The Long Road to Lawrence Ward 1989­96 continued

2.20.49 The meeting went on to discuss visiting. Broadmoor expressed concern at ex-members of staff continuing to visit patients. The minutes recorded that care teams watched the position carefully, especially when relationships had formed. Rampton were reviewing their visiting procedures. At Ashworth the clinical teams needed proof to substantiate Security Department's concerns before they were willing to ban a visitor. The situation was complicated by different procedures within each Clinical Directorate.

2.20.50 The following item, on pornography, was very germane to the Lawrence Ward situation:

"Mr Ives of the Paedophile Unit at Scotland Yard addressed the meeting on Computer Pornography, especially where children were involved. This followed concern about the ease by which patients had access to computers and how pornographic material might be obtained."

"Mr Ives explained that it was now possible for computers to produce photographic-quality images, and that pornographic images of children can be created from those of adults using a scanner and other computer equipment. He set out how the law had developed in recent years over the possession of pornographic material."

"It was possible to identify the material that might be used to build up photographic material, but it was also possible to disguise the possession of it by encryption and other means."

2.20.51 Sadly this timely warning of possible problems did not result in immediate action in the PDU.

6 December 1995

2.20.52 The situation as regards searching was as parlous as ever:

Item 4 "Searching"

Item 4.1 "Concern was expressed over the requirements for searching set out in the Service Specification for Security and the meeting discussed what was meant by the term. If a full search was required then this demanded a great deal of staff. Mr Street reminded the meeting that the conclusions of the Lamont Report made it clear that full searches were required. If this wasn't possible, because of shortages of staff, the General Managers would need to address the situation, since changes to the Service Specification would require the agreement of the Commissioning Board. Mr Street invited the Security Managers to let Mr Curd at Charles House know of their concerns and the different criteria that would meet their requirements."

Item 4.2 "The searching of patients was not being done at present in accordance with the draft Service Specification at Ashworth and Broadmoor, nor were they conducting a search of all packages and parcels for patients."

Item 4.3 "Mr Street stressed that it should be made clear that searching of visitors could be conducted. Broadmoor staff were not confident about doing this and were to receive training from British Airways. All three hospitals accepted that full searching required a big input of staffing resources and accordingly presented particular problems. They recognised that the Service Specification would present difficult challenges for the hospitals, and particularly for the Security Departments. A further aspect referred to was the requirement for staff to monitor visits to patients. At Ashworth this meant looking in the room from time to time, whereas the Specification would require full observation."

Item 4.4 "Ashworth referred to the Specification omitting reference to telephones, and how the existing need for a telephone policy and the need to monitor it, would be incorporated in the future."

2.20.53 The next item covered visiting. The minutes record that all the Hospitals had dispensed with the personagram system and only Broadmoor had so far substituted a similar system (Equinox). Ashworth were relying on written records, but were considering installing a system being developed at HMP Whitemoor. The minutes note that:

"The meeting discussed the arrangements at the hospitals for approving visitors and when CRO checks were made. There were particular problems over this at Ashworth, which Mr Street would discuss further on his next visit there."

13 February 1996

2.20.54 This is the final meeting for which we have seen minutes. The searching of staff was discussed. Carstairs said they conducted random searches every day on 1:6 staff entering the Hospital and also on anyone who triggered the metal detector. Occasionally 100 per cent searches were conducted and sometimes searches were carried out on staff leaving the Hospital. New X-ray equipment and metal detectors were being installed. The minutes continue:

"The meeting accepted that before arrangements for searching staff were considered, effective policies needed to be in place in the Special Hospitals for searching visitors. However, the Security Managers accepted the importance of searching staff in order to protect them from intimidation/manipulation."

2.20.55 This was the last minute of the Security Managers bimonthly meetings since the three Hospitals became independent in April 1996. We understand that quarterly meetings have continued.

2.20.56 From 1992 when Miss Kinsley wrote her Reports on each of the Special Hospitals until the demise of the SHSA in 1996, the same problems remained unresolved. There was a total failure to get the balance of security and therapy right. Insofar as there were policies designed to exist in harmony with therapy, they were revisited on a number of occasions; there was discussion and debate between clinical and security staff but little agreement; there were never proper instructions, only policies, and certainly at Ashworth those policies could often not be found in the wards.

2.20.57 We highlight two examples of this. First, when Miss Kinsley reported on Ashworth, she said that found no policies on searching clearly set down. Three years after her Report there was still no policy on patients' possessions. She said there was a lot of controversy about that topic. Various interested lobbies maintained that patients should have more property than they should:

"and the great defence, of course, was storage. I found it a bit difficult to accept that in large institutions there was not somewhere where things could be stored or handed out to relatives".

She clearly had in mind what our Committee had been feeling for some time. The real problem was the lack of interest or determination to reduce the level of property held in patients' rooms particularly at ward level.

2.20.58 Second, the same attitude was seen in the way in which ward visits were not properly supervised. Miss Kinsley said that when ward visiting was introduced, it was made quite clear that such visits should not happen unless they were properly supervised. She added:

"But it seemed to have gone ahead without that being ensured, and Ashworth were not the only ones because I found a similar situation at Rampton when I was visiting one weekend for the purpose of an inquiry. It was very difficult to get the ward staff to accept that these visits must be properly supervised. They thought they knew their patients and it would be alright."

In so far as children visiting wards was concerned, she had no knowledge at all of that happening. As far as children visiting wards housing paedophiles was concerned, she said she was horrified, as she imagined most people were, when she read about it.

2.20.59 Ward staff could, and no doubt did imagine that supervising visits was not particularly important because according to Paragraph 26.3 of the Code of Practice, "ordinarily, inadequate staff numbers should not be a deterrent to regular visiting". As we said earlier, as applied in the high security setting this is untenable and must be changed.

2.20.60 At this point we focus in greater detail on some of the recurrent themes that emerge from the Security Managers' meetings.

2.21.0 Security and the Security Department

Crying in the Wilderness

2.21.1 A number of extracts referred to above reveal the Security Managers' feeling that they were marginalized, not only at Ashworth, but also to some extent at Broadmoor and Rampton. The marginalization of security in the years post-Blom-Cooper was a concern of many witnesses. Thus Mr Maxwell, the former Security Manager, told us that there was an insidious process by which security became essentially a matter for PCTs, and the role of security advisers became less and less important. To be against any aspect of what was perceived to be the Blom-Cooper Report's agenda was to be labelled a dinosaur. Aside from Miss Kinsley he did not believe anyone at a senior level in the SHSA or the Hospital was willing to give security a higher profile.

2.21.2 Mr Maxwell also told us that, following the creation of Clinical Units, Clinical Managers were resistant to the idea of Security Liaison Officers for each Unit. He recognized that it was difficult for the new, more autonomous units to accept central direction on procedures, directions which would lead to confrontation with patients. In any case, the most that Security Liaison Officers could say was "do this at your peril".

2.21.3 Mr Paterson, his deputy for several years, told us that security matters did not receive sufficient priority. He and his colleagues felt that they were crying in the wilderness. There was no mechanism by which Clinical Units or Directorates had to report any matters to Security, even if they had wide security implications.

2.21.4 Part of the problem was that the Security Department was always relatively small: some 50 staff in total, the vast majority of whom worked in the Control Centre. The Security Liaison Officers were over-stretched; thus although Mr Day, the Security Liaison Officer
for the PDU, in theory should have attended all PCT meetings in the PDU, the PCTs on Lawrence and Macaulay Wards clashed. Given that Macaulay Ward was giving the Security Department more concerns, he rarely attended the Lawrence Ward PCT.

Community Card

2.21.5 One aspect of security which is not highlighted in the Security Managers' meetings is the community card system (formerly called parole). In their Inquiry Report Sir Louis Blom-Cooper and his team were critical about restrictions on patient movements within the North Site and recommended that the Hospital review escorting arrangements within the Hospital confines (recommendation 34). The rationale for this was that, given the highly secure perimeter fence, the Hospital could afford to relax aspects of security somewhat inside the walls. However, the high wall gave the Hospital a false sense of security. Attention was focused on preventing patients getting out. Little thought was given to what was coming in and to what was happening inside the walls.

2.21.6 The number of patients who were allowed to hold community cards increased dramatically over the years. With it the potential for security breaches increased, as community card patients had unescorted access to various areas (including the Lawrence Ward garden, a point to which we shall return). They could visit other so-called parole wards, offering a ready route for drugs and other illicit substances. The fact that community card patients could escort their visitors within the grounds offered an easy route for such substances to be introduced into the Hospital unobserved by staff.

2.21.7 So many patients had acquired this status that Mr Paterson told us that there might be up to 100 patients walking around the site unescorted in the summer. As more and more patients on even medium dependency wards got cards then they were asking whether their wards should be parole wards too. Mr Paterson felt the Hospital needed to consider how many patients holding community card status it could safely absorb. Such status should be a privilege, not a right.

2.21.8 We agree. Community card policies must be reviewed. On a large open campus they allow different types of mentally disordered patients to mix, sharply increasing security risks. Holding a community card should be a privilege earned and a privilege which can also be lost. Furthermore, in our judgment, unless personality disordered patients are physically separated from other mentally disordered patients, allowing personality disordered patients unescorted access to an open campus creates an unacceptable security risk.

Recommendation 6 2.21.9 We recommend: (i) The whole policy of issuing community cards should be reviewed. (ii) The total number issued should never be such as to jeopardise fundamental security requirements. (iii) Unless severe personality disordered individuals are physically separated from the mentally ill, those severe personality disordered individuals who hold community cards should not be allowed unescorted access to other parts of the Hospital.

Physical Security

2.21.10 Ashworth is a hospital, but it has to accommodate some individuals who would be category A in prison terms. The standards of security should reflect that fact. We were alarmed to hear that only about 65­70 per cent of the North Site is covered by security cameras and that the quality of the video pictures is not very good. Vehicles are only superficially searched entering the site; staff are not searched, nor are visitors, although their bags are searched. The personagram system for checking the identity of approved visitors never worked and has not yet so far as we are aware, been replaced by a more effective system.

2.21.11 We are aware that investment in new security measures is being planned at Ashworth. We see this investment as vital if Ashworth is to continue to hold highly dangerous patients.

The Renaissance of Security

2.21.12 Both Mr Paterson and Mr Gardner, the then Director of Security and Clinical Risk Management, sought to reassure us that security really had been improved. Mail was now checked centrally; independent search teams had been introduced; searching on the wards had been improved (although the quantity of patients' possessions still prevented effective searching) and there was more storage for surplus possessions; computer security had been addressed; illicit substances would always be a problem but the amount circulating in the Hospital had, they believed, been reduced; the amount of pornography available had been much reduced; children visiting had been tightened up greatly; a new telephone system was being investigated; Security now had a strong voice at Board level and there was more respect for security staff, linked to that higher status within the organization. We were pleased to hear that Mr Gardner could go to the Chief Executive to get a PCT decision challenged; he was reluctant to have a veto power lower down the organization.

2.21.13 The new Security Manual was produced during the course of our first session of hearings. This represented the first thorough revision of the Security Manual since May 1992, despite the Owen Ward recommendation for an urgent review of the manual. Mr Paterson told us that the new manual had been through an extensive process of consultation to ensure that it was right, a point supported by Mr Gardner, who told us that his Department had organized awareness sessions and training to support the introduction of the new manual. Staff were required to sign when they had read the manual and those lists would be audited. In addition, Mr Gardner told us that all Hospital policies were being put onto the Hospital's IntraNet system.

2.21.14 After so long it was time something effective was done. All these changes which had been taking place during the course of our Inquiry are still embryonic and certainly need to be revisited constantly. An example of this is the computer security policy to which we refer critically in Part Three paragraph 3.40.0 et seq. below. That it took so long to produce the new Security Manual is a matter which draws our most serious censure.

2.21.15 Our continuing lack of confidence in security at Ashworth Hospital even today leads us to recommend that another external review be taken of security, and that this be regularly repeated.

Recommendation 7 2.21.16 We recommend that an independent review of all aspects of physical security at Ashworth Hospital take place and be repeated at regular intervals.

2.22.0 Use of Telephones by Patients

2.22.1 The context for the security managers' concern about telephones was the Blom-Cooper inquiry team's recommendation on patient access to telephones:

"76. We recommend that patients at Ashworth should have a readily accessible personal telephone system, like those generally available in general hospitals and NHS psychiatric hospitals."

2.22.2 The SHSA duly purchased the Cambridge telephone system. Responsibility for approving numbers to be telephoned and for monitoring telephone use rested with the PCT.

2.22.3 We heard a considerable amount of evidence reinforcing the concerns of the security managers quoted above. Thus it quickly emerged that the new system was open to manipulation by more able patients. The POA described the policy as "near impossible to police". Mr Dale told us that he quickly learnt of seven or eight ways of cheating the system. Patients dialled numbers which were supposedly out of bounds. The phone cards rapidly became a form of currency. Mr Tarbuck noted that when he took over the Unit, telephone calls were not being monitored. In theory, control could be exerted either by turning the telephone off, or by limiting patients' calls, or by staff members standing next to patients as calls were being made. None of these options was particularly practicable with articulate personality disordered patients who would vociferously complain if their 'rights' appeared to be infringed. Even if control had been better exerted, the PDU patients could gain access to telephones on other wards or via third parties. Without the ability to limit the numbers being called and frequency of usage, the system represented a running security breach that had to be managed.

2.22.4 Mr Green confirmed that patients quickly found ways to subvert the Cambridge system. One of the recommendations of the Owen Ward report was to review the monitoring and use of telephones, yet when in April 1995 Mr Kaye wrote to the UGMs concerning security matters he noted that there appeared to be no coherent approach to monitoring the use of telephones at Ashworth, in contrast to Broadmoor and Rampton.

2.22.5 Mr Keown and his team found evidence of telephone cards being used as currency. One patient had amassed cards worth more than £300. The father of Child A had the biggest stock of all.

2.22.6 Dr Strickland agreed with the suggestion of counsel for the RCN that monitoring telephone calls was impossible when there were limited numbers of nursing staff and a phone available 24 hours a day." Who wants to be using a telephone at 3 am? We can see no justification for patients to be able to use the ward community telephone between midnight and 7 am, save in the most exceptional circumstances.

Recommendation 8 2.22.7 We recommend that patients should not be allowed to use the ward telephone between the hours of midnight and 7 am save in the most exceptional circumstances.

2.22.8 Mr Gardner told us in February 1998 that a new telephone system had not yet been commissioned despite the problems with the Cambridge system, although there were several more secure systems which the Hospital was investigating.

2.22.9 Mrs Miles confirmed the problems; she agreed with Professor Edward's suggestion that to say a Blom-Cooper recommendation was unworkable was not easy.

2.22.10 The importance of this potential abuse of telephones was, as we have seen, that it enabled patients to carry out various scams and inappropriate activities. To quote the Keown Report into events on Lawrence Ward in 1996:

"9.1. From the outset of the investigation process it was evident that the Lawrence ward community telephone . . . has been widely misused and abused by patients. The policies and procedures in place to govern the use of the community telephone proved to be inadequate at maintaining the security of the system. Patients have been able to conduct business transactions, trade in illicit goods, make unapproved telephone calls and participate in activities which can be deemed to have been fraudulent such as obtaining loans under false pretences."

2.22.11 But this is not the whole story. Mr Murphy noted that the Hospital telephone policy was well-known: the PCT was to determine whom it was appropriate for a patient to contact and to keep a list of suitable numbers It was the staff's responsibility to ensure that the right number was being called. But the Lawrence Ward policy on phones was, according to Mr Murphy: "a person can make a phone call to whoever they want whenever they want".
Mr Daggett confirmed this: "patients phoned anyone they wanted 24 hours a day".
Mr Murphy took action in September 1996 to insist that ward managers see the policy was enforced.

2.22.12 As it was couched this policy was very difficult to enforce and for that reason we find it difficult to criticize those staff who gave up trying to enforce an impossible set of rules. We are told that the Hospital is investigating purchasing a new system; a new system on its own, however, is not enough. It needs to be underpinned by an enforced, workable policy for telephone use.

2.23.0 Searching/Patients Possessions

2.23.1 As far as searching is concerned, there are two interlinked issues revealed by the minutes of the security managers: one, the legality of searching (of patients, visitors and staff), and two, the practicality of searching over-filled rooms. With regard to the former point, we have already discussed at length the Broadmoor judgment at 2.12.14 et seq. above and concur wholeheartedly with that judgment.

2.23.2 On the particular issue of searching staff we see no reason why staff should not be searched and the Carstairs practice seems an eminently sensible one. This idea was supported by Mr Paterson, notwithstanding the resource consequences. How this should be implemented should be discussed with staff representatives, but it should be implemented.

Recommendation 9 2.23.3 We recommend that searching of staff be implemented.

2.23.4 As far as the latter issue of patients' possessions is concerned, the Security Managers' concerns were shared by many others. Mr Tarbuck told us that when he took over the PDU four wards did not represent a problem in terms of patients' possessions. This was because they had less property in real terms (except for patients on Owen Ward) and because five beds on each ward had been taken out of commission, rooms which were used for offices, therapy rooms and for storage of patients' property. But there were problems on Lawrence and Macaulay Wards where the same strategy could not be adopted. There the Owen Ward Report recommendation on conducting searches could not be fully implemented due to the lack of storage for patients' possessions. He signalled this to the HMG and others frequently and did try to address the problem whilst taking account of the views of the patients, but in his view they had no option but to wait for the secure central storage area.

2.23.5 Mr Melia, who became Ward Manager of Macaulay Ward in August 1994, confirmed that the state of patients' rooms made searching enormously difficult. He told us that searching had ceased for some time on that ward; he reinstituted searches, much to the annoyance of patients. But the root problem remained; there was simply nowhere to put patients' property off the wards.

2.23.6 This despairing attitude appears to have been widespread. Mr Dale told us that the importance of the possessions issue was widely recognized but that no one, himself included, really gripped the problem, and in effect waited for the capital programme to sort the problem out. This was despite clear statements from Mr Kaye of staff's right and duty to search and the requirement that patients' rooms therefore not be over-cluttered. Mrs Miles told us that the amount of possessions patients had in their rooms at the time of the Owen Ward report was very much left up to PCTs. She was well aware of the problems with storage but noted that no one was beating down her door to say that it was an issue which had to be addressed as a high priority in the capital programme.

2.23.7 As far as Lawrence Ward was concerned, several witnesses told us that the quantity of possessions was considerable. Mr Moran admitted that the actual volume of possessions in patients' rooms on Lawrence Ward made searching "almost impossible". This picture was confirmed by Mr Arnold, who told us that fireproof cabinets were promised for storing excess videos, but these never materialized in his time. In their absence there was, he said, little they could do.

2.23.8 Mr Day, who became Security Liaison Officer for the PDU in January 1995, told us that patients' possessions were a continuing headache. For example, it was quite common on the PDU for patients to have more than one video recorder. When the Security Liaison Officers had first started they did draft a policy on possessions which was rejected as too draconian. It took a very long time to get a policy agreed on this issue.

2.23.9 Mr Maxwell told us that when core search standards were introduced there was negotiation with the Clinical Managers as to how many searches would be carried out on each ward. Once that was agreed the Ward Manager would be responsible for ensuring that the searches were carried out.

2.23.10 He had expected an uproar when the new searching policy was introduced, but in fact there was little complaint. This made him suspect that the returns the Security Department was receiving reporting that searching was happening were falsified. When his staff did an audit they found the quality of searching to be mixed. Those wards which had resisted the introduction of the standards were the worst, Lawrence Ward amongst them. As we have seen from the security managers' meetings, staff questioned the legality of the searches and complained that they spoiled therapeutic relationships; Mr Maxwell thought that laziness played a part, as did the fact that staff had become less skilled at saying "no" to patients.

2.23.11 Mrs Miles did ask Mr Dale to develop a policy on patients' possessions. A very lengthy policy development process followed, with much debate over the degree of freedom clinical units should have in implementing the new policy. A new policy emerged in June 1996, at which point Mrs Miles discovered the Finance Director was developing a policy on the storage of valuables. She insisted that the two be merged. The final policy had still not been finalized by the time we started hearing formal evidence, although Mr Gardner told us that a new policy was introduced in November 1997. Mr Gardner admitted that he and his colleagues had not audited the implementation of the June 1996 policy; he admitted that there had been an absence of auditing in the past to ensure that policies were properly implemented.

2.23.12 This air of pessimism, almost apathy, concerning patients' possessions was not shared by Mr Kaye and Miss Kinsley. Both thought that the problem of not having containers to store possessions was eminently soluble. Mr Kaye told us that no one ever approached him asking for extra capital for this, although he was aware of the problem. He and Miss Kinsley independently gave us the impression that the Hospital used the "lack of storage space" argument as an excuse for not tackling the, no doubt, difficult problem of challenging patients over the amount of property they had been allowed to accumulate over the years.

2.23.13 We agree with them. Storage should not be a problem as Mr Kaye said. The problem is the creation of a 'prescriptive right' over the years to keep bedrooms in an unsearchable state. And if Mr Kaye is right, Mrs Miles must bear the responsibility for not making the storage available.

Recommendation 10 2.23.14 We recommend that, as a matter of urgency, the level of patients' possessions in bed rooms be reduced to, and thereafter maintained at, a level which permits full and thorough room searches to be carried out in a reasonable time.

2.23.15 As far as a policy on patients' possessions was concerned, over three years after the Owen Ward incident a clear, implementable policy was not in place. This is a totally unacceptable state of affairs as it represents a significant breach in security. It is essential that the quantity of patients' possessions should never be so great that it prevents effective searching.

2.23.16 Everyone in authority knew there was a problem. It was not seen as a high enough priority despite Owen Ward and despite the activities of patient Mr Braund. No one at senior levels got to grips with the issue, even though, as Mr Kaye confirmed, cash could have been made available. If Mr Kaye was as keen as he made out to ensure that rooms were searchable he did not call Ashworth's bluff or that of the other two Special Hospitals, because it was a common problem frequently referred to in the minutes of the Security Managers' meetings. The problem was trying to find the balance between liberalization and security. There was blameworthiness at both SHSA and hospital levels. The SHSA did not prescribe a proper system. At the Hospital level, as UGM, Mrs Miles did not seek the necessary finance to provide adequate storage space.

2.23.17 A significant problem stemmed from the very wide meaning which was being given to "therapy" and "treatment". Some RMOs and PCTs had sharply downgraded security in pursuit of illusory therapeutic gains. Mr Corrigan, for example was allowed to accumulate four VCRs on this basis, even though multiple VCRs are only required for the purpose of copying video cassette tapes. Only two VCRs are required for that purpose. To possess four is to possess a production line. It is absurd to consider possession of that number of VCRs as therapeutic or as part of treatment.

Recommendation 11 2.23.18 We recommend that no patient should be allowed more than one video cassette recording machine in his bed room. If any copying or editing of video tapes is required this should be done under supervision within the Education Department.

2.23.19 Fundamental requirements of security should never be compromised.

2.23.20 We discuss another aspect of controlling patients' possessions, namely controlling access to cash cards, in Part Three below.

2.24.0 Devolution and Multi-disciplinary Working

2.24.1 What had gone wrong? The Hospital had delegated as much as possible to the lowest management level in the organization, the PCTs. At the same time the creation of Clinical Units focusing on the care needs of defined groups of patients, the breaking up of the old professional hierarchies, the introduction of Ward Managers had all been designed to help create multi-disciplinary care teams with the authority to make sensible clinical decisions about their patients. The authority of the Security Department was, as we have seen, seriously eroded in the process.

2.24.2 It is important to stress that delegation in itself and the development of better multi-disciplinary working are admirable in themselves. However, to delegate successfully
in that way one needs, first, a clear policy framework setting out limits to the autonomy
of PCTs and Clinical Units, and their responsibility for keeping senior management informed, so that everyone knows where they stand; second, alert management at every level capable of picking up possible dangers and ready to share any concerns at a higher level, so that any necessary action can be taken; and third, strong PCTs aware of their corporate responsibilities for the security of the whole institution, not just their own patients.

2.24.3 We discuss now each of those three prerequisites in turn.

2.25.0 The Policy-Making Process

2.25.1 We mentioned above that devolution has to be accompanied by a clear framework, so that staff 'at the coalface' understand the limits of their responsibilities and powers. A number of witnesses told us that before the Blom-Cooper Inquiry policies were clearly laid down and well-understood. Whether that was wholly true or not (and the experience of the deaths of Derek Williams and Stephen Mallalieu suggests that policy at ward level was not well-developed), the events on Lawrence Ward demonstrate a clear weakness with regard to the implementation of Hospital policies. We spent much time questioning witnesses on the policy-making process to identify what went wrong. Something deeper than Lawrence Ward having a 'rogue' PCT was involved.

2.25.2 There were indications of concern in the summer of 1995 that the mechanisms for policy-making were unclear. Thus Mr Dale noted at the HEG meeting in July 1995 that there was confusion over the differing roles of the HMT, Clinical Development Group (CDG) and the Risk Management Team (RMT) in the decision-making process. Two months later there was further concern raised about the position of the RMT. Eventually in October 1995 came the "Policies Policy",dated October 1995, which sets out a number of policy statements and outlines a policy-making process. It is worth quoting extensively.

"POLICY STATEMENTS

"1) The General Manager will be the Policy Coordinator and will be responsible for coordinating the Policy System and determining the Key Manager for all policies.

2) The Policy Coordinator in conjunction with the Hospital Executive Group will determine which areas receive a full set of policies and which departments require policies relating to their own specific areas.

The following will receive a set of appropriate policies:

a) All wards.

b) Day service departments.

c) All members of the Hospital Executive Group, Hospital Management Team and Clinical Development Group.

d) Senior Clinical Nurses.

e) Senior Managers

f) Chairman of the Hospital Advisory Committee.

3) Each policy will have a designated Policy Team.

4) With the approval of the General Manager/Group commissioning the policy, the appointed Key Managers will be responsible for gathering together a Policy Team; ensuring wide representation from appropriate staff within the service.

5) The Key Manager will be responsible for:

a) Chairing Policy Team Meetings.

b) Allocating work as required to individual members of the team.

c) Gathering information.

d) Ensuring consultation with appropriate parties.

e) Sending out information, including copies of draft operational policies to Team Members.

f) Making sure all policies under their jurisdiction are reviewed at the appropriate time in conjunction with the Policy Coordinator.

g) Ensuring consistency with Special Hospital Services Authority's policies.

6) It will be the decision of each Policy Team to determine the distribution of the Policy to other departments/areas not listed in 2) above. They will base their decision on the list of areas/departments provided.

7) The Hospital Executive Group will approve and authorise the implementation of all policies.

8) All policies should be reviewed annually unless circumstances require more frequent review.

9) To aid the speed of reviews and reduce paper work, all master copies of policies should bestored electronically. The disk(s) will be kept by the P.A. to the General Manager.

10) All policies will be contained within a file which will also be accurately indexed. All new policies will be automatically included on this index.

11) Ward/Departmental Managers will be responsible for ensuring that all staff have read and had opportunity to discuss all policies issued and that they have signed accordingly on the form provided that will be attached to the policy.

12) It should be clearly stated within each ward operational policy the precise location of the policy files.

13) To ensure reviews of policies are uptodate, any new or revised policies should carry on them the date of review."

This paper was distributed to members of the Hospital Executive Group, the Hospital Management Team and the Clinical Development Group (CDG).

We welcome your comments on this site. Prepared 12 January 1999