(c) Investigation by the District Management Team and above (continued)
4.99 The Area Health Authority had, and still has, serving on it, two of the
most active members of the former Management Committee responsible for the
Hospital. One of them gave evidence to us and told us that their views
on the Critique were 'broadly the same' and that they made them known to the Area Health Authority members. They were 'very surprised' at the contents of the Critique: "I thought it was related to the period when I first knew the hospital ten years before', when there might have been more justification, but it did occur to me that a great number of the things which the authors were imputing had already been dealt with". The following question and answer followed.
"Q. Did you think then that what was said in the Critique Part I was unjustified so far as this hospital was concerned in 1974?"
A. "A good deal of it. There were a few things which I felt were justified and which probably would have been dealt with previously if there had been enough money."
4.100 She added that, although she visited the hospital and toured the wards asking questions, she had not been aware of shortage of flannels or clothing or of infrequency of bathing on any ward. When asked about a minute of a meeting between the Regional and Area Officers in which the Area Officers were reported to have said that the Area Health Authority regarded the Critique as immature, she confirmed that this was so.
4.101 The minutes of the Area Health Authority meeting on September 17th record that three members of the District Management Team "were present at the meeting to answer Members questions on this matter. A copy of the Critique, which it was reported had had wide circulation, and comments on this document by the Canterbury and Thanet District Management Team were received. RESOLVED (i) that the authors of the Critique be asked to meet the Area Team of Officers to substantiate their allegations of mistreatment and malpractice in St. Augustine's Hospital, or to withdraw them". Further resolutions endorsed the steps which we have already said were being considered by the District Management Team.
4.102 On September 25th an Administrative Assistant from the Area Health Authority met Dr. Ankers at the hospital and extended an invitation to him and Mr. Weston to meet the Area Team of Officers and the Chairman of the Area Health Authority "to discuss the allegations of mistreatment and malpractice that had been made in the Critique". All their expenses would be paid. Dr. Ankers said that he would pass the invitation on to Mr. Weston and that they would send a joint reply. In the course of a friendly conversation he pointed out:
(i) that they wished to discuss the allegations of lack of policy and that too much was being made of allegations of mistreatment and malpractice, and
(ii) that judging from the documents circulated to the Press by the Area Health Authority and the Comments of. its members reported in the Press, the Authority seemed to have prejudged the tatter, and that it appeared that they Were "being hauled before the authorities almost as criminals".
4.103 The local newspapers had, indeed been full of reports and comments. Among the documents reported in considerable detail was that containing the comments of the District Management Team on the Critique. In the Kentish Observer of September 19th it was referred to under a headline 'Document suspect says the Hospital'. Members of the Area Health Authority were reported as having said "The contents are immature" and "the authors were confusing idealism with realism".
4.104 In the light of the following two extracts from the Press, which are typical of other reports, it is not surprising that Dr. Ankers and Mr. Weston interpreted the invitation as a "disciplining exercise': "Authority Chairman Mrs. Jean Cockerill suggested the men being told to appear before officials of the District Management Team, but Area Administrator Mr. Peter le Fleming felt this might inhibit them. 'If they have already refused to talk to the District Management Team they must talk to the Area Authority and confirm or withdraw their comments and afterwards make a press statement'." Another Area Health Authority member was reported as saying "If the authors are not prepared to substantiate the allegations of mistreatment and malpractice they can withdraw the critique as publicly as they put it forward." From the time these press reports appeared we are satisfied that Dr. Ankers and Mr. Weston abandoned any desire they may still have had to discuss the Critique with the Health Authority or its officers, and determined to press for a full scale independent enquiry. If the Area Team of Officers had really wished to discuss the contents of the Critique with its authors they should, and would, have issued an invitation before the public meeting of the Area Health Authority.
4.105 On the day following this visit there were further press reports of an interview with the Unit Administrator in the course of which he said 'a lot of trouble here has been caused by the lack of experience of these two young men', and that in his view, 'the Critique was outdated'.
4.106 On October 5th Dr. Ankers wrote on behalf of himself and Mr. Weston declining the invitation on the grounds explained in the interview on September 25th, and enclosing copies of a Press statement they had issued in answer to what had appeared in the press. Further efforts to get them to change their mind failed. These included a telephone call from the Area Administrator.
4.107 Although the Area Administrator told us that the District Management Team had been asked in September to be more specific in their answers to the Critique, the Area Team of Officers was still ignorant in February, 1975 a s to whether long stay patients had individual treatment programmes. Indeed they were still ignorant when our Enquiry opened in September. But in February there burst upon the scene the angry, bitterly expressed, second part Of the Critique.
4.108 At its meeting on February 26th the Area Health Authority was informed that the Regional Health Authority had decided that there must be an independent enquiry into the allegations. The Medical Staff Committee went through the incidents in the second part of the Critique with some care and were able to identify some of them. We have already referred to the note purporting to record Dr. Q's explanation of Incident 67. Dr. X's summary, as recorded, seems balanced. "There must be bad instances to write this sort of thing. Many sweeping allegations - some of which are definitely wrongly, reported… probably deliberately. There are patients in Heather Ward who refuse to leave. Hospital has received many letters of thanks. Although there are - obviously - deficiencies, [I] feel that the hospital is not all that bad."
4.109 This contrasts with the attitude of the Medical Executive Committee as a whole when it met on April 4th, 1975. The minutes record that a doctor "said the medical members of the District Management Team were worried about seeming complacency at St. Augustine's concerning the Critique. The Chairman replied that the Critique had been thoroughly discussed and some items identified. The members generally felt that this was a malicious document containing inaccuracies and falsehoods which was disparaging to the hospital staff both nursing and medical. Dr. R said in view of the points raised... the Committee should reassure the District Management Team that (a) we have considered the Critique and (b) having considered it feel, on the whole, it should be treated with the contempt it deserves. The Consultants had considered writing to the local press, but the Medical Defence Union felt this could be misconstrued and recommended their members to leave it to the Enquiry."
4.110 As a final commentary on attitudes we set out the last paragraph of a statement sent to us at the suggestion of the Regional Administrator by the former member of the Regional Hospital Board and of the Hospital Management Committee to whom we have already referred. "Finally I doubt if this campaign of witch hunting, digging up drains, opening cess pools is in the best interest of patients or recruitment of staff. I believe it may be part of a coordinated movement throughout the world to attack psychiatric methods and mental health care." But we have found substantially the whole of the first part of the Critique and a large proportion of the second part of the Critique to be well founded.
4.111 We do not forget that the first part of the Critique arrived at a very bad moment for the reorganised Health Service-and that the problems were very considerable at all levels. This to an appreciable extent mitigates the failure to take effective steps and the over—readiness Of Area and District Teams to rely heavily on the arguments and explanations of those who were themselves criticised, but we are not convinced things would have been very different had the first part of the Critique arrived a year later. The underlying attitudes would have been the same.
4.112 Full scale, outside enquiries should be avoided where possible. We suggest the following guidelines for the future.
(i) Every complaint, whatever it is and whatever form it takes, should go at once to the Management Team above the level which is criticised. The steps that are set out below should then be taken unless there are circumstances, which will be very rare indeed, making it clear that the complaint merits no serious consideration.
(ii) Unless the complaint can be answered at once from knowledge already possessed it should be acknowledged in writing and the complainant assured that it will be investigated. A time limit within which a further communication can be expected should be put in the response and, at the same time, any further information felt desirable should be requested, but this must not hold up the investigation unless progress is absolutely impossible.
(iii) At the same time the written comments of any individuals or groups who have been criticised should be invited. They should be told the nature of the allegation against them and asked to state specifically in relation to each allegation (a) whether and to what extent it is justified, (b) where they feel that the criticism is not justified they should give full reasons why it is not justified, and (c) where the criticism is justified but no immediate action is being taken, they should give full reasons for the absence of action.
(iv) When the replies are received the Management Team concerned must consider whether they meet all the criticisms which have been made and whether it can accept the response of those criticised. It should not so do, except in rare cases, merely on the face of what is said in the reply. It should go and see for itself whether the reply is accurate and whether excuses are justified. The Management Team concerned is responsible for the accuracy of the reply to the complainant: it is not just a redirecting house for the answers of those criticised.
(v) When satisfied as to the truth, the Management Team concerned should write to the complainant explaining the position and inviting him to indicate if the response is not clear. Where appropriate he should be thanked for raising the matter.
(vi) Only if necessary should the investigation be held up by referring the matter to a still higher level for guidance. This does not preclude ordinary reports which enable the next level up to monitor performance.
(vii) Finally the Management Team concerned should check that any promised action has been taken by the time when it can reasonably be expected to have been completed.
6 April 2025
