, who was in an old people’s home. When it came, the card would be handed to me with, ‘ Please read Mam’s card’. This was her treasure, her link with outer life. But usually, in the end, the sister would snatch it from her and burn it. When I protested, I was told that it was done in the interests of hygiene, because her hands were always filthy. The mutes seemed to love to hold something in their hands: perhaps little bits of torn paper, or paper handkerchiefs. These, too, were removed, for the same reason, and to discourage what was described as a ‘filthy hoarding instinct’. The tears and distress over the loss of these little treasures were often followed by double incontinence—not only for the victims, but for patients who had watched the scene.”
We accept the evidence of the nursing staff that because of the tendency of patients to hoard, it is necessary in the interests of hygiene to remove cards and other “treasures”—which frequently become dirty, soiled with excreta, etc.,—from patients at frequent intervals. The patients disliked things being taken away and they would immediately start collecting another hoard, but there was nothing cruel or unkind in their removal as Nurse Craythorne suggested. The allegation that such incidents were followed by incontinence is simply not true.
“The patients who were given drugs in syrup form were always thirsty. This was made worse for them by the fact that the ‘worker’ patients could buy their own tea and make it on the ward. They had to watch the tea-drinkers, and were constantly in trouble for trying to creep into the kitchen and drink the dregs. Some were so thirsty that they regularly drank from the lavatory pans'”
“1 could write pages and pages, and it is all heartbreaking.”
It emerged from the evidence that a number of patients in the hospital were compulsive drinkers as part of their schizophrenic behaviour. On the ward where Nurse Craythorne was normally employed one patient was a compulsive drinker from any vessel or receptacle she could lay her hands on. Other patients were cited to us as compulsive drinkers.
Nurse Craythorne, an untrained and inexperienced nursing assistant, did not understand the meaning of these things when she saw them and in accordance with her general theme of condemning the attitude of staff towards the patients she made it appear as though these patients were deprived of the chance of satisfying a natural thirst.
The evidence revealed a general adequacy of patient drinking arrangements, but on those wards where it was necessary to lock the kitchen at night and where patients were dependent on night staff to get their drink between the hours of 6.00 p.m., and 8.00 a.m., we recommend that some provision should be made to ensure that drinks are available between those hours.
“When I complained to the medical superintendent of the hospital about rough handling, hitting and kicking of patients, he heard me with apparent patience. 1 was told that it was known that all these things went on, but if the nurses concerned were sacked there would not be sufficient staff to run the hospital. While my complaints were investigated, I was taken away from the patients and spent my time cleaning the copper pipes in the bathrooms. The pages in the bath book on which I had recorded bruises seen on patients were torn from the book on the day that I made my complaints. Many (though not all) of my nursing colleagues were very angry with me, saying that it made an uncomfortable atmosphere in which to work, and that the nurses should stick together. I pointed out the need to stop cruelty to helpless patients.”
Nurse Craythorne told us that she had made a mistake in saying that she had complained to the Medical Superintendent of the hospital. She had mistakenly thought that the Superintendent of Nursing, to whom she alleged she had made complaint, was the Medical Superintendent.
According to her evidence, her complaint had been made on two occasions regarding bowls of water on a patient’s head. The Superintendent of Nursing had not received any complaint from Nurse Craythorne as alleged, but had had cause to interview her on 4th May, 1965, because of her frequent and unexplained absences from work and on account of a progress report which he had received concerning her. She made no complaint to him then about alleged ill-treatment of patients, nor did she give him any indication of her intention of resigning. A day or so later he received a letter dated 5th May, 1965 from Nurse Craythorne tendering her resignation.
Dealing with her first alleged complaint, Nurse Craythorne said that pages had been torn from the ward bath book on which she had recorded the fact that she had seen bruises on a patient. We examined the ward bath book and the casualty book with great care, but could find nothing to indicate that any pages were missing from what appeared to be a continuous contemporaneous record. Nurse Craythorne was invited to examine the book while giving evidence and examined the book carefully with her solicitor—she finally had to admit that the book appeared to be a complete record with no pages missing.
We find as a fact that the reason for Nurse Craythorne’s leaving her employment in the hospital was not because she had complained of acts of alleged cruelty by other members of the staff, or that she witnessed any such behaviour as she alleges under paragraph 11 and in this paragraph, but because she had been reprimanded by the Superintendent of Nursing the day before she wrote her letter of resignation. Following her letter she worked on 3 days, but thereafter did not attend at the hospital to work out her notice. Nurse Craythorne may have complained to other nurses about the conditions prevailing in some of the wards with which she was acquainted at that time, but we reject her allegation that she “pointed out the need to stop cruelty to helpless patients”, either to senior staff or to anyone else, or that this had anything to do with her resignation as this article alleges.
“Things improved for a brief spell. But very soon the old order returned, and within three weeks all was just as bad as before. I concluded that the powers that be see only what they wish to see. Or worse—that they lack the ability to care.”
Nurse Craythorne told us that this paragraph referred to the ” temporary improvement” when the male nurse was in charge of the ward. When questioned he said,
” Q. Do you know what she is referring to in paragraph 25?
A. No. I do not know what she is getting at by saying it was just as bad as before. You cannot change the place in three weeks. You do not do miracles. She seemed to think we should….
Q. Did she think you could improve things?
A. She thought I was going to do wonderful things; that a man was coming on the ward. I told her what we had been doing in my own department and she thought it was all going to take place on her ward and I knew it could not especially when I went down there and realised the situation.
Q. Did you ever explain that to her?
A. Yes, I did.”
Undoubtedly there were difficulties due to the environmental conditions under which staff had to work, and difficulties in trying to adapt old buildings for use according to modern concepts of mental health treatment, and to the heavy pressure on nursing staff due to shortage of adequately trained staff.
Nurse Craythorne was undoubtedly anxious to see an improvement in the prevailing conditions at the hospital, but so were all the other staff who were prepared to try to improve the lot of the patients by disciplined training and work under these conditions, not because they lacked an ability to care as she thought, but because they cared so much.
SUMMARY OF FINDINGS
13.As the result of exhaustive examination of the allegations we have no hesitation in saying that in our unanimous opinion there is no substance whatever in the allegations of cruelty by staff to patients as alleged in this article. We found no evidence to support any such allegations. To adapt the words of the sub-title of the book we find “there is no case to answer”.
14.Nurse Craythorne proved a most unreliable witness, whose judgment was manifestly unsound. We do not doubt her general standards of honesty and integrity and we accept that she was exceedingly interested in people in a sentimental way especially those who were in need of help or who were suffering in any way. She had no previous nursing experience or training and accordingly finding herself for a matter of weeks only in a large Mental Hospital, she misunderstood and misinterpreted and distorted incidents of behaviour of elderly people suffering from mental disorder.
15.Nurse Craythorne is rather a solitary person with a somewhat simple mind and we think it probable that she came to the hospital with preconceived ideas of it being a community in which there was a lack of humanity. Her observations from there on were formed on these preconceptions and not on an attempt to discover more about the life of this community of hard working people and what they were trying to do to help their patients. Her sentimental approach no doubt conflicted with the objective attitudes which perforce have to be adopted by doctors and nurses who deal with very grave matters of life and death, and in a mental hospital with severe and tragic mental incapacity.
16.In order to maintain their usefulness and efficiency, doctors and nurses must not allow themselves to become emotionally involved, they should be able to stand outside their patients’ problems and consider them with detachment in order to ensure that what is best for the patient in the long run, is done. Nurse Craythorne probably saw this as callousness, as not caring. The Committee, on the other hand, as we visited the nurses and patients in the wards were deeply impressed and, indeed, moved by what we saw. We saw a group of dedicated persons working under difficult conditions, making great effort with patients, the results of which might be regarded by many people as completely unrewarding.
17.We are satisfied that Nurse Craythorne’s conclusions could only have been founded on a lack of understanding and perceptiveness. We would not question the fact that she sincerely believes, and acts out of love for her fellowmen and women, but hers is a solitary kind of love just as she is a solitary person, and she is, therefore, not aware of the love of those around her expressed not in sentiment but in the group action of a community who understand one another, know their purpose and act together to achieve it.
18.The hospital has set itself a high standard in the quality of its medical and nursing staff, and in the efficiency of its administration. We were very impressed by all we saw and heard and by the kindness and understanding with which the patients are treated by all concerned. The attitude of the staff generally was typified by the Sister in charge of what is regarded now as the heaviest ward in the hospital in terms of nursing effort, not a very young woman herself who had frequently been offered a change to another ward and had always refused because of her strong sense of duty, expressed by her when she told us that until the conditions in the ward were such that she would have no worries or anxieties if her own mother or father were in the ward, she would not feel satisfied.
19. We listened to many witnesses describing to us quite frankly and openly their own attitudes and the attitudes of their nursing colleagues, and we had an opportunity of assessing their characters. We endorse the tribute paid by the Medical Superintendent to the nursing staff when he appeared before the Committee, and said: —
” I cannot speak too highly of the nursing staff here. I think they are excellent nurses. When I came here I think that there were many of them who were lacking in the know-how, but this was something that was not their fault, and they very rapidly caught up with the modern progress once given the opportunity to learn something about it. Although we have not perhaps directly instructed nursing staff in the way that one would like to see, I think we have, in fact, imported our ideas to them. … I should say that their other characteristic is their extreme kindness and tolerance. I have never seen such ability to tolerate disturbed behaviour as one finds among Cornish nurses.”
20.As to the Consultant and Medical Staff of the hospital, it is our opinion that they have utilised the resources at their disposal to the best possible advantage and without sparing time or effort. They have provided in the hospital and throughout the county psychiatric and psychogeriatric services of a standard which might well be an example to the rest of the country.
21.The publication of this article with its attendant local and national publicity, must have caused all staff great anxiety and concern, and tribute is paid to the fortitude and calmness with which they faced these criticisms. Further we are glad to be in a position to assure relatives and friends of patients in this hospital that these allegations of cruelty are unfounded in fact.
The Present Situation
22.In pursuance of the second part of our terms of reference, we made a full examination of the present situation in the geriatric and psychiatric wards of the Hospital. We inspected the Hospital buildings, the ward accommodation and equipment, and we talked with staff and patients in the wards and in the occupational and industrial therapy departments of the Hospital.
23.We also enquired into the development and organisation of psychiatric and geriatric services in the Hospital, in the community and generally in the county of Cornwall, and we review the respective roles of the Psychiatrist, the Hospital and the Local Authorities in providing a community based psychiatric service. We have submitted a full and detailed Report of these various matters of which the following is a brief summary.
24.The grounds of St. Lawrence’s Hospital extend to some 108 acres on the western outskirts of Bodmin. The Hospital buildings occupy 38 acres and consist of nine main blocks as follows: Foster Building; Harrison Clinic ; Rashleigh Building; Kendall Building; Carew Building; St. Aubyn Villa ; Williams House ; Radial Building; Townsend House. These buildings were erected in stages over the past 150 years, most of them to provide for the custodial care of patients and to separate them from the general life of the community.
25.Each addition to the buildings represented the prevailing concept of mental health design, consequently no overall plan for the Hospital was ever envisaged. Each new building was erected as a separate unit to meet a particular need at a particular time, and thus they lack both functional and architectural unity. Ideally the buildings at some stage should all have been demolished and replaced by purpose-built buildings designed to meet modern concepts of mental health treatment, but the problem for the Hospital over the years has been to adapt them to serve an increasing population and new policies in the treatment and care of mentally ill patients. Many of the present difficulties and complaints stem from the limitations and inadequacies of these very old buildings.
26.In addition to the main blocks within the Hospital grounds there are a number of ancillary units of varying size and purpose, such as laundry, workshops, nurses’ home, church, social club, administration offices and industrial and occupational therapy units. There is also a farm which supplies some of its produce to the Hospital and uses selected groups of male patients to carry out simpler types of agricultural work as part of therapeutic training.
27.Outside the main Hospital there are three other units forming part of the Hospital and coming under it for all matters of medical, nursing and general administration. These are Westheath House, Laninval House and Trevillis House.
28.During the last decade the Regional Hospital Board have undertaken the first and second phases of a hospital modernisation scheme, providing new ward and ancillary accommodation at a cost of the order of £850,000. At the same time, a considerable programme has been carried out by the Hospital Management Committee out of revenue funds, consisting in the main of extensive ward re-decoration schemes and upgrading of sanitary annexes and refurnishings.
29.We record our appreciation and admiration of the imaginative and functional way in which this work was carried out. We consider that the Regional Hospital Board must reach an early decision over the next phase of the modernisation programme, particularly in regard to the adaptation of wards for geriatric purposes since we found evidence that uncertainty as to the future of Foster Building has led to a delay in much needed improvement in sanitary annexes and central heating. Some fault can be found with nearly all the wards in this building and in a few there were many. We have no doubt that in the interim the Hospital Management Committee will make every effort to improve conditions here out of revenue funds but we stress that there will be no permanent improvement in the conditions of the wards in this building until the modernisation scheme is put fully into effect.
30.We note that the annual revenue allocation to the Hospital appears to fall short of the average regional allocation to psychiatric hospitals.
31.With regard to nursing services, we found that although the present ratio of nurses to patients may compare favourably with some other psychiatric hospitals, the nursing staff in post was insufficient, having regard to the aged and ageing population of the hospital. In our view a higher ratio is essential in order to reduce the strain on existing staff and to allow the maintenance and expansion of the nursing services. We found that there was much less overcrowding and pressure of work on the male side of the hospital. Over recent years, there has been a movement to introduce male nurses into female wards in an effort to improve the staffing position on the female wards.
32.The hospital has set itself a high standard in the quality of its medical and nursing staff and in the efficiency of its administration. Resources have been used to the best possible advantage. The standard of psychiatric and psycho-geriatric services provided in the hospital might well be emulated by the rest of the country. We commend the zeal of the medical staff in pursuing a community-based policy in the care of the mentally sick. The full extension of their work has been limited by a shortage of staff. We consider that the appointment of an additional consultant and supporting team is urgent. We recommend to the Regional Hospital Board that full support and guidance should be given to these local efforts in developing community-based psychiatry.
33. Arising from our investigation of the allegations in “Sans Everything we make the following recommendations: —
1.So far as practicable, Ambulift, or machines of a similar kind be provided and used for bathing.
2.Catering staff should be made available on all wards to attend to food service and ward kitchen duties.
3.On those wards where it is necessary to lock the kitchen at night and where patients are dependent on night staff to get their drink between 6 p.m. and 8 a.m., some provision should be made to ensure that drinks are available between those hours.
34. Consequent upon our examination of the general situation in the hospital at the present time, we recommend as follows: —
1.Early completion of the full modernisation scheme, particularly with regard to lift provision, is desirable. As a temporary measure, urgent consideration should be given to the installation of electric wall fires on one ward, pending structural alterations.
2.The annual allocation of revenue funds to the hospital should be reviewed by the Regional Hospital Board.
3.A well defined programme of training for nursing assistants, together with an introductory course of instruction, should be provided.
4.The service of a Ward Sister or her Deputy should be as much available at weekends as during the week. To spread the work, nursing staff of all grades should be available for weekend duty when required.
5.The supervision of each ward or group of long-stay wards should be the responsibility of a single consultant.
6.Discussion groups between medical and nursing staff should be resumed.
7.A higher ratio of nursing staff to patients is essential.