MENTAL HOSPITALS (FARMS) (Hansard, 11 February 1959)

§ Mr. James Dance (Bromsgrove)

I am grateful for the opportunity of raising what, to some people, may seem to he a rather limited but, to my mind, a very important factor in the treatment of mental sickness. I refer to farms run in connection with mental hospitals.

The policy of the Government has been to get rid of as many of these hospitals as possible. About three years ago, a hospital in my constituency in which I am interested, Barnsley Hall, was, I am glad to say, sympathetically reviewed by my right hon. Friend the Member for Thirsk and Mahon (Mr. Turton). I hope, however, that in view of our new outlook towards mental sickness and the treatment of it, this policy of review and getting rid of such farms will be reversed.

I believe that I am very much in order and in akin with the Report of the Royal Commission on the Law Relating to Mental Illness and Mental Deficiency, 1954–57. Paragraph 293 of page 204 of the Report states: The rest of our recommendations in this part of our report deal mainly with the special mental health services which are needed to meet the special needs which cannot be met by more general services"— and now comes the important point— but all our later recommendations should be read against the background of this general recommendation that the existence of some degree of mental disorder should not exclude any person from any form of care or service from which he can suitably benefit. These wards back up the view which I am putting forward.

I think that the value of farms is undoubtedly apparent to the layman. It is obviously a good thing that people who suffer from mental sickness should have the peace and comparative quietness of working on the land, and the hard manual work involved is also beneficial.

1318 I have said that that is the layman's point of view, but I am supported by the doctors. As I have said, there is in my constituency an extremely well run mental hospital, Barnsley Hall, which is on the outskirts of Bromsgrove, on the Birmingham road. I have visited that hospital. I have seen the people in it and have spoken to the doctors. Not only do they say a farm is of great value, but they also stress that it is essential for the cure of certain of their patients.

I think this is borne out by what has gone on during the past years. There are now about 50 people employed on this farm, 30 in horticulture and 20 in agriculture, which is about three times more than a few years ago. Therefore, this supports my theory that the doctors are in agreement with the views which I am bringing forward.

In addition to the patients employed on the farm, there is the very great value of this land to the other patients in the hospital. Due to its comparative seclusion, it provides a great recreational space around which other patients can walk, and I believe that it is of great value to them. Besides the 50 people employed on the farm, we have a seasonal increase at the time of harvesting, potato lifting, and so on. One should take that into consideration when viewing the whole matter.

In view of the new approach to mental health, we hope—I think that this is agreed on all sides—to provide a definite cure for some of the sick people. In paragraph 603 (i), the Report of the Royal Commission says: The aim of hospital treatment or training is to make the patient fit to return to life in the general community. I feel that the training that these people can receive on these farms is of very great value. I would stress what I said earlier. What better life is there for these people who have had mental sickness than to work on the land, away from the bustle and noise of the factories and the towns? I believe it to be absolutely first-class employment for them.

It would be wrong to ask for the retention of hospital farms which are badly run and where the husbandry is bad. This does not apply to Barnsley Hall, which is extremely well run. It has always made a profit, ranging from £1,000 to 1319 £5,000, I am informed, last year. Consequently, it cannot be said to be inefficient. I know that from the husbandry angle it is extremely well run.

I must be fair to my hon. Friend in respect of these figures and say that there is no payment for patients' labour, but, at the same time, there is no cost to the general public. It has been suggested that these farms should be let in the ordinary way. All I can say is that were the Barnsley Hall farm let it would bring in a far smaller revenue in rent than it is earning at the moment in the profits made by good farming.

That is a minor consideration. What is uppermost in our minds is the healing of the sick people. I would again stress the therapeutic value of these farms. I have referred to Barnsley Hall only because it is in my constituency and because I know it and have spoken to the doctors there. There must be many more hospitals of a similar nature throughout the country, and I am pleading on their behalf too, though, naturally, my greatest desire is to ensure that the hospital in my constituency carries on with its farm.

I hope that my hon. Friend will be able to assure me that these farms will not have to be reviewed every few years, as has happened in the past, but that the people managing the hospital will be able to continue undisturbed in their main task of healing the mentally sick and that those who run the farm will be allowed to continue with the primary idea of good husbandry, namely, continuity.

§ The Parliamentary Secretary to the Ministry of Health (Mr. Richard Thompson)

The subject of this Adjournment debate is very timely in view of the current interest in mental health and the legislation now before the House.

Two questions arise from what my hon. Friend the Member for Bromsgrove (Mr. Dance) has said tonight—the policy of the Ministry towards farms at mental hospitals in general, and the case of Barnsley Hall in particular. The legal position here is that the Minister has no power to farm as such. The hospital management committee may run a farm only to the extent that it is incidental to the management of its hospitals, and any farming activity having no real con- 1320 nection with the hospitals in the way of providing occupation for the patients or produce for hospital consumption is ruled out by law. A circular which the Ministry issued in 1954 interprets this as meaning that hospital authorities may run farms only in so far as they are an essential part of running hospitals, and that apart from that, the practice should be discontinued.

The general policy towards land around hospitals in excess of the actual site is that it should only be retained for four main reasons: first, reasonable seclusion; secondly, to provide suitable occupation for the patients, which was one of my hon. Friend's points; thirdly, to provide adequate recreational space; and, fourthly, to provide sites for future development, additional building and matters of that kind.

The circular to which I have referred requested regional boards to set up a special committee to visit each farm and, with the hospital management committees concerned, to advise whether the continuance of farming activities and the retention of the land that that involved was justified or not. As a result, considerable progress has been achieved. There have been 210 farms, with a total area of 43,804 acres, surveyed under these arrangements, and, consistent with the policy which I have just described of not retaining farms purely for the purpose of indulging in agriculture, agreement has been reached on 204 of these having a total area of 41,199 acres.

This farmland is being disposed of as follows: 10,094 acres by sale, 9,924 by leasing out, and 7,342 acres by termination of the existing leases. That all adds up to 27,360 acres. It has been agreed that farming will cease at 75 hospitals and will be reduced at a further 72.

My hon. Friend made a considerable point about the therapeutic value of farm work. Of course, there is no doubt about the therapeutic value of social and occupational activities at mental and mental defective hospitals. What we are doing in this respect has recently been producing some very encouraging results, but there is some considerable doubt whether farming is now a wholly suitable form of occupational therapy.

As an expert Departmental Committee which advised the Minister pointed out, 1321 there are two factors at work now which make it harder for patients to work on farms, and which, taken together, have led to an increased employment of skilled paid labour, other than patients. There is, first, the increased mechanisation which, of course, goes with good husbandry today, and which involves the use of intricate machinery which sometimes can be dangerous to people not fully in command of it; and, secondly, the great changes in milk production with consequently fewer openings for patients to be employed on this type of work.

The expert committee found that only 3.3 per cent. of male patients were actually employed on farming proper, while 3.2 per cent. were employed in gardening, and 0.3 per cent. of female patients were employed in farms and gardens combined. The whole percentage of patients in farming and gardening is a small one.

Furthermore, the modern tendency is for patients to receive active treatment. We do not, so to speak, simply keep them under restraint because there is no alternative. The tendency today is to give them active treatment and to keep them in hospital for a relatively short space of time. For patients of this kind farming is unlikely to be appropriate, nor does it meet the needs of the elderly chronic cases, of which we have a considerable number.

Therefore, to run farms for so few patients does seem, in my view, unjustified. We can provide equivalent outdoor work by an extension of market gardening or poultry keeping, and, of course, that has the advantage that it yields products of immediate value to the hospital concerned. These seem to me good and economical ways of using any land kept by the hospitals for amenity or development purposes.

On the financial side, the Comptroller and Auditor General and the Public Accounts Committee had made some comments based on an examination of the farms and gardens account. They had found that a good deal of expenditure was on ornamental gardens, amenity space, things of that kind, which bring in no returns at all. Recently, however, hospitals have kept proper trading accounts, and I agree that these show that farming activities are on balance profitable. Therefore, my hon.

1322 Friend can take it that the reasons for running down the farming activity are not financial but, as I said, in the first place, legal—the Minister has no power to be a farmer; and general—the different needs of patients which I have endeavoured to describe, and the unsuitability of farming work as a general form of activity for all kinds of patients. It is appropriate to some, but not by any means to all.

I said that, having dealt with the general position, I would say something about Barnsley Hall. My hon. Friend will be familiar with the site of this hospital, which is between the Birmingham-Worcester and the Stourbridge-Worcester Roads, a site of about 333 acres. Bath roads, as he will know, are built up, and the hospital estate is thus virtually an island in a built-up area.

In the light of the general policy I have already explained we gave consideration in 1955 to the disposal of approximately the northern half of the estate, consisting mainly of pasture. In the interests of seclusion it was visualised that the land would be leased for farming. My hon. Friend, on behalf of the management committee, argued then very forcefully, as he has argued now, in favour of the retention of the whole estate.

As he mentioned, the whole matter was given close personal attention by the then Minister, my right hon. Friend the Member for Thirsk and Malton (Mr. Turton). He fully recognised the desire of the medical superintendent to keep the farm for therapeutic purposes, and he also took into consideration advice from the Ministry of Agriculture, Fisheries and Food, which was to the effect that it was undesirable to split the farm, which, as I said, forms an island site, from the remainder of the hospital estate.

The upshot was that my right hon. Friend decided, in May, 1956, that in the rather special circumstances at Barnsley Hall the farm should be retained subject, as my hon. Friend has said, to the review in three years' time. I want to make the point that the review after a period of three years applied particularly to the Barnsley Hall farm and certainly not to the generality of hospital farms.

1323 In his remarks this evening my hon. Friend anticipated this review, and, frankly, it is impossible for me to give him a final answer on the occasion of this Adjournment debate. But I can assure my hon. Friend that the points he has made so well tonight will be very carefully considered. I think that he will realise from what I have said that there are powerful arguments on the other side, arguments not related solely to finance but to the appropriate treatment of patients today, many of whom we are trying to restore to mental health to enable them to go back to the very occupations which they left and which are often industrial or commercial, in factories or offices and probably not connected with farming at all.

I should like to leave my hon. Friend with the impression that we shall review this matter at the proper time, and, as I have said, very carefully indeed. We shall take into account all that he has 1324 said and the past history of the matter. I think that that is about as far as I can go tonight. I should, however, again say that my right hon. Friend the Minister has no legal power to go into business as a farmer. He can only do it subject to the farming being ancillary to the overall hospital requirement, which must always be the appropriate care and treatment of the patients. It may be that this will be the final determining factor.

I cannot give my hon. Friend a more definitive reply than that tonight, but I certainly think that he has done us a service by drawing attention to the important and useful work that can be done on the farms which, now somewhat run down, are still attached to some of our hospitals and where, particularly in the market gardening activity, there are still good opportunities for that kind of work being continued.