It is very good of you, Mr. Speaker, to stop the clock on this matter, because we are moving from the absurd through the ridiculous up to the sublime to discuss the threatened closure of St. Wulstan's Hospital in Malvern, in my constituency.
I begin by comforting the Government with the thought that Early-Day Motion No. 35 has been signed by the Leader of the Liberal Party, so it will be OK in the view of the joint consultative committee when it no doubt comes before them. The motion has also been signed by the Leader of the Ulster Unionists and 82 other hon. Members of all parties.
I am sure that the Minister will be completely familiar with the background to the St. Wulstan's case. I understand that he has been discussing it this afternoon with the Labour Mental Health Committee, to which I shall refer later. St. Wulstan's Hospital is one of the world's leading hospitals in developing methods for rehabilitating very bad cases of mental illness. The attempt is made by the hospital to give mental patients the widest possible opportunities to engage in normal daily life, and especially to engage in the widest range of work situations, from secretarial to light industrial jobs.
The record of the hospital has been extremely good. Of the 1,200 patients admitted to St. Wulstan's since 1961, 40 per cent. of these very difficult cases have been returned to normal life outside, and 90 per cent. enjoy a reasonably normal life working in the hospital. These numbers explain why parent hospitals in the West Midlands Region and other parts of the country have been referring a growing number of so-called hopeless cases to St. Wulstan's from all over the country.
In an Adjournment debate on 3rd March 1975 I said:
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."—[Official Report. 3rd March 1975; Vol. 887, c. 1233.]
More than two years ago I was pleading for the Government to resolve the miserable uncertainty surrounding this great and unique hospital. Since that date there has been only one major development. The West Midlands Regional Health Authority has published a paper recommending the closure of St. Wulstan's. This so-called consultation document has created so much anger among doctors, patients, medical professional bodies, and, I understand, the Labour Mental Health Group, that it has been felt necessary to produce a detailed response. This will be published next week. A copy will be sent to the Minister of State and to the 82 hon. Members, from all political parties, who signed Early-Day Motion No. 35.
As to the unique international reputation which St. Wulstan's has gained in the field of mental rehabilitation, there is no doubt. Ever since I have represented Worcestershire, South in Parliament I have received a continuing stream of letters from formal organisations at home and abroad concerned with mental health, but also—and perhaps even more poignantly—from patients and relatives of patients all over the country who have benefited from the hospital's unique care and rehabilitation. From this mass of correspondence, I shall read out extracts from just two recent letters.
A patient writes:
I have had just over twenty years in hospital and came here just over two years ago. Now, thanks to St. Wulstan's, I lead a very normal life. I have had 5 nervous breakdowns in my life (the first when I was 17) and very severe nervous trouble. I was at another hospital for over 13 years, and was never able to face going on holiday from there, but I have been away both years since being here and am going to Ilfracombe this year. I am now preparing to go
out as a day patient eventually, and to getting a job when I am fit enough. Now I hardly know myself, I have changed so much these last two years.
Another patient says:
What I wish to explain to you is how I myself have made excellent progress while I have been at St. Wulstan's, to such an extent that I am practically cured of my illness, which has pervaded me for so many years. I owe all this to the excellent work of the doctors, whose work is really worth admiring. I first started off as a very good domestic worker in one of the wards and after a short while one of the doctors found me a part-time job outside in Malvern and I am now doing very well. And after I have done another two months at the hostel, I will be found somewhere to live in Malvern. And better still, my boy friend and I will get married about August, as we are carefully saving most of our money between us. It is simply shocking to think that St. Wulstan's, which turns out such excellent work and does such excellent work for its patients, might have to close down. But for the benefit of all those who are not so lucky as to be housed outside, not only myself, but all of us most sincerely hope that the hospital will stay open.
The Government—in the person of two Ministers—the Foreign Secretary when he was Minister of State, and the present Minister of State—have, to be fair, consistently taken the line—and more recently given the impression of increasing commitment to it—that any recommendation from the regional health authority to close St. Wulstan's would not be accepted unless the Minister was thoroughly convinced that comparable rehabilitation facilities were available elsewhere for the present patients. On 14th March this year the Minister of State concluded a letter to me on this subject with the sentence:
I can assure you that we will need to be thoroughly convinced that there are comparable facilities in other hospitals in the region before agreeing closure.
The argument has thus rightly focused on the question of comparable rehabilitation facilities. It is on this issue where the regional health authority document has been most misleading.
In its consultation document the RHA says:
The reduction in overcrowding in psychiatric hospitals, improvements in staffing, and different methods of treatment, have radically increased the potential of other hospitals to undertake rehabilitation of the kind at present carried out by St. Wulstan's.
If, however, one looks rather more carefully at the document and turns, for instance, to the small print of Appendix E,
which deals in detail with the capability of alternative hospitals to receive any patients if they have to leave St. Wulstan's, one finds immediately that the picture is very different from that foreseen by the large print at the beginning of the document.
For instance, if one takes Burton Road Hospital at Dudley, one finds the extraordinary statement that a
complete rehabilitation service will be available providing the new Ridge Hill Hospital now being completed is fully funded and staffing levels are not restricted.
If one looks at more objective evidence than that provided by the regional health authority, the promises made by that authority about what will happen to the patients from St. Wulstan's begin to take on an appearance of total irresponsibility. So far as hospital services are concerned, a survey by MIND, published in June 1976, confirmed that
psychiatric illness, affecting 600,000 people every year, is scandalously neglected in the health service
rehabilitation schemes vary widely from hospital to hospital and many only pay lip-service to the idea of rehabilitation (possibly because of limited resources).
I do not want to go on boring the House by quoting, but in a recent memorandum on St. Wulstan's the National Schizophrenia Fellowship said:
The rehabilitation facilities which would be scattered throughout many hospitals, with lower priorities and without any expert team accustomed to work together, could in no way be regarded as adequate substitutes, individually or collectively, for St. Wulstan's.
Turning briefly to the other fundamental suggestion presented by the regional health authority, that St. Wulstan's patients could to a greater extent in future be treated within the community, this really does indicate that the authority is living in a fantasy world. All of us—and I am sure the Minister will accept this—who have had direct experience of the problems of mental rehabilitation, particularly in the West Midlands, know that the provision of so-called "community care" as a substitute for the work being undertaken, for instance in hospitals such as St Wulstan's, is, in practice, and in the present circumstances of scarce public resources, nothing more than a euphemism for throwing people back on to the streets.
As the National Schizophrenia Fellowship says:
It is wholly untrue to state (as the RHA's Consultation Document does) that as a matter of ' practical, professional experience ', the present ' emphasis is on treatment within the community ', since it is precisely in this field that the greatest failures, indeed disasters, are at present occurring.
The same point was made most effectively in a letter that I received only last week from the Mothers' Union in the Diocese of Worcester. It said:
In the present situation of spending cuts, it seems likely that more patients will be returned by mental hospitals to their families, and the RHA's Consultation Document presupposes that all these patients have ' super families ' who can carry out the same work as the hospitals.
What happens in most families is started by the patient's refusal to take the necessary tablets, etc. when away from hospital care. Ageing and perhaps widowed parents struggle hopelessly on; brothers and sisters, sometimes married, are not prepared to shoulder the burden. Broken marriages and broken families are not unusual, especially in the case of schizophrenic patients. Then follows a gradual sad drift into lonely lodgings and eventually into vagrancy, Social workers are not always as successful as they sound on paper, and they now increasingly call for voluntary help. The ex-mental patient vagrant dies in a derelict building, or he finds himself at last in a geriatric ward of a mental hospital and the wheel comes full circle. Does the DHSS understand that this sorry picture is, for many patients, what a 'return to the home environment' means?
That point has been confirmed by many other pieces of evidence, and certainly by most practical experience.
In his response to the Adjournment debate on 3rd March 1975 the then Under-Secretary of State accepted much of the case for St Wulstan's but said that the main argument against its continuance was that of cost. As I understand it, that may well be a continued argument. The present maximum estimate that I have come across on capital account for the continuance of St. Wulstan's is £618,000, of which £250,000 has already been allocated for a new nursing home, which anyone involved with the hospital thinks is not necessary. Indeed, £40,000 has already been allocated for immediate engineering works required. Therefore, we are talking of a maximum of just above £300,000. I am sure that the Minister will accept that the main point about St. Wulstan's is that it is not a lavish hospital but a collection of Second World War American Army huts in which a thriving community exists at relatively low cost to the community.
I cannot resist quoting again from the National Schizophrenia Fellowship, which states:
The alternative costs of providing comparable rehabilitation facilities at parent hospitals are not quoted in the RHA document at all. The omission is unlikely to be accidental. In fact, it may well be less expensive to retain St. Wulstan's.'
Tragically the issue today is precisely the same as when I spoke on the subject in the House two years ago. The Government have rightly said that they will not close the hospital unless comparable facilities can be found. The regional health authority claims, without producing any evidence to this effect, that comparable facilities are available. Meanwhile the weeks of uncertainty turn into months, and the months into years. There is now a danger of the years turning into decades.
It is entirely due to the courage of the staff and the patients that the morale of St. Wulstan's has not been shattered in the past five years. It continues to carry out its unique role in the rehabilitation of mental patients and, extraordinarily and ironically, it has taken an increasing share of the serious mentally ill cases in the West Midlands.
The Government's role has been largely to wash their hands of the problem until the moment when the specific recommendation arrives from the regional health authority. I gather that tonight the Minister said to the Labour Mental Health Group that community health councils should be encouraged to prevent the recommendation ever reaching him. That is not good enough. The Government must start playing their role. They know quite well what the recommendation will be. At the very least there should have been officials from the Department already visiting the hospital.
The Minister now has a duty to set a time limit. The consultation ends on 23rd April. The hon. Gentleman should say that by the end of May he will take a decision. I cannot foresee any circumstances in which his decision can be anything other than to keep this great hospital open. There are no comparable facilities. It is a sham to pretend that there are. It brings the authorities concerned into disrepute that they are producing a document pretending, given current available resources, that they can create out of magic, or thin air, resources that do not exist. My priorities are to spend money on those who cannot help themselves, and above all that principle must be applied to the mentally ill.
I congratulate the hon. Member for Worcestershire, South (Mr. Spicer) on securing the Adjournment debate and on the thoughtful way in which he has presented his argument in opposition to the proposed closure of St. Wulstan's Hospital. The hon. Gentleman has been tenacious in his defence of St. Wulstan's. He has written many letters to Ministers. He has asked several Questions and this is the second Adjournment debate that he has initiated on the issue.
As the hon. Gentleman emphasised, St. Wulstan's has a proud international record of achievement in the rehabilitation of the mentally ill. In the early 1960s, at a time when rehabilitation facilities were not as widespread or as fully developed as they are today, St. Wulstan's did pioneering work. It remained unique in the region and nationally. I know from the letters that the Department receives from former patients and the relatives of existing patients that the hospital is providing a good service and has many friends. In this context it seems paradoxical that we should now be discussing its closure.
Decisions on closure or change of use rest primarily with the appropriate health authority. In this case, where a hospital providing a regional service is involved, the appropriate authority is the regional health authority. After a great deal of consultation and consideration the West Midlands RHA asked the former Minister for Health, my right hon. Friend the Member for Plymouth, Devonport (Dr. Owen), for agreement to proceed to formal consultations on closure. It did so because it was convinced that facilities for the rehabilitation of the mentally ill had developed in many psychiatric hospitals in the region, and that it was now no longer necessary to have a specialist psychiatric rehabilitation unit. It was also only too aware that, if St. Wulstan's was to continue, a considerable amount of money would have to be spent there in maintaining what, by all accounts, are pretty poor buildings.
The Government's long-term aim is the development of locally based services for the mentally ill. I stress "long-term". We believe that locally based services make it 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. It therefore seemed reasonable to my right hon. Friend to allow the West Midlands Regional Health Authority to consult on closure, but he made it absolutely clear that the Secretary of State would want to take the final decision and that he would not agree closure unless it could be clearly demonstrated that the patients now at St. Wulstan's would not be disadvantaged.
I think it would be to the benefit of the House if I quoted from the letter that my right hon. Friend the Member for Devonport wrote to the hon. Gentleman on 12th April 1976 announcing that he had authorised the RHA to begin formal consultations. I quote:
I have today authorised the Authority to begin formal consultations on closure, making it clear that this in no way prejudices the Secretary of State's eventual decision on closure. I have made it quite clear that the Secretary of State would only be prepared to consider closure if it can be demonstrated in detail that the St. Wulstan's in-patients could be transferred to other psychiatric hospitals with comparable rehabilitation facilities, and that adequate arrangements could be made for the St. Wulstan's day patients who now lodge in and around Malvern.
When the hon. Gentleman wrote to my hon. Friend the Member for Lewisham, East (Mr. Moyle) last December about the arrangements for day patients he told him that he would not support closure unless the day care facilities available to the St. Wulstan's day patients were broadly comparable with those that they now enjoy. Further, in answer to the hon. Gentleman's Parliamentary Question on 8th March this year, when he sought a firm assurance that St. Wulstan's would remain open unless comparable facilities for the rehabilitation of the mentally ill could be found elsewhere, my hon. Friend the Member for Lewisham, East gave an unequivocal answer "yes".
Against this background of a belief that rehabilitation facilities for the mentally ill had developed within the region to such an extent that a specialised hospital for rehabilitation was no longer required, and in the full knowledge of the very tough criteria that my right hon. Friend has indicated would need to be satisfied, the regional health authority issued a detailed consultation document in January. This is in accordance with procedure that we have laid down and covers such matters as the reasons for the proposal, an evaluation of the possibilities of using the facilities for other purposes or the disposal of the site, implications for staff—of course their interests must be taken into account fully —the relationship between the closure or change of use and other developments and plans, and of course, the effect on patients who might be affected by the proposal.
In this case—the proposed closure of a regional specialty—comments have been invited within three months from all area health authorities and community health councils in the region, and from such bodies as local authorities, joint staff consultative committees and other staff organisations, family practitioner committees and local advisory committees.
The hon. Gentleman has anticipated what I am about to say. I shall come to that point if there is time.
Hon. Members whose constituents would be affected have also been informed of the proposal. Those who oppose the proposal will have a number of channels through which to make known their views on all aspects of the proposed closure, including the matters of concern emphasised by the hon. Gentleman.
If the community health councils, which are given the opportunity to study the comments of the other bodies consulted and the regional health authority's views on those comments, object to the proposals, they are entitled to submit to the authority constructive and detailed counter proposals, paying full regard to the factors, including restraints on resources, which led the authority to make its original proposal. It is, of course, open to the community health councils to submit counter-proposals individually or, it they prefer, as a collective response. If the authority is unable to accept a counterproposal the matter will come to the Secretary of State for decision.
There are some who would say that the closure procedures I have described are too complex. Indeed, I know that in some quarters they are considered over-elaborate and a deterrent to the redeployment of resources with maximum speed. It is, of course, essential, particularly at this time of economic constraint, that there should be no unnecessary barriers to impede the cost-effective use of resources. On the other hand, the NHS must be responsive to the views of both patients and staff, and to hon. Members. Our system seeks to balance the need for speed with that for local and, where relevant, regional and national consultation. At present, therefore, the RHA are in the middle of a very elaborate formal consultation procedure, and we have made it quite clear that if it wishes to proceed with closure after considering the views of all those consulted, it must submit the matter to the Secretary of State for decision. He will, of course, take full account of all objections to the closure, and my hon. Friend the Minister of State for Health has undertaken to visit St. Wulstan's in order to give the Secretary of State his personal view of the situation should the RHA decide on closure. Further, because the matter seems to turn very largely on the issue of whether comparable facilities are available in psychiatric hospitals throughout the region—and this is the core of the argument—a multi-disciplinary team of my professional advisers—doctors, nurses and social workers—will be visiting St. Wulstan's, and most of the other hospitals concerned, to make an appraisal of the comparability of rehabilitation facilities in these hospitals.
As we are in the middle of a consultative process, and if the regional health authority wishes to proceed with closure the final decision will rest with the Secretary of State, it would be wrong at this stage for me to make any comment about the merits or otherwise of the regional health authority's proposal. I hope, however, that what I have said will make it quite clear to everyone involved that this is a proposal that we shall be looking at rigorously.
I have already referred to the pioneering work of St. Wulstan's and the high regard in which it is held by many who have been patients there, or who have relatives there. The hospital is undoubtedly providing a real service. As a Government we are anxious to see an improvement in services for the mentally ill, and we shall certainly not agree to close what is by all accounts a valuable facility unless we are sure that the rehabilitation units of other psychiatric hospitals in the region are providing a comparable standard of service.