| Ashworth Special Hospital: Report of the Committee of Inquiry | ||||
 Background to the Inquiry continued 1.18.0 The Special Hospitals: a Short History 1.18.1 Section 4 of the National Health Service Act 1977 imposes a duty on the Secretary of State to
There are three such Special (High Security) Hospitals in England, Broadmoor at Crowthorne in Berkshire, Rampton near Retford in Nottinghamshire and Ashworth on Merseyside. 1.18.2 The Department of Health has always had a close and special interest and involvement in these hospitals. For much of their history they were accountable directly to the Department and were outside the regional framework of the National Health Service. There is, in the NHS, a necessary tension between delegating authority as far as possible to local management and clinicians to do the most effective job possible and maintaining central oversight and control over what is a national, publicly-funded service. The balance between delegation and central direction has shifted at various points over the last half-century and will continue to do so. 1.18.3 The Special Hospitals are perhaps an extreme example of how this tension operates in practice. There was, and is, a very strong and legitimate central interest in the detailed operation of these hospitals, given the nature of the patient population. Most of them are subject to some form of restriction order, giving the Home Office a veto on various aspects of their care; a small number are very high profile indeed, attracting a considerable amount of media attention. The importance of ensuring the safety of the public means that the centre of government has, and will continue to have, an abiding interest in the detailed management of these institutions. 1.18.4 Government's interest in this area is longstanding. The first institution in England specifically built for the "criminally insane" was Broadmoor, which opened in 1863. Previous to that the most dangerous criminal lunatics were housed in Bethlem, although the majority were in ordinary county asylums. There were several calls for a separate asylum or asylums for the criminally lunatic during the first half of the nineteenth century, but it was not until the Tenth Report of the Commissioners in Lunacy, 1856, that such calls were heeded. This report pointed to the apparent success in aiding recovery of the Central Criminal Asylum in Dundrum near Dublin, opened in 1852, and condemned the state of wards for male criminal lunatics at Bethlem. The Act for the Better Provision for the Custody and Care of the Criminal Lunatics 1860 gave authority for the construction of Broadmoor, which was built to house 400 men and 100 women. By the end of the 1860s more than two-thirds of the country's criminal lunatics were said to be in Broadmoor. 1.18.5 From 1863 until 1948 Broadmoor was managed by a Council of Supervision, appointed by the Home Secretary. It was perennially overcrowded, and had to expand its capacity on a number of occasions. By 1903 it was housing 750 patients. Rampton was built to relieve this overcrowding and opened in 1912. 1.18.6 The Mental Deficiency Act 1913 established the Board of Control and required it to provide and maintain provisions for mental defectives who were violent and dangerous. The Moss Side site in Maghull (later Ashworth South) was purchased by the Board for use as an asylum, but was not actually used as such until 1933. Until 1960 patients could only be admitted to Moss Side and Rampton under the Mental Deficiency Acts of 1913 and 1938, and most were transferred from other hospitals for mental defectives, whether or not they had faced previous criminal charges. Since 1960 both hospitals have accepted patients under all the categories specified in the Mental Health Act 1959 and re-enacted in the 1983 Act. 1.18.7 The National Health Service Act 1946 transferred ownership of Rampton and Moss Side to the Ministry of Health, but they continued to be managed by the Board of Control. The Criminal Justice Act 1948 passed responsibility for managing Broadmoor to the Board of Control and ownership to the Ministry of Health. The Home Secretary retained responsibility for admissions and discharges. The Board of Control was dissolved in 1959 and the Ministry of Health took over responsibility for the three Special Hospitals. 1.18.8 The perennial problem of overcrowding at Broadmoor led to the building of a fourth hospital, Park Lane, adjacent to Moss Side. Park Lane opened in stages between 1974 and 1984. 1.18.9 By the late 1980s the hospitals had for many years been centrally managed by a division of the Department of Health in its various manifestations. The officials directly responsible for this management function combined to form the Special Hospitals Service Board, chaired by an Under-Secretary, which made major policy decisions concerning the hospitals, controlled financial and manpower allocations and played a part in senior appointments. The day to day management of the hospitals was entrusted to local hospital management teams, consisting of a medical director, chief nurse and hospital administrator. 1.18.10 This situation combined notional central control with actual neglect. Local managers did not have the authority to run the hospitals effectively; the central Board was a clumsy and ineffective way of managing large hospitals. The end result was a management vacuum at the local level, a vacuum which the Prison Officers' Association in particular was happy to fill. 1.18.11 Dissatisfaction with this situation led to the establishment of the Special Hospitals Service Authority in 1989. In the "Operational Brief", a document setting out for the new Authority its key aims and objectives, the Government gave the SHSA six main aims:
1.18.12 Two policies underpinned the establishment of the SHSA. First, to integrate the special hospitals fully into the NHS. Second, to strengthen leadership and accountability through the appointment of general managers within each hospital directly accountable to the Chief Executive of the SHSA. Mr Charles Kaye was appointed the Chief Executive of the SHSA. New Unit General Managers were appointed to each of the three hospitals. 1.18.13 The SHSA was designed to introduce a different form of management to the Special Hospitals. The Operational Brief made this very clear:
1.18.14 Despite this injunction, there was, at the same time, a formidable management agenda which the SHSA was charged with driving forward. This agenda could perhaps be summed up as being to bring the ethos of modern forensic psychiatric care into the Special Hospitals. This involved, for example, recruiting high quality staff; stamping out unacceptable practices such as those later identified by the Blom-Cooper Inquiry Report; redeveloping the hospital estate; and making the hospitals more manageable in size. 1.18.15 In the early 1990s the NHS saw further radical change with the introduction of the purchaser-provider split and the internal market. One of the SHSA's original main aims had been to bring the hospitals closer to the rest of the NHS; by the later years of the SHSA's life this translated into preparing the hospitals for trust status, whilst taking part in developing new purchasing arrangements, which eventually emerged in April 1996. 1.18.16 Throughout the lifetime of the SHSA there was regular liaison between the Department of Health's mental health policy division and the Authority. There was a review meeting once a year which constituted the formal accountability mechanism. The review meeting would discuss the Authority's performance against agreed targets over the previous year and Ministerial priorities for the coming year. Beyond this there were occasional informal meetings between members of the SHSA and Ministers and their officials. A branch within the Department had the day to day responsibility for liaising with and overseeing the work of the SHSA, and for advising and briefing Ministers. 1.18.17 These arrangements were not of course perfect; the tension between central "control" and local freedom was played out between the Department and the SHSA. We will discuss below occasions when the system of alerting Ministers appears to have broken down. As will be seen later when we deal with the Owen Ward Report the liaison relationship proved to be too dependent on the goodwill of the Chief Executive of the SHSA to keep the civil servants with whom he liaised properly informed. At that stage liaison broke down. 1.18.18 In 1996 the purchaser-provider split was introduced into the Special Hospitals. The SHSA was disbanded; in its place appeared three Special Hospital Authorities and their purchaser, the High Security Psychiatric Services Commissioning Board (HSPSCB). The Board was charged with commissioning high security psychiatric care; developing a coordinated strategy for secure psychiatric services; advising on the development of services for patients currently in the Special Hospitals and elsewhere who required longer-term secure care at levels below high security; and advising Ministers through the Chief Executive of the NHS Executive. The following paragraphs are based on the statement of Sir Alan Langlands, Chief Executive of the NHS Executive, who set out the arrangements introduced in 1996 and further recent changes as a result of the allegations made by Mr Daggett. The Special Health Authorities 1.18.19 The original goal of trust status for the hospitals was not realized, as this would not have been consistent with the Secretary of State's responsibilities for carrying out the functions of "managers" in respect of patients detained in the special hospitals under the Mental Health Act 1983 (see Section 145(1)). But the three SHAs, Ashworth, Broadmoor and Rampton Hospital Authorities, are responsible for managing the special hospitals as separate provider units in much the same way as other NHS hospitals managed by NHS trusts. 1.18.20 The three SHAs are each required to have a non-executive chairman and eight or ten members, half of whom must be non executives (either four non executives and four executives, or five and five). The chairman and non-executive members are appointed by the Secretary of State. The executive members must include a chief executive, director of finance, a registered nurse and a registered medical practitioner. The Chief Executive and Director of Finance are appointed by the non-executive members; the other executive members are appointed by the non-executive members and chief executive. Each authority is required to hold at least one public meeting a year and to present its audited accounts and annual report at such a meeting. 1.18.21 The SHAs are funded through a top-sliced allocation from within the Department of Health/Hospital and Community Health Services budget (Vote 1). The allocation is managed by the NHS Executive through the HSPSCB. Thus the Special Hospitals still, in effect, appear a "free good" to local purchasers. 1.18.22 The SHAs are accountable to Ministers through the NHS Executive. The accountability arrangements introduced in 1996 were as follows:
The Chairmen of the SHAs also have direct links with the relevant Regional Chairmen and meet the Minister at least once a year on an informal basis. The High Security Psychiatric Services Commissioning Board (HSPSCB) 1.18.23 The HSPSCB is a non-statutory committee which advises Ministers through the NHS Executive. The Board's terms of reference are to provide advice on:
1.18.24 The HSPSCB has a non-executive chairman, Mrs Anne-Marie Nelson CBE (immediate past chairman of the SHSA); the Director of North Thames Regional Office is the Vice Chairman. Other members include representatives of NHS commissioners in England and Wales, the Home Office, Prison Service, Probation Service, Social Services and Mental Health Act Commission. The HSPSCB meets at least six times a year and provides an annual report to the Chief Executive of the NHS Executive. 1.18.25 The Secretary of State's responsibilities for commissioning high security psychiatric services are discharged through the NHS Executive. Services provided by the three SHAs are commissioned and monitored through a contract process which is similar to that which operates between Health Authorities and NHS Trusts. North Thames Regional Office is the centre of responsibility for commissioning high security psychiatric services and for ensuring consistency with Ministers' overall direction on mental health policy. This accountability is by way of the Regional Director to the Chief Executive of the NHS Executive. The Regional Director is supported by the officials of the High Security Psychiatric Services Commissioning Team (HSPSCT). 1.18.26 In determining the strategy for commissioning, the Director of the Commissioning Team works closely with the High Security Psychiatric Services Commissioning Board (HSPSCB). The Chairman and individual members of the Board work closely with HSPSCT. The Chairman of the Board also has occasional informal meetings with Ministers. 1.18.27 One might be forgiven, from a perusal of the above for asking what went wrong at Ashworth in February 1997. Clearly those events leading up to the establishment of this Inquiry highlighted problems in the operation of the arrangements instituted in April 1996. Sir Alan Langlands commissioned work to examine the working arrangements and to advise on changes that might be required. 1.18.28 That review identified a lack of clarity about the relationship of each of the three SHAs to the relevant Regional Office. As a result, the North West Regional Office had been less engaged with Ashworth Hospital than is likely to have been the case had it been an NHS trust. It was felt also there had been an over-reliance on the HSPSCT to monitor operational issues within the special hospitals, and to coordinate any briefing required. These problems, it was found, had both been compounded by, and resulted in, communication problems and difficulties in achieving effective working relationships between organizations and individuals. 1.18.29 A number of measures were taken to clarify the situation. North Thames Regional Office was reaffirmed as the centre of responsibility for the commissioning of high secure psychiatric services, whilst the three relevant Regional Offices (Anglia and Oxford (Broadmoor); North West (Ashworth), Trent (Rampton)) were given full provider monitoring responsibilities, including responsibility for tracking the implementation of Government policy and performance; for providing management support to the Special Hospital Authorities; and for undertaking an annual performance review. The Department's Mental Health Branch (HSD4) maintained overall responsibility for mental health policy. 1.18.30 Briefing for Ministers is provided by officials in the relevant part of the NHS Executive regional offices, HSPSCT or HSD4 depending on whether the issue in question relates to operational matters at one of the hospitals, policy on commissioning services, or broader mental health policy respectively following consultation as necessary with staff in the hospitals, colleagues in other branches and the Home Office. 1.18.31 The four Regional Directors concerned now meet with the Deputy Director of the Health Services Directorate on a regular basis to review progress on strategy, policy and operational matters relating to high security psychiatric services. 1.18.32 It remains to be seen of course whether the amended arrangements will stand the test of time. We go into more detail below on the problems and lack of clarity in the arrangements in place in 1996/7. What is clear is that the tension between central control and oversight and local freedom and autonomy will remain under the current arrangements. 1.19.0 The Problems of the Special Hospitals 1.19.1 All three Special Hospitals have been the subject of damning outside inquiries over the last 20 years. In 1980 Sir John Boynton chaired an Inquiry into Rampton,4 prompted by a critical television programme. Sir John and his team pointed to a number of serious problems, for example: the isolation, geographically, professionally and culturally, of the Special Hospitals; a general lack of medical and nursing professional leadership, a vacuum which, in the case of nursing staff, was filled by the Prison Officers' Association; recruitment difficulties, notably of clinical psychologists; a focus on containment rather than therapy; a poor complaints procedure (of 178 complaints made between January 1974 and December 1978 not one was substantiated); and poor facilities for visitors, particularly relatives. 1.19.2 In 1988 the Health Advisory Service (HAS) visited Broadmoor.5 Their report makes similar criticisms. The prevailing culture appeared to be non-therapeutic; multi-disciplinary working was under-developed; only five consultants were in post, with some having over 100 patients in their care; and the management structure was unwieldy. 1.19.3 In 19912 Sir Louis Blom-Cooper and his team examined Ashworth and recommended a thorough-going change in the culture of the Hospital. Sir Louis and his colleagues went so far as to "question the need for the Special Hospitals within contemporary forensic psychiatric services" (see below). 6 1.19.4 In the wake of the publication of Sir Louis' report in August 1992 one of our number, Professor Bluglass, argued strongly for the closure of the Special Hospitals. He commented:
Professor Bluglass7 recommended replacing the hospitals with new, smaller local high security units, linked to local regional secure units. 1.19.5 Reducing the size of the Special Hospitals and linking them more closely with regional services was also the key recommendation of the Working Group on High Security and Related Psychiatric Provision set up in the wake of the Blom-Cooper Report. In the covering letter to his team's report Sir Louis Blom-Cooper QC, had said the following:
The then Government duly responded to these remarks by setting up the above Working Group in October 1992, under the chairmanship of Dr John Reed. Professor Bluglass was a member of the Group. The Group finished its work in April 1993, but their report was not published until 1994. They recommended that high security services should become more dispersed, with units catering for no more than 200 patients each. The number of units required would be determined in the light of needs assessment. The Group also recom-mended that NHS purchasing contracts should aim to meet the needs of those patients requiring long-term medium security. 1.19.6 More recently Professor Elaine Murphy, a member of Sir Louis' Inquiry team, has argued that the overly-custodial and anti-therapeutic ethos of the hospitals would not change until the POA was ousted from the hospitals.8 1.19.7 These reports and articles paint a picture of insular, closed institutions whose predominantly custodial and therapeutically pessimistic culture had isolated them from the mainstream of forensic psychiatry. Recruitment of adequate numbers of high quality managerial and clinical staff had therefore proved almost impossible. Patients had little or no say in their own lives. But as we set out later, the implementation of the Blom-Cooper Report throughout the Hospital was flawed and provided no effective solution. 1.19.8 The SHSA's six objectives quoted above reflect a determination to address the problems of isolation, inadequate care and therapeutic pessimism. It is generally agreed that life within the hospitals has improved. The philosophy of the Patient's Charter has been extended to the high security sector, but ineptly. Ashworth has had its own Patients' Advocacy Service for several years (as recommended in the Blom-Cooper report). Patients' Councils are in place in each hospital and millions have been spent in upgrading the estate. The balance has shifted away from an overtly custodial ethos to one which professes to be therapeutic. Links have been forged with outside academic institutions, albeit not always successfully. And the creation of a purchaser-provider split has brought the hospitals greater freedom to run their own affairs, but whether they were ready for that is doubtful. 1.19.9 However, has the pendulum swung too far the other way, creating institutions which, although more like hospitals and less like prisons, now sit uneasily in the middle, unable to balance security and therapy appropriately? Our Inquiry prompts that question. So too does the review of Broadmoor, which took place shortly after our Inquiry was established. 1.20.0 The Broadmoor External Management Review 1.20.1 During February 1997 the then Secretary of State for Health, The Rt Hon Stephen. Dorrell MP was alerted to concerns expressed by staff associations about the security of Broadmoor Hospital, the alleged undue influence of the Patients' Council and the quality of patient care. There were allegations of drugs finds and a possible child pornography ring. Mr Dorrell ordered an External Management Review of the Hospital to investigate the truth or otherwise of the allegations. The Review, led by a senior official from the Anglia and Oxford Regional Office of the NHS Executive, took place in March 1997. 1.20.2 The Review team demonstrated that most of the allegations made so vociferously in the media were unfounded. They reported that substantial improvements had been made at Broadmoor since the damning 1988 HAS Report. They rejected the charge that the Patients' Council "ran the hospital". And they found that security was given a high profile at Broadmoor. 1.20.3 This Review also made a number of comments and recommendations pertinent to our own Inquiry. Thus the team pointed out that whilst all visitors were required to pass through an anti-metal detector, official visitors, such as solicitors and visiting health professionals, were not, nor were staff. There were no rub-down searches at all. The team recommended random rub-down searches of all staff and visitors. They also recommended introducing an X-ray machine to scan all bags and packages being brought into the hospital. 1.20.4 As will be seen these are recommendations we also make concerning Ashworth. 1.20.5 The team noted that the security manual was not comprehensive and required updating, a task which they regarded as a high priority. They were concerned that the Director of Security post was advisory only and lacked the requisite authority; they recommended that the Director of Security become a non-voting associate director of the Hospital Board. 1.20.6 We are also of the view that the Director of Security should be on the main Hospital Board. 1.20.7 The team found inconsistent practices as far as searching was concerned and heard that staff were afraid sometimes to search for fear of complaints from patients. Many patients had more than the Hospital limit of personal belongings in their rooms, making searching very difficult. The team recommended that it be made clear to staff that patient areas could and should be searched. The policy on personal belongings should be reinforced. 1.20.8 It will be seen hereafter that in our view security policies need to be enforced rather than reinforced. 1.20.9 The team pointed out that introducing a new therapeutic culture to the Hospital was heavily dependent upon the skills of Ward Managers. In some places clinical practice had moved forward, and in other places it had not. 1.20.10 Although the Patient's Charter had been introduced into the Hospital some years earlier, the team felt that senior managers had not given enough thought to how such a charter should be applied in a secure setting. This had led to the promotion of patients' rights at the expense of maintaining a safe and secure environment. They recommended redrafting the Charter to take into account the unique nature of Broadmoor. 1.20.11 The appropriateness of the contents of the Patient's Charter should also be reviewed for the whole high security sector. 1.20.12 There was a widespread perception amongst staff that patients used the complaints system to try to undermine staff. Some nurses told the team that they were reluctant to undertake basic security tasks for fear of a complaint. This perception was not well-grounded in fact, but it was a common feeling nevertheless. 1.20.13 It is also a common feeling at Ashworth. 1.20.14 The team examined the workings of the Patients' Council. Whilst rejecting the media allegations, the team pointed out that the Council was not representative of the general patient population, since most of the representatives suffered from personality disorder. They recommended that the working of the Council be reviewed to make it more representative of the patient population. See paragraph 2.29.7. below regarding the recommendation we make concerning Ashworth Hospital. 1.20.15 This problem is by no means unique to Broadmoor. 1.20.16 The team noted that personality disordered patients were generally treated on the same wards as mentally ill patients, although there were several wards specializing in the treatment of personality disorder. Staff told the team that where more relaxed regimes were introduced on mixed wards psychotic patients appreciated the improvements, whereas personality disordered patients took advantage of them. 1.20.17 It will be seen that, in our judgement, patients with a sole or primary diagnosis of personality disorder should be managed in a separate high security facility. 1.20.18 The team reviewed internal and external communications within Broadmoor. Whilst praising the latter, the team saw internal communications as being rather more complex:
1.20.19 The team concluded:
1.20.20 We find this to be not only essential but elementary. 1.20.21 The issues raised above are all germane to our own Inquiry. This Review demonstrates that the task of managing a large high security psychiatric hospital is a huge one, made more difficult in some respects by recent policy changes. Has the move towards creating a therapeutic environment gone too far? The existence of our Inquiry and the Broadmoor Management Review are vivid reminders of the need continually to pay attention to the first of the SHSA's six objectives, ensuring the continuing safety of the public. 1.20.22 We turn our attention now to Ashworth Hospital. 1.21.0 The History of Ashworth Hospital 1.21.1 Ashworth High Security Hospital is situated in Maghull, some ten miles north of Liverpool city centre. There has been a hospital on the site for over 100 years. Originally the estate was owned by a prominent local merchant, Thomas Harrison. In 1878 it was sold to the Liverpool Select Vestry, overseers of the Liverpool Workhouse, who used the large house as a convalescent home for children from Liverpool workhouses. Eventually a new hospital was planned as an epileptic colony and construction began in 1911. In 1914 the Lunacy Board of Control bought the whole estate, including a large unfinished hospital. Before it could be pressed into use as a State Institution, however, the Hospital was taken over for the treatment of shell-shocked soldiers from the Great War. In 1920 the Ministry of Pensions took the Hospital over and it was not until 1933 that the Hospital became a State Institution. In 1948 the Hospital became part of the new National Health Service and in 1959 the Ministry of Health took over responsibility for running the Special Hospitals. 1.21.2 The Hospital was enlarged from the 1920s by building on what is now Ashworth East. Further enlargement came in the 1970s when the decision was taken to build a fourth Special Hospital to relieve overcrowding at Broadmoor. There was still land available from the original estate in Maghull and 50 acres of land were made available for the new Park Lane Hospital. Park Lane opened in stages between 1974 and 1984. Unlike Moss Side, it was surrounded by a high security wall, completely separating it from the rest of the site. Moss Side and Park Lane shared some facilities but operated as independent hospitals. 1.21.3 One of the first acts of the new Special Hospitals Service Authority (SHSA) was to merge the two hospitals. On 19 February 1990 the new hospital, Ashworth, was born. The old Moss Side Hospital became known as Ashworth South and East, and Park Lane was renamed Ashworth North. Ashworth South, the original Moss Side Hospital, closed in 1995. There are now plans to build a prison on that site. 1.21.4 In March 1991, the Hospital was severely criticized in a Cutting Edge television programme alleging widespread abuse of mentally ill patients by staff at Ashworth. This led to a wide-ranging public inquiry, chaired by Sir Louis Blom-Cooper QC, which put forward 90 recommendations which amounted to no less than a clarion call for wholesale culture change at Ashworth. This led to a further reorganization of the Hospital and much work to try to change the culture of the institution. 1.21.5 In April 1996 the Hospital became a Special Hospital Authority when the High Security Psychiatric Services Commissioning Board succeeded the SHSA. 1.22.0 Ashworth Hospital Today 1.22.1 The total capacity of 520 beds was gradually reduced. As one of the three Special High Security Hospitals, Ashworth receives patients from the North of England, Wales, the West Midlands and North West London. Approximately 80 per cent of patients have been convicted of a criminal offence, most of whom are subject to restriction orders. The average length of stay is eight years, but a small number of patients will never be regarded as ready to leave and will spend the rest of their lives at Ashworth. 1.22.2 Ashworth Hospital today consists of two sites, Ashworth East and Ashworth North. Ashworth East consists of six refurbished wards, two newly built wards and the Wordsworth Ward, a new 16-bedded "ward" consisting of four separate four-bedded flats. It has a total capacity of approximately 150 patients. All of Ashworth's female patients are located on the East Site, as well as a large number of mentally ill men. Physical security is provided by a high wire wall. 1.22.3 Ashworth North has 17 wards with a total capacity of approximately 370 patients. The Personality Disorder Unit and most of the male mental illness wards are located on the North Site, which also contains extensive recreational, rehabilitative and educational facilities. It is surrounded by a high concrete wall providing very considerable physical security. 1.22.4 The total capacity of 520 beds was gradually reduced. As of 12 February 1997 there were 478 patients within the Hospital as a whole, 427 men and 51 women. 79 (16.5%) had come from Medium Secure Units, 158 (33.1%) from the prison system and 105 (21.9%) from the Crown Court. A further 80 (16.7%) had come from other Special Hospitals. The largest single legal classification was mental illness (284, 59.4%), followed by psychopathic disorder (136, 28.6%). 20 patients (4.2%) had a legal classification of mental impairment and five (1%) one of severe mental impairment. A number of other patients had dual classifications, the most significant being mental illness with a secondary classification of psychopathic disorder (24 patients, 5% of the hospital). 77% of patients were subject to restriction orders. 1.22.5 The Hospital employs approximately 1,500 staff, the majority (more than 900) being nurses. Over 60 per cent of the nurses are qualified . 1.23.0 The Personality Disorder Unit 1.23.1 The Personality Disorder Unit (PDU) came into its present form in April 1994, bringing together male patients diagnosed as suffering from a personality disorder onto six Wards, namely Lawrence, Macaulay, Newman, Owen, Ruskin and Shelley. Lawrence and Owen had already cared for personality disordered patients since the 1980s, Owen (previously Forster) Ward caring for younger PD patients and Lawrence older men. 1.23.2 The decision to create a PDU was taken in the wake of the Blom-Cooper Inquiry. A Task Force was set up to oversee implementation of the Report, in particular, the creation of a new, more therapeutic ethos. As we shall see, the Task Force pointed to problems of outdated attitudes, anti-therapeutic care, professional isolation and resulting recruitment difficulties and bureaucratic and over-interfering management. They argued for the creation of a new, more patient-centred culture, with effective multi-disciplinary working and greater delegation. The Task Force recommended restructuring the Hospital into generalist mental illness units relating to specific geographical areas, and specialist units. One of the specialist units proposed was a unit for men classified as suffering from psychopathic disorder. 4Report of the Review of Rampton Hospital (Chairman Sir John Boynton) (1980) London: HMSO, Cmnd 8073. 5 NHS Health Advisory Service/DHSS Social Services Inspectorate (1998), Report on the Services Provided by Broadmoor Hospital, London: DHSS, July, HAS/SSI(88)SH 1. 6Op.cit., p.iv. 7 Bluglass R. (1992) 'The special hospitals should be closed', British Medical Journal 305, pp.3234. 8 Murphy E. (1997) 'The future of Britain's high security hospitals', British Medical Journal 314, pp.12923.
| ||||
