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THE AEGIS CAMPAIGN TO IMPROVE STANDARDS OF CARE IN^HOSPITALS: A CASE STUDY OF THE PROCESS OF SOCIAL POLICY CHANGE D . A . Cochrane Submittted in accordance with the requirements for the Ph.D Degree 1990 University of London: London School of Economics UMI Number: U615774 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. Dissertation Publishing UMI U615774 Published by ProQuest LLC 2014. Copyright in the Dissertation held by the Author. Microform Edition © ProQuest LLC. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code. ProQuest LLC 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106-1346 CONTENTS Page Abstract 1 CHAPTERS ONE CONTEXT, AIMS AND METHODOLOGY 2 TWO THE CASE FOR A CAMPAIGN 29 THREE TOWARDS THE LEADING PRESSURE GROUP 52 IN MENTAL HEALTH FOUR SANS EVERYTHING AND A CASE UNANSWERED 86 FIVE ELY AND FRIENDS 120 SIX THE END OF THE OSTRICH ERA 141 SEVEN SCRUTINEERS, COMPLAINANTS AND 166 INVESTIGATORS EIGHT A PARTIAL VICTORY 192 NINE A 92% VICTORY 219 TEN EVALUATING THE REFORMS 243 ELEVEN COMPLAINTS MACHINERY 281 TWELVE POLICY CHANGE IN MENTAL HEALTH: 319 INPUT POLITICS THIRTEEN POLICY CHANGE IN MENTAL HEALTH: 351 THE STATE'S RESPONSE Appendix 1 List of people interviewed for research 389 Appendix 2 A Postscript 390 Appendix 3 Selected mental hospital scandals 399 Appendix 4 Detailed cost and activity data 405 Bibliography 418 Abstract This study explores the process of decision-making in central government health policy. It also documents the history of the pressure group Aid for the Elderly in Government Institutions (AEGIS) and thus the career of its Chairman Mrs Barbara Robb as a social reformer. There are two major arguments in the thesis. Firstly, the study demonstrates that AEGIS played the key role in initiating and sustaining the extraordinary succession of scandals in the mental hospital service between 1965 and 1975 and that these were one of the major determinants of policy between 1970 and 1980. There are two broad areas of policy. The establishment of mental illness and mental handicap as priority services. Empirical evidence is presented to support the argument that the policy has achieved a considerable measure of success. The second area is the redress of grievances in the NHS through the development of formal complaints procedures, special inquiries and the Health Commissioner, where the conclusions are that reforms have been largely cosmetic and largely unaffected the established autonomy of the medical profession to investigate allegations of performance failure brought against its members. Secondly, none of the major competing models of state activity gives a complete understanding of the process of change in the study. The policy process in mental health thus emerges as an example of the professionalised state thesis in neo-pluralism, set within an ideological framework which establishes medicine as the dominant profession. -1- CHAPTER ONE CONTEXT. AIMS. AND METHODOLOGY "Social Policy is easier to describe than to define." (Francois Lafitte) "Now what I want is, Facts. Teach these boys and girls nothing but Facts. Facts alone are wanted in life. Plant nothing else, and root out everything else. You can only form the minds of reasoning animals upon Facts: nothing else will ever be of service to them." (Thomas Gradgrind, Hard Times, Charles Dickens) "A person does not exist without a social context. You cannot take a person out of his social context and still see him as a person, or act towards him as a person. If one does not act towards the other as a person, one de­ personalises oneself." (R.D.Laing) On the 21st of January 1965, Mrs Barbara Robb, of 10 Hampstead Grove, London NW3, visited an acquaintance in Friern Barnet Psychiatric Hospital in Southgate. Mrs Robb was accompanied on subsequent visits by her friends and associates, David (Lord) Strabolgi the Labour Peer and later Minister, and Audrey Harvey, the poverty campaigner.^ For these three people, the first visits to Friern were their initiation into the shabby, twilight world of the back wards of British Mental Hospitals in the 1960s. As a result of her experiences at Friern and beyond, Mrs. Robb, with the assistance of her two friends and a number of other influential people, had, within 6 months, founded the small, elite pressure group, Aid for the Elderly in Government Institutions (AEGIS). Within a year she was spearheading a national media ^■MacGregor S, The Politics of Poverty.(London:Longman. 1981) pp.138-9 and Banting, K.G., Poverty. Politics and Policy. (London: Macmillan, 1979) p.24 -2- campaign on conditions in psychiatric hospitals and was engaged in a protracted wrangle with the Ministry of Health about changing them. Within three years she had published a book called Sans Everything^ setting out her case, and within five had been instrumental in restructuring the political agenda in mental health and health policy generally. By the time she died of liver cancer in 1976, the political history of psychiatric services and health service complaints machinery had been altered irreversibly. Sans Everything was the first in a wave of mental hospital scandals which lasted beyond Mrs Robb's death and into the 1980s. During her lifetime, inquiries at Ely, Farleigh, Whittingham and South Ockendon Hospitals and the events which gave rise to them made front-page news. What is less well known about these events is the critical role AEGIS played in instigating and sustaining the press interest, and by thus raising the issue of care in mental hospitals, inspired the principal complainants at Ely and Whittingham to pursue their grievances. The South Ockendon Inquiry would never have taken place without the efforts of Barbara Robb over three years beginning with the first serious injury to a patient there in 1968. This study documents Barbara Robb's political career as a social reformer between 1965 and 1976. It also examines in detail the career of policy reforms which concerned AEGIS, up to the present day. But the fundamental objective is to use a case-study to analyse the process of policy change in health policy in England and Wales. In this introductory chapter, the context of the study in academic social administration is established. The aims are then set out and followed by a review of the major schools of methodology from which a framework for analysis is distilled and discussed in the ^Ed. Robb, B. Sans Everything: a case to answer. (London:Nelson, 1967) -3- context of the source material used. Finally, the structure of the study is outlined. Context The study has been conceived of and researched within the academic tradition of social policy and administration. This originated in a number of empirical investigations in the 19th and early 20th centuries into the lot of groups in society whose state of material, physical and social well-being troubled the conscience of the elite groups from whom the investigators were largely drawn.^ In addition to documenting the plight of the 'submerged 10th', studies also advocated government action to remedy the evils unearthed. Pre-dating this work, utilitarian philosophers such as Jeremy Bentham had developed moral theories of what was beneficial to individuals both in isolation and as members of society and formulated and promoted elaborate prescriptions of government intervention to foster welfare as defined.4 Bentham himself even designed a technical device to implement some of his prescriptions. Just as the contemporary steam engine was forming the technological base for the development of mass industrial production, so the Panopticon served as the blueprint for the workhouse and the insane asylum which facilitated mass social engineering. ^ Then in the late-1920s the Webbs embarked upon ^See Simey, T.S. and M.B. Charles Booth:Social Scientist (Oxford: Oxford University Press, 1960) 4Klein argues that the first example of policy analysis in social administration was the work of the Benthamite Poor Law reformers, See Klein, R . , The rise and decline of policy analysis: the strange case of health policy-making in Britain, Policy Analysis. Vol. 2, No.3, (1976) pp.459-476 5Evans, R. Bentham's Panopticon: an incident in the social history of architecture, Architectural Association Quarterly. Vol. 3, Jul. 1977, pp.21-37 -4- their epic English Poor Law History® and pioneered a historical perspective to the emergent discipline. When the first Chair in social policy was created in 1950, these three traditions, the philosophical. the empirical and the historical were the core approaches of the discipline. However, its focus, the social services had by now become so extensive and elaborate that whole texts were required simply to outline the major elements of health, housing, social security, and local authority welfare services^, and a fourth descriptive approach had emerged. Then later in the decade, the discipline attracted two young Cambridge academics, Brian Abel-Smith, an economist and Peter Townsend a sociologist. With the research which the former did on the cost of the National Health Service® and Townsend's study into the elderly poor of east London^, social administration had acquired economic and sociological perspectives. If one was to draw up a comprehensive list of the literature at the core of the discipline written before the 1970s, it would be possible to classify studies by this six element typology philosophical, historical, descriptive, economic and sociological. Sirice the categories are not mutually exclusive, the concern in this hypothetical allocation would be to identify the primary aim of a study.

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