3.99 In November, 1971, the National Health Service Hospital Advisory Service recommended that nursing staff should not be involved in the distribution of patients' cash and that urgent consideration should be given to a new memorandum from the Department of Health and Social Security which was at that time about to be published. This memorandum was published in November, 1971, and recommended that a patients' bank should be set up, that nurses should not be used as agents for paying patients, and that, except for patients who were severely handicapped or confused, all goods paid for by a patient or from his account should be delivered to him personally and not form part of a bulk issue to the ward.
3.100 On September 1st, 1975, a patients' bank was opened at the hospital. Initially it operated for three wards and is to be extended progressively throughout the hospital. The position at that time for most of the hospital was that nearly four years after the first recommendation a senior member of the nursing staff from each ward was still required to go to the Finance Office each week to collect cash in bulk, which the nursing staff then paid out to each patient after obtaining individual receipts.
3.101 The reason we were given for the delayed implementation of this recommendation was that it had not been possible either to find a suitable room for the bank until 1975, or to release a clerk from the finance department to take the cash each week to the patients in their wards. It was said that the South East Metropolitan Regional Hospital Board had not provided the money to the Hospital Management Committee for an additional clerk to handle patients money, but we doubted whether during the years 1972 to 1974 a strong enough case had been made to the Regional Hospital Board for the necessary additional revenue. Certainly in one of those three years this post ranked next to last in the submissions made to the Regional Hospital Board for extra money. In any event, we consider that had the Management Committee really wished to implement the scheme, the Regional Hospital Board should have been asked for funds to be switched from the nursing head of expenditure, which was invariably under spent at the and of each year because of staff shortages. In our view this would, at least initially, have been a legitimate transfer of funds for it would have relieved the nurses of a very time consuming task.
3.102 We found it difficult to escape the conclusion that the Hospital Management Committee had not given a high enough priority to the need for relieving the nurses of the responsibility for handling of patients' money, and that it had missed an opportunity to demonstrate in a practical way that it was concerned about the pressures and difficulties under which its nursing staff was working. To the nurses, it must have seemed that the Management Committee and the top administrators were oblivious of the time which they had to devote to handling patients' money and the accompanying risk to them of accusations of mishandling.
3.103 We endorse the view taken in some psychiatric hospitals, that except for severely confused patients, details of patients' personal accounts should be treated as confidential and not released to ward nurses except with the approval of the patient concerned. It may be necessary at times for a senior nurse to be given some indication of an individual's overall credit worthiness, but in general we consider that patients' financial affairs should be treated in the same way as any hank would treat those of its customers.
3.104 It was stated in Incident 17 that the allowances of pocket money paid to patients were ungenerous and we were told of delays in passing on increases in standard allowances to the patients. We are satisfied that both these criticisms had some foundation. Senior ward nurses were always notified of increases in the standard allowances, and, in accordance with the regulations, it was left to them and the medical staff to decide to what extent the increases should be passed on to individual patients. When we checked the position in Heather Ward the records showed that there were two patients who only received 30p and 25p respectively per week in 1973, this being payment for their work in the Industrial Therapy Unit. At this period they had no other source of income and were not receiving pocket money from the Management Committee. We noted, however, that from the first week in January, 1974, shortly after a change of Charge Nurse, both these patients were allocated the maximum pocket money allowance of E1.55 per week. Heather Ward records also revealed that the increase of the pocket money from £1.35 to £1.55 authorised by the D.H.S.S. in October, 1973, was not reflected in increased payments to the patients until the arrival of the new Charge Nurse in January, 1974. As the former Charge Nurse himself commented at the time on the low rates of pay we assume that he was unaware of the patients' entitlements rather than that he had deliberately withheld money from them. Nevertheless, we would have expected the Nursing Officer responsible for Heather Ward to have discovered these lapses.
3.105 It should be added that, if money was withheld from individual patients, it was certainly not because of a shortage of funds since the Regional Hospital Board always funded the Hospital Management Committee with the amount requested by the Group Treasurer, and this allowed for increases authorised by the D.H.S.S.
3.106 We have given a considerable proportion of space in this Report to this subject of patients' moneys, not just to draw attention to the irregularities uncovered and the delayed implementation of an alternative arrangement, which we particularly regret, but also to illustrate the importance of the correct handling of patients' moneys or goods purchased on their behalf. It is essential that doctors nurses at all levels Occupational Therapists, industrial therapy officers and administrators, as well as the finance department, should be involved and encouraged to work together be produce a solution satisfactory for the patients and those responsible for them.
3.107 A policy document should be prepared for the guidance of everyone involved in the lives of long-stay patients. This should be available to, and clearly understood by, every member of the staff. In particular, it should incorporate an approved method for handling purchases made by nursing staff on behalf of those patients who are unable to manage their own affairs; and there should be proper safeguards to protect both the property and privacy of the patients as well as the nursing staff.
6 April 2025
