Some of society's most unfortunate and dangerous people are housed and helped in the State Hospital at Carstairs. Working in such a system is not easy but, if the best efforts are to be made for the patients and if the staff at Carstairs are to carry out their tasks properly, it is of the utmost importance that established procedures are followed. They are not there as an optional extra but to make sure that matters run smoothly and safely. The fact that the most basic legal obligations regarding staff safety and the reporting of assaults appear to have been ignored by management at Carstairs is a disgrace. Frankly, the hospital management officers should think themselves fortunate to have been given a breathing space until the end of July to put their house in order. A report to the procurator-fiscal and a prompt prosecution of the hospital might have been more effective and appropriate.

The ultimate holder of responsibility for Carstairs is the Scottish Office but staff at the hospital believe that the problems which they suffer derive from the dismissive attitude to trade unions which was fostered under the previous government and which, they believe, was adopted with enthusiasm by hospital management. The outcome was dangerous incidents, including alleged assaults on staff, going unreported and this fed into an apparently lackadaisical attitude to health and safety issues which has now been noted and acted upon by the Health and Safety Executive. If the management of Carstairs has been deficient in its duties it is clear that others in responsibility, right up to the Scottish Office, should have noticed that problems were emerging. That said, it should also be borne in mind that the strains of running an establishment like Carstairs are considerable and that a more regular

method of inspection and assessment should be devised to complement the hospital's annual report which, until now, has been the only external way of gaining an understanding of its operation.

The establishment of better methods of assessing and monitoring the operation of hospitals like Carstairs is a subject ripe for investigation on a nationwide basis. There are many points of difference between high-security hospitals in England and Wales and the regime operated at Carstairs but it has seemed in the past that Carstairs compares favourably with other institutions. The mix of security levels operated at Carstairs has been admired in the south and it is generally true that, despite bed-blocking in other NHS establishments, patients ready for transfer from Carstairs usually manage to move on much more quickly than in similar hospitals in England. Neither has there been anything at Carstairs remotely approaching the dangerous and at times farcical situation now reported from Ashworth Special Hospital on Merseyside. Nevertheless, the situation discovered by the Health and Safety

Executive at Carstairs cannot be tolerated in such a place. The treatment, care, and control of highly damaged and often dangerous people should be the subject of energetic and continuous assessment. Now, in the wake of Ashworth, and with worries over staff safety at Carstairs, might be an opportune moment to investigate and implement new measures, and to insist on proper compliance with old ones.