2.54 This was the first ward on, which Dr. Ankers worked between his arrival at the hospital on July 16th, 1972, and the reorganisation on August 15th. It was a long stay ward for about 57 long stay epileptic males whose ages ranged between 20 and 80 years and many of whom were incontinent. Very often there were only three nursing staff and on domestic worker on duty, and there were no proper ward meetings. A few patients went to the Industrial Therapy Unit or worked on the farm. In the past an occupational therapist had spent part of two days a week on the ward helping some patients in rug making, basket weaving and tray and lamp making, but this had almost wholly, if not completely, lapsed during the run-down period when Dr. Ankers worked in the ward. During that period there were no ward outings, although patients were occasionally taken out into the sunshine, and two dug in the garden. Those who were able to occupy themselves did so both in the ward and on outings to Canterbury, but the remainder watched television or just existed.
2.55 Many of the patients were Chronically institutionalised. Of such patients, Dr. Ankers said, and we agree, "I feel that those people need some encouragement as part of their care and treatment in the hospital to participate in activities. If a patient is of a mind and well enough to participate of his own accord, that is a good thing, but a lot of these patients were not. They sat around in chairs on Ash Ward all day long. I felt that the nurses should be doing something more for the patients, and, indeed, that they should have been instructed to do so. There should have been a policy. There was not this policy. It was lacking," He described how he and another Nursing Assistant on their own initiative helped an elderly patient, who could only walk with a' walking frame, to get some exercise round the ward as an alternative to just sitting.
2.56 It must be remembered, however, that Dr. Ankers was seeing with fresh eyes and mind a ward in which staff had been battling with appalling conditions for a long time, and in which much of the Staff's time was concentrated on the impending reorganisation. He probably saw it at its worst period for some time, and what he saw was put in perspective by a Charge Nurse who had worked there as a Student Nurse shortly before.
2.57 "Ash Ward really looked like a Victorian poor law institution. There were filthy floor boards, the furniture was dreadful, there were far too many patients, the ward had not seen even a lick of paint in donkeys' years. The dormitory was shocking. The ward was just unbelievable. You had got to see it to believe it. There was Mr. E and Mr. N, a tiny nursing staff, on this ward and Dr. S was there as the ward doctor. They had this dreadful situation to work in, nobody did anything about it and the way things were in that ward, the situation was stagnant". The same witness emphasised that Mr. E had worked hard in Ash for seven years with far too few staff, and had formed a good rapport With the patients. He said of him, "He is a good nurse. He is a nice chap who tries his best. He had been a bit of a rebel in his younger days. He had knocked his head against a brick wall for Ash Ward and got virtually nowhere over many years. I think it affected his overall performance. He had the spirit knocked out of him over the years by getting nowhere."
2.58 The demoralised condition of the staff is well illustrated by the state in which they left the ward on changeover day. The chamber pots under the beds were unemptied. Two mattresses in side rooms were soaked in urine and covered in green mould on their underside, and the whole ward had to be disinfected.
Incident 7
2.59 This accurately records the circumstances in which Mr. T lived during the month Dr. Ankers worked on the ward. The ward report books show that between July 1st, 19721 and changeover day (August 15th) Mr, T was nursed in bed in a side room every day, other than July 10th when he was allowed up for exercise in the afternoon, and August 8th when he was allowed up in a dressing gown.
2.60 Why was this considered necessary? One nurse told us that when he had worked in Ash in 1970 Mr. T had spent most of his time on the ward, but that when he returned in 1971 he was spending Most of his time in the side room. We have no doubt that Mr. T presented a management problem: he was unpredictable and violent at times: he set his clothing alight on several occasions, and his side room mattress on another. Mr. E tried, but failed, to get him transferred to Box Ward. The Nursing staff received little help from the Consultant, and we find that they understandably took the line of least resistance and confined him for longer and longer periods to prevent the Ward from being unnecessarily disturbed. The side room door Could only be opened from the outside. Mr. T slept on a mattress On the floor and the shutter was often over the window during the day to prevent him emptying his chamber pot onto the grass outside. He frequently urinated on the floor and, although the room was cleaned out at least once a day, it inevitably stank. There was no proper heating although some hot water pipes ran through the room., One of the Charge Nurses of that period said that his treatment "involved fairly heavy sedation, and he probably preferred to sit quietly or lie and sleep in his room".
2.61 Dr. Q, who was Mr. T's Consultant at that time, said that he would be "put in seclusion in a side room for a limited period only. The nurses were permitted to do this and he would be secluded for about two hours until his medication took effect". Dr. Q's recollection does not accord with facts. Dr. Q was one of the two Consultants responsible for patients in Magnolia ward throughout 1975 until his retirement on July 31st 1975. We have already reported that a Charge Nurse who started work in February in that ward never saw him there at any time. We shall have to refer to him in further passages of this report.
2.62 Mr. T's subsequent treatment in the hospital is worthy of note. After spending periods in Magnolia and Holly wards he was transferred to Cedar. Dr. R, his present Consultant, described what then happened thus:-"He has had a horrifying - perhaps I should qualify that word - a disquieting number of sedating injections over the years coupled with an amount of medication which, unhappily, one has had qualms about. But, again, in this situation of an overcrowded, disturbed ward with less than adequate staff, it is Hobson's choice. One has to increase medication if what one has prescribed does not achieve results. You get to the point where you defeat your own object. In retrospect, I can see that this happened in my own management of (Mr. T). He got to the point where he was becoming somewhat confused through the effect of the medication. Therefore we transferred him to Cedar Ward. This has happened more than once. In Cedar Ward it was found possible to nurse him without medication, simply because of the environment of that ward which is in part a sick ward. There are general hospital patients there as well as ill mental patients. The staffing ratio is also a little higher. It is generally a very pleasant ward... There is an air of tranquillity and peace in there which is quite remarkable. This patient settled down in this environment - it took time - on no medication. Indeed, it was possible to train his habits to a certain extent, though not as much as we would hope, because the nursing staff there have other duties to a time he was able to attend industrial therapy. This is a clear example of the undesirability of excessive medication. Again, I do not want to give a wrong impression. This is one case. There are other individual cases. I think that by and large, overall, I would not subscribe to the view that in this hospital, or any part that I know, there has been consistently an over-prescribing policy in general. I do not believe that to be true in general, but there are individual cases. Mr. T is the best example I can give of an extremely intractable, disturbed patient."
2.63 The initiative to reduce Mr. T's medication came from the nursing staff and Dr. R responded. This is an excellent example of both disciplines sharing in a true partnership of care. As we will emphasise later in our Report, there is, in our opinion, no aspect of a patient's treatment or care which is solely the responsibility of any one discipline.
Incident 10
2.64 We do not agree that nurses did the bare minimum. There may well have been rather more tea drinking by staff on this ward than on some others, but this was understandable where staff were working with difficult patients in very depressing surroundings.
2.65 We do not find that any patients went hungry as a result of staff eating food sent up for them. It was, however, the practice for staff, on occasions, to eat food that was surplus to requirements rather than put it in the dustbin. This can, of course, be abused, particularly when staff work the shift from 7.00 a.m. to 2.00 p.m. and bring sandwiches to eat in their meal break. Nine bottles of beer were sent up each day for those patients who had been authorised to have it by the Ward Medical Officer. The Charge Nurse had to take action over one nurse who consumed a bottle of patient's beer at Christmas, and there was evidence which suggested that this was not an isolated instance. We do not find, however, that nurses were in the habit of drinking patients' beer.
2.66 With these exceptions the description of Ash Ward given in Incident 10 is substantially correct.
Ash Ward since August 15th, 1972
2.67 On reorganisation Ash became a female geriatric ward in Clinical Area 1 with Dr. A as the Consultant. Within a few months the ward had been completely redecorated and there were new curtains and floorboards. Since 1972 new bathrooms and toilets have been added, and in February, 1974, the ward, became a mixed admission ward.
2.68 When the ward first opened as a female geriatric ward there were about 57 patients who constituted a very heavy workload for the staff who normally numbered three or four. By August, 1973, the numbers had been reduced to 36. An occupational therapist came on several mornings a week and helped some of the old ladies to knit, but a large number of the patients did not appear to wish to be disturbed and were left in their chairs to watch television or listen to the radio or just sit. Voluntary workers sometimes came from the Social Centre and took patients out in the grounds.
2.69 The patients do not seem to have been regularly reviewed, and none had individual treatment programmes in the sense that that word has already been described. There were irregular ward meetings attended by all available ward staff, the Ward Medical Officer and the Nursing Officer. These consisted of fairly informal discussions about ward problems and the progress of some patients. Ward changeover meetings took place each day.
2.70 In the Autumn of 1975 Ash seemed to function effectively, and Dr. A. was holding regular multidisciplinary meetings.
09 February 2025
