St. Wulstan's Hospital, Malvern

HC Deb 30 November 1983 vol 49 cc961-8

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

9.24 pm

Mr. Michael Spicer (Worcestershire, South)

This is the third time in the past nine years that I have had the chance to raise on the Adjournment the issue of the future of St. Wulstan's hospital, Malvern.

It is a matter of fact that since its opening in 1961 St. Wulstan's has led the world in developing institutionalised techniques for the rehabilitation of mentally-ill patients. This very day Dr. Morgan, the hospital's director, is flying to Chile to address an international conference of psychiatrists in Santiago on the subject of rehabilitation.

The threatened closure of the hospital, arising out of the decision of the Worcester district health authority, raises a number of problems, and I am extremely grateful to have the opportunity to put them before the Minister tonight. The issue illustrates once again the cumbersome, sometimes tedious, undoubtedly expensive and certainly unsatisfactory way in which some decisions seem to be reached within the Health Service.

Until some time earlier this year—it is part of my argument that we do not know exactly when—St. Wulstan's was the sole responsibility of the regional health authority. This was sensible, as referrals to St. Wulstan's were made from health districts throughout the West Midlands regional health authority and, for that matter, from authorities all over the country. Previous decisions to keep St. Wulstan's open were made largely on the basis that comparable facilities did not exist in the other health authorities in the region. I shall return to this critical point in a moment.

In recent years the region has maintained a committee structure to oversee St. Wulstan's and has launched at least one inquiry into the management of the hospital. Some time earlier this year—we do not know when—an unpublicised decision was made to pass responsibility for the hospital to the Worcester and district health authority, which now maintains three separate institutions for the mentally ill. In this way—I stress behind closed doors—intolerable budgetary pressures were placed on a single district authority despite the fact that 94 per cent. of the patients at St. Wulstan's are drawn from the whole region and, as I said earlier, from the whole country.

By implication, and without public debate, there were apparently the makings of a major change in policy away from one by which St. Wulstan's was to be kept open so long as there were no comparable facilities in the region. Such procedures do not increase public confidence that decisions in the Health Service are made on a rational basis. Certainly, in this case, they are not being made on an open basis.

The second issue raised by the threatened closure of St. Wulstan's, which should certainly be capable of some form of rational assessment, concerns the whole future of institutionalised care of the mentally ill. Of course it must be right to ensure that the maximum number of mentally-ill patients lead lives as near normal as possible within the community. Indeed, by sheer coincidence the Worcester project, one of the most advanced experiments in community care for the mentally ill, operates geographically alongside St. Wulstan's. The fact is that, however successfully community care progresses, there will always remain a danger that for certain patients this community care will be a euphemism for throwing them on to the street, especially when resources are scarce.

The evidence is strong today—stronger than 10 years ago—that, even in the foreseeable future, there will be a role for some form of institutionalised care. The National Schizophrenia Fellowship wrote on 20 August: This Fellowship's experience is that community care—even in those few areas where it is adequately provided—is only suitable for the less severely ill patients. According to the fellowship, severely-ill patients still need institutionalised care. The main questions, therefore, are what sort of care should be provided, and in what sort of institutions.

Since its foundation, St. Wulstan's has successfully striven to break away not only from the practice but from the environment of the 19th century asylum. What has been created has little appeal for those whose ideal is a palace of hygienic plastic. That is part of the promotional problem from which St. Wulstan's has suffered. It is no more than a collection of adequately refurbished separate units, whose prime characteristic in the past 20 years has been the provision of work experience and, above all, a happy home for well over 1,000 patients from all over the country.

In the 10 years during which I have represented Worcestershire, South my tiling cabinets have been full of evidence from patients, their families, referring doctors and psychiatric experts at home and abroad that what is special about the St. Wulstan's experiment is the sense of community. I have here a letter dated 4 August 1983 from Mrs. Alison Ashfield to the district administrator. It is about the experiences of her twin sister who had been a patient in St. Wulstan's. The letter ends: May this letter be one of thousands that ask for St. Wulstan's to be kept open for the people who would otherwise take a very much longer time to recover or who may never leave the hospital to which they are sent. One of the arguments for closing St. Wulstan's has always been the cost of keeping it up to date. The current jargon is "upgrading". One of the figures currently being bandied around is £4.5 million. When I first came into contact with this problem in the mid-1970s the figures quoted for the installation of new heating arrangements were between £500,000 and £1 million, but in fact a fine new boiler and associated heating installations cost only £187,000. People at the hospital now believe that £150,000, rather than the estimated £4.5 million, would be perfectly adequate to improve insulation and carry out regular maintenance in the roofs. There is therefore a large area of dispute. It may cost £4.5 million to create a great plastic palace, but if one is merely trying to run a hospital as it has been run in the past, making sure that it has appropriate heat insulation and is properly maintained, those who are connected with the hospital believe that £150,000 will be sufficient.

I hope that my hon. Friend the Minister will address himself to the question of comparable facilities. When the hospital was last threatened with closure, the Government of the day accepted that it should not be closed until there were comparable facilities for the rehabilitation and treatment of the chronically mentally ill throughout the region. That has always been the Government's policy.

Having set up their own inquiry in the mid-1970s, the Government of the day found that, contrary to what they were told, the facilities in other hospitals throughout the region were, by and large, no match for those provided at St. Wulstan's. At that time it was decided to keep the hospital open.

My only request to the Minister tonight is that before he decides whether or not to support the district health authority's recommendation to close St. Wulstan's, he should send his own inspectors—I stress that—to establish for himself, independently and directly, whether the promised comparable facilities now exist. There is—this is central to my reason for bringing the matter before the House—strong evidence in at least four districts that the comparable facilities do not exist.

In support of that view I quote from two letters. The first is from Dr. O'Shea, the chairman of the medical staff committee at the John Conolly hospital in Birmingham. He wrote on 3 August: The regional study group on rehabilitation, having paid us several visits, has offered us no additional resources to develop facilities for rehabilitation, only advice about setting up committees and we are only too aware that the minor improvements to other hospitals listed in the consultative document"—— that is the consultative document of the regional district—— offer no prospect of the development of services comparable to those offered by St. Wulstan's. If comparable services were to be developed in each hospital this would be much more expensive than maintaining St. Wulstan's. The chairman of the medical staff committee at the John Conolly hospital in Birmingham is quite clear in his mind that there are no comparable facilities in his hospital.

The second extract is from Dr. Morgan, the director of St. Wulstan's, who on 1 August wrote: Four senior staff from Shelton hospital, Shrewsbury visited us last week and admitted in the course of conversation that they really have no proper rehabilitation service in their hospital. A few months ago St. Mary's hospital, Hereford told us the same. In March, Newtown hospital, Worcester told DHSS representatives that they have no proper facilities to offer to their growing number of long-term patients". Those are the allegations. I merely ask the Minister to agree to investigate for himself whether they are true. Whatever his final decision on St. Wulstan's, he owes it to the patients, the staff, the families and the practice of psychiatry to reach a conclusion on the basis of the most objective evidence available to him.

9.38 pm

The Under-Secretary of State for Health and Social Services (Mr. Tony Newton)

I congratulate my hon. Friend the Member for Worcestershire, South (Mr. Spicer) on introducing this debate on the future of St. Wulstan's hospital. It was clear from what he said that the work carried on at St. Wulstan's over the years had been very valuable in developing industrial rehabilitation for the mentally ill. I associate myself and the Department with the congratulations and support he gave to the importance of that work as it had been built up in past years.

As it happens, as the Minister responsible for the disabled I have a strong interest in the subject. Only last year I had the good fortune to address the annual general meeting of the British Institute of Industrial Therapy. Although I do not recall having the opportunity while I was there to meet anyone from St. Wulstan's, I formed a clear impression of the importance of the industrial rehabilitation work going on in many places throughout the country, often being developed in new ways, particularly in connection with the general theme of care in the community.

I assure my hon. Friend that it is very much the Government's wish to do all we can to support and encourage the development of such work in appropriate ways to suit modern circumstances, whether it be in his area or any other part of the country, and to develop the priority that is given to improved services for the mentally ill.

I join my hon. Friend in paying tribute to the care and attention given by the staff of the hospital to the patients living there. My hon. Friend clearly demonstrated the great care with which he has researched the facts and the genuine concern he feels about the position of this hospital. If there is any doubt about that concern, one has only to look at his record of endeavour over the years on its behalf. This goes back to an Adjournment debate that he introduced on 23 March 1977. My hon. Friend's constituents and those concerned with the hospital are very lucky to have a Member of Parliament who has made sure that the case is fully and properly considered before important decisions are taken.

It follows inescapably from what I have said that St. Wulstan's has been the subject of a good deal of discussion and correspondence. However, it is clear there is still a degree of misunderstanding of the present position. I am particularly glad that my hon. Friend has raised the question of the future of the hospital as it gives me an opportunity to go as far as I can, although I fear that it will not be as far as my hon. Friend would like, to clarify the position.

As my hon. Friend said, the current situation is that consideration is being given to the future of the hospital under the standard procedure for the closure or change of use of health buildings which has been in force since 1975. Under this procedure the district health authority concerned has recently undertaken a comprehensive programme of consultation and, in view of the fact that the local community health council has disagreed with its proposal to close the hospital, has referred the matter with recommendations to the West Midlands regional health authority.

Regional health authorities are required to seek the approval of the Secretary of State before proceeding with the closure or change of use of health buildings. The Secretary of State has just received from the regional health authority the papers relating to the future of St. Wulstan's and will shortly be considering these, including all the comments received as the result of the consultation exercise.

My hon. Friend will, I am sure, appreciate that in these circumstances it would not be appropriate for me to express a view on the merits of retaining or closing St. Wulstan's. However, I should like to take the opportunity presented by this debate to outline some of the more important recent developments that have led to the present position and to the arrival of these papers on my right hon. Friend's desk.

In May last year, the West Midlands regional health authority accepted a report from a working party of members of the authority who had reviewed the role of St. Wulstan's hospital. In its report, the working party recognised that patterns of rehabilitative care in psychiatric hospitals had changed considerably in recent years and that, with a few specific exceptions which were being remedied, the general standard of rehabilitation facilities and services throughout the region was now comparable to or better than that provided at St. Wulstan's hospital. I emphasise that that is not a judgment that I am making but one which was the conclusion of that working party report.

The working party also noted a number of weaknesses in the role now played by St. Wulstan's. It noted, for example, that St. Wulstan's was now in effect a long-stay chronic psychiatric hospital and was no longer fulfilling its original brief to provide a regional service and to return patients to their own communities. It also noted that the admission of patients to St. Wulstan's from a regional catchment area and their eventual discharge mainly into the Malvern and adjoining communities was imposing an increasing and unwarranted burden on local social services and housing departments. Again, I report the working party's view rather than endorsing it at this stage.

The working party pointed out that the numbers of new admissions had fallen considerably since 1975. During the six years 1976–81. admissions had averaged fewer than two patients per month. Only 108 patients had been admitted from other hospitals in the region during that period. Local patients were now treated within the Worcester development project—a programme set up by the Department of Health and Social Security to demonstrate how problems of transition from the old to a modern psychiatric service could be solved in a cooperative exercise involving local and hospital authorities. My hon. Friend will know that this is a type of development to which all Ministers attach considerable importance.

The working party drew attention to the fact that the regional strategy document published by the regional health authority included among its objectives: To establish in each District a social and industrial rehabilitation programme provided by consultants with a special responsibility working with community nurses and paramedical workers, eg therapeutic staff, social workers and phychologists. Industrial training facilities are essential and should provide courses covering a variety of skills. The working party pointed out that, since rehabilitation services should, by definition, be district-based, it was clearly unacceptable, in its view, that patients should continue to be sent to a hospital which might be up to 60 miles from the patient's home district.

As my hon. Friend is aware, the Worcester and district health authority is responsible for the management of St. Wulstan's. This summer, against the background of the regional working party's report, and as part of its work of ensuring that it was making the best use of its resources, the district authority began a wide-ranging programme of consultation on the future of the hospital. It consulted both on the question of whether the regional rehabilitation service for the mentally ill was still necessary, and on the pattern of services in Worcester which would best meet the needs of existing mentally ill patients.

The authority considered the results of its consultation on 28 October and, in the light of the comments received, decided that the regional rehabilitation service should end. It also agreed that St. Wulstan's should be closed and that an independent multi-disciplinary assessment panel should assess each existing patient with a view to recommending the most appropriate form of future care.

As I said earlier, the Worcester and district community health council opposed the closure of St. Wulstan's, and the local health authority has referred the matter to the regional health authority.

The RHA's sources of advice on St. Wulstan's have been the working party of members which was set up by the RHA in May 1977 and, via the working party, a regional advisory team in psychiatric rehabilitation and a task force appointed by the RHA in June 1981 to obtain detailed basic factual information about the patients resident in and dependent on St. Wulstan's hospital

In addition, the region's planning advisory group held meetings earlier this year with district management teams. The meetings provided an opportunity to check the situation with those DMTs likely to be affected by any change relating to St. Wulstan's.

I understand that in all cases it was confirmed that no difficulties could be foreseen in maintaining services in the event of St. Wulstan's closing. Against that background, I understand that the regional health authority supported the closure proposal at the meeting of the full authority held on 16 November 1983.

I am sorry that it is not possible at this juncture to be more specific about the approach that will be taken by my right hon. Friend the Secretary of State in judging the case before him. Clearly, however, he will wish to examine all the evidence as objectively as possible before reaching a decision. I can certainly confirm to my hon. Friend that the nature of rehabilitation facilities generally in the region will be a central element in my right hon. Fiend's consideration of the closure proposal. However, I cannot go so far as to say that proof that facilities comparable to those at St. Wulstan's exist in all 22 districts in the west midlands region is an absolute condition for closure.

Mr. Michael Spicer

My hon. Friend is giving a fair and reasoned answer to what I have asked. Can he say whether the Secretary of State will examine this matter himself or send one of his inspectors, and not rely just on the advice from the region, because it is a fairly well-established thought, if not fact, that the region has had, from the word go, a point of view about the proposed closure? The working party to which my hon. Friend referred is not truly objective. I have given evidence about the comparable facilities. Will the Government examine the matter, as have other Governments, with their inspectors?

Mr. Newton

I appreciate my hon. Friend's concern. I hope that he will in turn recognise that the reports coming to my right hon. Friend the Secretary of State when considering these matters go beyond the information provided by the working party of the regional health authority. I have touched on the views that I understand have been expressed by district management teams throughout the region.

We shall be looking at the case presented by the regional health authority, together with all the evidence that it has presented, from whatever source, along with all the objections made, including the matters to which my hon. Friend has referred and reaching a judgment on the overall picture. If my right hon. Friend thinks that additional information is needed to enable him to do that, he will, of course, seek it. I assure my hon. Friend that my right hon. Friend the Secretary of State and my hon. and learned Friend the Minister for Health, when considering these matters, go to great trouble to satisfy themselves that they have a full and proper basis for taking the decision that they are asked to take. I shall communicate to my right hon. Friend and my hon. and learned Friend the particular anxiety that my hon. Friend has expressed and the specific matter to which he referred.

It has been helpful and instructive to listen to what my hon. Friend has said and in some respects to the additional information that he has provided of the background against which my right hon. Friend has to make a decision. I give my hon. Friend an absolute guarantee that all relevant factors, including, not least, what he has said on behalf of his constituents and the hospital, will be reported to my right hon. Friend the Secretary of State and taken into account before he reaches his decision.

Question put and agreed to.

Adjourned accordingly at six minutes to Ten o'clock.