HC Deb 23 April 1969 vol 782 cc620-8

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

10.46 p.m.

Sir John Langford-Holt (Shrewsbury)

On 25th February of last year a serious fire occurred at the Shelton Mental Hospital near Shrewsbury in my constituency. In one of the wards 21 of the 42 patients lost their lives. It was a women's psychiatric ward occupied mostly by elderly and bedridden patients. I mention this not to create emotion but to place the facts on the record.

In a Private Notice Question the following day I pointed out, among other things, that the building had been erected 14 years before the Indian Mutiny. Being a quite solid building, I suppose that, on purely structural grounds, it is correct to say that it should be restored to its previous condition. That would be true if it were anything other than a mental hospital.

As I have said many times, it was built in the age of mad-houses and is wholly unsuited to the requirements of modern medical knowledge and to an age in which we are endeavouring to understand and treat mental sickness. In making these comments I am not criticising the hospital management committee, the Minister of Health or the present Government. I appreciate only too well that this is a problem affecting not one but every post-war Government and every Minister of Health.

Following the fire an inquiry was conducted, under Mr. Sabin, into its causes. Although the inquiry had some critcisms to make, I will not dwell on them. But all the criticisms having been made and all the prayers having been said, we are left with this building.

I wish to make it clear that I do not speak tonight for the management committee. Nobody has sought to brief me. I speak for myself and for myself alone. I hope that the figures I have are accurate. I believe that since 1948 capital expenditure on the hospital has been £689,052. Care and maintenance costs over the same period have amounted to £722,532. That is a total of £1,411,584. Allowing for the loss in the value of money, I suppose that it is fair to say that that sum represents about half of the cost of a new hospital today.

A great deal of money has been spent on the hospital, and some of the figures are worth noting. The building of a nurses home and training school some years ago cost £137,684; a new boiler-house, £43,848; rewiring of wards, about £35,000; provision of heating and hot water installations, £38,220. These and other expenditures amount to about £355,900. The effect of building a new hospital at once, were that possible, would be to make many of these expenditures a waste of money, and this is probably one of the deterrents to the rebuilding that I hope will take place.

I am sure that the Minister and I are absolutely at one, and that our aim is the same—to make the best use of the resources which are available and which are likely to become available in the future. How much is available to the Health Service at large, how much to the hospital service and how much to the mental hospitals within that service is a political question on which I will not dwell tonight. One can say, I suppose, that more money has been spent in 1969 than in 1964. It is probably equally true to say that more money was spent in 1964 than in 1951. These are sterile and unworthy arguments, and I would not seek to put them forward. Our main consideration, tonight and always, must be the service that can be provided to the patients, who are the sufferers in all this.

What are we to do? We can go on providing as much money as we can from time to time. We can go on repairing and patching up this old building. Alternatively, and this is the course I urge on the Minister, we can look forward to, say, 1987, which is about as far ahead from the present day as 1967 was when the Health Service began. We can look forward to that time, because then mental medicine will be about as far away from us as are the mad-houses of the nineteenth century, when this hospital was built.

I ask the Minister, first of all, to take a special interest in this hospital. I know that there are other mental hospitals, all of which have their problems and some of which have recently acquired publicity, but a particular moment has arisen in this hospital as a result of this tragic fire. I ask the Minister to see if we can now work to a plan, because it is clear that this old building, if it is to continue to be patched up, will not be able to do its job in 1987. More money spent on patching it up would put off the chance of a new building being constructed. I ask the Minister to produce a blueprint of a new hospital on that or an adjoining site. I do not ask him to produce an extravagant blueprint, but one which will look as far into the future as possible so that those who sit on these benches in 1987 will not be faced with this same problem.

Having produced that plan, I ask him to see that every development and expenditure is made on that hospital to conform with that plan. In that way I am certain that in 20 years from now we shall be providing a far better service than would have seemed possible only a few years ago.

10.56 p.m.

The Minister of State, Department of Health and Social Security (Mr. David Ennals)

I am grateful to the hon. Member for Shrewsbury (Sir J. Langford-Holt) for raising this matter. I assure him that I am very interested in this hospital, so much so that I have already planned to visit it on 30th May. This from my point of view adds to the interest in this debate. I know that the hon. Member has visited the hospital on a number of occasions and shown much interest in it.

The problems are not just problems of finance. There are some fundamental questions of philosophy and it is in the context of how we ought to deal not only with patients in Shelton but the problem of mental patients generally, which is the real issue. Great advances are being made in the care and treatment of mental illness and it is our responsibility to see that the National Health Service evolves to match these changes and to contain them within the total available resources of skilled manpower and money. Treatment for mental illness is directed to the patient's rehabilitation and his return to the community. The old concept of going into a mad-house and of patients spending the rest of their lives there is absolutely out. It is a bygone concept, and thank God that is so.

As a result, much more active treatment is directed to getting patients back into the community, and 90 per cent. of new mental illness patients now leave hospital within a year, half of them within six months. The numbers of mentally ill patients in hospital at any time are far fewer today than they were a few years ago.

Regional hospital boards were advised in 1964 how to improve the effectiveness of hospitals for the mentally ill. They were asked to take these concepts into account when planning the development of their hospital services. In the review of the hospital plan of 1965 they were asked to give psychiatric services a due and early share of capital and revenue resources. Last year we advised boards what accommodation should be provided at district general hospitals for the psychiatric services.

Our policy now is not to replace existing buildings by new ones on the same site but rather the opposite. We see the psychiatric services of the future centred not on large and often isolated hospitals but on the community. A district general hospital should have a mental illness unit, usually of 90 to 120 beds, with 120–160 day places, to serve some 150,000–250,000 people. This unit should serve any type of mentally ill patient except the few who need treatment under conditions of special security. The day places would provide patients, both from the in patient beds and the surrounding community, with occupational, recreational and other rehabilitation facilities. There should be close links with the community services. These units would deal with the new patients suffering from mental illness.

The existing, large, out-of-date psychiatric hospitals should not be part of the future pattern. In the meantime some improvements at older hospitals may be necessary to raise standards of accommodation. Such expenditure must be related to the length of life planned for the hospital, the ultimate object being to replace it by a modern comprehensive service based on the district general hospital. In the last few years a number of new units have been opened. I should like to be present at the closure of some of these enormous hospitals for the mentally ill. Such hospitals are part of our past and are certainly not part of the future concept of handling mental illness.

As I have explained, rebuilding Shelton Hospital has never been a practical proposition, because it would not fit in with these new concepts. Even if the tragic fire last February had caused more extensive damage than it did—and only one ward was damaged badly on the upper floor of a ward block—the Birmingham Regional Hospital Board could only have considered replacing what was burnt owing to the structure of the building which remained. The Board has arranged to reinstate the damaged ward and this work should be completed this summer. Thirty-nine patients will be accommodated in the rebuilt ward, instead of 45 patients as before. At the same time some changes will be made to provide additional safeguards against fire and improve the facilities, so that there will be significant differences in the layout of the floor.

As the hon. Member may know, there are about 13 large and very old psychiatric hospitals, including Shelton, in the Birmingham region. Most were built in the nineteenth century. Shelton was built in 1843, as the hon. Member said, and the block where the fire occurred a few years later.

The Board's building programme will provide psychiatric facilities in district general hospitals as they are built, and the service provided by the old large hospitals is being gradually reduced. There is, for instance, a new psychiatric unit at the district general hospital in Stoke-on-Trent, another will be opened at Coventry this year, and a third at Wolverhampton next year. This progress will continue as present building plans are realised.

The Government are involved in a huge building programme which dwarfs the efforts of previous Administrations. The hon. Gentleman said that this is a sterile argument. It is not. One has to spend money to build. We are now spending five times what was being spent 10 years ago. We are spending 10 times as much as was being spent on hospital building in the first 10 years of the National Health Service. This is not surprising. Money has to be found to do this. We would not be able to replace, in the long term, hospitals like Shelton unless we could provide what we need in the new district general hospitals which are being built as the programme goes forward.

Sir J. Langford-Holt

I meant that it was sterile in that I did not wish to bandy figures across the House in order to score points off the Minister.

Mr. Ennals

This is not sterile because it is the meat of making the Health Service effective and able to deal with present problems. We could not deal with it unless we were prepared to make public resources available to do so.

Between July, 1948, and March last year the Birmingham Regional Hospital Board spent £6.3 million, or over 12½ per cent. of its capital resources on improving the mental illness services. Half as much again was spent on improvements for mental subnormality.

In the Board's current building programme no money is allocated to rebuild psychiatric hospitals as such, but the Board has drawn up a programme to provide such facilities in district general hospitals. This is the pattern which is going forward.

Meanwhile, in the old psychiatric hospitals and with improvements being made to them, the staff are treating an increasing number of patients for short periods in hospital. In 1967, 82 per cent. of the male and 86 per cent. of the female mentally ill patients in the region spent less than three months in such hospitals. One gets a rapid turnover of people diagnosed as being mentally sick, they go into hospital, they are treated and come back again into the community.

I can illustrate the effect of the Board's policy by considering Shelton Hospital itself. There has been a steady decline in the number of patients. In 1960 there were 1,012 patients, in 1962 there were 959 patients, and in 1967 there were 761 patients. When Beech Ward has been reinstated there will be 699 patients. There has been a rapid and steady decrease. Seven years ago 70 per cent. of the male and 73 per cent. of the female patients were inpatients for less than three months. In 1967—the last year for which figures are available—the percentages had risen to 82 per cent. and 86 per cent. respectively. The Report of the Committee of Inquiry last year mentioned the programme of continual improvements carried out there by the Board over the years.

I want to pay my tribute to those who have worked in Shelton Hospital. There have been some criticisms because of the fire, but I want to pay my tribute to the service which has been given in treating patients who are there and many who are not there now but are living happily in the community.

The hon. Member mentioned £1½ million as having been spent on the hospital since 1948. I think that he mentioned it when he was interviewed on the Midland Region of the B.B.C. today. He must recognise that this sum, if that is exactly the figure—I do not question it—was spent over a period of 20 years in all sorts of different ways. Most of what was available in the early years was spent on the laundry, which serves not only Shelton Hospital but other hospitals in the Shrewsbury Group. In the long term the Board plans to provide psychiatric services for the area now served by Shelton Hospital at the new Copthorne District General Hospital, Shrewsbury, and probably at Telford Hospital.

Regional hospital boards, in consultation with the Department, are responsible for drawing up their own building programme giving priority to the areas of greatest need. The 1966 Review of the Programme—Cmnd. 3000—showed that the Birmingham Region has to plan for a population which is expected to increase by one-fifth to some 5.97 million in 1981, largely by a high rate of natural increase in and immigration into the region. The major problems are to provide for this increase, including the new towns proposed at Telford and Redditch, to provide better accommodation where there are large populations, and to improve the hospitals elsewhere and also the geriatric and psychiatric services. Inevitably the Board is faced with tremendous problems in assessing priorities where the backlog of old and inadequate buildings is great.

This evening the hon. Member has argued that the Board should replace a psychiatric hospital, and I have explained why this will not and should not be done. On other occasions he has drawn attention to the large waiting lists for general surgery in Shrewsbury and pressed for earlier provision of a district general hospital. He also pressed for planning of this hospital to continue when it seemed that building schemes with a higher priority elsewhere in the region might absorb all the Board's resources. The hon. Gentleman was doing his constituency duty well.

I assume that the hon. Gentleman is not now arguing that the reprovision of the Shelton Hospital facilities should take precedence over any improvement in acute services at Shrewsbury.

Sir J. Langford-Holt

indicated assent.

Mr. Ennals

From the indication the hon. Gentleman is giving I assume that he is not arguing this. In fact the need for additional acute facilities at Shrewsbury has been recognised by the Board as being so urgent that it has already provided a maternity unit with boilerhouse and engineering services. The second stage of the rebuilding, to provide an out-patient department and some diagnostic departments, is in progress now and further stages to provide acute beds, geriatric and psychiatric services are envisaged as the Board's resources and priorities permit. Similar claims could be pressed on the Board by all hon. Members representing constituencies in that region. All in all, I think that the Board is sensibly following a carefully prepared programme with reasonable provision being made for the most urgently needed services.

The fire at Shelton Hospital affected seriously only one ward. This justified reinstating the ward only, as the Board is doing. The Board plans to continue to make improvements at Shelton Hospital and to reduce the number of patients there.

In the long term, the best solution for Shelton is not to rebuild it or to rebuild any of the other 12 large psychiatric hospitals in the region, but to provide psychiatric facilities at the new district general hospitals, and the Board is making this provision in its hospital building programme. Inevitably this will take time and money, but I am sure hon. Members will agree that this is the right and proper course.

Question put and agreed to.

Adjourned accordingly at ten minutes past Eleven o'clock.