The Daggett allegations continued

3.36.2 Mr Keown was probably being over-generous in crediting the PCT with that degree of knowledge.

3.36.3 For our part, we heard abundant evidence that in a number of areas the PCT was not abiding by Hospital policies. Thus there were core search standards in place which were not monitored; the policy on possessions was not implemented (though there is a dispute as to whether that was a realistic policy in the absence of adequate central storage facilities); the standing instructions on handling patients' financial transactions were not followed; and Hospital policy on patient access to cash cards was ignored.

3.36.4 We heard evidence on the working of the Lawrence Ward PCT. The key players did not see any real problems. Dr Strickland told us that the Lawrence Ward PCT worked as a multi-disciplinary team. He denied being the one holding all the power, and strongly denied that he ever protected any patients, in particular Mr Corrigan. Dr Crispin, Mr Arnold and Mrs Day all told us that each member of the PCT was able to make his or her voice heard, and that they were able to reach a consensus.

3.36.5 Despite the warm words, we were hard-pushed to see any obvious signs of effective multi-disciplinary working. We have already discussed the communication failures between the PCT and the ward-based staff; that lack of communication extended to within the PCT. Thus we were somewhat alarmed to hear that Mrs Day and fellow psychologists kept a separate set of notes, mainly informal notes and test results, which could, we were told, be misinterpreted by other professionals. This did not sit easily as far as we could see with a commitment to multi-disciplinary working. In answer to the questions of Counsel for the patients, Mrs Day was unable to demonstrate any clear mechanism for liaising between the psychology and social work departments to see whether checks had been made on the background of visitors.

3.36.6 Mr Daniels put it to Dr Strickland that the impression he had gained was not of a multi-disciplinary team, but a collection of individual professionals who happened to meet once a week. Dr Strickland pointed out that it was very difficult to get close multi-disciplinary working when individuals had responsibilities across several wards. One problem with PCT meetings was that they took place during ordinary working hours when a lot of staff had to be on the wards. That said, they did attempt to involve a patient's primary nurse in a discussion.

3.36.7 The PCT also struggled with irregular attendance. Some members of the PCT were irregular attenders. Dr Stowell-Smith in particular seems to have had a reputation for attending irregularly and leaving early. This was also an issue with Mr Berry, who appears to have failed to keep appointments with patients and to complete Reports when requested. Mr Berry argued he had too many patients on his workload. He did not attend the Lawrence Ward PCTs and did not work there; but he continued to have responsibility for patients there until Mrs Day took over.

3.36.8 Despite the general politeness, we were conscious of some blame-shifting between the different professions. Thus Dr Crispin told us that whilst she accepted responsibility for the care of her patients, the responsibility for the ward itself rested with the Ward Manager. She and her fellow RMOs had responsibilities but not the power to go with that responsibility: they were not in a position to control the environment in which patients were being treated.

We disagree. The RMOs had the power but did not properly apply their roles as clinical leaders.

3.36.9 As we have seen, a previous Ward Manager, Mr Moran, was more critical of the medical leadership of the Lawrence Ward PCT. He confirmed that the Lawrence Ward PCT did on occasion feel entitled to confront Hospital policy and make representations further up the management line to prevent policies applying to Lawrence Ward patients. An example given to us dating from April 1994 was a decision to write to the Security Department asking that the opening of patients' mail should not apply to Lawrence Ward patients. He told us that the RMO would take the final decisions about certainly clinical issues, having listened to others' views. He agreed that distinguishing between clinical and non-clinical issues when the RMO's responsibilities were so all-encompassing was arbitrary.

3.36.10 The introduction of Ward Managers was never properly thought out, and the tensions in the relationship between the RMO's overarching responsibilities and the Ward Manager's day-to-day responsibility for running the ward were never resolved. The system introduced confusion as to how therapy and security could be harmonised. See Part Four below.

3.36.11 Dr Strickland was asked whether consultants had become almost "external experts", spending all their time doing assessments, court work and writing Reports, and very little actually working on the wards. Dr Strickland described that as an exaggerated view, but pointed out that he had a large case load of patients on several wards, no senior registrar support and a heavy administrative load. In theory he could have refused to serve on some of the committees he was involved with, but would have faced considerable pressure from colleagues if he had done so.

3.36.12 Mr Arnold was candid in his self-criticism. He agreed that as Ward Manager he was responsible for leading the nursing team, maintaining standards of care and for the day-to-day security and management of the Ward. He could have taken any concerns about the regime on Lawrence Ward to the Clinical Manager. He admitted that he lacked managerial experience and that much had been happening on Lawrence Ward of which he was unaware. Mr Arnold admitted he had not worked with personality disordered patients as a group before. He agreed he would have benefited from more specialized training . He had had no formal induction on taking up the post.

3.36.13 We must balance Mr Arnold's self-criticism by noting that we heard a number of staff praising him as a good Ward Manager (for example, Ms Karran). Mr Cannon praised him, in particular with regard to his support for staff, but felt he became embroiled in non-clinical issues such as the ward shop. That said, he had inherited the situation, as had previous Ward Managers. Mr Melia told us that Mr Arnold's staff were very supportive of him and felt that the PCT had let them down, not Mr Arnold. Mr Melia was not convinced that was an accurate assessment of where the responsibility lay between Mr Arnold and the rest of the PCT, but it was firmly held.

3.36.14 We believe Mr Arnold was well-intentioned, but naive. He lacked the skills and experience to do a very difficult job.

3.36.15 Mr Daniels suggested to Mr Arnold that discussions at PCT meetings did not always get properly minuted or put into the clinical notes or care plans. This appears to have created major communication problems. Mr Arnold explained that the ward lacked proper clerical support.

3.36.16 This is not good enough. Good communication between different members of the PCT, and between the PCT and ward-based staff, was essential. It deserved more attention than it got.

3.36.17 Our discussion of the visits of Child A reveal a PCT which did not communicate effectively with ward-based nursing staff and vice versa. Instructions and changes in policy were written into the clinical notes and passed on as telegraphic comments in PCT minutes; but, as Mr Daniels pointed out, if notes in the clinical records do not get translated into formal policy documents the situation is hopeless, particularly with new staff joining the Ward, who cannot be expected to read back through clinical notes to pick up
policy changes. Nursing staff were concerned, but the messages did not come through clearly.

3.36.18 Mr Arnold should have been linking the PCT and the ward staff together. He did not do this adequately. Other members of the PCT were very rarely on the ward, and when they were there did not seem to be paying adequate attention to what was going on. This did not help. If they had had closer relationships with the nursing staff the problems would have been identified earlier.

3.36.19 We felt that the Lawrence Ward PCT was reluctant to think through what it was trying to do. Much was done superficially; the attitude to record-keeping is an example, which had dangerous implications. We realize that the RMOs were very busy, but one does not get any sense of Dr Strickland in particular, and Dr Crispin, seeking to find out what was really going on; rather there is a consistent attempt to shift blame subtly onto the nurses in general, and Mr Arnold in particular. This will not do. We were left with the impression that the Lawrence Ward PCT was arrogant, with a deep sense of their own infallibility as far as the management of their patients was concerned.

3.37.0 The Investigation by Merseyside Police

3.37.1 Merseyside Police conducted a thorough investigation of events on Lawrence Ward from February 1997 onwards and passed a Report to the Crown Prosecution Service (CPS) in September. The CPS in the event decided not to prosecute any patients. An ex-member of staff was prosecuted for failing to reveal previous convictions on applying for a job at the Hospital. He was eventually given an absolute discharge.

3.37.2 The decision not to prosecute does not mean that nothing untoward was found. The CPS has to weigh up the likelihood of gaining a conviction on any given charge; and the public interest in prosecuting individuals who are already detained under conditions of high security and who, in most cases, will be subject to restriction orders. An experienced police officer after such a long and thorough inquiry cannot but come to some conclusions. We asked Inspector Marsden of Merseyside Police to share his views with us.

The Chairman: You, in the course of this investigation, were investigating the various allegations made by Mr Daggett, the bringing in of videotapes of a pornographic nature, drugs and all the various matters which are familiar to those who have been sitting in this court.

Q: Did you yourself, looking at the setup at Ashworth at that time, form a view from your experience that videotapes of that nature and drugs had or had not been brought into Ashworth?

A: I had no doubt as a result of the experience of this investigation, but other investigations I have carried out at Ashworth prior to this, that drugs were available to patients and I have certainly no doubt that pornographic videos were certainly available as well, via the various patients within that Hospital.

Q: From your general analysis, did you formulate any view as to the routes by which for instance the video tapes could be brought in?

A: The route that has been described to this tribunal so far by various patients, together with I was present when Daggett gave evidence on Monday, the experience that he described as being the route in, I am more than happy that that is a feasible way of getting videos into that Hospital.

Q: So coming in via visitors?

A: Yes.

Q: Via obtaining from outside commercial sources?

A: Yes.

Q: Which were undetected at the Hospital at that time by reason of their security arrangements?

A: Yes.

Q: What about drugs?

A: Yes, drugs ­ again from the investigation ­ I spent two days with Daggett obviously in an effort to try and get from him what evidence he had of what he was alleging in his document. Again Daggett explained during his interviews that it was just the culture, he knew it because he lived it, he was there and although he may not have seen silver foil being passed from one individual to another and money changing hands, apart from one incident taking place which he said took place in the Lawrence Ward garden, it is more than feasible that drugs are being passed around that Hospital. I am certainly aware through the security department, prior to this Inquiry being set up, of seizures that had been made by the security department.

Q: I suppose cannabis resin being brought in in tobacco tins mixed with tobacco and things of that sort?

A: I have also seen, again detected by the security department, within a container of talcum powder, cannabis resin being concealed within there. Some quite ingenious ways or rather not ingenious, because the security department found out about them.

Q: From your analysis of all that you collated, forgetting whether or not others may have thought it highly unlikely to have reached the necessary standard of proof beyond reasonable doubt according to a criminal trial, of the basic Daggett allegations as to what went on, what is your judgment?

A: Just with respect to the drugs?

Q: Of drugs coming in, of pornographic literature coming in?

A: Again, I am quite happy to say as a result of this Inquiry that drugs were coming into that Hospital undetected, they were being sold and supplied by patient to patient around the Hospital. I have certainly from my interviews with a number of patients where they actually describe they have actually had access to pornographic videotapes, some of which have been described containing children, and that is well documented in my Report, and I have no reason to disbelieve what I have been told. It has in a number of manners been corroborated by other witnesses.

Q: Corroborated, if you like, by uncorroborable evidence.

A: It was corroborated to my satisfaction but not to the satisfaction of the CPS.

Q: In the sense that there was so much smoke there must have been some fire?

A: Absolutely.

Q: To put it in a colloquial way.

A: Yes.

The Chairman: Thank you very much.

Mr Royce: Inspector Marsden, there were actually two matters I just wanted to ask you about in addition. In relation to property that was recovered from patients' rooms, there was a search as we know at the Hospital on 17 January, and various items were recovered from patients' rooms which were passed on in due course to the police, to you?

A: Yes.

Q: Amongst the items in Mr Hemming's room were a collection of boys' underpants, were there not, 19 pairs of boys' underpants?

A: Yes.

Q: There was also in his room a child's school uniform skirt?

A: That is correct.

Q: In Mr Corrigan's room, there was a ring binder which contained pictures of children in various stages of undress?

A: It did, and what was more disturbing about that piece of evidence was the fact that on a number of the pages, it had actually been compiled carefully over a period of time, it would appear, but in fact you had the top halves of boys which were superimposed on top of what appeared to be adult male genitalia. To me, that had been put together over a long period of time.

Q: At Child A's father's home, you recovered a document detailing Mr Corrigan's index offence, setting out full details of that.

A: Yes.

Q: That was recovered by you as part of the investigation?

A: That is correct, and so much so that we actually contacted the Force that investigated the matter for which Corrigan was detained at Ashworth and we actually contacted them with a view to finding out whether this was in fact an accurate document, and it was. Corrigan later, when I interviewed him, actually admitted that they were the circumstances of his index offence.

The Chairman: Just finally, you heard the evidence of Child A's father this morning?

A: Yes.

Q: You heard his concession that if you take certain of the photographs of the child in isolation, he said they could be of some interest to those with paedophiliac predilections towards young girls?

A: Yes.

Q: I think in the course of your investigations, one of the things you did was to submit photographs of that nature to an expert in this subject for making that point of judgment?

A: That was actually done by the Hospital themselves, but I was aware of that fact.

Q: How consistent was Child A's father's concession with the view of that expert?
A: They were at odds to put it at the least. Certainly the ­

Q: His concession, that they could be of interest to a person with paedophiliac nature?

A: Sorry, certainly they would be of interest to somebody with Hemming's background.

Q: Yes.

3.37.3 Having considered the evidence we have heard and the documents we have read we agree entirely with the Inspector's judgments.

3.37.4 He had formed another judgment as well:

Professor Edwards: When you responded to a question from the Chairman about Mr Daggett, you answered the question specifically with regard to pornography. Can I ask the question in a slightly broader sense: what is your judgment about the credibility of Mr Daggett's overall story.

A: At first I was somewhat doubtful. Having spent originally two days where we interviewed him on his original allegations, and again based on my own experience and other patients I have spoken to during the course of this Inquiry, I am quite happy that Steven Daggett is a reliable witness, and I am quite content that certain behaviour towards Child A took place and as the Chairman or Mr Royce put to her father this morning that the child was being groomed, I have no doubt about that. As I say it is amply supported by the property that was found in Hemming's room.

That is also our judgment.

3.38.0 Conclusion

3.38.1 Mr Daggett paints a picture of a ward which was out of control, where staff had lost control and where patients manipulated staff and systems more or less at will. He exaggerates in part. Nonetheless the overall picture is convincing, and confirms much of what earlier inquiries had reported.

3.39.0 Computers in the Future.

3.39.1 Finally, we noted at 3.35.15 that we were so concerned about the highly sophisticated computer equipment possessed by patients on the PDU that we commissioned an independent review of the computer systems at Ashworth Hospital. We were lucky indeed to have the services of Professor Tony Sammes, Professor of Computing and Information Systems Management at the Royal Military College of Science, Shrivenham. Professor Sammes and his colleague Dr Hunter produced a Review of Information Technology Systems at Ashworth Hospital, for us in February 1998, and Professor Sammes later gave evidence. Because of the importance of the Review to Ashworth we decided to provide the Management with the full Review as soon as possible and did so. The actual Review which we circulated to interested parties had material sensitive to the future security of the Hospital edited out and the parties were so informed. We are extremely grateful to Professor Sammes and Dr Hunter for their thorough Report.

3.39.2 Professor Sammes and Dr Hunter found that Ashworth Hospital had a relatively large and advanced computer network with almost 600 inter-connected PCs (personal computers), and 1,350 named staff users hold network accounts. "The system which is largely used for e-mail, word-processing and as an intranet, seems to be configured, using good current commercial practice, to maintain a 24-hour service."

3.39.3 Only two PCs on the Hospital network currently have access to the Internet. They are dial-up connections via modems. The one in the IT Department uses Compuserve as the ISP (Internet Service Provider), the other, in the staff library, uses AOL (America On Line) as the ISP. Apparently it is intended that two additional PCs will be set up with Internet browsing facilities for staff use only.

3.39.4 The first phase of a new software system was due for delivery in January 1998. It is called PACIS (Patient Administration and Clinical Information System), and will operate over the existing Hospital network, will hold clinical notes on patients, and will provide access to some 1,000 users.

3.39.5 The Hospital network is connected to the patient's educational network by means of a "one-way bridge". The education block is within the secure perimeter of the North site, and in it there are a number of computers for use by patients under supervision connected to a separate network with its own server. Those PCs have had their floppy disk drives disabled. Apparently the bridge link to the Hospital network was provided because the education team considered it necessary to obtain rapid on-line support from the IT Department. This view is not shared by the current Head of the Education Department who feels that a visit by IT staff could fulfil its role just as well. The "one-way bridge" itself is located in the education block, and operates by refusing to pass on packets of information from the patient's educational computers to the main Hospital network. However, it seem likely that the bridge will permit packets of information broadcast from the Hospital network to be passed to the patients' educational computers. Physical access by patients to the bridge is considered unlikely because of its proximity to the main entry control desk.

3.39.6 On 24 September 1996, the Patients' Use of Computers Project Team Report had been produced within the Hospital, and prior to Mr Daggett's absconsion patients had been allowed to use their own computers on the wards within the limits of that Report. Following the absconsion that facility was removed from patients.

3.39.7 The internal telephone system is controlled by an external exchange computer.
A modem system with multiple pass-word protection permits access to the exchange computer and also permits re-programming should it be required. It is shortly to be replaced by a more up to date system, but currently engineers from the company can access and re-program the exchange computer remotely from their help desk and this will also apply to the new system.

3.39.8 Paragraph 4 of the Review is an assessment of the risks of the system. The first is that unauthorized access to clinical information requires a "read" access to the Hospital network which may be achieved electronically either through the direct or indirect use of an authorized working terminal or by subverting the main Hospital network in some way. The Review considers it unlikely that patients could easily gain direct use of an authorized working terminal. The possibility of patients overlooking an authorised working
terminal in a ward area is minimised by suitable positioning of the computers. However,
it is possible for others to gain access more readily and subsequently pass clinical
information to patients, a possibility which will become more serious with the introduction of PACIS.

3.39.9 Professor Sammes noted that subversion of the Hospital network by patients is conceivable. Operational data is broadcast in packets of information throughout the entire Hospital network, and it is, theoretically, possible to read off any packets from any part of the network. Normally, terminals will only access information which matches their internal wired-in address, but software can be written so as to read all information passing over the network. Access to cabling in the wards should therefore be protected, and it is. The authors of the Review, however, suspect that the one-way bridge between the educational computers and the main Hospital network does not block incoming packets, and if that is right, then it would be possible to load software on to the educational computers that monitored all the Hospital network's information. There is also another possible way of accessing the Hospital network: the one-way bridge could be subverted by changing the internal wired-in address in a patient's educational computer. This could most easily be done by connecting the computer via a parallel port ethernet device.

3.39.10 Professor Sammes considered that there was a real risk of subverting the main Hospital network while the one-way bridge remained in place. That risk was not justified by any need for rapid on-line IT support, particularly since there was a reasonable alternative of a member of the IT staff being called in. We agree that the one-way bridge should be removed.

3.39.11 He continued: "Because of the nature and complexity of the PACIS system, it would be wise to have a full security audit carried out by an outside agency before the system is brought into use." We agree that such an audit should be done.

3.39.12 Professor Sammes also considered that the PACIS system would increase the level of risk of subverting the Hospital network by the comprehensive and sensitive information that is to be held about every patient. "For this reason a System Security Policy should be written for PACIS and software changes should be rigorously controlled through a formal Change Control Board. In addition all printed outputs from the system should carry user and session codes embedded in the documents to permit subsequent tracing of the originators." We agree this should be done.

3.39.13 In so far as access by patients to illegal and paedophile material is concerned, it is thought the most likely route is via visitors bringing in floppy disks, ZIP disks, portable hard drives or CD-ROMs which up to now the patients have been allowed to have. The authors say that the current policy of such items being taken only if passed through the IT Department for checking may be difficult to enforce without infringing the civil liberties of visitors. We agree with much of what they say in their Report but not this. If you want to travel by air, you may be required to submit to searches at Airports. If you want to visit a prisoner in prison or a patient in a High Security Hospital you should be prepared to submit to a search if requested to do so. If you refuse to be searched at an Airport then you do not fly. If you refuse to be searched at a prison or High Security Hospital then you do not visit. There is no difference.

3.39.14 No doubt someone will claim it is an infringement of civil liberty, but the security of society is of paramount importance. As a matter of general common sense, now supported by the judgments in the Judicial Review we have discussed at length above, we can see no reason why searching of visitors and their belongings should not be carried out if they want to enter the Hospital to visit a patient. Of course, they cannot be forced to be searched, but if they refuse to be searched, then, in our judgment, they can and should be refused entry.

3.39.15 As we recommended above at 2.12.32 visitors should be searched. Potential visitors should be informed that they may be asked to be searched and if they refuse then they will not be permitted to enter. Notices to this effect should be clearly displayed at the entrance to the Hospital also.

3.39.16 Although we recommend a policy of searching in any event because computer materials are not the only contraband to be considered, we also deal with the alternative approach suggested in the Review. It is to deny patients access to any devices that can use floppy disks, Zip disks [we would add also Zip drives], portable hard drives and CD-ROMs. As the Review says, "This is not to say that patients are denied access to computer equipment, just that the computer equipment with which they are provided has no means by which floppy disks, Zip disks, portable hard drives or CD-ROMs can be attached. The opportunity for copying, distributing or viewing illegal material is then much reduced."

3.39.17 How this could be achieved is set out in paragraph 4.2.3 of the Review. "This policy could be implemented by prohibiting all patients' own computers and providing, from Hospital resources, a separate network of patients' ward computers, similar to the patients' educational network. All data and software would be down loaded to the patients' ward computers from a staff controlled server. Acceptable personal material that had been approved by the IT Department could be mounted on the server. No peripheral devices (other than the keyboard and display) of any kind would be permitted on the patients' computers, and all printing would be done through a central print server. In order to help defray running costs and to inhibit demands for all patients to have ward computers, a nominal hire charge might be made."

Recommendation 33 3.39.18 We recommend that patients should only be allowed adapted computers connected to a patients' server in their rooms.

3.39.19 The Review deals with the Internet, which is the most accessible source of illegal material and which is used by paedophiles both to distribute material and to make contacts with children. "It is very difficult to monitor or control its use and the risk of abuse is high if it is made available to patients. The main means of access to the Internet is via a modem and an outside telephone line. To limit such access, no modem should be permitted in ward areas and access to external telephone lines should be carefully monitored by staff." The authors noted that there was a telephone point in the ward visitor's room which would normally be set for internal access only. It is conceivable that the exchange computer could be re-programmed from anywhere in the internal or external telephone network, by a telephone engineer or someone who knows the engineer's passwords, to give outside access to such a point. "This would seem to be an unnecessary risk and the policy of permitting external telephone engineers to control the exchange unchecked should be re-considered. A simple confidence check could be made regularly by instructing the exchange computer to print a list of all telephone points that have outside line access and comparing that list with an authorised list."

We agree with those views.

Recommendation 34 3.39.20 We recommend: (i) No modems whether external or internal should be permitted in ward areas. (ii) Patients' access to telephones should be limited to: a. Telephone numbers on the list of the patient's list of approved numbers. b. All telephone calls by patients should be carefully monitored, except privileged calls, such as those to legal advisers, in which cases the number should be dialled by a member of staff who, having done so ,should retire out of ear-shot, but maintain observation to ensure no other number is dialled. c. Telephone points in ward visitors' rooms should be removed. d. Permitting external telephone engineers to control the Hospital's telephone exchange should be reconsidered.

3.39.21 In paragraph 4.2.6 Professor Sammes and Dr Hunter note "it is also possible to access the Internet using a mobile phone and a personal organizer such as the Psion series. Mobile phones should be banned as should all electronic personal organizers, palm-top computers, hand-helds and laptops. [We also add pagers to this list as, in his evidence, Professor Sammes agreed]. In addition to providing potential access to the Internet, many of these devices can act as computer terminals on the Hospital networks and may be used as display devices for illegal material."

Recommendation 35 3.39.22 We recommend that patients are not allowed to have in the Hospital: mobile telephones, personal organisers, palm top computers, hand-helds, laptop computers and pagers.

3.39.23 The authors considered other ways of achieving unauthorised access to information. Planted listening devices is one such means, and the Report makes recommendations to combat that risk. They looked at the educational electronic workshops to assess the risk of scanners, listening devices or modern microprocessor devices being built covertly. The technology taught there and the facilities available were adequate for building simple scanners and listening devices, but it was considered unlikely that such devices could be built without the workshop staff becoming aware. Currently the technology taught and the facilities available would not support the covert development of modern microprocessor based devices.

3.39.24 The authors saw the main physical security risk to the Hospital arising from the computer systems as being through the telephone exchange computer as we have already discussed and they recommended that the policy of allowing external telephone engineers to control the exchange unchecked should be reconsidered. We agree.

3.39.25 In the Review some general observations are also made.

1. The IT team was found to be thoroughly competent, professional and well led, but by comparison with IT teams for similar levels of responsibility, particularly with the introduction of PACIS and the additional security needs of such a system, the authors considered the grade of the team leader to be on the low side. From the security point of view it was essential to retain good staff.

2. The Hospital Board should consider putting in place an over-arching Information Systems Strategy for the Hospital as a whole tied in with a comprehensive Security Strategy.

3. System Security Policies should be written for each new computer based system that has security implications. Currently this applied to the proposed gate management system.

4. The increasing importance of IT to clinical and Hospital management and the security implications of its use needed to be fully understood by all staff. Programmes for awareness training, core training and continuous professional development training should all incorporate IT and security modules. In addition, a "Champion" for these issues should be established at Board level.

3.39.26 In the course of his evidence Professor Sammes enlarged on some aspects of the Review.

1. The problem with the Hospital network was the intra-net. Packages of information are sent to all terminals and it is the terminal which prevents the packages from entering its actual processor. "There is nothing to prevent a packet snoop piece of software from looking at everything going on the network, and such software is not difficult to come by."

2. He was asked about the internal (October 1996) Report referred to in 3.39.6 above which said that the use of the Internet in education was something that needed thinking about for patients. He repeated his view that it was extremely difficult, almost impossible, to control. So-called "nanny software" can limit access to particular sites, but that software itself can be subverted by someone with computer knowledge. His recommended approach would be to down load educational or other approved sites to the local patients' intra-net for patients' use without them having access to the Internet itself.

3. He was concerned with the recommendation in that Report that the PCT should decide who should have computer systems. PCTs would not have the expertise to assess the risks associated with particular computer systems which was why they recommended the staff-controlled server system set out in the Report.

4. He had visited wards where patients had computers in their rooms. ". . . it would be very difficult to see whether a patient was misusing a system without having continual observation of the patient and the system for the whole time."

5. The Report's suggestion that patients should be allowed to use computers on the basis of a contract which if knowingly flouted would result in the confiscation of the computer was not in his view wise. He very much doubted if PCTs would have the expertise to know if the contract was being flouted.

6. He disagreed with the Report's statement that "suitable peripherals and software should include CD-ROM and extra disk drives as being acceptable". They would permit access to illegal material brought in by visitors on CD-ROMs or floppy disks.

7. He did not consider the Report's statement that when a patient's computer arrived on a ward the staff should check it to be a practical solution. They would not have the expertise to check peripheral devices, particularly cards such as PCMICA cards. Encripted material might be on the hard drives. Neither did he agree with the proposal that if files on a patient's computer were password protected, or suspected to be so protected, failure to divulge the pass word would be considered a breach of the policy. "I think it would be possible to hide information even from the IT department, and I did not see any particular tools in the IT department which would enable information to be found if it had been hidden in what is known as the master boot record."

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