Including the contents, composition of the enquiry committee, terms of reference, legal representation, and the Chairman's foreword
SOUTH EAST THAMES REGIONAL HEALTH AUTHORITY
REPORT OF THE COMMITTEE OF ENQUIRY ST. AUGUSTINE'S HOSPITAL, CHARTHAM, CANTERBURY
MARCH, 1976
Including
1. The Hospital Buildings
2. The Authors of the Critique
3. The Background to the Critique
4. The writing and circulation of the Critique
5. The Form of the Enquiry
1. Box
2. Birch
3. Magnolia
4. Ash
5. Heather
6. Hawthorn
7. Hazel
8. Elm
9. Maple
1. Living Conditions
2. Medical Matters
3. Occupational and Industrial Therapy and Physiotherapy
4. Electro Convulsive Therapy 63
5. Laundry and Linen Services 71
6. The Requisitioning System 73
7. Patients' moneys 75
1. The J Enquiry
2. Absence of clear Complaints Procedure for Staff
3. The Complaint against Mr. IN
4. Other impediments to Criticism
5. Reaction to the Report of the Hospital Advisory Service on St. Augustine's and St. Martins Hospitals and the visit of the Regional Advisory Team
6. Reaction to the Report on the Survey of Teaching at Ward Level
7. Reaction to and the Investigation of the Critique
A. The Wards
1. The Nurses
2. The Doctors
3. Patients Activities
4. Supplies of clothes, sheets, flannels etc.
5. Mentally Handicapped and disturbed patients
B. Above Ward Level
1. The Nurses
2. The Doctors
3. The Group Management Committee
4. The District Management Team
1. Those with a management role must manage
2. Those with a monitoring role must monitor
3. Training
4. Staff Appraisal
5. The Patients Activities Team
6. The Voice of the Patients - Patients' Committees
7. Information Systems
8. The relationship between the professions
9. The need for assessment and review of Doctors' workloads
10. A multidisciplinary framework for the Hospital
A. Ward Multidisciplinary Team
B. Clinical Area Multidisciplinary Team
C. The Hospital Management Team
D. A Nursing Committee
11. An Outside Inspectorate
12. Matters that we suggest that the Regional Health
Authority should consider drawing to the attention of the Secretary of State
1. Map showing catchment areas
2. Critique Regarding Policy
3. Critique Regarding Policy - Part II - The Evidence
4. Statement of Chairman (posing three Questions)
5. Patient Mr. EV
Mr. J. Hampden Inskip Q.C. Recorder of the Crown Courts, Chairman
Dr. Alex A. Baker C.B.E., M.D., Consultant Psychiatrist, M.R.C.P., F.R.C.Psych. Coney Hill Hospital, Gloucester.
Mr. D.J. Downham Assistant Director, King Edward's Hospital Fund for London.
Mr. John Greene 0.B.E., S.R.N.,R.M.N. Area Nursing Officer, Gloucester Area Health Authority.
Mrs. Betty K. Lowton J.P. Member of Barking and Havering Area Health Authority.
Appointed by the South East Thames Regional Health Authority with the following Terms of Reference:
To enquire into the allegations concerning the care and treatment of patients at St. Augustine's Hospital, Chartham Down, Kent, contained in two documents entitled 'A Critique Regarding Policy' and 'A Critique Regarding Policy - Part II - The Evidence' by Dr. William Brian Ankers, Ph.D., and Mr.Olleeste Etsello, R.M.N., dated April 1974 and February 1975 respectively and to make recommendations
MR. PETER SCOTT, instructed by Messrs. Bird & Bird, appeared as Counsel for the Committee.
MR. ANTHONY HIDDEN, instructed by Messrs. Furley Page Fielding & Pembrook, appeared as Counsel for the South East Thames Regional Authority, Kent Area Health Authority and Canterbury and Thanet Health Health District.
MR. ANDREW BROOKS, instructed by Messrs. Hempsons, appeared as Counsel for Members of the Medical Defence Union and Members of the Medical Protection Society.
MRS. M.E. NEWSTEAD (Consultant to the Labour Relations Department, Royal College of Nursing) appeared for the Members of the Royal College of Nursing.
MR. ANDREW HILLIER, instructed by Messrs. Gillhams, appeared as Counsel for the Members of the Confederation of Health Service Employees.
MR. PETER COOPER, instructed by Messrs. Robin Thompson & Partners, appeared as Counsel for the Members of the National Union of Public Employees.
MR. CHARLES GIBSON, instructed by Messrs. Bracher, Son & Miskin, appeared as Counsel for Other Members of Hospital Staff.
MISS A. WORRALL, instructed by Lawrence Grant, Esq., Law Clinic, University of Kent, appeared as Counsel for Dr. William Brian Ankers (8.9.75. - 26.9.75.)
MR. ADRIAN TAYLOR, of the Law Clinic, University of Kent, appeared for Dr. William Brian Ankers (17.11.75. - 28.11.75.)
Secretary to the Committee - Mr. G.A. Ferguson Solicitors to the Committee - Messrs. Bird & Bird
"I would know my shadow and my light,
so shall I at last be whole. Then
courage brother, dare the grave passage."
From "A Child of Our Time" by Sir Michael Tippett
This Report contains matters which, in our views should be known not only to all levels of the Health Service, but also to the public for whom the service is run.
We were told on several occasions, both in formal evidence, and in informal conversation, that the conditions and care at St. Augustine's at the time of the Critique were no worse than at many other mental hospitals. Those members of our Committee with experience of such hospitals in many parts of the country on the whole agree. In some respects, indeed, particularly in many of the acute admission wards, St. Augustine's is well above average.
If conditions in some of the long stay wards during 1974 and early 1975 approximated to those now existing in many other mental hospitals, it is right that every interested person should understand precisely what this means in human terms. We cannot see that it is healthy or useful to keep such information private.
If there had been true multidisciplinary team work between the professions at St. Augustine's, conditions in the long stay wards would have been much better, and this long, disrupting and expensive enquiry would have been unnecessary. Exhortation to a multidisciplinary approach is no good without ensuring that the medical profession fully participates, and this will not be achieved without giving clear guidance as to how this should be done, even if this does mean grasping some nettles.
Although we have used letters of the alphabet rather than people's names, many will be readily identifiable, particularly within the hospital. What we say will cause distress to some, but we are sure that it will be transient for it will be clear from the contents of this Report that although there were many unsatisfactory practices and unnecessary mistakes all members of the staff thought that they were doing their best, and many were. But they were working in difficult conditions with inadequate guidance. Similar mistakes will only be avoided elsewhere if people can read and understand and share in the ups and the downs and the frustrations and the low standards of these wards. Although much remains to be done to improve conditions and care in the long stay wards, we are confident that the staff have the skills and ability to solve these problems and that any patient can now enter St. Augustine's with confidence that he or she will be satisfactorily cared for and treated.
We hope that the Press will approach anything they say about or extract from this Report with caution and responsibility. It will be easy to seize upon extracts which without the context of the whole Report will present a cruelly distorted picture. We particularly commend to all those exercising this responsibility the last sentence in the preceding paragraph and paragraphs 1.9-10, 1.35-36, 2.144, 2.198 and 5.5.
Although we have endeavoured to produce a readable Report in which each Section grows out of those which precede it, we recognise that it is long and that there will be some readers who will not wish, or have the time, to get too deeply enmeshed in the affairs of St. Augustine's. We commend to them
Sections 1, 5 and 6 in their entirety
Section 2, paragraphs 154-156 and 238-239
Section 3, paragraphs 31-40, 41-55, 103 and 106-107
Section 4, paragraphs 15-17, 47-48, 51 and 112
With real pleasure we record our debt to our Secretary and our Solicitors and their respective staffs, and to our Counsel, for the friendly efficiency which characterised their work from beginning to end, and we recall with gratitude and admiration the warm and interested welcome we received from staff wherever we went in the hospital, even from those who knew that they would be criticised in this Report.
09 February 2025
