In a previous post I wrote about the 1976 inquiry into St Augustine’s Hospital, Chartham, Kent.
Three years after the publication of the report of the committee of inquiry the chairman of the committee, J. Hampden Inskip, together with psychiatrist J. Guy Edwards of Knowle and Southampton University Hospital Groups*, published an article in the Lancet (24 March 1979), “Mental hospital inquiries”. It began:
“Major hospital inquiries burn up money that is desperately needed to improve the Health Service, disrupt the work of the hospital, and often have a devastating effect on individual and group morale, leaving in their wake a legacy of corrosive bitterness. They should be avoided wherever possible”.
What you might hope is that inquiries would leave in their wake a legacy of improved care for patients and redress for victims. The allegations of abuse at St Augustine’s hospital, everything from washing patients with the same dirty flannels to abuse of electroconvulsive therapy (ECT), in one case leading to a patient’s death, were found to be almost entirely justified. But the authors of this article were concerned only with the impact on psychiatrists and other staff.
The authors blame the Department of Health and Social Security for abolishing the “old system of physician superintendent, which for all its faults had at least a clearly understood chain of command, and for substituting in its place a multidisciplinary framework without any intelligible guidance as to how this was to be reconciled with the clinical autonomy of consultants as then understood”. Standards of care were inevitably low, they claimed, given the shortage of resources, “combined with an aging population” (the aging population is still blamed for all sorts of ills – it is just a different generation that is aging). The authors gave handy tips on how to avoid committees of inquiry: the setting of reasonable targets, and delegation, for example. If standards of care were slipping too far, consultants could write to the authorities and say they were too overburdened with committee work to provide patient care.
There follows a section on leadership: “Every group of people looks for a leader because it needs one”. Even though the National Health Service had abolished the post of medical superintendent, psychiatrists, according to the authors, could still assume the role of leaders. Then there was a long section on how committees of inquiry worked, what psychiatrists could expect if they had the misfortune to be involved in one, and how staff morale could be maintained. The advantages of a private versus a public inquiry were made clear: “More informality is possible, and the Committee can mingle with witnesses during tea-breaks, when tentative views can be expressed”. The witnesses were of course all clinical and management staff; no patients or their representatives were called as witnesses. In fact, patients were almost entirely absent from the minds of the authors. Concern about the abuses inflicted on the patients appears only parenthetically and is heavily qualified:
“An inquiry inevitably has an emotionally traumatic effect upon some people (if staff have behaved inhumanly to patients, this may well be deserved, although even here an attempt should be made to discover any mitigating circumstances).”
* The original version of this post said that J Guy Edwards was of the Royal South Hants Hospital and Park Prewett Hospital near Basingstoke. Park Prewett was the wrong Hampshire hospital. It should have been Knowle Hospital near Fareham (according to the 1975 edition of the Medical Directory).