Reports & recommendations

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.

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’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 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 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.

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.

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 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.