HC Deb 04 March 1968 vol 760 cc189-200

Motion made, and Question proposed, That this House do now adjourn—[Mr. Fitch.]

10.52 p.m.

Mr. William Price (Rugby)

I am grateful for the opportunity to raise the question of the Central Hospital at Warwick. What began as a purely local issue has inevitably taken on added significance as a result of the terrible threat only last week at Sheldon Hospital.

I shall not seek to widen the debate, even if it were in order to do so, in view of the full inquiry which is to take place. This would not be the appropriate time to hold an inquest. I shall resist the temptation, therefore, to use Sheldon to further my case. I say only that we are tonight discussing probably the most overcrowded mental hospital in Britain. Only by the grace of God have we escaped a major disaster through fire or epidemic.

I should like to quote from what my local newspaper, the Rugby Advertiser, said recently: The place was built more than a century ago, in an unenlightened age when the stigma of mental illness was indeed heavy and when psychiatric treatment was almost as crude as it had been when Bedlam was founded in 1676. The overcrowding is scandalous I regard that as a completely accurate description.

The Central Hospital is not in my constituency. It is in Warwick and Leamington, the constituency of the late Sir John Hobson, who had been closely associated with the problem until his death. It is, however, a county hospital. About 100 of my constituents are there. It is for that reason that it has attracted the interest of my hon. Friends and myself over the past two years.

My hon. Friend the Member for Coventry, South (Mr. William Wilson) and I first visited the Central more than 18 months ago. We have been on a number of occasions since, and it is no exaggeration to say that we were shocked and distressed by what we saw. It has always been recognised that conditions are far worse on the men's side.

We saw 73 men living in a ward made for 38. We saw patients carrying their toothbrushes and other personal belongings in their pockets because there was no room for lockers between their beds. We saw long-term mentally disturbed patients living in adapted corridors and in recreation rooms. We saw a ward where nurses had to move five beds before they could change the clothes on the sixth, and we saw a lot more besides. I am not by nature squeamish, but the memory of that day will haunt me for the rest of my life.

The photograph which I have with me, depicting by no means the worst ward in the hospital, was reproduced in newspapers all over the country. I know from the reaction which I received that it caused many people a great deal of heart-searching. The position at the Central Hospital is fairly simple and straightforward. It was built 112 years ago, and it could comfortably take 900 patients. The numbers fluctuate. They have been as high as 1,700. The average over the past few years appears to have been about 1,400.

Who, then, must accept responsibility for this desperate state of affairs? It may seem curious, but I do not seek to attribute blame in any direction at all. I doubt whether recriminations, even if they were necessary, would achieve anything at this stage. I believe the blame, not only for the Central Hospital but for mental hospitals all over the country, lies with society as a whole. We just have not over the years given the treatment of mental illness the priority it needed.

I certainly have no wish to blame in any way at all my right hon. Friend the Minister of Health. His file on the Central Hospital must be growing to a formidable size. Throughout he has treated our representations with great care and consideration. It was partly at his instigation that a project team was established to investigate ways of solving the overcrowding, and a number of recommendations, the main one being a reduction in the catchment area by 85,000 people, were brought into force.

I accept that, to a limited degree, they have worked, but they were never intended to be more than a holding operation. It could never have been otherwise in view of the rapid expansion in the population of Warwickshire and Coventry. All of us associated with the Central Hospital have known for a long time that there is only one solution and that is the building of a new psychiatric hospital for nearly 300 people at Walsgrave, on the outskirts of Coventry. This proposal has had a chequered career. It has appeared from time, to time in capital programmes, but was not expected to materialise till, the mid-1970s, by which time Central Hospital would have choked to death.

We therefore set out to get the date advanced, and after a long correspondence we met the Minister of Health and were given the agreeable news that he had made the money available and the new hospital at Coventry would be built

as soon as planning has been completed. That was nearly twelve months ago.

It is, in effect, an extension to the £9 million new Walsgrave Hospital. The land and services are there, and we thought it not unreasonable to expect it to be completed some time during 1969. It was then we received the shock which has led directly to this Adjournment debate.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

Do I understand my hon. Friend to say he was informed this new hospital would be completed by the end of 1969?

Mr. Price

No. I am not talking now about the new Walsgrave Hospital. That is nearing completion now. What I am saying is we thought it would not be unreasonable to expect to complete the extension of the hospital within two or three years.

We have now had a letter in which it became clear it was to be six years. This is the letter, dated 29th November, written to me by the Parliamentary Secretary: The preliminary statement of content and estimated cost of the hospital are being considered at present in my Department and the Regional Hospital Board have prepared preliminary sketch plans. it is expected to complete planning so that building can start as originally proposed in the financial year 1969–70, and the Regional Hospital Board have made financial provision for a start in that year. The building work will take about two and half years to complete, and the hospital should therefore be built and admitting patients in 1972 if there are no setbacks. We are here up against the unescapable fact that the processes of planning, design and construction of buildings as complex as hospitals take longer than is the case with other types of building. That is the most distressing letter I think I have yet received from a Minister. I was shattered to learn that we should have to tolerate present conditions at the Central for almost another five years. I note what the Parliamentary Secretary says about processes of planning, design and construction, but I refuse to believe that it takes six years to produce a fairly modest extension to an existing hospital once the money has been made available. It is for the purpose of presenting this point that I sought this debate. Somebody, somewhere, is clogging up the works, and 1,300 people will suffer as a result. What I want my hon. Friend to do is either to justify that six-year delay or to repudiate it. The Warwick Advertiser summed it up recently as follows: The sad thing is that it takes so long and so much effort to move Whitehall to take action even when it is so obviously needed. Overcrowding at the hospital first became notorious some 20 years ago. I do not believe that that criticism of Whitehall is justified, because I know of the many demands on the funds which are available. What worries me is that, having got Whitehall to move, having produced the money, we still cannot see the light at the end of the tunnel.

Before I sit down, may I express the appreciation of all concerned of the staff at the Central Hospital. This hospital has had more publicity than perhaps any other in the country, and it could easily have had the wrong effect on the men and women who work there. I am proud to say that I know many of them. Led by the Medical Superintendent, Dr. Edward Stern—a man for whom I have the greatest admiration—they have done a magnificent job in the most difficult conditions. It can truly be said that there is an element of Florence Nightingale about the Central Hospital. The conditions would have been a disgrace in her day. But the one redeeming feature is that the staff have carried out their duties in the highest tradition of the nursing profession.

The position was summed up by a member of the Hospital Management Committee in an article in the Sunday Mirror. I am sorry to rely so heavily on newspapers as an indication of the interest in the future of the hospital. She wrote: Conditions at the hospital are disgusting, disgraceful and degrading. Men should never be expected to live like this. The staff are magnificent and work all hours with an amazing amount of success to treat their patients. How they do it, God alone knows. Let there be no doubt that had it not been for the devotion and loyalty of the staff at the Central Hospital it would have shut down a long time ago. The question which I ask is, what might they have achieved under the right conditions?

My final quotation is from the Leamington Spa Courier. Last week the paper wrote: Two or three years from the word go would not have been unreasonable, but with all the architectural talent that must be available to the Hospital Board and all the modern building techniques that can be employed, six years is ridiculous". The paper was writing about the psychiatric hospital at Coventry. It continued, If during the debate someone is moved to emulate the Duke of Edinburgh, who has been known to use a particularly choice wartime phrase to shock people into action, it will be amply justified. I hope that it will not be necessary to use that phrase. Indeed, if I used any at all it would be much stronger than that phrase.

I hope that I may be forgiven for ending on a personal note. Soon after I was elected to the House, one of my constituents—a much-respected man who had spent a lifetime fighting to help others—died in the Central Hospital. Because of the acute overcrowding, members of his family were not able to sit around his bed during the last evening they were together. They had to be content with chairs at the bottom of the bed. I vowed then that I would use every means at my disposal to ensure that it never happened again. I assure the Minister that the fight will go on for as long as may be necessary.

11.4 p.m.

Mr. Leslie Huckfield (Nuneaton)

I will be as brief as possible, but I speak mainly because I have had a previous interest in the Central Hospital, Warwick, as at one time the Parliamentary candidate for Warwick and Leamington. I also have a more direct interest as many of my constituents, particularly from the Bedworth part of the Nuneaton constituency, fall within the catchment area, and have fallen within the catchment area in the past. Many more of my constituents go to the hospital at Burntwood, Lichfield. I have had some sort of complaints, though not at all to the same extent, of that hospital. But, most of all, I pay all tribute to the very encouraging campaign run by my hon. Friend the Member for Rugby (Mr. William Price) and my hon. Friend the Member for Coventry, South (Mr. William Wilson). I congratulate them on their efforts in bringing the conditions at this hospital to the notice of everyone, including the Minister of Health.

In conclusion, I fully associate myself with the remarks made by my hon. Friend the Member for Rugby. Warwickshire is a very fast growing county. We have a desperate need for more capacity in mental health facilities and I, too, look forward to the adequate provision of extended facilities at the new Walsgrave Hospital at Coventry.

11.6 p.m.

The Parliamentary Secretary to the Ministry of Health (Mr. Julian Snow)

I can well understand the anxiety which has led my hon. Friend the Member for Rugby (Mr. William Price) to raise this subject tonight. It is one which he has pursued most vigorously, particularly since his visit to the hospital in August, 1966, to see the conditions for himself.

In April, 1957, my hon. Friend the Member for Rugby, together with others, discussed conditions at this hospital with my right hon. Friend, the Minister of Health. It was common ground that the hospital was overcrowded. However, whatever the causes of the overcrowding might be, my right hon. Friend agreed that it must not be tolerated for longer than could be helped. He explained the measures proposed by the Birmingham Regional Hospital Board to remedy the situation. I should just like to run over these. They were, first, the reduction of the area to be served by the Central Hospital; secondly, the transfer of patients without local connection to other hospitals; thirdly, the commissioning in 1969 of the short-stay psychiatric unit of 42 beds being included in the building of the new district general hospital at Walsgrave, Coventry; and, fourthly, accelerating the start and increasing the planned size of a new psychiatric hospital for medium-stay patients at Coventry.

The first of these measures took effect in May last year. St. Matthews Hospital, not the Burntwood Hospital which was mentioned, happens to be in my constituency and I am aware of the situation there. It is a very good hospital and I hope that people will not criticise it without adequately investigating the matter for themselves. St. Matthews Hospital, near Lichfield, and Highcroft Hospital in Birmingham between them undertook to provide a service for 85,000 of the population which had until then been included in the area served by the Central Hospital. My hon. Friend the Member for Coventry, South (Mr. William Wilson) has generously recognised the improvement which this and other measures have contributed to bring about.

The number of patients in residence at the end of February was 1,242 compared with 1,337 a year earlier and 1,389 at the end of 1965. Similarly, the number of beds has been reduced to 1,444 com pared with 1,465 at the end of 1966. This enabled the remaining beds to be better spaced and made room for two lifts which have been constructed in the last year.

Undoubtedly the Central Hospital is a better place for both patients and staff than before. Indeed, the nursing staff numbered 298 at the end of last December compared with 283 twelve months earlier. Not only has there been a progressive increase in staff since 1961, but it is also improving in quality. Qualified and student nurses have replaced unqualified nursing staff, whose numbers have been reduced from 73 at the end of 1966 to 49 at the end of 1967.

My hon. Friend the Member for Rugby has expressed disappointment at what he considers to be slow progress in building the new psychiatric hospital at Coventry. This he regards as providing the real solution to conditions at the Central Hospital. Before I talk about the progress being made with the building, I would just like to make the point that I think he underestimates the contribution which will be made by the commissioning in 1969 of the new short-stay psychiatric unit.

Mr. William Price

42 beds.

Mr. Snow

This is what I want to point out. I think that my hon. Friend underestimates the effect of the 42 beds, because he misunderstands one point. This short-stay psychiatric unit can make a contribution out of all proportion to the number of places it provides for inpatients, for it will permit the treatment of mental illness within the community and without necessitating prolonged residence in an isolated hospital. It should result in fewer admissions, and, if arrangements can be made for a day hospital in addition, earlier discharges from the Central Hospital, and this will lead to a further improvement in the conditions there next year.

I will turn, now, to the matter of progress in getting the new medium-stay psychiatric hospital built at Coventry. This will also be at Walsgrave. Originally the Regional Board had in mind that the building of a 100-bed unit would start in about 1972. Other demands on its capital resources prevented any earlier start. However, as my right hon. Friend told my hon. Friend and others when they met him in April of last year, he had been able to make an additional allocation of capital to the Board. The consequence was that the Board would be able financially to start the scheme as soon as plannng could be completed, the size of the scheme would be increased, and all possible means of cutting short the planning period would be explored.

The Board had hoped that it would be able to use, with any necessary modifications, plans already used for the building of a psychiatric unit in some other region, but it turned out that there were no suitable plans which it could use, so design had to start from scratch. The Board decided to built a unit with 284 beds, which will include a treatment centre, a day hospital and out-patients department, and the usual services needed by such a hospital. The scheme will cost £1½ million approximately. Building is expected to start in December, 1969, and the expected completion date is 1972. The Board's architects and engineers do not think it realistic to improve on these times, and I would like to say that it really is hoping for too much to assume that the time from the idea for a hospital and completion can be much under five years. It just is not on. There are great technical difficulties, and however many architects and engineers are employed, it seems to have little relationship to the actual completion time.

A standardised ward plan has been used, and this has helped in speeding up the design. Once it had been concluded that no existing plans could be used, the whole building scheme was thought out and sketch plans finished in five months. This is a considerable achievement for a building of this kind. A modern psychiatric hospital is not just simply residential accommodation. It must be designed with the rehabilitation of the patients continually in mind. This has to be thought out, just as the technical requirements of general hospitals have to be thought out, and I must confess that we have not as much experience in building new psychiatric units of this size as we have in building other kinds of modern hospital accommodation. It may be hard to understand why, when a decision is made in April 1967 to build a hospital, it takes until 1972—five whole years—before the first patients can be admitted. I have explained what the time scale is in this matter, and I must ask the House to accept that this is a reasonable time for a good job to be done, and that it compares favourably with the time span of schemes of comparable size in this area. It is also a great improvement on the original proposals, for the new unit will be finished in 1972, which was the year originally proposed for building to start. It will also be much larger—for 284 in-patients instead of 100.

My hon. Friend referred to the tragic events at Sheldon Hospital. I should say that the most careful precautions have been taken at the Central Hospital. Fire precautions have been worked out by the Hospital Management Committee in co-operation with the Warwickshire County Council which is the fire authority. There are the normal arrangements and equipment in the wards. There is also an electrically-operated fire alarm, which is examined twice yearly, and a direct telephone line to fire brigade headquarters, which is tested daily. There is a fire-fighting team formed among the staff, and there are two fire pumps on the hospital premises. All trainee nurses are given instruction by the Warwickshire Fire Brigade, the fire arrangements are inspected twice yearly by the fire authority, and its recommendations are acted on. I thought that I would make that point because it was referred to by my hon. Friend.

Mr. William Price

Time is on our side, and there is one point that interests me. As I understand it, the sketch plans are now at the Ministry.

Mr. Snow

Yes.

Mr. Price

I understand that the builders and the architects are on the site, and have been heard to claim, perhaps wrongly, that they are ready to go ahead. Why is it that it will be another 20 months before building can start, in December, 1969?

Mr. Snow

I have no information to corroborate what my hon. Friend has said. I would like to check on the facts that he has given to the House. I am not sure that my hon. Friend can be right. It is highly unlikely that such a delay as he suggests is involved. I was going on to say—

Mr. Price

rose—

Mr. Snow

I must continue to deal with what I have been asked.

Mr. Price

rose—

Mr. Snow

I am sorry I must insist. It is no use my hon. Friend's making a propaganda speech and then not allowing me to answer it.

Our psychiatric hospitals are frequently the subject of criticism, but we should look at things in perspective and recognise achievements as well as the many tasks yet to be accomplished.

There have been many advances in psychiatry in recent years. The development of treatment by physical methods and the discovery and use of psycho-tropic drugs in the last decade have given us a range of rapid and successful treatments which have been used to good effect. They have made possible a great extension of informal admission and outpatient treatment. Numbers of nursing staff in mental illness hospitals are increasing, and at March, 1967, totalled 34,159, an increase of about 9 per cent. since March, 1964.

Many problems remain. We are not complacent, and if there is any justification for my hon. Friend's allegation that there is likely to be an unnecessary and undesirable and unreasonable delay we will look into the matter. I give him that undertaking, and I must ask him to believe that the plans we have in mind for this hospital should deal with the serious problem which he has rightly described. I would say that this applies to many of the older hospitals which we inherited, and which we have had only about three years to deal with. We now have a huge hospital building programme—the biggest in our history. My hon. Friend must understand that we must apply some ceiling on the physical amount of work we can undertake. In time we shall be able to abandon many of these hospitals, or remodel them, or replace them, but this calls for careful planning and will inevitably be a gradual process.

I therefore ask my hon. Friend to agree that my right hon. Friend fully agrees that the present accommodation, which is improving while other arrangements are being made, is nevertheless a building which he would like to get rid of. But my hon. Friend must understand that we are limited not only by the physical resources but by the time scale necessary in the building of the new hospital.

Question put and agreed to.

Adjourned accordingly at sixteen minutes past Eleven o'clock.