Barbara Robb

Barbara Robb, née Anne (15 April 1912-21 June 1976), founded the pressure group AEGIS (Aid for the Elderly in Government Institutions) in 1965. It aimed to improve the care of older people mainly in long-stay wards of National Health Service (NHS) psychiatric hospitals. Robb compiled Sans Everything: A Case to Answer (1967), a controversial and best-selling book about the inadequacies of care provided for older people, with suggestions about how to make improvements. Ultimately, Robb contributed to several important policy changes in the NHS.

Biography

Early life

Born into a landed Yorkshire Roman Catholic recusant family, Barbara Anne had a privileged early life, a convent education, and attended finishing school in Kensington, London. She danced with the Vic-Wells company, the forerunner of the Royal Ballet, but an ankle injury ended her dancing career. Instead, she went to the Chelsea College of Art and studied theatre and stage design. At Chelsea she met Brian Robb, artist, cartoonist and illustrator. They married in 1937. Robb's grandfather, Major Ernest Charlton Anne (1852-1939) inspired her. Robb recalled his words many years later: ‘when you see somebody needing help - help him’ and ‘wherever there were nettles there were sure to be dock leaves to cure the sting … Remember that everything in life is like the nettles, there are always dock leaves if only you look hard enough.’

Amy Anne, Robb’s mother, died of cancer in 1935. Robert Anne, Robb's brother, was killed on active service in 1941. During the 1940s, Robb trained in Jungian psychotherapy with some guidance from psychoanalyst and Dominican priest Father Victor White. Robb undertook a ‘remarkable self-analysis’ and mainly taught herself the techniques of the discipline. White corresponded and collaborated with Carl Jung. Letters between them refer to Robb’s dreams and their interpretation, her personality and appearance: Jung wrote: ‘She decidedly leaves you guessing’, and that she was ‘an eyeful and beyond!’ White called her ‘quite a corker’ and did not quite know how to ‘deal with’ her.

The middle years

From the 1940s until 1965, Robb practiced as a psychotherapist. She and Brian lived in a tiny cottage in Hampstead, each of the three floors measuring little more than 2-by-3 metres. They wanted children, but had none. The Robbs holidayed in Venice, where Brian painted. They had a good social-life, including in the company of artists and politicians, often left-wing. Robb liked her fashionable clothes and hats: as CH Rolph wrote in his memoir: ‘Even if it were possible to forget Barbara, it would not be possible to forget those extraordinary, carefully chosen, and obviously expensive hats, with which she seemed to transmute every occasion into a kind of one-woman Ascot.’

Robb visits Friern Hospital

White introduced Amy Gibbs(1891-1967) to Robb in 1943, for psychotherapy. Gibbs was well for the next 20 years. She worked as a seamstress, and took up art in retirement. In late 1963, Gibbs was admitted to Friern (psychiatric) Hospital for ‘anxiety’. She expected a short admission to sort out her medication which was making her feel ‘muzzy’. In December 1964, a mutual friend informed Robb that Gibbs was still in Friern, on a long-stay ‘back ward’ and wanted to see her. Convinced that Gibbs was not a ‘mental patient’, Robb thought it would ‘not be improper’ to visit. On her first visit in January 1965, Robb was shocked by what she saw and heard on the ward: the patients’ uniform haircuts, no activities, institutional clothing, lack of personal possessions including spectacles, dentures and hearing aids, and harshness from the nurses. Robb began a diary of her visits, ‘Diary of a Nobody’, as ‘I felt that I would never have another really easy moment unless I did everything I could to try to right this situation.’

Establishing AEGIS

Within months Robb established AEGIS which became one of the country’s most determined pressure groups. It was small, elite and high profile, using the media to create publicity. Its team of advisors and active supporters included Brian Abel-Smith; CH Rolph; Audrey Harvey; David Kenworthy, 11th Baron Strabolgi; psychiatrists Russell Barton, Anthony Whitehead and David Enoch; nurses with senior roles at the Royal College of Nursing; and others when needed. Strabolgi ensured that a copy of ‘Diary of a Nobody’ reached the Minister of Health, Kenneth Robinson, who said he would investigate, but nothing happened.

The campaign years (1965-c.1975)

Robb was passionate about her chosen cause, and worked incessantly to achieve improvement in the long-stay wards. Her cottage became AEGIS’s headquarters. She described her campaign style: ‘I’m better suited to Walls of Jericho than to Trojan Horse tactics.’ The Sunday Times described her extraordinary drive and her punishing schedule, 12 hours a day 6 days a week, including acting as counsellor to ‘hundreds of distressed nurses’ and responding personally to a constant stream of correspondence. Through her unrelenting determination and her contacts with the press, Robb achieved the reputation of being ‘a terrible danger’ to the Government. Richard Crossman (Secretary of State for Health and Social Services, 1968-70) wrote that she was a ‘bomb’ which the government ‘had to defuse.’

The AEGIS campaign reached an abrupt halt when Robb was diagnosed with cancer in 1974. Although her diary began to fill a few months later, the campaign never regained its full strength. Robb died at home in Hampstead on 21 June 1976. A memorial stone with her name (and later her husband’s) is in the family cemetery at Burghwallis, Yorkshire. Her epitaph reads: ‘Fearless champion of the cause of old people in hospitals’.

The Sans Everything Story

Sans Everything and its reception

AEGIS published Sans Everything in 1967. Chapters by nurses and social workers and Robb's ‘Diary of a Nobody’ described scandalous inhumane and inadequate care in long-stay wards in seven hospitals. Wards were over-crowded and under-staffed. Undignified and unkind practices included: rough handling, teasing, slapping, swearing at patients (‘bloody bitch’, for example) and rushed ‘production-line’ bathing of over 40 elderly and frail patients in a single morning. There was little, if any, privacy, including for personal care. Bed time could be as early as 5 pm. Some wards were locked and un-staffed at night, with senior staff disregarding the risks, for example, of fire. There was lack of medical attention, and usually no attempt at rehabilitation. Staff were rarely deliberately cruel, but harsh, disrespectful and patronizing nursing practices, especially for older people, were accepted by staff as standard. The practices often evolved from attempts to devise time-saving methods to get through the workload and manage large numbers of patients in overcrowded environments, or were due to ignorance of modern psychiatric and geriatric treatment and care. Widespread, excessively negative, stereotypic understanding of inevitable and hopeless chronic decline in old age, pervaded and contributed to staff negativity. Staff who complained or wanted to change practices were accused of being disloyal, and could be victimized, to the point of resigning or being dismissed from their posts. Sans Everything proposed remedies, including: specialist psychiatric services to treat, rehabilitate and support mentally unwell older people, based on the model practiced at Severalls Hospital, Colchester, which prevented admission and enabled discharge; building homes for rent on surplus land around the psychiatric hospitals to generate income for the NHS to pay for better services and accommodation for older people; and ways of monitoring to ensure high standards through improved NHS complaints procedures, a hospital ombudsman and an inspectorate. The Ministry showed little interest in these proposals.

Throughout AEGIS’s campaign, health service staff, patients and their relatives, the media and the wider public, responded in a diversity of ways. These ranged from absolute endorsement of the allegations of bad practice, such as by the press and most relatives, to absolute rejection, most apparent in higher tiers of NHS administration. AEGIS struggled to convince the Ministry of Health and the Regional Hospital Boards (RHBs), which managed the hospitals, about the happenings in them. Robinson, publicly criticized the book, and announced on the BBC1 television news programme ''24 Hours'' (TV series) that he was sure poor-care was almost non-existent and ‘I hope that any enquiries we can make will bear that out.’ This view, aired in public by a Minister, did not suggest unprejudiced hearings. The press and public criticized Robinson’s approach.

Inquiries into the allegations

Robinson asked the RHBs with responsibility for the hospitals in Sans Everything to establish committees of inquiry. These committees adopted various protocols during their investigations which protected the image of the staff and the NHS. These included: discrediting Sans Everything evidence as false, unreliable or exaggerated, based on their assessment of the witnesses’ personality; using leading questions; accepting that practices were correct because that was how they were always done; and justifying their decisions based on comments by senior staff who they were judging, rather than using independent sources about best psychiatric and geriatric practice. The committees demonstrated their assumptions, about the excellence of nursing care and that the NHS was 'as good as anything in the world', and they held excessively negative ideas about older people and mental illness. They also appeared unaware of the rigid and self-defensive administrative and nursing hierarchies in the psychiatric hospitals and that complainants could be victimized. The committees lacked professional experience of investigating government appointed Boards which had neglected their responsibilities to the detriment of the population they served (such as at Aberfan, 1966). Some committees ignored, or were unaware of, current guidance about NHS complaints management. The Council on Tribunals criticized Robinson's handling of the inquiries.

The outcome of the Sans Everything inquiries

The inquiries made 48 general recommendations, but did not uphold the specific allegations in Sans Everything. This outcome was due largely to the inquiry processes. Robinson published the inquiry reports as a White Paper and announced, in the House of Commons, that the allegations were ‘totally unfounded or grossly exaggerated’ and that the committees reported ‘very favourably on the standard of care provided.’ An in-depth study of the White Paper showed that Robinson’s interpretation was incorrect, verging on deceitful. Robinson told Crossman that the White Paper ‘would be completely uncontroversial because it would simply demolish Mrs Robb.’ Robinson underestimated Robb’s determination. Crossman described the committees as ‘fairly well rigged'.

Other scandals revealed as a result of Sans Everything

In response to Sans Everything, allegations emerged of similar ill-treatment in other hospital. A nauseating World in Action television documentary about Powick Hospital, Ward F13Ward F13, exposed undignified batch-living of 78 elderly women on one Nightingale ward, and valiant and over-worked nurses. There was ‘smouldering discontent’ among the nursing students at Whittingham Hospital, Lancashire, but the senior nurses ignored their concerns. An employee at South Ockendon Hospital, Essex, anonymously sent Robb pages torn from a ward report book, describing severe injuries probably inflicted by staff on a patient. The sender's action pointed to Robb’s reputation for dealing with serious NHS complaints, and emphasized the need for an official, independent authority, e.g. an ombudsman, who staff could approach directly. Other disturbing reports emerged, including deaths of patients at Farleigh Hospital, Bristol, and the convictions of three ward staff for manslaughter.

A report about Sans Everything by David Roxan in the News of the World triggered letters of concern from staff and former staff about other hospitals. Roxan forwarded them to the Ministry. One concerned Ely Hospital, Cardiff. The Ministry planned an inquiry. Geoffrey Howe, an outstanding lawyer, chaired the committee of inquiry at Ely. He had recently represented the Coal Board managers at Aberfan so had experience of an inquiry into treacherous neglect in the public sector. Howe conducted the Ely Inquiry rigorously, and avoided the prejudiced processes of the Sans Everything inquiries. He meticulously weighed all the evidence from the whistle-blower, nursing auxiliary Michael Pantelides. The committee upheld most of Pantelides' allegations, which were similar to those in Sans Everything, including ill-treatment of patients, victimization of staff who complained and inadequate hospital management. Howe wanted his full report published. Crossman, (Robinson had left the Ministry of Health by then), fearful of Howe’s legal skills and Robb’s relationship with the press, agreed. The day Crossman revealed the Ely Inquiry findings in the Commons, he also announced plans to establish a NHS hospitals' inspectorate to help ensure higher standards. The Ely Inquiry, along with those at Farleigh, Whittingham and South Ockendon, vindicated Robb and Sans Everything, although the NHS authorities made no public apology. Sans Everything faded from the agenda and from history, while the other inquiries, especially Ely, achieved highly regarded status.

Outcome: 1969 and after

Creating NHS policy was, and is, complex. Robb and AEGIS could not make changes independently, but they undoubtedly influenced them. Robb continued to exert pressure on the government to implement proposals, through the press, Members of Parliament, peers including Lord Strabolgi and directly into the DHSS, (Department of Health and Social Security) via Abel-Smith. Crossman was keener than Robinson to remedy deficits in the long-stay hospitals. In 1969, Crossman established the Hospital Advisory Service (HAS), an inspectorate. (The Care Quality Commission is the 2016 incarnation.) The HAS linked to proposals in Sans Everything. Crossman, with Howe, Abel-Smith, Robb, Peter Townsend, Bea Serota and some others made a powerful case for making improvements and allocating more funds to the long-stay hospitals. The DHSS also produced 'blueprints', in conjunction with NHS clinical staff, for future developments. These contributed to improving services for people with mental illness and ‘mental handicap’, and for older people.

Other changes linked to Robb’s work took place, some under successive governments. They included: triggering other revelations of ill-treatment and pressurizing the government to establish inquiries into them; the first review of complaints procedures in the history of the NHS (1971-3); the NHS Ombudsman (1973) and the DHSS’s first guidance on preventing violence in hospitals (1976). Other pressure groups followed AEGIS’s style and adopted more assertive methods by using the media to shift public opinion and bring pressure to bear on the government. Sans Everything also linked to campaigns to improve education and employment aspects of the nursing profession, and to the development of the new specialty of ‘old age psychiatry’, taking a proactive and rehabilitation approach to mental illnesses in older people.

In 1974, Barbara Castle, Secretary of State for Health and Social Services, acknowledged Robb’s impact: ‘You can feel proud at the outcome of all your efforts.’ Robb left a significant legacy. As Abel-Smith said in 1990: ‘For one woman … to suddenly do so much in such a short period - and tragically, to die so soon - is a remarkable story.’