I wish to raise the subject of security at St. Helier hospital in my constituency. The debate takes on an additional tragic dimension because of the double tragedy at Wakefield earlier this week, which affected hon. Members—in all corners of the House. My hon. Friend the Minister will be as shocked and saddened as I am, but our right hon. Friend the Secretary of State has acted quickly to inquire into precisely what happened. It throws hospital security well on to the national health service agenda. Some guidance is essential now from the Department.
I shall outline the circumstances of a horrendous crime committed in St. Helier hospital, Sutton. The hospital serves a wide area, including my constituency, and enjoys a considerable reputation throughout many parts of south London and Surrey. The horrendous crime was perpetrated against a constituent.
On 14 October 1990, a young girl of only 11 years was raped and indecently assaulted in the children's ward. I am certain that my hon. Friend will share my prime concern not only about the background to this terrible crime, but about the overall security of the whole site, the buildings and the unit. I am deeply concerned about the welfare of nursing and medical staff, clerical and administrative staff, maintenance, professional and technical staff as well as the welfare of the patients.
The father of the child wrote to me. His letter states:
My daughter has got a bit better physically and is now able to walk without help for over a week. She still gets very tired both physically and mentally but we hope and pray that as time goes by she will feel better.
Nobody can describe the distress felt by the parents, the community and, I suppose, the nation at large that a defenceless child left in the care of the local hospital could have been subjected to such an outrage. None of us can imagine the anguish of the parents of the girl as they try to help her come to terms with her terrible experience. Nobody in this House or outside it can appreciate the terror felt by the child who was unable to cry for help, alone in a cubicle and unsupervised, while the two nurses on duty were grappling with an emergency admission. Tragically, unknown to them, the real emergency was being enacted only yards away.
I emphasise that there were only two people on duty in that children's ward. I suppose that my hon. Friend and the inquiry board will query whether that level of staffing was adequate. One has to bear it in mind that the hospital and the area health authority are responsible for the girl's safety. This heinous crime should never have been allowed to happen. The fact that it did raises serious questions about staffing levels, both nursing and security, the quality of control and the direction exercised by the Merton and Sutton health authority and by the district general manager.
I am alarmed that my constituents were not given a little more tender loving care when it most mattered. The father said in his letter to me:
Since they (Hospital Admin.) have found out from my wife that I am in contact with you regarding this incident their whole attitude has suddenly changed and they are now, at a
very late stage, being extremely apologetic and diplomatic in their replies. I hope they do not give evasive answers to either you as my M.P. or to myself.
I hope that my hon. Friend will be able to comment on a number of points that need urgent consideration and, no doubt, action. We need to know how security requirements were co-ordinated between the Department of Health and the Merton and Sutton health authority, and with the St. Helier hospital itself. We need to know what instructions or guidelines were issued by the Department and whether they were followed to the letter of the law by the hospital.
If my hon. Friend's committee is satisfied on those points, will he consider issuing further and tougher guidelines? On 26 November, following the tragedy at Wakefield last week, the British Medical Association, through the voice of Dr. Patricia Price, a retired doctor from Birmingham, and one of the two BMA representatives on the Department of Health advisory committee on violence, said:
Recommendations on training, preventive measures and other aspects to help reduce the incidence of violence were made in our report and health authorities were advised to put them into effect. Unfortunately, these recommendations have only been partially taken up. We recognised that we could not eliminate violence, but in view of this sad incident I would ask all health authorities to take a fresh look at their existing procedures to see whether they need updating.
What security system was in place at St. Helier at the time of the rape of this child? Is my hon. Friend satisfied that it was adequate? Is there any evidence of negligence by the security firm involved, or was it given inadequate and vague guidance by the hospital? Why was the child moved from the larger ward into the small private room at that time? How was and is liaison between security staff and the medical staff conducted? Is it good, and are the rules laid down scrupulously observed by all concerned? Were they observed on 14 October?
I had a communication today from the BMA's parliamentary officer, who has highlighted something that had been expressed by its members. The letter says:
I understand from BMA members working at the hospital that the paediatric ward is situated at a distance from the main hospital and is somewhat cut off and also that there is no fence surrounding the hospital. I also understand that a number of female houseofficers have felt nervous about working at the hospital at night.
It seems that there have been general site security problems at this large hospital for some time and that the public and many schoolchildren use the gate at the rear of the hospital as a short cut through the hospital grounds. I am also told that people are allowed to walk their dogs and ride their bikes in the grounds and that shopping trolleys are wheeled across a corridor which is a connection between hospital units and blocks. There appears, sadly, to be no authority to stop them, and I suspect that many other hospitals face the same difficulties.
There are some interesting and revealing facts that the Minister may need to review in the light of this occurrence and the most recent horrendous crimes in Wakefield. Security at St. Helier until July 1989 was the responsibility of the portering staff. That in itself seems an onerous task for people who have other prime functions to perform and I find it astonishing, given the growth in crimes of violence on hard-working hospital staff in the past 10 to 15 years. One wonders how many other NHS hospitals still depend on that type of security.
The bitter irony is that, rightly and properly, the St. Helier hospital management wanted a more professional approach to security and appointed Gardner Merchant to handle site security. I hope that the Minister and his officials will be able to determine where responsibility lies when a private contractor moves into an NHS unit. Does that contractor take over duties without any day-to-day involvement of the hospital staff, and how frequent is that contact?
I have the feeling that, despite the devoted excellence of the staff in all quarters of St. Helier hospital, something is lacking in management direction. One wonders whether the reception area is manned properly at all times. I am told that hospital staff are vulnerable at weekends, especially on Saturday nights. Who supervises the security office, and what studies have been made by hospital and authority management staff of the work of the one person in the security control office? For what hours is the reception area manned?
I fear that there is anxiety and a lack of confidence in those responsible for the management of some aspects of the hospital, but is it their fault? Is not the unit at St. Helier too large for efficient and effective day-to-day control? Is not the site disadvantageous? What is the infrastructure like from the point of view of future planning, direction and control? Much work must be done now to restore confidence and morale.
There is another element of confusion. I received a letter from the chairman of the proposed St. Helier NHS trust saying:
The security at St. Helier is arguably the best in the region and has been recognised by the staff as a huge improvement on the pre-privatisation system.
Unfortunately, the evidence at present does not point to that. He goes on:
No-one associated with any normal hospital can expect prison-like security.
Of course not, and we do not want that, but we want an effective balance between the two extremes. He goes on:
The inquiry found no negligence, but made some recommendations as to additional security.
Many questions must be answered. It is for the police to identify the way in which this depraved man was able to enter the hospital, and to bring him to justice, but that will not bring back this child's happy, carefree, innocent former life, probably now gone for ever. It is for the area health authority to determine whether security and nursing systems broke down, as in time they were bound to under the present administration in so large a hospital on such an unsatisfactory site; and it is for the district health authority to determine the capacity of an administrator who described this disgraceful and repulsive assault on an innocent child asleep in a hospital bed as "an untoward incident."
It is for the Minister's Department to determine whether the hard-stretched medical services in the hospital are receiving the direction and support that they have a right to expect, or whether the Merton and Sutton health authority has been negligent. I do not point the finger at anybody, but the time has come for the investigation to he made public and for the parents of their 11-year-old daughter to be made fully aware of what took place.
My hon. Friend the Member for Sutton and Cheam (Sir N. Macfarlane) is right to be outraged by the incident that took place in St. Helier hospital. He takes the district general manager to task for using the phrase "an untoward incident". While that may be national health service terminology, it certainly does not properly express the sense of outrage that any decent person would feel on reading the background to that incident. In addition, it does not express the sense of disappointment felt in the district health authority that the incident should have taken place in one of its hospitals. However, my hon. Friend should not read into that choice of words any sense that the health authority is any less concerned by the sad and tragic incident than he is or any right thinking person would be.
I associate myself and the district health authority with the sympathy that my hon. Friend expressed, primarily for the victim of the terrible crime, whose life is at risk of being scarred by what happened, at the very least for a long time, and possibly for ever. It is right that I should also associate myself and the district health authority with the sympathy expressed by my hon. Friend for the victim's family, as it is to them that the prime burden falls of trying to rebuild the victim's confidence, and bolster her belief and desire to pursue her childhood into a full and fulfilled adulthood. To that extent, the district health authority and I share my hon. Friend's sense of outrage and his sympathy for the victim and her family.
My hon. Friend asked me to go into some detail on the Government's attitude toward security in hospitals. As I think my hon. Friend would recognise, that is not an easy subject, particularly when set against the background of the incident at St. Helier hospital and the even more tragic incident of the murder of two people at Pinderfields general hospital earlier this week. Those are terrible crimes, which raise with a new urgency the difficult problems faced by hospital managers every day of their working lives as they try to secure a proper balance in the security policies pursued by their hospitals.
A hospital manager has to have a clear policy and to recognise his responsibility for the security of the premises, staff and patients. An important part of his duties is to ensure that he takes the necessary steps to discharge that responsibility. Proper security precautions must be taken in hospitals to ensure that NHS property is not stolen, NHS staff are not subjected to personal abuse, physical threats and violence of the sort that we saw earlier this week, and patients on NHS property do not become victims of the sort of terrible incident that we are discussing. Those are the primary responsibilities of NHS managers in dealing with security.
However, we must also remember that a hospital is a place of open access and it is important that we do not pursue a security policy that makes the legitimate visitor to a hospital feel that he has to get past a security guard before his condition can be treated. That difficult balance must be struck. The key of any successful security policy in an NHS hospital is the word "balance." We must meet our proper security obligations without making the visitor to an NHS hospital feel that he has to justify himself to the security guard. Many of the people who come to NHS hospitals are either suffering from a condition requiring urgent treatment, so that the last thing they want to do is negotiate their way over a security hurdle, or are emotionally upset because they are the friends and relatives of people who may be ill. The last thing the relative of a cancer victim wants to encounter is a stroppy security guard. A difficult balance must be struck.
My hon. Friend has asked how the Department tries to strike this balance and to discharge our responsibilities. First, we must recognise that security in NHS institutions is necessarily and rightly the responsibility of managers of those institutions. We cannot have Ministers second-guessing routine day-to-day managerial decisions in every hospital around the country—that way lies disaster. I firmly believe that the best way of ensuring efficient and effective management of the NHS is to give managers the authority to allow them to discharge their tasks and then to support them when they make reasonable efforts to discharge them.
That is not to say that there is no place for guidance and support for these managers. That is why in 1984 the Government supported the production by the National Association of Health Authorities of an NHS security manual, which is the reference volume that all NHS managers use to assess and develop their security policies.
The National Association of Health Authorities and Trusts, as it is now, proposed that the document should be updated. In the Department's initial response we suggested that NAHAT should recover the cost of a revised security manual from the sale of the books to health authorities. I have reviewed that decision in the light of the recent events in my hon. Friend's constituency and in Pinderfields hospital earlier this week, and I have today asked for £20,000 to be made available to NAHAT to meet the pre-production costs of an updated version of the manual. I am sure that NAHAT will produce an equally valuable updated version that will take into account recent experience. I hope that that shows the seriousness with which the Government view recent incidents and my determination to ensure that the lessons from them should be learnt and applied.
I distance myself from some of the criticisms made by my hon. Friend of the way in which the incident in St. Helier hospital was acted upon by Merton and Sutton health authority. The authority is entitled to some credit for having quickly set up an inquiry to look into all the circumstances and to learn the lessons from the incident. Merton and Sutton health authority spends £140,000 a year on security at St. Helier hospital. Clearly, that security did not work in this case, so the authority's record is not perfect, but security is taken seriously at the hospital.
My hon. Friend suggested that part of the answer lay in the number of nurses on the children's ward. He rightly said that there were two on duty that night—but he did not say that it was a Saturday night and that there were five patients on the ward. Two nurses for five patients on a Saturday night cannot be said to represent thin staffing levels, and I do not believe that the right response to a security problem is necessarily an increase in staff nursing levels.
More important, perhaps, is the fact that we should not try to debate specific security precautions—in a specific hospital—on the Floor of the House. I take some comfort from the knowledge that the health authority set up a proper committee to examine the issue quickly, and that that committee in turn reported within a fortnight of the incident.
Let me quote two of the comments made in the committee's report. First, it states:
it is the considered opinion of the Committee…following extensive interviews and receipt of comprehensive written reports and evidence, that security arrangements at St. Helier Hospital have improved over recent years, are valued by those working within the hospital environment and have been found to be a greater level of comprehensiveness than a number of systems in comparable hospitals.
That is not the report of a committee overwhelmingly concerned by its findings—although it went on to make a number of proposals, including some that were touched on by my hon. Friend, on such matters as the gate at the back of the hospital and the need for proper fencing round the hospital. Those proposals were considered, and recommendations were made—recommendations which the health authority has said it will take very seriously.
Secondly, the report states:
It is considered that the staffing levels generally employed by Unitrust"—
the security firm—
at St. Helier Hospital are adequate.
Although the report does not say—indeed, it could not, in the circumstances—that everything in the hospital is wonderful and no improvements can be made, it gives qualified support to the security policy pursued there and makes a number of detailed proposals for its improvement.
Let me quote from another report about the incident—by Merton and Sutton community health council, which is not always a friend of hospital management. It is on record as saying:
Given the timescale the Committee conducted a thorough investigation"—
I take comfort from that.
The report and background evidence compiled show that St. Helier Hospital is comparable if not better than other hospitals with regards to security.
It also states:
The report indicates an improvement in security since the appointment of a specialist security firm and an improvement in the security consciousness of staff".
I hope that my hon. Friend accepts that that suggests that the health authority has taken the problem seriously. It has set up a committee to advise it on how steps can be taken to improve the position and, furthermore, the committee's report has been examined by the CHC, which has declared itself satisfied that it is a serious piece of work which makes sensible proposals about how improvements can be made.
We are talking about a tragic incident, which demonstrates the existence of a problem to which we have not yet found a wholly satisfactory answer. I hope that my hon. Friend will welcome the fact that the Government have acted today to provide additional money to ensure that the NHS security manual is fully up to date, and that all the lessons of recent experience are learnt and applied. I hope that he will also accept that the district health authority has taken action to try to ensure locally that lessons are learnt, and that at all levels in the NHS—local management and Department of Health—we shall do what we can; but, if I may return to my first point, we must recognise that security policy in NHS hospitals is properly and inevitably a matter of balance.
It would be wholly irresponsible for any Minister to stand here and say that any steps taken by him, or any taken by NHS managers, can constitute an absolute assurance that such an incident will never happen again. Such an assurance cannot be given; the assurance that I do give is that we will try hard to learn the lessons of these incidents, and also try to stop them from happening again.