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St Wulstan's Hospital, Malvern

Volume 887: debated on Monday 3 March 1975

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12.25 a.m.

Order. This is taking time out of the period allotted to the hon. Member for Worcestershire, South (Mr. Spicer) for his Adjournment debate.

Despite the behaviour of the Leader of the House I am grateful to you, Mr. Speaker, for allowing me to raise a matter that is of great importance to my constituents. I am embarrassed by the situation, because the behaviour of the Government, and particularly the Leader of the House, should be indicated by all hon. Members who believe in the House of Commons. The situation is completely unprecedented, and if it were not for the importance of this issue to my constituents I should consider not proceeding with my Adjournment debate and instead asking the Leader of the House to answer a little more frankly than he has done so far.

I am advised by my hon. Friends not to proceed with my debate. May I just reiterate that we are infuriated by the actions of the Leader of the House. He is empowered to represent both sides of the Chamber, and the fact that he came along after the Division and did not give any indication of what the motion was about in the first place is reprehensible. Nevertheless I am grateful for this opportunity to raise what to my constituents and to many members of the Gallery is a vital issue, and with your permission, Mr. Speaker, I shall pursue this.

I shall speak briefly, because I have a rather severe attack of laryngitis and it is not making life easy for me. I hope that the Minister will be able tonight to tell the House that the fears about the future of St. Wulstan's Hospital are totally misplaced and that the recommendation for its closure by the officers of the Birmingham Regional Health Authority has been turned down.

There is no doubt that St. Wulstan's has an essential and leading rôle to play in helping patients who are suffering from severe mental illness to lead a normal life. The importance of the work carried out at St. Wulstan's has been emphasised over and over again in the many letters that have been received by right hon. and hon. Members who have signed Early-Day Motion No. 184.

St. Wulstan's has the massive support of consultant psychiatrists and heads of psychiatric units throughout this country and abroad. A letter which I understand is to be published in the next edition of the Lancet from Dr. Calanca of the Clinique Psychiatrique Universitaire, Lausanne, Switzerland, is typical of many that I have seen. He writes:

"Dear Sirs,

I read in the Lancet of 25th January 1975 on page 229 that St. Wulstan's Hospital in Malvern may be closed. I am very astonished and sorry about this news.

In 1968 I visited St. Wulstan's Hospital and was very interested by this very impressive rehabilitation service. I visited in the United Kingdom about 33 hospitals; but this one was for me the most important place where I learned what really was a rehabilitation centre, and how to manage and to give a chance to chronic patients. This experience was very helpful to me, so that we created some similar centres in Switzerland based on what we had seen in Malvern, especially for the organisation, rating scales, and so on.

I strongly hope that my letter will be taken into consideration."

I should be grateful if my hon. Friend would also recognise that it is not only the consultants, of whom he speaks so accurately, but the Conservative Members of Parliament throughout the West Midlands who strongly support him in what he is trying to do. If we were not severely cut short by the rules of the House and by the shortness of time for this debate, I can assure my hon. Friend that there would be many other Members present to support all that he is trying to do.

I am most grateful to my hon. Friend. It is right that many Members have already signed the Early-Day Motion on the subject. My hon. Friend is right to suggest that it is not only psychiatrists and members of the profession who feel strongly about this matter. I had a letter only this morning which reads:

"My brother was in Stafford Hospital from 1936 to 1965—from the age of 18 to 47. He was transferred to St. Wulstan's and made excellent progress, so much so that he has worked away from the hospital for about six years. St. Wulstan's has continued to help my brother and recently assisted him to get employment in Cheltenham."
There is no doubt that St. Wulstan's is seen throughout the entire psychiatric profession as one the world's pace-setters in developing methods of rehabilitating and reintegrating severe cases of mental illness—namely, those who twenty years ago would have been considered beyond help. To my knowledge there is no other hospital in this country comparable to St. Wulstan's. What a tragedy it would be if once again we were to set in motion the process of undermining and eventually killing off yet another centre of excellence.

I shall consider for a moment the future of St. Wulstan's in the context of a national policy towards mental health. I hope that when the Minister replies he will not merely shrug off this matter as a regional problem. It is, as I hope to show, a national problem. The Minister will know better than I the vast deeps to which the national problem of mental health descends but which as yet to a large extent goes publicly unrecognised. Over half a million people are thought to be suffering from some form of mental disorder. The rate per thousand is growing alarmingly. According to the figures in the 1971 White Paper—that surely underestimates today's problem—over 120,000 people suffer from severe mental illness and are in need of specific hospital treatment.

The objectives of the previous Conservative administration were reasonably well spelt out in broad terms, and the indications given last Wednesday by the Secretary of State for Social Services suggest that the present Government broadly follow those objectives. I do not want to make a political point, but I am looking for a rather more elaborate and detailed statement from the Government.

However, as far as I can see, the objectives appear to be broadly the same as those set out by my right hon. Friend the Member for Leeds, North-East (Sir K. Joseph) in 1973. My right hon. Friend said that there were four objectives for the mental health service: first, that it should be realised that the chronically mentally disabled would be living in the surroundings provided by the service for a considerable time and that the services and the environment provided should be good and full; second, that there should always be the possibility of rehabilitation and that the necessary services for this should be provided; third, that the service should be provided in such a way as to attract and retain good and devoted staff; fourth, that the provision of the services should allow residents to be as close as possible to their families and communities. The question of St. Wulstan's centres precisely on those four objectives, with which I assume the Minister has no quarrel.

On the first objective, that of providing a good life, if there is any doubt in the Department about the acceptability of the environment provided by St. Wulstan's and the happiness of patients who are benefiting from its treatment, I beg the Minister to visit it. Nothing would give me greater pleasure than to accompany him. Some of the most pathetic pleas for a favourable outcome to this issue have come to me from the patients themselves.

On the second objective, there can be no doubt that St. Wulstan's has led the entire field, to a large extent the entire world, in experimentation and the provision of rehabilitation methods. Its special contribution, of course, has been in industrial therapy, the importance of which has been to provide the necessary range of employment so as to return to the patients a sense of involvement and of being needed by society and ultimately the desire once again to take on the outside world.

There are many in my constituency, which adjoins that of my hon. Friend, who describe the services he has mentioned as a lifeline. It is particularly in the on-going provision of sheltered workshops that we hope that the Minister will satisfy us.

I am grateful. My hon. Friend speaks as someone in whose constituency a new psychiatric unit will soon be opening, so he speaks of this matter with great knowledge and a sense of balance.

Of the 1,000 patients referred to St. Wulstan's since its opening in 1961, the hospital has had a 95 per cent. success ratio in terms of helping patients to return to some form of employment and a 50 per cent. success ratio in helping them to take a part again in the outside world. This compares with a national average of one in 20. These results are the more remarkable when it is realised that St. Wulstan's accepts the more difficult patients from other mental hospitals. It is a condition of acceptance at St. Wulstan's that one must have been a patient for two years at another mental hospital.

It is on the third objective—of providing a service which attracts the best possible staff—that St. Wulstan's becomes so important. This is the main significance of this debate. The case for St. Wulstan's rests partly on the range of services that it can provide, but also on the quality of staff it attracts and the teaching and research in which they can take part.

The tragedy of this story so far is not the threat of closure itself—one assumes that the Minister will dismiss that out of hand—but the damage which has already been done to the morale and retention of good staff and the recruitment of new staff. The leaks and the gossip which have surrounded the regional health authority's protracted discussions of this matter since July 1971 are the real scandal. That is why it is now imperative that the Minister declare his own hand. It would do immense further damage if his response tonight were merely that there were to be further discussions on the matter behind closed doors.

Finally there is the whole question, which I realise is a sensitive one, of how St. Wulstan's fits into the Government's total strategy towards the form and location of services for the mentally disabled. In a speech last Wednesday the Secretary of State for Social Services indicated that she was determined to continue the policy implied in the 1971 White Paper to provide help for the mentally handicapped within the community by running down the large mental hospitals and building up units attached to local hospitals and local authority hostels.

While that policy is broadly accepted on both sides of the House, there are two strong qualifications. First, the economic circumstances in which we find ourselves today are totally different from those in which the 1971 White Paper was written. We know that cash for mental health will be very scarce. We should therefore look very suspiciously and with extreme scepticism at a programme which involves the closure of one type of hospital in exchange for vague promises about new hospital or units to be attached to general hospitals. Necessary cutbacks, particularly in local government spending, make it highly probable that the desired programme, for instance for hostels, will not be forthcoming in the foreseeable future. We already know that 10,000 patients in England and Wales could be discharged at this moment if there were the necessary hostels to receive them.

The second qualification to the broadly correct policy of dispersing relates directly to St. Wulstan's. Although there is much consensus, I believe, about the need to disperse and reintegrate the general population of the mentally disabled, there remains and will continue to remain—I beg the Under-Secretary to accept this—the quite distinct problem of the chronically and severely sick. The question of how they should be treated is a much more difficult one.

The 1971 White Paper succinctly made the point that there were two quite distinct sets of opinions about this. On the one hand there were those who considered that
"there should be no separate hospitals of the present sort"
and that the whole thing should be dispersed. There were the others who, in the words of paragraph 191 of the White Paper favoured
"larger specialised hospitals as in the present hospital service … In such hospitals, they say, it is easier to provide a wide range of services for occupation, training and recreation."
The last paragraph of that section of the White Paper states:
"The Government considers it premature to form a final view on these questions. Experience of various solutions is necessary to test the theories in practice. The Government is therefore encouraging alternative lines of development".
The right hon. Lady in her speech last Wednesday indicated that she was of the same opinion and was keeping her mind open. There is no reason whatever for the Government to be ashamed of that point of view. Indeed, I believe it is the right point of view, because if one fact stands out alone in this whole matter it is that we do not really know what are the causes of many severe forms of mental health. How, then, can we start to suggest a final, ultimate, complete and only solution? It is imperative that we consider a whole range of solutions and should not be afraid of doing so.

One of the arguments used for dispersing is that patients would then be close to their relatives. In the case of St. Wulstan's, 60 per cent. of the patients there do not have any contact with relations and 75 per cent. have very weak links with the outside world. Therefore, this point does not begin to apply in the case of a hospital like St. Wulstan's.

I wonder whether the critics of hospitals and institutions such as St. Wulstan's are not obsessed by the fact that in a physical sense it is a poor status symbol. It has no fine, glossy buildings. Indeed, as regards capital costs it has been run on a shoe-string.

I beg the Minister to make a visit because even the briefest of visits will show that in place of shining plastic floors and beautifully-fitted strip lighting there is the warmest, happiest and friendliest atmosphere among the 280 patients in St. Wulstan's. I beg the Minister to move as quickly as possible to ensure that morale is returned to the patients and staff of the hospital and that this great British experiment is permitted to continue to lead the world in this desperately difficult field of medicine.

The objective must be to build more St. Wulstan's. In the meantime, I beg the Minister to keep the only one we have.

12.45 a.m.

Let me tell the hon. Member for Worcestershire, South (Mr. Spicer) at the outset that I appreciate and share with him his obvious concern for those who are mentally ill. But I must say that he did less than justice to his cause by the first part of his speech. I am sure that when he reads the report of it tomorrow he will agree with me.

The hon. Member is an expert at that kind of thing. If he wishes to take up time on the Adjournment, I am willing to let him do so.

I am prepared to give way provided the hon. Member bears in mind that if he proposes to say much he will not give me the opportunity to say things that he may want me to say.

Will the Minister specify what remark he took exception to? I have looked at my notes, and I am not ashamed at anything in them.

The hon. Member made a first-class speech, except in his attack on my right hon. Friend the Leader of the House, when his remarks were both unwarranted and unfair.

I shall move from that arena. I have said that I share with the hon. Member all the concern that he expressed so adequately this evening. I shall skip most of the prepared things I intended to say and try to deal with the specific point raised, namely, the suggestion of the closure of St. Wulstan's. In passing, I agree that it is quite true that I have not visited the hospital, any more than I have visited several other equally important institutions throughout the country. This is largely due to lack of time. Nevertheless my advisers have done so, and at the moment I accept both the hon. Member's words and the words of those who have advised me.

No one disputes—certainly not I or the Department—the value of the work with St. Wulstan's, and particularly its staff, has rendered to mentally handicapped people for a long time. That is not in dispute between us. Over the past few months, however, as part of its consideration of the organisation of health services across the region as a whole, officers of the West Midlands Regional Hospital Authority have been giving much thought to the future of St. Wulstan's and have begun discussions with officers of the Hereford and Worcestershire Area Health Authority. I am advised that there are two reasons behind these considerations and the discussions which are taking place at officer level. First there is the question of cost. No one in the House can pretend that cost is not an issue in these matters.

The hospital buildings date from 1942 and are said to be completely outdated, with engineering services at the end of their useful life. Regional hospital authority officers have estimated that more than £500,000 will need to be spent in the near future if the hospital is to continue in use for more than a year or two. Even if this expenditure were undertaken the basic design problems of the buildings would remain. There is a substantial sum to be spent on renewing old buildings, and it is clearly right that before a sum of this size is spent the responsible authorities should be satisfied that there is a longer-term rôle for the hospital.

The second factor is the related question of the future pattern of services for the mentally ill, including rehabilitation services. When St. Wulstan's opened in its present form in 1961, it was unique in this respect. But in the last 10 years or so other hospitals in the region—I have a long list in front of me, but I shall not detain the House with it—have built up their rehabilitation units and are themselves rehabilitating patients as part of their accepted function. There has been a consequent reduction in admissions to St. Wulstan's, so that today there are only some 200 or so in-patients as against the 260 that could be accommodated.

The development of locally-based services for the mentally ill, including rehabilitation services, is very much in accordance with the Department's long-term policy—the policy instituted by my predecessors. Locally-based facilities make it much easier for the health and social services to co-operate, make services more accessible for the patients and enable patients to stay in touch with their families. There is far more chance of the patients successfully re-establishing themselves in the community if their treatment and rehabilitation is carried out as close as possible to their home areas. We shall this year be publishing a White Paper on services for the mentally ill which will spell out the advantages of this policy in more detail.

In brief, present policy envisages rehabilitation as embracing a wide range of occupational and rehabilitative activities for both in-patients and day-patients, and occupational facilities at local authority day centres for those not needing, medical and nursing care. As well as the contributions by the health and local authorities in developing patients' employment potential, there is the wide range of resettlement services under the Department of Employment and the Manpower Services Commission. These services include employment rehabilitation centres and skillcentres, together with the Disablement Resettlement Service with its function of placing people in open or sheltered employment. The need for co-operation between the health, social and employment services is of paramount importance.

One of the matters for concern where there is a regional hospital unit serving a wide area is that patients may lose touch with their home areas. I understand the figures that the hon. Gentleman has given. I shall take into account all that he said about percentages. I hope that he will take account of the figures I now propose to give on this issue.

I understand that of the 128 St. Wulstan's patients who came originally from outside the Hereford and Worcester area and who were discharged between 1970 and 1973, 121 have remained in the Malvern area. That does not suggest that there was a return to their home environment.

It is thus the likelihood of considerable expenditure soon on what is basically relatively poor accommodation—there is no criticism of the staff in that connection—set against the background of the national policy of moving towards more locally-based provision for the mentally ill that has led officers of the regional and area health authorities to review St. Wulstan's future.

The status of the present inquiries is as yet simply that of a review of provision by officers. When they have completed their review they will doubtless report their findings and any recommendation they wish to make to their respective health authorities. It is the authorities, the members, who then have to consider the matter and decide to seek my right hon. Friend's approval to begin.

The Question having been proposed after Ten o'clock on Monday evening, and the debate having continued for half an hour, Mr. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at five minutes to One o'clock.