Whittingham Hospital Inquiry

The Department are, we understand, about to issue guidance on the problems of transition from mental illness services based on specialist psychiatric hospitals such as Whittingham to those based on units in general hospitals. Further thought and advice are urgently needed on provision that will have to be made for elderly long-stay patients who cannot be permanently accommodated in these new general hospital departments.

There is a need for improvement in procedures to deal with complaints from staff and patients: we refrain from making a more specific recommendation because, since our Inquiry began, a special Committee has been set up to look into complaints procedures.

The Department are now preparing new guidance on the control of patients’ money which will avoid the retention of large sums at ward level. We welcome this but hope that nurses will be able to retain and develop their therapeutic role of participating in the assessment of patients’ capacity to handle money and guiding them in spending it.

Since audit inspections at Whittingham before 1969 apparently failed either to detect the collapse in the system of ward records of patients’ money or to investigate the decline in volume of shop takings compared with the amount of patients’ allowances, audit inspection procedures generally should ensure that matters of this kind are properly examined in future.

Deficiencies in staffing at Whittingham Hospital shown in annual returns to the Department and to the Board have not resulted in action to remedy them and we consider that monitoring arrangements need re-examination.

We note the absence of local authority facilities in the Whittingham catchment area and consider that the Department should take steps to promote closer co-operation between the Regional Hospital Board and the local authorities concerned in planning the development of services for the area.

In the light of our findings we consider that the Board have suffered from a lack of advice from the field. The Board should establish a multi-disciplinary advisory panel containing comprehensive professional representation from the field to advise them on current problems in developing psychiatric services in the Manchester Region.

The Board should review its monitoring of staffing levels in psychiatric hospitals.

The Board’s programme of reorganising mental illness services should emphasise factors which seem to us not to have been adequately recognised and are essential to the implementation of their policy: (i) the need to provide day places as well as beds in new district general hospital departments, (ii) the need for effective liaison with those responsible for supporting community services—hostels, day centres, group homes, old people’s homes and social work support—and (iii) the need for a positive policy for long-stay and elderly patients in mental illness hospitals, including alternative accommodation for such patients when existing specialist hospitals are replaced in the course of time.

At least four new consultant psychiatrists should be appointed to Whittingham Hospital, with appropriate junior staff, and in making appointments the special needs of long-stay psychiatric and geriatric patients should be borne in mind. There will need to be an equitable reallocation of sessions to ensure that all consultants obtain a suitable variety of work.

The present members of the Hospital Management Committee should be invited to resign and the Committee reconstituted. In view of the pressing need to reorganise services at Whittingham, a small committee of about eight should be set up pending the establishment of an Area Health Board covering the Preston area. There is a need both for fresh blood and for continuity ; and also for close links with the Preston and Chorley Hospital Management Committee and the Directors of Social Services for Preston County Borough and Lancashire County.

The new Hospital Management Committee should carry out a thorough review of the reorganisation of services needed at Whittingham Hospital.

The new Hospital Management Committee should be responsible for drawing up a plan for the hospital, on the lines set out in Chapter 5, which should be agreed with the Regional Hospital Board and made known to all hospital staff.

There should be a drastic reduction in the number of sub-committees. With a small Hospital Management Committee we doubt the need to have any standing sub-committees at all.

The new Hospital Management Committee should maintain close liaison with the Preston Group to co-ordinate policy, particularly in relation to the admission unit at Sharoe Green and to plan a new service based on general hospitals at Preston and Chorley.

The senior medical staff with clinical sessions at the hospital, together with representatives of other medical staff, should constitute a Medical Executive Committee, electing a Chairman whose appointment should be subject to yearly renewal. The Chief Nursing Officer and other professional heads, including the local Directors of Social Services, would no doubt be invited to attend as appropriate. It would ease communications if the Group Secretary could be appointed its Secretary. The Committee’s task should be to co-ordinate medical policies not only for Whittingham Hospital, including Ribchester, but also the psychiatric unit at Sharoe Green and the out-patient departments and new psychiatric facilities planned for the Preston Group.

The Group Secretary, the Chairman of the Medical Executive Committee and the Chief Nursing Officer, with other appropriate professional heads, should constitute a Professional Executive with delegated authority for day-to-day management of the hospital. They should maintain close liaison with the local authority Departments of Social Services. Similar co-ordination at other levels should be achieved by setting up multi-disciplinary therapeutic teams, consisting of doctors, nurses, social workers, psychologists and occupational therapists.

The employment of general practitioners should be rationalised to cover the day-to-day needs of long-stay patients: but their valuable contribution should not be regarded as a substitute for specialist services.

The Chief Nursing Officer should become head of a co-ordinated psychiatric nursing division, including Ribchester, Sharoe Green and the future hospital department at Preston. The current reorganisation of nursing staff on Salmon Report lines should continue within this framework.

Training for student and pupil nurses and experience of trained staff should be arranged in co-ordination with Sharoe Green and the new Preston hospital facilities to give adequate variety in all types of patient care.

Procedures for the selection and appointment of nursing staff (including internal promotions) should be brought into line with the recommendations of the Report of the National Nursing Staff Committee and a staff appraisal system, as recommended by that Committee, introduced as soon as possible. In particular, all posts at Ward Sister/Charge Nurse level or above should be advertised outside the hospital.

The extension of service after retirement age should be most carefully considered in each individual case and regularly reviewed.

The General Nursing Council should be invited to inspect Whittingham Hospital.

Domestic duties should, so far as possible, be separated from nursing duties and a special programme started for recruiting and training domestic workers.

Psychologists employed at the hospital should form one department and their work should be integrated into the therapeutic programme as a whole.

A strong group of social workers should be recruited in association with the Local Authority Social Service Departments of Preston County Borough and Lancashire County and services built up along the lines set out in Chapter 7.

All occupational services, including industrial therapy, should be effectively co-ordinated under the aegis of a professional Resocialisation Group. They should be expanded, with the emphasis on industrial therapy, to provide activities for all patients who can make use of them.

The Treasurer’s Department should be strengthened to enable the measures recommended in the audit reports to be implemented as soon as possible.

The inner catchment area of Whittingham Hospital coincides with that of the Preston Group. This should be split into defined districts, each with the responsibility of a single multi-disciplinary therapeutic team.

Admission of patients from outside Preston and its surrounding district (the inner catchment area) should cease as soon as possible.

In so far as a psycho-geriatric assessment unit would bring relief to Whittingham, we consider such a unit should be provided in Preston, not at Whittingham itself.

There should be a crash programme to update sanitary facilities in all wards that have not been upgraded.

The complement of building and engineering staff should be reviewed.

Overtime worked by building and other staff should be more strictly controlled.

Farms and market gardens should be sold as soon as possible.

There should be a simple and attractive information booklet which should be given to each patient and his relatives on arrival specifying, among other things, the procedure for making suggestions and complaints.

Truly unrestricted daily visiting, which does not exist at present, should be introduced as soon as possible.

To assist visiting by relatives and recruitment of staff there should be a considerable improvement in transport facilities to and from Preston and the surrounding area.

A paid co-ordinator of voluntary services should be appointed and local community participation in the hospital’s activities developed by every possible means.

The out-dated aura of seclusion at Whittingham should be dispelled by positive public relations activity. A member of the administrative staff, with suitable qualities, should be given a special responsibility for liaison with the press so as to cultivate constructive public interest in the life of the hospital.