Complaints about the Garlands Hospital in Carlisle were ignored, says report

Five trainee nurses who stepped over the threshold of Carlisle's Garlands Hospital six years ago were there for practical lessons in the care of the elderly.

Five trainee nurses who stepped over the threshold of Carlisle's Garlands Hospital six years ago were there for practical lessons in the care of the elderly.

What they found shocked them. In debriefing sessions at their college, St Martin's, they told a disturbing story. Patients' genitals had been washed with flannels that were later used to clean their faces; some were forcibly confined to a dormitory; medication was concealed in sweets. Others were tied to commodes; yet others were forced to eat while restrained.

Their tutor informed the hospital, which asked its training manager Ann Barlow and the patient services manager Rex Oates - both of whom have now been disciplined - to investigate the observations.

An internal report in 1996 was never revealed to the North Lakeland NHS Trust Board, but sections of it provide a depressing commentary on the culture of those entrusted with caring for these patients.

Many practices were even condoned: restraining and feeding a patient on a commode "appears unsatisfactory", said the report, "but the benefits gained for the patient and her family seems to justify it".

No one was disciplined as a result of the1996 report. It is a measure of how far the culture of the trust had become "unprofessional, cruel and degrading", as a later report put it, that when staff were interviewed by the Commission for Health Improvement (CHI) earlier this year, some failed to recognise that the abuse wasunacceptable practice.

The only staff disciplined following the 1996 inquiry were the student nurses who had helped to expose the abuse. When the CHI interviewed two of them, it concluded they had had "a very difficult time". They were intimidated and pilloried by other staff in the trust and the local area.

By contrast, some of those accused of abuse "received a lot of support from colleagues". The CHI concluded that the effect of the 1996 report was to "confirm and even condone unacceptable practice".

But abuse of elderly patients continued. In 1997, Ward 21 was merged with two other wards to create Kielder House, a 30-bed unit that brought together patients with severe physical disabilities and those with behavioural problems. In December 1998, two locum nurses, who brought a fresh eye to the "closed, inward-looking and insular" culture of the trust, lodged a complaint about the physical abuse of patients.

A second investigation by the trust revealed incidents similar to those found in 1996. Three of the staff identified had been named in the previous report.

The 1998 allegations said staff stood by and laughed as a patient struggled to get up after twice falling; a nurse failed to change the soiled clothes of a male patient while dressing him; a male nurse flicked a patient's genitals and said: "I'll show you how to deal with them."

Four months later, in April 1999, the trust set up a third inquiry to look at the handling of the 1998 investigation at the request of the NHS regional office due to continuing worries. It delivered its devastating verdict last March, saying some staff had used "degrading - even cruel - practices".

Alan Milburn, the Health Secretary, sacked the chairwoman of the Trust, Mary Styth, after the external review's description of her relationship with the chief executive Alan Place as "dysfunctional".

The worst mistake, the CHI report said, was to ignore the students' warnings. "Had the trust responded positively to the student whistle-blowers in 1996, it might have prevented further abuse of the kind reported in 1998," it said.

High-level disciplinary measures are now under way. The chief executive Alan Place was sacked last month along with personnel director Catherine McCreedie. David Moorat, the director of quality and nursing, has taken early retirement ahead of a disciplinary hearing.

Last night East Cumbria Community Health Council, a watchdog for Carlisle patients, said the ward had been under suspicion, but for other reasons.

"We certainly had our concerns about Garlands," said CHC's chief officer Peter Canham. "But our focus was on the fact that ordinary elderly patients were being left out amid improvement in acute care ...

"This was the least of the problems, yet it was a closed culture and we never heard a whisper. We've found the reality to be terribly painful."