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Two months on from the Fallon inquiry, Laura Donnelly visited Ashworth Hospital to see how it is changing

The sun is shining over Ashworth Special Hospital. A chill wind sweeping across planes of surrounding farm land is the only sound to disturb its empty grounds.

Anything could be happening among the 2,000 staff and patients sealed within low-lying buildings. Infamously, almost anything did.

The Fallon inquiry into the management of the high-security hospital's personality disorder unit found evidence of pornography, drug abuse and unsupervised contact between paedophiles and a young girl.

Former judge Peter Fallon QC concluded that the hospital 'should close at the earliest opportunity'.

His report criticised a 'dysfunctional management culture' in which 'senior managers were secretive, out of touch' and could not control a large population, which includes severely personality disordered patients.

But health secretary Frank Dobson did not order Ashworth's closure. Instead, its board has until May to create an action plan to meet a long series of recommendations in the report.

Monthly meetings between chair Ian Pirnie - appointed on the day Fallon reported - and Mr Dobson ensure there's little chance of the spotlight fading.

Spend a day at Ashworth and there's no avoiding the F-word.

As director of corporate safety and security Roger Kendrick spells out measures to tackle what was identified as 'grossly inadequate' security, the word Fallon, written in capital letters on a board behind him, vies for attention.

'Clingfilm is a superb garrotte,' declares Mr Kendrick, warming to his subject, as he explains the perils of bringing home-made sandwiches to work.

But there is a serious issue underlining tales of the unlikeliest of weapons and the impossibility of total security.

Ashworth is about to go out to tender on a£4.2m scheme to upgrade security, increasing both CCTV surveillance and sophisticated control and intruder systems.

It follows a series of practical security measures since the inquiry began two years ago. Patients' access to computers has been restricted and visitor identity cards introduced.

But former prison governor Mr Kendrick insists: 'All of this is almost immaterial if we can't get the culture to think of security as part of the care process - not an obstacle to it.

'The emphasis has to be not about how you manage control but how you carry out care and treatment in a secure environment.'

He admits that changing the culture of an institution which now has second- generation staff is not easy.

There is also debate about the extent to which Fallon's recommendations tackle the dysfunctional culture his report identifies.

Chief executive Peter Clarke says: 'The recommendations don't capture what we believe are the major themes of both the report and Ashworth.'

Because of this, the board is also to publish 'quite specific proposals for the way in which we develop the staff and invest further in the clear management of the organisation'.

Last week, Laura Roberts, an executive director of Trafford Healthcare trust, was seconded as assistant chief executive - with no operational responsibilities other than producing and delivering the plan in the next 12 months.

Both Mr Clarke and Mr Kendrick are determined that closer working between Ashworth and the outside world is the best way forward.

And Mr Clarke - seconded from Mental Health Services of Salford trust - is 'exploring an alliance' between the trust and special authority, ahead of Mr Dobson's plans to legislate for amalgamated trusts.

He believes Ashworth did not share in 'the learning curve the rest of the NHS has been through, as links developed between clinical and management systems'.

He says: 'We have to look at the formal ways in which the organisation works - the values expressed through its culture, the way staff relate to management.'

And Mr Clarke says weaknesses in the interface between high and medium- security mental health services are a crucial link.

'I don't think you can have good quality community services if the system behind them is not working.'

Many staff refer to talks between Salford and Ashworth as 'the merger', before checking themselves.

Mr Kendrick bluntly describes any change in Ashworth's status as 'cosmetic political dressing'. He says: 'I think it is a load of rubbish. It doesn't matter whether it is a trust or a health authority or what.'

Yet on the crucial point - of 'turning Ashworth's face outward' - he echoes Mr Clarke: 'What's crucial is a link between us and units outside. The main thing is breaking down the barriers.'

But other staff suggest there is serious resistance to the more 'superficial aspects' of Fallon's findings 'which we have had to swallow and just get on with'.

One consultant psychiatrist is well aware of the problems for Ashworth in recruiting staff to care for 420 patients while the glare of bad publicity continues.

'We have been losing consultants over the past year - down from 21 to 16.5.'

But Mr Clarke is confident that the action plan will turn things around.

'The next four years will see an enormous change in Ashworth as a focus for the work that will go on for a long period ahead. I think it is absolutely wrong to believe the process is unmanageable.'