(b) Investigation by the Medical Staff within the Hospital
4.74 Dr. R said of the first part of the Critique "No doubt its overall purpose was intended to be constructive, but the general tone is exclusively destructive". Dr. W felt that it "made one or two constructive suggestions which could only be carried out if we had an increase in medical and nursing staff and additional money was spent. I find a lot of the things said in the Critique were destructive and detrimental to the morale of nursing and medical staff". He explained "I meant mainly by that it created a paranoid atmosphere in the hospital, an attitude of paranoid anxiety which is very difficult to work in... T think it has destroyed the morale of this hospital for many, many years to come". We are convinced that he is wrong in this. The hospital will never be the same again, but it was necessary that in the long stay wards it should change. The great majority of the young staff, who were not consulted about the Critique, were wanting change, and, to use the words of one as we walked round, are looking toward the recommendations in our Report as a lifebelt.
4.75 Dr. I described the first part of the Critique as "more a linguistic exercise than informed comment. It struck me that the points which the authors were making would probably apply to any organisation employing a large number of human beings. It seems to me that it was designed to arouse emotional response rather than to convey information. It is also written, in my opinion, from a certain social and political standpoint which may not have general agreement in this country". He explained that he meant by that last sentence that it was written from a perfectly respectable body of social and political opinion which may not be shared throughout this country, but which "holds that institutions, using the term as applicable to this hospital, are inherently bad things, and overall that the abuses contained within them are greater than any benefits which they offer". We do not understand how any sensible person approaching the first part of the Critique with an open mind could come to such a conclusion.
4.76 Dr. X, who is now Chairman of the Medical Executive Committee, demonstrated his disapproval in what he now generously acknowledges to have been a most unfortunate manner. He had begun to give teach-ins to nurses shortly before the Critique was circulated. In his own words "I said to myself 'If this is what they think of us I am going to stop it’," He did not recommence those teach-ins until August 1975 and he agreed that that gap of 16 months was a measure of his disapproval.
4.77 All these doctors accepted that there were some good points in the Critique and that some improvements were necessary, but that two junior staff should have sought to hasten them in this way seems to have stirred deep resentment.
4.78 The Medical Staff Committee met on May 9th. The minute of their informal discussion of the Critique, after indulging in what was almost a ritual 'knocking' of the authors, accepted by inference that much of it was well founded and, in effect, asked for help. "The general view was that while the document was the product of two people who were not really qualified to criticise the management of the hospital and the care of patients in particular, it nevertheless reflected disquiet felt by some members of the nursing staff. Everyone was aware that there was room for improvement particularly in the care of long stay patients… There was discussion whether Consultants could give more time to the care of long stay patients, either directly or indirectly through their colleagues, but all present felt that demands on their time for the care of acute cases must be given priority and therefore it was not possible to see how any better arrangements could be made."
4.79 This was amplified on the same day by a letter from the Chairman of the Medical Staff Committee to the Chairman of the Medical Executive Committee. After saying that the Critique "as it stands shows an immature and naive approach and unrealistic expectations", the letter concluded forcefully, that it "should not be ignored. It shows disquiet and dissatisfaction among nursing staff and an apparent breakdown in communication. At the very least more efforts should be made to channel the desire of these nurses to do more for their patients and to give them an opportunity to take part and speak at ward meetings. Consultants should look again at their work programme and perhaps review more closely what is happening in long stay wards: their own junior staff need more help."
4.80 On May 22nd Dr. A, then the Chairman of the Medical Executive Committee, wrote a long letter to the District Administrator giving the views of the Medical Executive Committee and the Medical Staff Committee. It is full of conflicting views. After stating that constructive, informed and well intentioned criticism is always welcome it continues "In the case of the Critique, however, although the medical staff as a whole felt that they must accept it at its face value as an honest attempt by two members of the nursing staff - though one of them no longer works here - to improve what they considered to be a state of affairs very much in need of improvement, at the same time some reservations were expressed that this was in fact so". He went on to allege that Mr. Weston by a previous written communication had gone a fair way to wrecking "relationships between the hospital and an after care hostel by alleging lack of co- operation which was 'totally untrue'. He was also the author of a somewhat questionable article in the Nursing Times." He then refers to a psychological test carried out on Mr. Weston before he was accepted as a student nurse, and continues "he should not in my opinion have been engaged as a psychiatric nurse in the first place. Of the other author, a Nursing Assistant, I am afraid I know next to nothing. However, I am only writing about the Critique as it seems to affect medical staff and medical policy and it is certainly not my purpose to denigrate its authors." After stating that the policy of the Medical Executive Committee is to reduce the number of patients by 400 before 1981 he accepts that the Consultants spend too little time on the long stay wards and explains the problems caused by to few Consultants. He concludes "On the whole I think the publication of the Critique will do nothing but good, though whether this was the intention of its authors I am afraid I am less convinced. By a reorganisation of our working days some of us have been able to cut out what we had felt to be essential in favour of other things which our nurses obviously felt were more essential . But as it stands, the Critique is really little more than theory, some of it preconceived I think, little that is original and much that is very familiar. It contains few facts, some distortions of fact and many half truths. There is however some good in it and as such it is welcomed, and I have no doubt that its publication will have a beneficial effect on psychiatric performance at St Augustine's."
06 April 2026
