MIXED-SEX WARDS IN PSYCHIATRIC UNITS – 9 February 1999
Mr Deputy Speaker (Mr Michael Lord): I call Dr Julian Lewis.
Hon. Members: Hear, hear.
Dr Julian Lewis: I am grateful to my colleagues for giving me such a warm send-off on my debate, although start-up might be a more appropriate term.
Let me begin with a quotation:
"Patients' charter offers Hobson's choice on mixed-sex wards. Government not even attempting to collect figures on patients denied beds in single-sex wards."
Those are not my words, nor those of any Conservative hon. Member, but the words of the then shadow Secretary of State for Health, the right hon. Member for Islington, South and Finsbury (Mr Chris Smith), in a Labour party press release dated 20 November 1996. At the outset, I state that I am not, and have never held myself out to be, a medical expert – [Interruption.]
Mr Edward Leigh (Gainsborough): On a point of order, Mr Deputy Speaker. May we have some order in the Chamber, so that we can listen to this important debate?
Mr Deputy Speaker: That is a matter for the occupant of the Chair to decide.
Dr Lewis: Thank you, Mr Deputy Speaker. I have come to the topic by a gradual process, through my involvement with people who have experience as professionals, as designers of mental health hospitals and units, as psychiatric experts and even as users of psychiatric services. I hope to explain why I felt it necessary to apply for this debate, by taking hon. Members through the process of the problem's gradual emergence in my awareness.
I return to the position in November 1996, when the Labour party was, rightly, protesting about the continuing problem of mixed-sex wards. I shall quote the right hon. Member for Islington, South and Finsbury further, because I totally agree with him. He said:
"The last Patients' Charter ... said that patients could expect single-sex washing and toilet facilities; and that their wishes to be treated in single-sex wards 'will be respected wherever possible'."
Note the words "and that", for they mean that it is not enough to give patients single-sex washing and toilet facilities and then to say that single-sex wards have been achieved. As the right hon. Gentleman went on to say:
"These two promises sound good on paper. But a report from the Patients' Association yesterday revealed that segregated washing and toilet facilities are far from being the norm; while patients all over the country commonly report that if they do express a preference to be treated in a single-sex ward, as the Charter encourages them to do, they are suddenly told that in fact their wait for treatment will be far longer as a result."
Let us look at the relevant section of the patients' charter, which states:
"You have the right to be told before you go into hospital whether it is planned to care for you in a mixed ward for men and women. (It may not be possible to tell you this if you are admitted to hospital in an emergency.) In all cases, you can expect single washing and toilet facilities. If you would prefer to be cared for in single-sex accommodation (either a single-sex ward or 'bay' area within a larger ward which offers equal privacy) your wish will be respected wherever possible. There may be some cases, particularly emergencies, where a hospital cannot provide single-sex accommodation."
Labour was saying that that was a dead letter.
Mr Leigh: Does my hon. Friend remember that the Labour party manifesto said that it would take steps to abolish mixed-sex wards in the NHS? What has happened to that commitment?
Dr Lewis: I shall explain the developments. I am happy to acknowledge that some steps in that direction have been taken, but by no means enough has been done. I am concerned that, having taken a few steps in the right direction, which the manifesto commitment outlined, the Government are almost trying to say that the battle is won, the deed is done, the problem is solved. That is not so. Since I first took an interest in this subject some months ago, some worrying developments have made me realise the need to bring the matter more closely to the House's attention.
I remind the House that, on 12 December 1997, I proposed that the provision of single-sex ward areas be made a statutory commitment under the Mental Health (Amendment) Bill, which I moved after being fortunate enough to draw second place in the ballot for private Members' Bills. Sadly, the Government saw fit to amass a combination of Back Benchers and Front Benchers to waste five hours of parliamentary time and talk out the Bill.
Subsequently, there have been some more encouraging developments. In particular, I was tipped off about a development of a mixed-sex ward in a new psychiatric unit at Charing Cross hospital. I raised the issue with the Secretary of State, who gave a characteristically forthright response. He said, "It's news to me if any new mixed-sex wards are being constructed, and if they are, I will put a stop to it." As far as I can see, in this case, he did so.
At that point, the plot began to thicken. As a result of the Secretary of State rightly instructing Charing Cross hospital to revise its plans to create a new mixed-sex ward, the Goodmayes hospital – which was concerned that its proposals for its psychiatric unit would fall foul of the Secretary of State's determination to abolish mixed-sex wards – wrote to the NHS executive.
Mr Philip Hammond (Runnymede and Weybridge): Does my hon. Friend agree that, in view of the express determination of the Secretary of State to end mixed-sex wards in psychiatric hospitals, it is very odd and surprising that the recently published mental health code of practice makes no reference to such a management objective?
Dr Lewis: I agree with my hon. Friend; indeed, I am about to explain why I think that may be. I much welcomed his reference to this omission in the code, when he considered it in Committee in January.
The Goodmayes hospital received a reply on 3 August 1998 from a lady called Judith Guest of the patients' charter unit at NHS executive headquarters. It was sent to the consultant psychiatrist and clinical director of Goodmayes hospital, Mr Andrew Margo, and said:
"Patients have a right to feel safe in hospital and it is recognised that there are special circumstances in mental health wards that have to be addressed to make patients feel secure. There should be separate sleeping and washing areas for men and women and those should be accessible to people when needed and suitable arrangements put in place to ensure that the area is safe. But completely segregating services would not be acceptable, as there are good clinical reasons to provide an environment in hospitals which, as closely as it can, prepares people for their return to their own accommodation".
I am very concerned about that advice. Indeed, I have raised it in correspondence with and questions to the Secretary of State. Nor will it come as any surprise to the Under-Secretary, because I have done my level best to inform his office of my entire line of argument, in the hope that that would assist him in addressing specifically the points which concern me so much.
Mrs Angela Browning (Tiverton and Honiton): In considering what would be the norm in the community, under what circumstances can my hon. Friend imagine, for example, that women would find it the norm to have men whom they did not know in the same sleeping accommodation, and vice versa?
Dr Lewis: I am most grateful to my hon. Friend, as I am always am when she brings the searchlight of her intellect and her specialised knowledge to bear on these topics. She anticipates a point that I intended to make later, but I shall deal with it now because it is precisely what the group of users from the Maudsley hospital has emphasised to me in my two meetings with its members.
I take the opportunity to pay tribute to Jolie Goodman, Cath Collins, Lynne Clayton and Denise McKenna for the campaign that they have been running. They have collected a number of deeply worrying examples of what is entailed for a woman who finds herself an in-patient on an acute ward. First, they contrast two quotations to make the point that my hon. Friend has just emphasised. They quote a pilot wing manager from the Charing Cross development as saying:
"Sexual harassment is a fact of life in mental health wards ... We feel that single-sex services themselves are not suitable here because we're trying to create a normal environment."
The campaigners' response states:
"Mixed wards don't reflect a 'normal' society. They are full of a completely mixed bag of strangers in extreme distress who are forced to live in intimate circumstances with each other."
We can all anticipate the extreme examples of abuse that might occur in such an artificial environment. I shall give only two examples that the campaign group has drawn to my attention. These are the experiences of people who have written to the group. The first concerns a female user who, in 1998, wrote:
"In 1995 I was a patient in" –
I shall not name the hospital –
"and a woman on my ward was raped by a male patient who followed her into the female bathroom."
I interject that all too often what is lacking is a proper definition of what is meant by a ward. The term "bay" is particularly misleading because it refers to corridors: a male corridor opens off in one direction and a female corridor opens off in the other, but there is nothing apart from the vigilance of the staff to stop people going from one to the other.
The second example concerns a 17-year-old woman who, in 1998, wrote:
"I, too, have been sexually assaulted by two male patients on my ward in July of this year. This experience was so traumatic and dreadful that it stopped any progress I was making for several months."
As I said, we could all imagine those extreme cases, and I had already thought of what might be entailed by those terrible circumstances; but what came as a revelation to me in the first-hand testimonies of the campaign group were the examples of more everyday occurrences with which female in-patients have to contend. I make no apology for reading out one or two that some people might find rather disgusting. The first states:
"On entering the games room, a female patient tripped over the legs of a male patient who was lying flat on his back on the floor masturbating. When she complained to a nurse, she was told, 'He's very ill, you know,' and nothing was done."
The funny thing – funny peculiar or funny ironic, but not funny in any other sense – is that that patient was ill, and indeed it was not his fault; but he should not have been where she could stumble across him in that way, or vice versa.
Another example concerns a woman who found herself surrounded by half-dressed men asking whether she wanted a boyfriend, as she queued for breakfast. It has been explained to me that queueing is a key part of life as an in-patient. One queues for meals and one queues for medication. What does a female do if she is being groped or interfered with in a queue? What does she do if someone starts to bully her for her food or benefits? A further example concerns a frail old lady who was bullied by a young male patient into handing him her benefit money.
Then there are the cases caused by proximity and geography. The men's toilets are sometimes at the beginning of the corridor leading to the dining room, and the doors are frequently left open while the toilets are in use. That is not the fault of the mentally ill people who leave them open, but it should not be visible to women.
What can I say in the short time that remains? There is a risk that the pendulum will swing too far. This keeps happening in mental health. At one time, the pendulum swung too far in the direction of institutionalisation: anyone who had anything wrong with him was put away for years – for the better part of his life, sometimes forever. That injustice was recognised. Then the pendulum swung the other way, with care in the community, and hardly anyone was admitted as an in-patient.
A compromise has now been reached in distinguishing between those who need to be long-term in-patients and those who can do well in the community. That is good, but I was disturbed to hear the Secretary of State say some time ago in a statement on mental health that community care had failed. No; part of it failed, and part of it succeeded. Now we are trying to get the balance right.
I appeal to the Minister to come out from behind the obfuscation of official language. He cannot have it both ways. Either the Government believe in the principle of single-sex wards, or they believe in the philosophy of a "normalising" environment – in which the single-sex wards that he is talking about relate only to very basic functions, and there is nowhere for women to be during the day without the intrusion of men.
If the Minister's concern is genuine, he must say once and for all tonight that the idea of creating a "normal" environment by putting sick men with sick women, in circumstances in which they cannot be held responsible for their actions, is fatally flawed, is unacceptable, and will finally be rejected.