The persistent ill-treatment of patients went unheeded by management through the 1980s, conjuring up an 'unwholesome image of the criminal lunatic asylum' rather than a therapeutic environment for rehabilitating damaged and disturbed people. Honest and hard-working staff learnt to keep quiet about bullying and brutal treatment for fear that they or their families might be the next victims.
A four-member committee, appointed by the Government and headed by Sir Louis Blom-Cooper QC, reached these grim conclusions after a year-long inquiry into allegations of abuse at the 650-bed hospital. It houses Britain's most dangerous criminals, including Ian Brady, the Moors murderer, and patients whose mental illnesses pose minimal risks to others and who probably should not be there. Patients have to be approved by an admission panel before going into Ashworth and are referred by hospitals, courts and prisons.
Ashworth, with 1,300 staff and on a 200-acre site, is the largest of Britain's special hospitals. Some of the wards in the older Moss Side area are scheduled for eventual demolition.
The better rooms on the more modern Park Lane side have lavatory facilities and allow patients their own possessions. Some are decorated to personal taste, are full of gadgets and even have birdcages. In stark contrast are the seclusion rooms - bare rooms containing only a rubber mattress and a cardboard urine container.
The culprits behind the Ashworth scandal were at all levels of the organisation, the inquiry said. There was a lack of commitment by many nursing staff to the care and rehabilitation of mentally ill people, and patients with learning disabilities; the psychiatric service was less than adequate, and doctors tended to be reactive rather than pro-active in their work. There was little sign of leadership and an 'absence of firm hospital management'.
This left 'a power vacuum which has only been too readily filled, often inappropriately and misguidedly, by the main trade union, the Prison Officers' Association, which is by history and tradition committed to the priority of security and not wholly committed to the therapeutic concept of a special hospital'.
The report states: 'Some of the evidence gave rise to the concern that there may well have occurred breaches of Article 3 of the European Convention on Human Rights, to the extent there has been inhuman or degrading treatment or punishment.
'Such has been the low standard of much patient care at Ashworth, the hospital must be a prime candidate to be included as one of the establishments to be visted in the near future by the Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment.'
William Waldegrave, the former Secretary of State for Health, set up the Blom-Coooper inquiry in response to a Channel 4 television investigation on 4 March 1991 into the physical ill-treatment of some patients. The programme was broadcast two years after the Government, alarmed at the quality of management at the three English special hospitals, transferred responsibility for them to a new Special Hospital Services Authority. Last year it had a budget of pounds 106m to look after a total of 1,700 patients - about pounds 65,000 per patient.
As recently as last October, David Edmond, the SHSA chairman, conceded that it had done nothing but 'scratch the tip of the iceberg' of reforms needed. Nearly a year later, the Blom-Cooper inquiry, reporting yesterday, appeared to concur: 'In the final analysis, we were unable to feel confident that the fundamental cultural changes required were in train. We doubt that the current strategy for change is sufficiently revolutionary for the task in hand.'
Sir Louis and his colleagues on the inquiry, all members of the Mental Health Act Commission, are understood to have felt frustrated by the terms of reference they were given. They were requested to only look into complaints received about Ashworth - not its general regime, nor the role of special hospitals.
In a letter to Virginia Bottomley, the Secretary of State for Health, accompanying his report, Sir Louis suggested that special hospitals were no longer appropriate homes for Britain's most mentally ill and disabled individuals. 'A review of the size and location of special hospitals seems to us to be a matter of some urgency, and should form a vital part of a wider review of the special hospital system. Indeed, we would even question the need for the special hospitals within contemporary forensic psychiatric services.'
Mind, the leading mental health charity, is pressing the Government to acknowledge the need for an alternative strategy, putting patients in smaller, more homely units closer to their communities. But with a welter of further inquiries and committees unleashed by yesterday's report, those alternatives many be many years away.
The Report of the Committee of Inquiry into Complaints about Ashworth Hospital; Published by HMSO in two volumes as Command 2028-I and 2028-2; pounds 26.60 and pounds 14.90.
The inquiry's main recommendations
Independent patients' advocacy service for people in Ashworth, Broadmoor and Rampton to ensure complaints are investigated.
Slopping out to be ended. The Special Hospitals Service Authority, which runs the three insitutions, cannot effect cultural changes needed at Ashworth while it persists.
Dissemination of racist, homophobic and extreme right-wing literature at Ashworth to be subject of internal inquiry.
Medical leadership at Ashworth to be strengthened to give doctors 'more forceful role' in protecting hospital's therapeutic aims.
Seclusion of patients to be phased out within three years; patient control and restraint techniques to be used only when there are no alternatives.
Code of practice on patients' rights to receive visitors to be drawn up.
Comprehensive training and appraisal strategy for staff to be implemented as soon as possible.
All staff to be told they must co- operate with internal management investigations. Prison Officers' Association had advised its members they had a right to silence in internal inquiries relating to criminal events.
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