Administrative Matters

314.The second substantial allegation in XY’s original statement to the News of the World, was of pilfering by members of the nursing staff. “The amount of foodstuffs stolen by the staff” he said, “is unbelievable “. He also alleged theft of clothing brought into the hospital for patients. The investigation of this serious allegation occupied a great deal of our time.

315.Other administrative matters were brought to our attention in the letters which we received from patients’ relatives, by our own observations or from such documents as Mrs. “Z’s” report. A number of these subsidiary matters have recently been taken in hand by the HMC for reasons unconnected with our Inquiry and we do not consider them at great length.

Pilfering

316.Pilfering, however, calls for rather fuller consideration. XY’s main allegation was that food which was sent up to the wards for the patients, notably fruit, eggs, cheese, butter and bacon, was either being taken away from the hospital in fairly substantial quantities or being consumed by nursing staff on the wards. He made specific allegations against a number of named people. We spent much time cross-examining many of them. They all denied the allegations categorically, although not all their explanations were equally convincing.

317.One of XY’s specific suggestions was that the ward staff regularly ate their breakfast on the ward, consuming food originally intended for the patients—eggs, bacon, bread and so on. Indeed, he claims that he was led to believe by the Chief Male Nurse, at the time of his appointment, that this was one of the prerequisites of the job. We are not satisfied that he was told this by the Chief Male Nurse. But it is plain that it was in fact so regarded. Indeed, one of the motives for XY’s complaint under this head, was his resentment at being excluded from the eating privileges enjoyed by other members of the staff. He was, however, more genuinely concerned at the impropriety of pilfering on the scale which he alleged and had, indeed, calculated the annual cost at between £8,000 and £10,000 (a figure which we do not feel able to confirm or reject).

318.We were naturally reluctant, in face of flat denials on all sides, to accept these allegations in the absence of any corroboration. Eventually, however, almost at the end of our proceedings, “D” (the State Enrolled Nurse who had been dismissed in November, 1967) confirmed the substance of XY’s allegation that members of the nursing staff on the male side did indeed help themselves to food, at least to the following extent:

(a) Many members of the staff who took their meals on the wards made use for this purpose of food which had originally been sent to the wards for the use of patients who were on special diets:

(b) A significant proportion of the fruit which was sent to the wards weekly (on the basis of one apple, one orange, one banana per patient) was shared out to members of the ward staff: much of this was consumed on the ward but sufficient quantities were probably involved to make it probable that packages of fruit were taken away from the hospital by some members of the staff. It seems probable that other commodities, such as cheese, butter, chocolate and sweets were from time to time disposed of in this way.

319. XY’s allegations went further than this. He gave a circumstantial account of the way in which bags and cartons of food were taken by certain members of the staff to their cars and thus transported home. We heard no evidence to corroborate this. But one of XY’s named witnesses, “P”, was interviewed, on 16th August, 1967, by an official of the Welsh Board of Health. “P” then expressed his concern at “the amount of stealing from the hospital” and suggested that a watch should be placed on those nurses who parked their cars near the wards. “Goods” he said “were taken out of the hospital in cars by the dozen”.

320. “P”, unfortunately, is one of those witnesses who was unwilling to testify before us, so that we were unable to test his evidence. In view, however, of the extent to which XY’s other allegations about improper use of food have been substantiated, we think it probable that theft on this more substantial scale, did, from time to time, take place. We regret the necessity for expressing our findings on this matter in such general terms which will necessarily cast a slur on some people who are entirely innocent. But the kind of police investigation which might have enabled us to identify guilty individuals with more particularity was quite beyond our capacity, particularly in view of the length of time which had elapsed between XY’s departure from the hospital and our first investigation of his allegations.

321.Pilfering of the kind described is, of course, notoriously difficult to prevent. It is often said that a system can always ensure the arrival of food on the wards but seldom that it actually reaches the patients. In the present case, however, dishonesty is made easier for several reasons which can, and should be eliminated, as follows:

(a) Although there is a good staff dining room and proper system of payment for meals consumed there, either by the purchase of tickets or deduction from weekly pay packets, a number of members of the nursing staff, understandably, find it cheaper or more convenient to bring their own food to eat at the hospital. There is, however, no accommodation set aside, where members of the nursing staff may eat their own food (although modest accommodation for this purpose is available for members of the manual staff). A report prepared by Catering Officers from the Ministry of Health, following their visit to the hospital on 18th/20th September, 1967, recommends the partitioning of the dining room to provide a suitable coffee/ sandwich room; a memorandum commenting on this report pre­pared by the Group Secretary on 6th December, 1967, indicates that this suggestion “needs to be looked at in conjunction with other proposals for reorganising stores and other accommodation and 44… building superintendent will be asked to give it consideration in due course.” Meantime, members of the nursing staff have been regularly permitted to take their meals on the wards. Although this arrangement to some extent mitigates the difficulties of shortage of staff, it exposes the nursing staff to great temptation to help themselves to the available stores. And it is clear that this tempta­tion has not always been resisted.

(b) Much of the food which has been improperly consumed was intended for patients on special diets. The system in force, as between wards and kitchen for the provision of special diets, provides for weekly or daily requisitions to be submitted by the wards. This appears, on the face of it, to be in order. But our examination of patients’ records showed that few, if any, of them contained up-to-date medical instructions as to the diet to be provided. When we examined in some detail the distribution of, for example, the eggs being supplied to one ward, it was plain that the total delivered was only coincidentally related to the actual orders recorded on the patients’ records, which were many years out of date. The Charge Nurse was able to identify, plausibly enough, the patients whom he now claimed to be receiving such a diet. But the system was plainly being operated, in practice, substantially at his discretion. Once again the resultant temptations to malpractice are obvious. And the system of diet control is plainly too lax to prevent abuse.

311. XY made one other allegation about the pilfering of food. “The Senior Nursing Staff”, he said, “often have the best cuts of meat and so on before they are issued to the patients”. We could find no specific evidence to substantiate this. But the report by Ministry Catering Officers already quoted does contain the following observations: —

“Issues to staff are high. The menu includes a high proportion of quality meats at all meals and the standard order of 20 pounds meat per day for staff when the number of meals served is about 30 mid-day and evening meals per day, indicate that there is less control over orders and issues for staff than is desirable”.

These two pieces of evidence, taken together, plainly indicate the need for tighter control in this respect.

314. Pilfering was also said by XY (as well as by “P”, in his untested testimony quoted above) to extend to clothing. This allegation was not said to involve hospital clothing (that is to say stock actually purchased or provided by the hospital) but only to gift clothing, sent or delivered by patients’ relatives. In addition, certain patients’ relatives did suggest that clothes which they had brought to the hospital had “gone astray”.

315. In this context, it should be borne in mind that garments of all kinds can easily be lost or destroyed in a community such as Ely, where patients are inevitably prone to appropriate garments for themselves. We heard no acceptable evidence of any specific impropriety by members of the staff in connection with clothing. We cannot, therefore, regard this allegation as having been established. Plainly, however, the more effective general standards of discipline among the nursing staff, the less is the likelihood of anxiety in respect of matters of this kind.

Food and diet control

314. We had ourselves recorded a number of observations on this matter before we became aware of the existence of the report from Ministry Catering Officers referred to above. Since this report, as might be expected, covers the relevant ground very fully and has been the subject of consideration and report by the Group Secretary and other officers, we make no further observations under this head save to underline the urgency of implementing the Ministry Report’s recommendations.

Clothing

315.A satisfactory system is in operation for the control of stocks of hospital clothing.

316.Underclothes, socks and shirts are communal issues. The only clothing given individually to patients are suits, trousers and sports jackets. Patients relatives have in the past complained—as they did in letters to us—that articles of clothing have disappeared or been worn by other patients. Relatives are thus advised to allow patients to wear hospital clothing and to keep their personal clothing for periods of leave. Some relatives suggested to us that more should be done to ensure that patients wore, and continued to wear, their own clothing of all kinds. Such a policy would be in line with that recommended in Circular HM(65)104, as follows: — ” All patients, adults and children must have personal marked clothing, including underclothing, which they can regard as their own”.

317. This is obviously desirable in order to develop in each patient the maximum social independence of which he is capable. But, as the Circular itself points out, it is only ” given sufficient staff, adequate space, good equipment and labour saving devices ” that such high standards of care can be achieved and maintained. There are obvious difficulties in the very large, under staffed wards at Ely, where there is insufficient room for each patient to have his own locker. Notwithstanding these difficulties, we formed the impression that the standards recommended in the Circular have been too readily regarded as beyond the bounds of what is possible at Ely.

Patients’ pocket money

318. Some patients’ relatives complained that patients were receiving insufficient pocket money—and in one case that the patient was receiving no pocket money at all.

319. Circular HM(64)45 (primarily applicable of course, to hospitals for the mentally ill but also commended by the Ministry as relevant in hospitals for the mentally sub-normal) points out that: — “Saving and spending of money is an important aspect of the re-training of many patients, and no patient is deprived of the right to use money while in hospital … all patients receive payment for work done in the hospital and those who have no private means are entitled to pocket money “.

There must obviously be some exceptions to this approach with those patients (of the kind found at Ely) who are wholly irresponsible in their dealings with money.

320. As long ago as 1959, however, the Commissioners of the Board of Control, in their report on Ely, observed that the pocket money rewards given were too low, and then significantly below those being given at Hensol Castle, a neighbouring hospital for mental subnormality. The Commissioners also observed that: “Patients get rewards in kind, free visits to the cinema, cigarettes and sweets, but such a method is out of keeping with modern views”.

During the week ended 10th February, 1968, 130 patients received cash pay­ments; 31 of these received more than 10/- and 51 of them 5/- or less. 59 patients received no cash but cigarettes, sweets or tobacco worth not more than 5/9£d. per week. Additionally, some 28 patients were receiving industrial therapy incentives or additional incentives at the discretion of the Chief Male Nurse, not exceeding (except in one case) 5/ – in value.

321. The foregoing rates of pocket money or reward received by the patients are fixed by the Physician Superintendent based upon his assessment of the need of the patient, the patient’s ability to appreciate or benefit from the payment and his willingness to earn the money if he is capable of doing so.

322.Even bearing in mind the severe subnormality of many of the patients at Ely, the current value of rewards or pocket money seemed to us to be low, in light of the passages which we have quoted from the Ministry Circular and the Board of Control- Report. A more liberal standard of judgment certainly deserves to be considered. And it must be clear that payments for hospital work are payable even to patients who have their own resources.

323We investigated the present system for controlling the distribution of pocket money and rewards about which we heard no complaints. The present Hospital Secretary is clearly aware of the need to keep a close watch on this and no special recommendations are called for.

Laundry

324 Our own observations caused us concern about laundry arrangements at the hospital. We accordingly summarise the material facts.

325.Early in 1967 the Laundry Superintendent at the hospital retired and was succeeded by the former Assistant Superintendent. In these circumstances, the question of laundry came particularly to the notice of the new Hospital Secretary.

326. On 17th May, 1967, an Assistant Nursing Officer of the RHB visited the hospital and expressed concern at the fact that foul linen and clothing were still being sluiced by hand on the wards. The Hospital Secretary then undertook to prepare a report on laundry arrangements for the Group Secretary.

327. On the occasion of Mrs. “Z’s ” visit to the hospital on 30th May, 1967, she expressed her concern in the following terms: — “At present nurses do sluicing of fouled linen by hand—in one ward this is carried out in the same room as the sterilising. It was disturbing to see sluiced linen piled into an overflowing dustbin. Nurses also count linen”.

(The Group Secretary’s letter of 30th August, 1967, commenting on this Report stated that: — ” The sluicing of foul linen has been concerning us a great deal for some time and the Hospital Secretary and the Group Engineer are working out proposals and costs of installing the necessary equipment”).

328.On the date of Mrs. “Z’s” visit, the RHB’s Assistant Nursing Officer confirmed that, contrary to her original belief, sluicing was still being done at ward level in other psychiatric hospitals within Wales.

329. On 31st May, 1967, the Hospital Secretary prepared for the Group Secretary an Interim Report on laundry arrangements, which was described as ” based on a first reading of HM(60)1 and the Central Health Services Council Report on Hospital Laundry Arrangements enclosed therewith as well as on HM(63)52″. This Report drew attention to the following matters:

(a) Staffing: Laundry establishment had not been increased, notwithstanding the reduction in the working week from 48 to 40 hours and, in consequence of the lowering of the grade of patients, the increase in volume of foul wash and diminution in availability of patients for work in the laundry;

(b) Sluicing: The need for mechanical sluicing preferably at a central point and the inadequacy of the existing machine for that purpose;

(c)The fact that the porters’ electric trolley (which only served the two children’s villas) was being used for dirty laundry, clean laundry, refuse and swill;

(d) The fact that the hospital had ” an insufficient assortment of unsuitable baskets and trucks with no distinguishable containers for foul laundry”.

330. Authority was immediately sought, and granted by the Group Secretary, for discontinuance of any counting and checking of soiled linen at ward level. This was, of course, in accordance with the specific instructions contained in the two Circulars (quoted in Paragraph 329 above) issued some seven and four years previously.

331 Authority has now been given for an extension of the Hospital laundry, the purchase of two mechanical sluicing machines, six laundry trolleys, 150 foul and soiled laundry bags and 24 fibre boxes—and also for one additional laundry operator. The implementation of these proposals should remove the need for sluicing at ward level.

332. When we inspected the wards, foul linen was not separated (in suitably coloured bags) from dry dirty linen. Linen was, moreover, being tied up in sheets awaiting removal to the laundry. Substantial quantities of linen of all types was being left on the wards (unsluiced) all day, because the collection of such laundry was infrequent. It is important that the mechanical sluicing machines should be sited away from the wards, yet within easy reach and not in the laundry. When and if laundry work is centralised at an area laundry (which is under consideration) the sluicing of foul linen must continue to be carried out within Ely itself.

333. In the result, suitable re-organisation of laundry arrangements is now being undertaken. It is, however, a significant matter of concern that the arrangements which we have described should have subsisted until the beginning of May, 1967, notwithstanding the specific instructions contained in the Ministry documents to which we have referred in Paragraph 329 and 330 above.

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