HC Deb 22 June 1976 vol 913 cc1558-70

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

1.17 a.m.

Mr. George Gardiner (Reigate)

The Matter I raise in this Adjournment debate is the current proposal by the South-West Thames Regional Health Authority to build a regional forensic psychiatric unit in Redhill, immediately adjacent to the Royal Earlswood Hospital, which is the home of some 650 mentally handicapped people, including around 80 children.

This proposal is the end product of a process that began with the Butler Report, which urged the creation of these units for patients who present severely disruptive behaviours, who suffer from psychopathic or severe personality disorders, some of whom may be offenders, but all of whom need to be kept in conditions of substantial—though not high—security.

In this debate I do not wish to question that such units are necessary. Neither do I intend to take issue with the guidelines offered to regional health authorities by the Department, nor even with the criteria adopted by the working party set up to find a suitable site within the South-West Thames Region. My purpose is purely to sound an alarm to the Minister that a site is being proposed that will cause damage and distress unforeseen by the working party, in order that work can start to find an alternative before more valuable time is lost.

The working party began by considering nine possible hospital sites. These were narrowed to two meriting serious feasibility study, and from these the Earlswood Hospital site was its final choice. Its decision was announced on 14th April, and a mere six weeks allocated for so-called local consultation. After protests, this was extended to 10 weeks, expiring later today. Since then members of the working party and its chairman have put in many hours attending local meetings and hearing objections.

But they have been engaged in a process not of meaningful consultation but of explanation. I and others have asked for details of other sites considered, and the reasons for preferring Earlswood. We have been refused. But how can we have meaningful consultation when only one option is offered to us. Throughout this, so that we can make proper comparisons, I have urged that we should take a broad community view, but how can we possibly do this without knowing all the options available? I hope that the Minister will offer guidance that in future local consultation should start at the short list stage, and not when a working party's mind is already made up. Small wonder there have been local complaints that the working party is merely "going through the motions", and that we are being presented with a fait accompli.

I hope that tonight the Minister will be able to assure us that this is still an open question, that his mind is not closed, and that full account will be taken of all the objections lodged by residents, medical opinion, and the East Surrey Community Health Council.

I recognise that no site proposed for such a security unit, designed to accommodate criminal elements among others, will ever be greeted with enthusiasm by local residents. I have no intention of saying "Yes, there should be a security unit, but not on our doorstep". However, the fact that there will always be objections from local residents does not mean that in some instances they may not have a very valid point.

Already in the tight area to the south and east of Redhill there is a security unit within the Philanthropic School run by Wandsworth Borough Council for juvenile delinquents.

Within the Earlswood Hospital there is a locked ward, though, having visited it, I must say nearly all its occupants are in such a condition that they would have difficulty in getting more than 500 yards from it. Then, just to the east, there is the Rainer Foundation Home for problem teenagers.

Is this not enough for any one community to cope with? The generosity of local people has already been shown by their friendship and understanding of the mentally handicapped patients of the Royal Earlswood. But there is a grave danger in pushing them too far.

Furthermore, the working party's proposal appears to have been drawn up with no knowledge of the fact that a new middle school has been built and recently opened within a few hundred yards of the proposed site. Its catchment area includes a large housing estate nearby—and the school and estate are linked by a footpath running right past this site. Is no thought to be given to the fears of mothers and children who have to use that path perhaps four times daily?

The revised report of the Department of Health and Social Security working party on security in NHS hospitals included the statement: It is important that an overbold decision leading to the establishment of a unit in an urban setting close to a reluctant community should not result in a situation where in the long term it proves impossible to admit to the unit the full range of patients for whom it should cater. I submit that we have just such an "overbold decision" here, and it would be wise for the authorities to recognise the fact.

I now turn to another group of objections which must weigh very heavily on the Minister's mind—those from the patients of the Royal Earlswood Hospital, their relatives, the staff, voluntary workers and the Friends of the Hospital. I speak with some feeling, for, since entering this House, I have followed closely the marvellous work undertaken at this hospital, as did my right hon. and learned Friend the Member for East Surrey (Sir G. Howe) who represented Reigate before me. Indeed, both his wife and mine are now closely involved with the Friends of Earlswood Hospital.

Since its foundation in the last century this hospital has followed a progressive "open door" policy. Its mentally handicapped patients, many of whom live there throughout their lives, are free to wander through the grounds, and indeed are a familiar sight on shopping expeditions and walks into Redhill. There is splendid community involvement—but, as one letter to me observed: it has taken many years of hard, heart-aching work to persuade the public to accept our children. Of course, many of these patients effectively remain children throughout their lives.

There is a mountain of evidence that these patients, and the understanding they get from the community, will suffer enormously if a unit including psychopaths and convicted criminals is made part of their home and hospital complex—for inevitably the community will come to see the two institutions as one.

I submit that it is a monstrous injustice to these unfortunate and defenceless people to graft a forensic psychiatric unit on to a hospital catering solely for the mentally handicapped. There is strong medical opinion that for these and other administrative reasons the psychiatric unit would be more properly located with a psychiatric hospital. Remember, too, that the Earlswood Hospital contains some 80 children, who receive their lessons in its classrooms.

I have received so many submissions on this point from those who work with the mentally handicapped, from their families, from doctors, from the local branch of the Confederation of Health Service Employees, and, indeed from fellow Members, including my right hon. and learned Friend the Member for Surrey, East that I shall read the Minister but one letter from Mr. George Lee, Secretary-General of the National Society for Mentally Handicapped Children. He writes: Parent members of this Society in the district, especially those whose children, of whatever age, are cared for in the Royal Earlswood Hospital, are acutely distressed at the effects such a proposal will have on life in the Hospital, and on the image of the mentally handicapped. I am writing therefore, to associate the National Society unequivocally with the local concern and to express the hope that you might be able to ensure that the responsible authorities have given the most careful consideration to the anxieties which have been aroused and also to possible alternatives. But, alas, neither the area health authority nor anyone else can consider the possible alternatives, because this information is kept from them.

However, despite the lack of information, I must tell the Minister that the East Surrey Community Health Council has adopted a most responsible approach to this matter. It has studied the Royal Earlswood proposal, and the working party's arguments for it. At the same time, it has accepted the need for a forensic psychiatric unit, and has no objection to one being located in its own district. It is quite willing to have one on its doorstep. That is quite a brave position for such a council to take up, but it has also looked at other hospitals in the district, including a psychiatric hospital, and has concluded that this psychiatric hospital matches the working party's own site criteria far better than the hospital for the mentally handicapped that it has chosen.

I do not know whether its alternative is the best, but if a psychiatric hospital can be found within its own district—and within my own constituency—that measures up to the criteria, I am sure there are several others that might profitably be examined too.

All these objections are due to be considered by the Surrey Area Health Authority later today, before reporting to the regional authority in time for its meeting on 14th July. Of course, I cannot anticipate either decision.

My purpose tonight is simply to alert the Minister to the fact that a great deal of information and evidence has come forward since the proposal was made known which cannot possibly have been taken into account by the working party since its procedures barred it from undertaking meaningful consultations at the formative stage.

I recognise that the Secretary of State is anxious to see that these forensic psychiatric units are built, and that time is an important factor. But the very worst outcome would be for the regional authority, or indeed him himself, to feel stampeded by shortage of time into making a bad decision. May I urge him to use his influence with the regional authority to persuade it to open consideration of other sites now, before more valuable time is lost, for I warn him that if he accepts this proposal, presented without any meaningful prior consultation, it will generate untold bitterness not only among local residents, doctors and NHS staff, but among the most defenceless members of our society—namely, the mentally handicapped.

1.30 a.m.

Sir Geoffrey Howe (Surrey, East)

I am grateful to my hon. Friend the Member for Reigate (Mr. Gardiner) and to the Minister for allowing me a few minutes to intervene in this important debate.

I wish to underline the points made by my hon. Friend on what is inevitably a difficult issue. No more than he would I, on behalf of my constituents, suggest that such an institution should be established other than in our part of the country. This is an important part of the social service network. It is, therefore, difficult to decide where such a unit should go.

I recognise that the working party has given careful consideration to the issues that arise. I ask the Minister and the authorities that operate beneath him in this matter to recognise that this proposal, rightly or wrongly, has given rise to a great deal of concern over a wide area spreading into my constituency. For example, residents' associations as far afield as South Nutfield and Nutfield have objected to it. The Purley and Caterham Districts Society for Mentally Handicapped Children has also objected to it. These people, with an enlightened view of the community's needs in these matters, feel a genuine sense of anxiety, which is supported by the Friends of the Royal Earlswood—an organisation which is concerned for the welfare of patients of this kind.

I suggest that the siting of an institution of this kind can be acceptable only if the process by which the decision is arrived at commands the confidence of the community.

Mr. Turner, the working party chairman, said at the meeting a few days ago that the community's understanding is vital. It is quite clear that a meeting of that kind, attended by 400 people of whom only two supported the working party's recommendation, has not succeeded in achieving that kind of community understanding.

The Surrey Mirror and County Post has been reporting these matters fairly and will play a part in helping to secure understanding, but what is missing, as my hon. Friend pointed out, is the feeling that a genuine process of consultation has taken place.

It is difficult to believe that in this case, any more than in the cases of Stan-stead and Maplin, for example, the consultation has been genuine if the people being consulted are not allowed sight of the alternatives and of the reasons that led people away from those alternatives, however well the working party may have considered them. That point was made in another place by my hon. Friend's predecessor, Lord Reigate.

If people are not given an insight into the alternatives and the reasons for the final decision, they will believe that the process has been conducted on the footing of the old bad rule for judges "Do not trouble me with the evidence. My mind is already made up". There is bound to be a feeling that the community has not been troubled with the evidence because it would add to the difficulty of arriving at a fully consultative decision.

I urge the Minister to consider that point sympathetically. It is important not only to get the right decision but for the community to be taken along with the rightness of that decision.

1.33 a.m.

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

I welcome the opportunity of giving the hon. Member for Reigate (Mr. Gardiner) and his right hon. and learned Friend the Member for Surrey, East (Sir G. Howe) some background to the Department's policy that regional security units—which will be specially funded—should be built throughout the country, to explain more about the type of patient likely to be accommodated in these units, and to say something about the South-West Thames Regional Health Authority's proposals, and the reasons behind its working party's suggestion that the unit should be built at Redhill.

Since its inception the National Health Service has had the responsibility of providing facilities to treat all types of patients with mental disorder, the only exception being those comparatively few who require to be treated in conditions of maximum security in the special hospitals. The Mental Health Act 1959 did not change this fundamental responsibility.

In recent years there has been a growing problem as more and more psychiatric hospitals have become entirely "open-door", but have often not made alternative provision for those continuously difficult and behaviourally disturbed patients who were formerly contained in locked wards. We certainly do not 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. However, places need to be available in each region for patients requiring treatment with varying degrees of supervision.

The Department of Health and Social Security established a departmental working party in 1971 to consider the present and future need for security and to make recommendations. This working party and the Interim Report of the Butler Committee on Mentally Abnormal Offenders both emphasised the urgent need for special units to be provided for patients requiring a degree of security. Since then we have been pressing health authorities to meet this need by establishing regional units. The initial aim is to provide 1,000 places in England by 1980, either by adapting existing buildings or by constructing new purpose-built premises. Because of the urgency and importance attached to the establishment of regional security units we decided to make special financial allocations to regions to meet the capital costs once proposals have been agreed.

This is the background to the policy. I think there are few people who would argue with the proposition that facilities where staff can more adequately manage difficult patients are urgently needed: this provision would take pressure off the more open facilities in our psychiatric hospitals and reduce the growing demand for patients to be admitted to the special hospitals—that is patients who really do not require the maximum security which they provide.

I should also like to say something about the type of patient who would be cared for in regional security units, as I fear that there may be some continuing misunderstanding about this.

Such patients present severely disruptive behaviour; they may be mentally ill or mentally handicapped or may suffer from psychopathic or severe personality disorder either alone or in conjunction with mental illness or mental handicap. It is these for whom regional security units are intended. However, it is not intended that regional security units should take all patients who cause difficulties in local psychiatric hospitals or units either by their behaviour or by occasional absconding, but only those who present such problems as to make their continuing local management impracticable in the facilities available.

I should also stress that regional security units will not be expected to cater for patients who are rightful candidates for special hospitals. They should, however, be able to cater for the type of patient who has in the past been inappropriately admitted to a special hospital because no "open" hospital was willing to accept him, even though his need for treatment was not in doubt. They will also be expected to accept some mentally abnormal offenders who have sometimes had to be given penal sentences just because they were considered to require more security than was available in the local hospital.

The other point I should especially stress is that the units will form an integral part of the psychiatric services of a region. We must be careful not to isolate them and the patients in them from the rest of the service. We need a flexible service with patients moving in and out of security as the need for close supervision arises and recedes. We hope, too, that the units will develop as centres of expertise in dealing with difficult patients and that they will be able to play an active part as a source of advice and training for the staff of the other psychiatric services in the region.

The South-West Thames Regional Health Authority's proposals have come in for some adverse publicity, and have been a matter of considerable concern to the hon. Gentleman's constituents and others—a concern which he so graphically described this morning.

Before going on to explain how the regional health authority came to propose the Royal Earlswood site and how the matter now stands, I should like to emphasise that we are talking about a proposal on which the regional health authority and the area health authority are consulting—not a firm decision or recommendation to my right hon. Friend. My right hon. Friend has not received such a recommendation. I therefore do not propose tonight to debate the merits of this proposal, which is still a matter for local consideration, but only to explain the steps by which the present position was reached, and what are the next steps.

In response to my right hon. Friend's request, to which I referred a few moments ago, the South-West Thames Regional Health Authority set up a multi-disciplinary working party, chaired by a member of the authority. This working party drew up detailed proposals for a regional unit and also considered a number of possible sites, coming to the conclusion that land at the Royal Earlswood Hospital would be the most suitable of those available.

Obviously, there is a considerable element of judgment in any such choice, and, equally obviously, different people judge differently. The working party did, however, go into the matter very thoroughly. It selected, and included in its report, a number of criteria by which potential sites should be judged. These included geographical location in the region, the availability of suitable Crown land, the presence of good road and rail communications, the adequacy of supporting facilities on site, which could both service the unit and reduce costs, and the possibility of providing unobtrusive security at the perimeter of the unit which would be properly effective for the containment of patients requiring security. This last point is, of course, a most important one and I should like to enlarge on it a little.

It is not the intention that these units should be as secure as the special hospitals, as the patients will not constitute a comparable risk to the community. While not inhibiting patient rehabilitation, they must be sufficiently secure to enable staff to provide care and treatment without being continuously worried about custodial problems, and they must provide a degree of protection against patients wandering abroad which is acceptable in practice to the surrounding community and to the relatives of patients in the neighbouring hospital. I understand that the proposals seek to provide that. It is not envisaged that the patients of this or any other security unit would go outside the unit grounds unless escorted.

There are other criteria, too. The Butler Report recommended, and the regional health authority accepts, that it is best to place units of this type near centres of population where they can form an integral part of a comprehensive health service. The hon. Gentleman will remember that nearly a year ago he spoke in this Chamber on the need for expansion of health facilities in East Surrey. All being well, this health district will now benefit from the first phase of a brand new hospital, probably based on the Department's "nucleus" design, which it is also proposed to build on the Royal Earlswood site. This was one of the factors which the working party took into account. In addition, there is a need to provide adequately for staff, in terms of accommodation and of nearby educational, shopping and recreational facilities.

I understand that the proposals fur siting the unit were designed to avoid ill effects on the Royal Earlswood Hospital. The unit would take up only five to eight of the 155 acres which constitute the present Royal Earlswood site, with the new general hospital taking up a maximum of another 10 acres at the other end of the site. It would have a separate access, in addition to the security arrangements which are one of its essential features.

The regional health authority accepted its working party's recommendation as a basis for consultation. It has consulted very widely other health and social service authorities, the Community Health Council, residents' associations, the Friends of the Royal Earlswood Hospital and at least 10 other organisations with which meetings have been held to explain and discuss the proposals. Among the discussions which have been held, I understand that the chairman of the working party has considered with the Director of Social Services for Surrey the increased demands which may be made on his department, both in the unit and in helping to resettle patients who are discharged. I think the House will agree that this represents very comprehensive consultation into which the regional health authority has put an unusual amount of effort. I see no evidence that the timetable has in any way prevented or inhibited the expression of views.

The hon. Gentleman said that there is a particular site in the same health district which many of those who opposed the present choice feel would be more suitable. I welcome indications that the local approach is not merely negative but has a constructive side, too. I think I should say that the site the hon. Gentleman has in mind was considered by the working party, which thought it less suitable than Royal Earlswood. Nevertheless, I am sure that the regional health authority will be very ready to look at it again if it carries the support of the local interests and is more acceptable to the local community, and if it commends itself to the area health authority.

As I said earlier the matter still rests with the Surrey Area Health Authority and the South-West Thames Regional Health Authority. The area health authority meets today and will consider what recommendation to make to the regional health authority. In reaching its decision it will take fully into account the views expressed during consultations, including the anxieties, which I know are very real, of those who have children in the Royal Earlswood Hospital and those who feel that the unit would adversely affect the hospital's present work. I hope that the area health authority will consider the proposal which has been put forward for an alternative site. It will have to take into account possible local reaction to that site as well, and also the likely difficulty of finding any site which will not raise objections of one kind or another.

The regional health authority will consider the area health authority's recommendation at its meeting next month. It will have a very difficult decision, as will my right hon. Friend should it be necessary for the matter to come to him. I assure the hon. Gentleman that it will not be taken lightly. But, wherever it is eventually decided to site the unit, at the Royal Earlswood or elsewhere, I hope that all concerned will bend their efforts to making it a success and not allow the legitimate concerns of our present debates to cloud its future.

Finally, I know that the health authorities are deeply aware of the loyalty and devotion of the staff, and of the value of the voluntary effort and local good will which have given the Royal Earlswood Hospital such a good name over the years. I should like to recognise those contributions tonight, and to express the confident hope that whatever happens there will be no diminution of the staff and voluntary effort which is so vital to the continued excellence of the hospital.

Question put and agreed to.

Adjourned accordingly at thirteen minutes to Two o'clock.