PRESTWICH HOSPITAL (SECURITY UNIT) (Hansard, 14 July 1976)

§ Mr. Jim Callaghan (Middleton and Prestwich)

I am grateful for this opportunity to raise a matter of great importance to my constituents.

Because of the mischievous and misleading statements in the Press recently that Myra Hindley, who was convicted in the Moors murder trial, was to be transferred to the proposed security unit at the Prestwich Hospital in my constit 866 uency, malicious rumours swept the area. As rumour fed upon rumour, public feeling was high throughout the region, despite denials from me that there was any basis for such misleading statements.

Nevertheless, public attention was focused upon the proposed security unit. Several large public meetings were held in the area and great fears were expressed about the type of patient to be treated in the hospital. A petition has since been organised objecting to the siting of the security unit in the Prestwich Hospital. To date the petition bears about 5,000 signatures.

Despite the fact that I have been in regular consultation with the Department of Health and Social Security and with Mr. Eddie Lawson, the regional secretary of the Confederation of Health Service Employees, and have published in the local Press—the Prestwich Guide and the Bury Times—the details of the correspondence which related to the setting up of the security unit, it went largely unnoticed by the public. It was the Myra Hindley story that raised fears for the safety and security of the public in my constituency. As that story is circulated annually in the region, I shall be grateful to my hon. Friend the Minister if he will make a statement tonight confirming that there is no possibility of her ever coming into the security unit at Prestwich.

This emotive story highlighted the difficulties which have arisen in connection with the proposed new security unit. Because of the fears of my constituents, it is necessary to list the events behind, and the reasons for, the setting up of the security units, with particular reference to Prestwich Hospital.

In September 1972 the Butler Committee was set up to consider among other things what changes were necessary in the powers, procedure and facilities relating to the provision of appropriate treatment in prison, hospital or the community for offenders suffering from mental disorder or abnormality, and to their discharge. Since that committee's report has been published I have been informed that the type of patient who will be admitted to the Prestwich security unit is similar to those who have been treated in the hospital for many years. But I am also informed that the security unit will include patients referred by the 867 courts and admitted under Part V of the Mental Health Act 1959 because they need psychiatric treatment but do not require the high degree of security provided by the special hospitals such as Broadmoor.

The Department of Health and Social Security working party is reported to have said that in general the units are required for patients who present severely disruptive behaviour who may be mentally ill or mentally handicapped, or those who suffer from psychopathic or severe personal disorders, alone or in conjunction with mental illness or handicap. However, there have been criticisms expressed in the correspondence in the columns of the British Medical Journel about the lack of precision about the type of patient for whom the new security units should cater and about the relationship of the units to the special hospitals. Because of this lack of precision, fears have been expressed locally about the possibility of patients who are dangerous, violent or criminal being transferred from the special hospitals to the Prestwich security unit. Therefore, there would inevitably be an immediate danger to the public if they absconded.

In the light of these fears, could the Minister state precisely the type of patient who will be admitted to the security unit in the Prestwich Hospital? I am informed that as part of the new arrangement in the Prestwich Hospital for the provision of treatment in conditions of security, an existing ward, known as Elton Ward, is to be used as an interim secure accommodation of 30 beds pending the establishment of the proposed new unit elsewhere in the grounds of the Prestwich Hospital. I am told also that it is the intention of the regional health authority to submit plans to the Department of Health and Social Security for an 88-bed adult unit and a 20-bed adolescent unit.

In my discussions with Mr. Eddie Lawson, the regional secretary of the Confederation of Health Service Employees, about Elton Ward he indicated to me that there will be a high ratio of skilled staff, including three doctors, 30 nurses, a social worker, a clinical psychologist and an occupational therapist for the patients of the ward. Mr. Lawson has said that all the professional and trade unions concerned with the hospital 868 have agreed on the staff security and staff consultation and are happy with the arrangements for the unit. This I do not doubt, but my purpose tonight is to bring to the Minister's notice the alarm and anxiety, fears and distress that the proposal to site a unit in Prestwich Hospital has caused in my constituency.

In doing so, I realise that any site designed to accommodate criminal or dangerous patients will meet with local opposition, wherever it is proposed to place such a unit. Nor do I wish to see a reversal of the trend towards more open care and treatment of the great majority of patients in hospitals for the mentally disordered. I realise that places need to be available in each region for patients with varying degrees of supervision. I also know that, because of the urgency and importance attached to the establishment of regional security units, special financial allocations have been given to the regions to meet the capital costs of providing units. The initial aim is to provide 1,000-plus places in England in 1980.

I know that we need a flexible service with patients moving in and out of security as the need for close supervision arises and recedes and that we must be careful not to isolate the patients and the units from the rest of the psychiatric service of the region. But while not inhibiting patient rehabilitation, units should be sufficiently secure to enable staff to provide care and treatment without the public in the area being worried about custodial problems.

Dr. Campbell, the consultant in charge of the unit—incidentally, a man whom I greatly admire—has informed me that he is happy with the custodial arrangements for the Prestwich unit. He has sought at all times to allay the fears of the public in the Prestwich area and he has attended many public meetings.

Despite these assurances, there is no doubt that the establishment of the security unit has caused great alarm, anxiety and fear among certain sections of the public living close to the hospital. They need to be reassured that the patients in the hospital unit will not include dangerous prisoners who are rightfully candidates for special hospitals. They want reassuring that those patients who are referred by the courts because they need psychiatric treatment but who are 869 too disturbed to be managed on open wards cannot obtain release into the community. Although Dr. Campbell has shown to councillors, the public and myself the security arrangements in the Elton ward, the public needs reassuring that the doors, the windows and fencing of the security unit will give maximum security consistent with maximum treatment facilities. I call on the Minister to give these assurances.

My constituents also need the Minister's assurance that the patients who come to the unit will not be those who are so dangerous that they will require the high walls of a prison, a special hospital, or the security guards that go with them. What is sought is a workable and fair solution acceptable to all parties concerned—patients, staff and the general public.

§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)

I am grateful to my hon. Friend the Member for Middleton and Prestwich (Mr. Callaghan) for raising this matter, as this provides a further opportunity to discuss the general policy of regional security units and the unit at Prestwich in particular which, unfortunately, as my hon. Friend has pointed out, has caused considerable anxiety among his constituents.

The proposed provision of regional security units at Prestwich Hospital, Bury, has to be viewed in the context of the policy considerations governing the provision of such accommodation generally. Levels of security for the treatment of some patients under the National Health Service, short of those secure conditions provided by the special hospitals, have always to some extent been necessary. Since its inception the National Health Service has had a responsibility to provide facilities to treat all types of patients with mental disorder, the only exception being those who require to be treated in conditions of maximum security. The Mental Health Act 1959 did not change this fundamental responsibility.

In recent years there has been a growing problem as a result of an "open-door" policy being progressively applied in psychiatric hospitals, often without alternative provision for those continuously difficult and behaviourally 870 disturbed patients who were formerly contained in locked wards. The Department would not wish to see a reversal of the trend towards more open care for the great majority of patients of hospitals for the mentally ill, but within this policy it is essential for provision to be made in each region for those patients requiring treatment in conditions of security short of that provided by the special hospitals.

In 1961 a departmental memorandum was issued to hospital authorities in which it was made quite clear that no region should be without facilities for treatment in National Health Service hospitals of patients who were continuously difficult and therefore needed security. It was not considered necessary for every hospital to have such facilities, but each region should develop special units to which patients from other hospitals should be sent. A departmental working party was established in 1971 to consider the present and future need for security and to make recommendations.

Following receipt of the working party's revised report and the interim report of the Committee on Mentally Abnormal Offenders, chaired by Lord Butler, both of which emphasised the urgent need for regional security units, a circular was issued in July 1974 asking all regional health authorities to take urgent action to establish such units. The initial aim is to provide 1,000 places, either by adapting existing buildings or by constructing new purpose-built premises. In the interim before new security units can be provided, authorities have been asked to make arrangements to designate certain hospitals to provide treatment for this group of patients.

The definition of this group was set out in the circular. It refers to the need to provide services: for those mentally ill and mentally handicapped patients who, although not having the dangerous or violent propensities which would require their admission into a special hospital, cannot satisfactorily be managed in the ordinary wards of psychiatric hospitals. I can assure my hon. Friend that the patients at these units will not be those who need the treatment given in special hospitals.

Because of the urgency and importance attached to the establishment of regional security units a special financial allocation will be made to regions to meet the 871 capital cost once proposals have been agreed.

The final report of the Committee on Mentally Abnormal Offenders published in October 1975 criticised the lack of progress in the provision of units and recommended that, to achieve more speedy progress, the running costs as well as the capital costs should be met from Government funds. This recommendation has been accepted and regional health authorities were notified on 24th February last of the amounts which would be allocated to them in the financial year 1976–77. We are providing £5.2 million in 1976–77 which is the bulk of the estimated revenue cost—the balance will be expected to cone from revenue savings. Because of the importance of understanding the role of these units I think it would be helpful to turn now to the question of which patients will be accommodated in them.

It is not intended that regional security units should take all patients who cause difficulties in local psychiatric hospitals and units, either by their behaviour or occasional absconding, but only those who so consistently present such problems as to make their local management impracticable in the facilities available. They will not be expected to cater for patients who are rightful candidates for special hospitals. I emphasise that for the benefit of my hon. Friend and his constituents.

Local hospitals are expected to deal with patients who occasionally exhibit difficult behaviour and violence, and there will be a continuing need for places to be available throughout the regions for patients requiring varying degrees of supervision and security. I understand that the Home Office has written to my hon. Friend assuring him that there is no question of Myra Hindley being admitted to the new unit at Prestwich.

We have not attempted to give any detailed guidance as to the proportion of places that will be needed for the mentally ill, the mentally handicapped or the personality disordered—psychopath—primarily because we feel that the regions will know their own requirements. What we have done however, is to indicate that all these three broad clinical groupings need to be catered for. 872 Some regions may choose to have a single "all-purpose" security unit covering all types of patients, but in other areas—particularly where the unit is to be associated with existing mental illness or mental handicap hospitals—the region may find it better to have two units, one primarily for the mentally ill and one primarily for the mildly mentally handicapped/personality disorder cases.

We have, however, indicated that we do not regard these units as being suitable places for severely mentally handicapped patients. The severely mentally handicapped with very disturbed behaviour are, in general, few in number, and the departmental view is that special provision should be made for their management within ordinary mental handicap hospitals.

As far as the ages of patients are concerned, we have indicated that the units would, in general, be expected to admit adults and older adolescents but that it may exceptionally be necessary to admit the very disturbed younger adolescent—that is, aged 12–16 years—or, even more rarely, the occasional child who has proved unmanageable elsewhere in the National Health Service. Both sexes will, of course, be catered for, but the number of women is expected to be fairly small. We would not expect units to take large numbers or prisoners on transfer from penal establishments, although, of course, if it seemed appropriate in an individual case, this would be possible.

All regional health authorities have been investigating the needs in their regions, and although progress in establishing regional security units has been slow, regional health authorities are now well aware of the priority we attach to their establishment. We realise the need which staff in regional security units may have for additional training in order to provide this type of service. The joint Board of Clinical Nursing Studies is setting up a panel to prepare an outline curriculum for training courses for nurses, and a course for doctors in forensic psychiatry is available in Birmingham. The Department is considering whether and what additional arrangements for training might be needed to supplement these and local arrangements for training already within regions.

873 It is against this background that the North-Western Regional Health Authority, in consultation with the Salford Area Health Authority (Teaching) and Bury Health Authority have drawn up proposals for interim and permanent regional security unit provision at Prestwhich Hospital. The North-Western Regional Health Authority's proposals for permanent regional security units include an 88-bed adult unit and 20-bed adolescent unit for mentally ill patients at Prestwich. It is planned to provide the adult unit by upgrading existing accommodation, and a start on site is anticipated for December 1978, and for completion and commissioning in October 1980. The adolescent unit will be a new purpose-built unit, and a start on this is planned for November 1978, with completion and commissioning expected in September 1980.

In the meantime accommodation in particular hospitals throughout the region has been designated for provision of treatment in conditions of security until such time as proper regional security units can be provided. As part of these arrangements an existing ward, Elton Ward, which was originally intended to be used as a forensic unit after upgrading, is proposed to be used as interim secure accommodation, with about 30 beds for male patients, pending establishment of the proposed permanent new units. The patients to be admitted into this ward are in the main those already admitted to Prestwich Hospital, and who will be brought together in more suitable accommodation.

Some concern has been expressed—I understand my hon. Friend's point of view and that of his constituents—about the adequacy of the hospital's security arrangements. I understand that the hospital authorities have been looking closely at what might be done and they are now considering whether the number of hospital entrances can be reduced. They have decided to erect a gatehouse lodge and employ gate-porters to keep a watch on patients leaving the hospital so that any patients intending to leave improperly dressed or in an obviously disturbed condition can be stopped. Arrangements have also been agreed with the local residents' committee for the hospital to pick up quickly any patients 874 who may cause a disturbance outside the hospital.

My hon. Friend will be aware from correspondence he has had with the Department of the delays in opening the interim regional security unit at Prestwich Hospital. The regional health authority and the other health authorities concerned had hoped to open the Elton Ward as an interim regional security unit early this year, but the proposals met with resistance from some staff and other interests.

Some professional staff are genuinely doubtful about the merits of providing secure accommodation in existing psychiatric hospitals and feel that such a move is both retrogressive and might harm the good name of the hospitals in which they are working. It must also be conceded that whether or not a person's disorder requires or will respond to medical treatment is a matter of clinical judgment, and differences of opinion between doctors in individual cases can and undoubtedly do arise from time to time. This is particularly relevant in the difficult field of personality disorder, and the final decision must rest with the doctor who would carry out treatment if the patient was admitted to hospital.

The Butler Report stresses that psychopathic offenders present particular difficulties to the health services. Where treatment and facilities are offered but repeatedly rejected and where any future law-breaking is likely to be minor or of nuisance value only, the Committee thought that it may be right to accept that the offender was not susceptible to rehabilitation and that the official services should consider whether continuing attempts to help would serve a useful purpose.

As we said in our recent White Paper "Better Services for the Mentally Ill" we need to think very carefully about this whole field, and we are currently considering the need for further research and new approaches to this very difficult problem. Some nursing and other stall who have the extremely taxing and difficult task of coping day by day with these difficult patients feels that the task is too onerous and at times risky and, along with some doctors, feel that such patients should be accommodated in the 875 special hospitals. However, we consider that only patients with continuously and seriously disturbed behaviour who pose a serious threat to public safety require the very high degree of security of the special hospitals, which are already under very severe pressure of numbers. Some nursing staff have also expressed concern that the high level of staffing required for interim security accommodation would place further heavy demands on the present staff available.

Difficulties over nurse staffing of the interim regional security unit at Prestwich Hospital have, I understand, now been overcome following recent discussions on staffing levels and implementation of the agreement reached last year by the Nurses and Midwives Whitley Council which, among other things, provided with effect from 1st April 1975 for a new allowance to assist the staffing of security units. Meetings with other staff interests, including ancillary staffs, have been arranged locally, and it is hoped that from the staffing point of view the way will soon be clear to open the interim regional security unit in the next two months.

So far as the local community is concerned, the North-Western Regional Health and the area health authorities concerned have been anxious to allay any public fears or misunderstanding about the purpose of the proposed units. As long ago as 876 ford Area Health Authority (Teaching) and the North-Western Regional Health Authority convened a conference at the Prestwich Conference Centre to discuss the implications of the regional security unit and the tentative plans. This was attended by a wide range of staff and by Press representatives who were given as much information as was then available.

More recently, the area health authorities involved have been consulting the local community health councils and local authorities on the proposals. A first meeting has been held with a local residents' committee and a second meeting is planned this month. It is also intended that another meeting will be held on 20th July with all the hospital staff.

In conclusion, I hope that from what I have said my hon. Friend will be able to reassure his constituents on the wisdom of these units. We would hope that they would recognise the trend towards more open care and treatment for patients who form by far the great majority of those in hospitals for the mentally ill and regard the provision of regional security units as a means for the better protection of the community in respect of those few patients who require treatment in conditions of security less severe than those found in the special hospitals.