As I’m being increasingly swaddled in the bri-nylon sheets of middle age (comfortable, slightly uncomfortable, OUCH STATIC ELECTRIC SHOCK, and repeat) my sense of historical time is wobbling around more and more alarmingly. Last week can feel like distant history, while 40 years ago can become a blink of a(n?) historical eye [“Now children, imagine a time when people didn’t have computers or mobiles, duvets hadn’t made it to the UK, push-button phones were a bolt from the future, and you had to go to a shop to buy music played by putting a needle on to a big black plastic plate”]
It was in this mood that I went to our spankingly refurbished University library (“Look! A tree! Indoors!”), which still finds room on its gleaming shelves for all sorts of old books, reports and statistical publications. I was looking for things that might give me some way to think about what’s happened to inpatient services for people with learning disabilities in England. Are the supposedly specialist inpatient services still existing the tail-end of the old institutions or are they mainly newer services that have been developed? What clues do we have about what has changed and what may not have changed very much for people with learning disabilities living in specialist hospitals over time?
One way for a nerd like me to think about this is to look at old statistics about services for people with learning disabilities. In this blog I’m going to pull out a few statistics from a report on hospitals for people with learning disabilities in England collected 40 years ago, in 1976 (DHSS, 1980). It’s quite a comprehensive report (and very revealing in its assumptions about services for people with learning disabilities) so I’ll only pull out here some bits and pieces that I think might be relevant to 7 days of action.
The first thing that hit me was the sheer number of people with learning disabilities in hospitals in 1976. As of 31st December 1976, there were a total of 52,725 ‘available beds’, with 48,959 people living in them. 9% of these 48,959 people were children under the age of 16. It’s also worth reminding ourselves how big many of these places were – by 1976 hospitals were gradually shrinking, but there were still 12 hospitals with over 1,000 people living in each of them.
What were people living in these hospitals doing in 1976? Just over three-quarters of people (75.5%) were ‘occupied’ on the day before the census, categorised in quite revealing ways: 12.0% of people were in full-time education; 18.5% of people were engaged in ‘industrial’ activity, 19.5% of people in ‘handicrafts’, 17.4% of people in ‘social training’, 9.7% of people in ‘hospital service departments’, 1.5% of people in a local authority training (day) centre, and 2.1% of people in open employment outside the hospital. Although inpatient services now classed as ‘specialist’ would argue that they are catering for more ‘complex’ people, I wonder what people placed in inpatient units now are doing on a daily basis? As far as I’m aware, we don’t have an equivalent national picture for inpatient services today.
By 1976 there were also minimum standards in place for hospitals for people with learning disabilities. These minimum standards are in some ways set so low as to reflect how appalling these hospitals were, but again I wonder from the accounts of people and families how many current inpatient services would meet all of these standards?
The first set of minimum standards were about staffing ratios (reports around this time are very exercised about staffing ratios – while high staff ratios are certainly no guarantee of good support, very low staff ratios are probably a guarantee of poor support). The first minimum standard was 1 member of medical staff (i.e. a doctor) per 250 people – out of 61 hospitals with more than 200 residents, 3 hospitals failed this standard. The second minimum standard was 1 nurse per 4.4 people – 3 hospitals failed this standard too. The final minimum standard here was that 3.5-6.1 hours per ‘bed’ per week should be spent on the time of ‘ward orderlies and domestics’ – fully 53 hospitals failed this standard.
The second set of minimum standards was about ‘amenities’ for people living in hospitals. How this was defined I found quite shocking. First, each bed should have a minimum of 50 square feet in ‘night space’, the equivalent of a box room around 7 feet square – 11 hospitals failed this standard. In addition, there should be a minimum of 30 square feet of ‘day space’ per person (there’s no definition of what this ‘day space’ should consist of) – 8 hospitals failed this standard. People living in hospitals were also supposed to have a personal cupboard each (just one per person, mind) – 10 hospitals failed this standard. People were also supposed to have personal clothes (only for each ‘ambulant patient’ though) – again, 10 hospitals failed this standard.
To my mind these minimum standards are in many ways an artefact of an institutional era, but nagging away at me (thinking of Steven Neary’s experience in the ATU about his clothes, for example) is a question about how many inpatient specialist units now would meet all of these minimum standards?
Finally, reading through the lists of hospitals 40 years ago was an eerie experience for me. Some of them have been bulldozed, and some converted into schools, luxury hotels, complexes of executive flats, or NHS Trust HQs. Many of them are still (sometimes under different names) providing specialist inpatient services for people with learning disabilities 40 years on, in 2016. Below is a list of ‘special’ inpatient units or wards listed in 1976 (I’ve kept the original words for how units were described), picked out by me as claiming to provide similar functions to specialist inpatient services now. At the end of 1976 there were 923 people in these specialist units, with an estimated further 700 people with learning disabilities ‘accommodated in the private sector under contractual arrangements with the NHS’ (Department of Health and Social Security, 1980). How many of these places are still going, 40 years on?
Special in-patient units or wards (selected by me, relevant to ATUs) 1976
Location Type Number of beds
Prudhoe & Monkton Investigation & assessment 35
Prudhoe & Monkton Behaviour disorder & psychosis 22
Northgate & District Security (locked) 41
Northgate & District Security (locked) 38
Brandesburton, Cherry Burton Security (locked) 46
& The Beeches
Aston Hall Emotionally disturbed adolescent 60
Aston Hall Security (locked) 50
Little Plumstead Security (locked wards) 60
Leavesden Interim Regional Secure Units 100
Harperbury Security (locked wards) 21
The Manor, Epsom Security 12
Royal Earlswood, Earlswood Security 30
Home & Farmfield
Queen Mary’s Children – mental illness 26
Tatchbury Mount & Locked Ward 43
Burderop & North View Child Psychiatry 20
Coleshill Hall & Security 75
Over Whitacre House
Greaves Hall Security (adolescents – locked wards) 30
Mary Dendy Psychopathic/disturbed 55
Brockhall Security 79
Calderstones Security 14
Royal Albert Security (locked wards) 66
Wayland Behaviour disturbance 8
Department of Health and Social Security (1971). Better services for the mentally handicapped. London: Her Majesty’s Stationery Office.
Department of Health and Social Security (1979). The facilities and services of mental illness and mental handicap hospitals in England 1976: Statistical and research report series no. 21. London: Her Majesty’s Stationery Office.
Department of Health and Social Security (1980). Mental handicap: Progress, problems and priorities. A Review of Mental Handicap Services in England since the White Paper “Better Services for the Mentally Handicapped”. London: Department of Health and Social Security.