Catálogo de publicaciones - libros

In January 1965, Barbara Robb visited seventy-three-year-old Amy Gibbs, a patient on a back ward at Friern psychiatric hospital in North London. There, Barbara stepped into the murky, hardly shifting territory of older people’s long-stay care. Shocked by what she saw, such as harshness from nurses and the patients’ uniform haircuts, institutional clothing and lack of personal possessions and occupation, Barbara set out to make improvements. Her campaign triggered a series of scandals about psychiatric hospitals, ultimately resulting in change in National Health Service (NHS) policy and practice. This chapter outlines the historical context of Barbara’s campaign, at a time when consumer rights, equality, social justice and the quality of healthcare were among public concerns adopted by new pressure groups.

During the first two decades of the NHS the Ministry made little headway with improving mental health services used mainly by older people. Fearful of demographic changes due to increasing longevity, it showed little commitment to older people in the context of competing demands for limited resources. The medical profession paid little attention to evidence that many older people could be treated as effectively as their younger counterparts, and most older people stoically accepted health impairments. Some psychiatric hospitals encouraged psychosocial and rehabilitative treatment, but mainly for younger people. Many other hospitals, such as Friern, typically with regimented staff structures and poor leadership, maintained an outdated, untherapuetic, custodial approach, particularly for older people.

‘Mrs Robb has always been a terrible danger’ to the government, a fine tribute from a Cabinet Minister. How did she build such a fearsome reputation? What was her background? How did she acquire her skills? What made her take on the cause of older people in hospitals? How did she cope with NHS bureaucracy? This chapter illuminates aspects of Barbara’s background and personality that motivated her and sustained her in her campaign. It also introduces Amy Gibbs and the ‘Diary of a Nobody’, Barbara’s visit-by-visit record of her experiences at Friern that underpinned her campaign. Early events of the campaign included Barbara’s meeting with Dr Tooth at the Ministry of Health and Lord Strabolgi’s passionate and provocative speech in the House of Lords.

In October 1965 Barbara established AEGIS (Aid for the Elderly in Government Institutions). AEGIS, became a high-profile pressure group. It aimed to call public attention to serious defects in the care of older patients in psychiatric hospitals. AEGIS won the support of policy experts, such as Brian Abel-Smith. Barbara compiled the book , incorporating accounts of poor practice from whistle-blowers who were mainly hands-on staff and new to a hospital. also suggested remedies, including dedicated and proactive psychiatric services for older people, a hospitals' inspectorate, an ombudsman and improved complaints procedures. AEGIS planned tactically, aiming to kick-start the Ministry out of its complacency. This chapter also explores comparisons made by contributors between psychiatric hospital long-stay wards and Nazi concentration camps.

Barbara enthused journalists to publicise AEGIS’s concerns, to enlighten the public and to pave the way for . In early 1967, the Ministry began to prepare for the outburst of public opinion which it predicted would follow publication. The Ministry prioritised protecting staff against criticism, rather than safeguarding patients from poor care, and fumbled over establishing appropriate inquiry processes. Directly related to , unrest surfaced among staff in other hospitals, such as at Ely in Cardiff, from where a nursing assistant wrote to the describing similar conditions. The newspaper forwarded his report to the Ministry. Overall, the press supported AEGIS and criticised the Ministry and the NHS leadership, which continued to defend hospital standards.

The inquiries (August 1967–February 1968) were disturbing. A sense of open mindedness to evaluate the allegations was minimal, and the Ministry expected conclusions to indicate that practices were satisfactory. This chapter explores three hospital inquiries in depth—Friern, St Lawrence’s and Storthes Hall—corresponding with availability of archive sources. The inquiry chairmen lacked experience of public sector administration, including of the way statutory authorities could cover up deficiencies. They discredited witnesses based on their personalities and status within the hospitals, rather than evaluating the evidence they gave. They made errors when judging standards, due to their stereotypical expectations and lack of knowledge about good clinical practice. The Council on Tribunals, the public body monitoring inquiries, criticised the procedures. Cabinet Minister Richard Crossman described the inquiries as ‘fairly well rigged’.

Kenneth Robinson, Minister of Health, announced that the inquiries disproved the allegations in and vindicated the hospitals. However, careful reading of the reports indicated much unsatisfactory practice. Newspapers criticised the Ministry for its deceitful and ‘deplorably hostile’ view of , and public support for AEGIS increased. More hospital staff voiced concerns and attempted to make improvements. In 1969, investigations at Ely Hospital revealed appalling standards, gave credence to and reiterated AEGIS’s proposed remedies. AEGIS continued to chip away at the shield defending officialdom and worked to improve hospital provision. The government established a NHS inspectorate (1969), reviewed the complaints system (1971–1973), appointed an ombudsman (1973) and created blueprints for improved services for people of all ages with mental handicap and mental illness (1971–1972).

The concluding remarks draw together aspects of AEGIS’s campaign and Barbara’s work, the role of women in the campaign, the last years of Barbara’s life, and AEGIS’s legacy for twenty-first century health and social care policy and practice. Inadequate care still occurs in the twenty-first century, but recurrence of scandal does not invalidate Barbara’s achievements, or those of other pioneer social reformers: William Wilberforce, for example, would be busy today, dealing with modern slavery and people trafficking. Some risky patterns of NHS practice continue: understaffing and regimented monitoring of task-driven rather than person-centred practice is common, and staff new to a hospital are rarely asked for feedback about their experiences and insights, which, seen through a ‘new pair of eyes’, may be valuable.