2.159 Although neither Dr. Ankers nor Mr. Weston worked on this ward, there are 11 incidents in the second part of the Critique which relate to it. Ten of those were based on information supplied to Dr. Ankers by a Miss OA who, after obtaining a degree in History and English at the University of Kent, worked as a Nursing Assistant in the hospital from November 18th 1973, until July 13th, 1974. She worked in Hazel Ward until January 14th and thereafter in Elm Ward. During her eight months at St. Augustine's she was absent from work on 50 days, usually as a result of ill health, and was frequently late. She was aloof from the majority of the staff and more interested in attitudes than basic physical care. At times her attitude towards those requesting her to carry out routine tasks approached dumb insolence. The more unreceptive the senior staff were to her ideas, the more she withdrew from them and from the rest of the staff, and she was fairly regarded as setting herself apart from the team. She proved herself an intelligent and an astute, if selective, observer, but she was not in our view a good nurse, and it is surprising that the hospital continued to employ her as long as it did, even on the basis that she was a pair of hands.
2.160 Hazel has been a female psychogeriatric ward in Clinical Area 3 since August, 1972. The number of patients was reduced from 65 to 45 in the first 12 months. In November, 1973, when Miss OA joined the staff of Hazel, there were 42 patients, of whom 19 needed feeding and 30 needed dressing, and of whom more than 20 were doubly incontinent. There were normally three, sometimes four, staff on duty. There was only an occasional visit by an Occupational Therapist, who helped some patients with knitting and painting, and about six patients went on very occasional outings. There were virtually no ward activities for patients: they were, in the words of one nurse, "dressed, placed in their. chairs, fed at meal times and put back to bed. As I recall, in between there was absolutely nothing."
2.161 The problems of the staff were enormous. They had no guidance and no effective support. Within their own limitations, and the environment in which they had to work they all probably did their best. We think that there was force in Miss OA's answer to the question "Are you suggesting that the nursing staff on Hazel Ward were not making a proper effort to look after the patients adequately?" She replied "I do not think that it is as simple as that. I know that they had been with these patients and each other for a number of years. They were still working with set procedures and attitudes which they had learned quite a while ago. There did not seem to be any kind of training or educational opportunities offered to bring them up to date. Therefore, in their own eyes they might have been doing the best that they thought possible ... I felt that they themselves, just as much as the patients, had been worn down by routine to accepting anything which went on, doing it mechanically, not seeing these patients as people but as objects to be potted, fed, put to bed and so on."
2.162 This insidious dampening down of the sensibilities by the environment was spoken of by Miss QB, another young nurse of high calibre, who worked on the ward a year later. After she had told how, because of shortages, she had used one flannel for several patients on all parts of their bodies, she was asked if she knew that it was wrong. She replied "Of course. One of the criteria that I have always used is: 'would I like it to be done to me or my mother?' obviously to be washed with the same flannel as a complete stranger, and especially a geriatric patient who is incontinent, is not very pleasant, and I was aware of this, but after a day or two when you are a new nursing assistant, and you are not in a position to introduce any new procedures, after going along with the others for a day or two it just became an insignificant issue. That is all I can say. I was aware that it was wrong."
2.163 We now turn to consider the incidents relating to Hazel in the order most helpful for understanding the ward's way of life and problems.
Incident 26
2.164 There is much truth in this allegation. The staff's knowledge and understanding was out of date. We accept Miss QB's description of the ward at the end of 1974, and find that it applied with equal force to the time when Miss OA was there. "Compared to other wards in the hospital, many of the procedures were disgraceful... I did find that all grades of nursing staff expressed attitudes which were insensitive and degrading to the patients on Hazel Ward. I frequently heard such statements, said from one nurse to another as they were washing the patients, as 'this ward is the end of the road', 'you can see this one is on the way out'... It was assumed that the patients were so demented that they would not understand, but in my opinion sometimes they definitely did. I did hear nurses on my ward describe patients on other wards as being 'a bunch of psychopaths', In some ways the physical care of the patients was excellent e.g. they were washed regularly, this being a priority, although the baths were few. Also I never saw any bed sores throughout my (six month) stay on the ward... When I first went on the ward it was common practice to spend at least an hour over the tea break for the shift. I feel that the morale of the staff and the conditions of work were so bad that the only way they could tolerate the work was by getting it over quickly in time for their tea break. If Mr. RC was on duty this did not happen. With him the breaks were much shorter and sometimes less often."
2.165 Mr. RC was a Charge Nurse who was described by Miss QB as, a capable man who worked very hard to alleviate the load on the nurses. He was kind and had the patients welfare at heart but "when I worked on the ward he did not seem interested in altering the day to day routine which I found surprising:. .I got the impression that he had tried to make changes in the past, but had received insufficient support."
2.166 We find that at this time the staff were providing only the bare minimum in care, and that for the reasons explained by Miss QB there were frequent and long tea breaks.
Incident 8
2.167 We accept that patients were not bathed sufficiently-often. At this time they did not receive more than one bath a month, and sometimes the gap was much longer. Miss QB, speaking of October, 1974, to April, 1975, said. "As far as I remember, the bathing tended to happen in spates. When someone would get enthusiastic one morning quite a few baths mould be done. Otherwise they were only done when a patient was exceptionally dirty, and there was absolutely no routine whatsoever about the bathing. Some patients went for several months, two or three months, without a bath. I know that for certain."
2.168 The frequency of bathing was totally inadequate. Although every patient had a daily 'strip wash' this did not include the feet, and it is a crude and Undignified procedure.
Incidents 18 and 28
2.169 We find these incidents proved
Incident 39
2.170 We find this proved. Miss QB said that the Ward doctor visited the ward daily and would spend a few minutes in the office talking to the Charge Nurse "If a patient became physically ill the doctor would then, examine the patient, but I never saw a doctor go round the ward aid look at each patient. I was never made aware of the medical policy, if any, in treating patients on the ward, as I was to be involved in their nursing I thought I should have been. I never saw a Consultant on the ward, and I do not know who the Consultants were for that ward. A Consultant could, of course, have come onto the ward when I was not on duty." Dr. Q, one of the Consultants for the ward, said he never held a multidisciplinary meeting in Hazel between August 1972, and his retirement in July, 1975, and he never heard of any other Consultant holding one there. The problem, he claimed was getting sufficient people to attend.
Incident 23
2.171 We are satisfied that it was an unwritten ward practice that the dozen or so most helpless patients who were unable, or did not like, to ask for more received unduly restricted liquid. This resulted partly from forgetfulness, and partly from a desire to limit the output of urine onto the floor or chairs by incontinent patients. Miss QB noticed that the urine of these patients was strong and concentrated. A student nurse of that time told us, and we accept that when he started to brew up mid- afternoon tea for" the helpless patients he got strange looks from the permanent staff and that one of the enrolled nurses said that they did not usually do that.
2.172 Food at this time was sometimes unappetising and unimaginative and often cold. There wasp and still is, too great a-reliance on mince for patients who are alleged to be unable to manage ordinary food. We accept that helpings were often small. This was probably a consequence of the need of so many patients to be fed.
Incident 19
2.173 Save that we substitute 'several' for 'ten to twenty', we find this incident proved. Incident 16
2.174 All patients who needed spectacles were not deprived of them, but there was a practice to keep spectacles belonging to a number of the patients in a cupboard in the office in order to prevent them getting lost or broken. The effect of this practice was that a patient's spectacles were kept in the office unless she proved that she had some use for them and would be able to look after them properly.
2.175 With this qualification we accept the matters alleged in this incident as substantially accurate.
Incident 12
2.176 This refers to Mrs. NE who qualified as a Registered Mental Nurse at the end of 1969. She has worked in Hazel Ward since August, 1972, first as Acting Ward Sister then, from January, 19731 as Ward Sister. She had an arrangement with Mr. RC that she would be responsible for the administrative work, and this meant that she spent most of her time in the office. In our opinion she has limited insight into psychiatric nursing and the needs of the elderly. She is a bit of a martinet who lacks tolerance for the young and tends to display too much deference to those in authority. For example, she endeavoured to explain to Miss OA that she should 'stand up' in a proper manner for higher nursing staff. She contrasted what she regarded as that "established courtesy" with Miss OA's practice of standing with her arms folded.
2.177 We accept that Mrs. NE discouraged criticism and suggestions and that she dealt with Miss OA's suggestion about flannels in the manner alleged.
2.178 We reject the suggestion that patients' gifts were not distributed. Gifts of the kind described were kept in the office and gradually distributed. We do not accept that fresh fruit, cheese and cake were never distributed. They normally were.
Incident 4
2.179 This refers to Mrs. SF. She has worked at St. Augustine's for about 30 years. For the first ten she worked in the housemaid section; thereafter she has nursed mainly on geriatric wards. About ten years ago she qualified as a State Enrolled Nurse by virtue of long service and has worked in Hazel since August, 1972. We found Miss QBs description of Mrs. SF to be fair and accurate "I worked closely with her for long periods. Mrs. SF is a very kind, good hearted woman, and often worked very hard indeed on the ward. She is, however, a moody woman, and tended to be impatient. Her handling of the patients was very rough, but she had no conception, in my opinion, that she was being insensitive to the patients' feelings. As an example, when getting patients up in the morning she would roughly strip the bed clothing from a sleeping patient and lift them on her own out of bed, she being a very strong, well built woman, and then slam them onto a commode. Although the patient cried out I can honestly say I do not think she realised that she was being unkind to them." We would add that she had no real insight into the patients' needs and that she never learnt to nurse the whole patient. Moreover, some measure of deafness causes her difficulty in hearing the patients. She and Mrs. NE desperately needed in service training. At present they are good examples of well meaning nurses who are unsuited to carry out their tasks.
2.180 We are not satisfied that the particular incidents alleged in sub paragraphs (a) and (b) of Incident 4 have been proved.
Incident 62
2.181 We do not find this proved. It was based information given to Mr. Weston by a patient.
09 February 2025
