§ Motion made, and Question proposed, That this House do now adjourn.—[Mr. David Hunt.]
§ 10.1 pm
§ Sir Nicholas Bonsor (Nantwich)
I am grateful to you, Mr. Deputy Speaker, and to the House for the opportunity to raise a matter that should cause grave public concern. It arises from the decision of the Cheshire area health authority to close a hostel for the mentally handicapped in my constituency at Wrenbury.
I should like to tell the House something of the patients currently at that hostel, its purpose and the patients' way of life. At the moment there are 11 patients in the hostel, which is built to cater for 17. They range in ages from 28 to 73. Two of them are over 70—a 72-year-old and a 73-year-old, who have been there for 16 and 32 years respectively. All the people who live in the hostel consider it as home and consider the wardens who run it as their parents and the only people to whom they can turn for the love and affection that they need.
The manner in which the closure has been proposed of the hostel is also a matter that should cause the greatest concern, particularly because the doctor who is in charge of the patients, Dr. Austin, the psychiatrist who is responsible for looking after them and the medical director of Cranage hospital, to which the area health authority proposed to send the patients, agreed that any such move would have disastrous consequences on the health of the people who live in the hostel.
Whatever the merits or demerits of the closure of the hostel, nothing can excuse the manner in which the area health authority went about its task. Nothing can excuse the fact that, despite assurances throughout the proposal closure from the area health authority that each one of those 11 patients would be given individual attention and would be placed according to his needs, there was at all times a plan to put all 11 into a hospital the medical director of which said was totally unsuited to them.
When the local residents discovered that, and having more or less reconciled themselves to the fact that the hostel might have to be closed, they decided to take steps to do something to save those people from the danger in which they were placed, particularly as the doctor had said that the two 70-year-olds might not survive any further move from that place to another institution.
When the local residents got together and decided to form a charity, they asked me to come to their meeting and to do what I could to help. At the meeting they expressed a fear that the hostel might be closed before they had the opportunity to do anything to get their charity under way, to purchase the hostel and to make arrangements for the necessary funds to be raised to run it and to allow the residents to continue their lives in it.
Therefore, I telephoned Mr. Argent of the area health authority. He categorically assured me that nothing would happen until the end of February. It was upon that assurance that the committee and I assumed that there would be time for the charity to be formed. A few days later I wrote to the chairman of the area health authority, Mr. Stevens, and explained the position. I asked him to give us time, by deferring the closure until we could see whether the charity could be set up. He received that letter on 13 January and presented it to a meeting on either 14 or 15 January.
104 Simultaneously with the meeting held by the area health authority, however, on its authority a van was sent to collect the residents from the Wrenbury hostel and remove them to Cranage mental hospital. That was done without informing the warden or any of the people concerned with setting up a charity to save the hostel. Indeed, it was done on a day when the area health authority officers believed that Mr. Stephens, the warden of the hostel, would be out on his day off. As fortune would have it, he did not go out and was at the hostel when the van arrived to remove the unfortunate patients to a place where a doctor had advised that at least two of them might die. The warden thus stopped the move and, with local councillors, residents and the police, prevented the people from being taken away.
After that, I again contacted Mr. Stevens, the chairman of the area health authority, and again requested time so that a charity could be set up. Notwithstanding the letter in which I had set out the facts or the way in which the residents were demonstrating their support for the hostel and those living in it, he refused point blank to defer closure of the hostel or to prevent the removal of the patients in any way. Fortunately, pressure on the ground was stronger and the people from Cranage returned without the patients. Moreover, I believe that my hon. Friend the Minister of State intervened to ensure that there would at least be an opportunity for the matter to be deabted in the House before any further steps were taken to remove the people from the hostel.
The story did not end there. Shortly afterwards, the warden of the hostel was summoned to a disciplinary hearing, the intention clearly being to dismiss him from his job and thus render the continued operation of the Wrenbury hostel impossible. Had the warden been removed, there would have been no further possibility of preventing removal of the patients to the mental hospital. On the advice of his union and others, the warden did not attend the disciplinary hearing but insisted that when he attended he should be properly represented by both a union representative and a legal representative. There the matter now stands.
A further letter was sent to the warden by a Mr. Briggs of the area health authority, however, couched in terms which, to put it mildly, were somewhat illiterate and which displayed great objection and hostility to the proposal to set up a charity, attempting to obstruct meetings being held at the hostel by those wishing to set up the charity and forbidding the holding of any further such meetings without his consent.
I should say at this point that the warden and his wife have shown unstinting devotion to the care of the patients, giving them love and understanding far beyond the call of duty. Indeed, in 1978, they were singled out in the regional health authority report by the author, Dr. Simon, who commended them for the care and affection given to the patients and for the loving and homely environment created for them.
Not content with the petty vindictiveness that it had so far displayed, the area health authority a week ago last Thursday removed the caravan which the Women's Institute had provided 15 months previously for the use of the unfortunate people at the hostel for rehabilitation and to help them to do useful things. The caravan was removed on the entirely spurious ground that it constituted a fire risk. It was subsequently sold for £50, despite the insurance valuation of £1,500 and notwithstanding the 105 obvious anger of the people who had saved money and devoted much effort to provide it for the use of the patients. I do not know the real reason for that, but we are asked to believe that it was coincidental that such a move was made at precisely the time when there was a dispute about the future of the hostel.
To return to the charity and the possibility of keeping the hostel open, great steps have already been taken to set up the charity. An ad hoc committee has been formed. An independent valuation has been made by a qualified local valuer. If the district valuer sets a similar value on the property, I believe that funds are available for the purchase and continued running of the hostel.
Furthermore, the Department of Health and Social Security has been contacted and I have been assured personally by the Department's representative that the home will obtain section 1 classification at any rate for a 12-month period so that certain minor improvements may be made. Moreover, he sees no reason why that should not be permanent once the improvements have been made. The resident will then qualify for grants of up to £50 per week, plus £7.70 pocket money. That should enable many of the running costs to be defrayed from that source, particularly if another three or four residents can be found to add to the happy family living there at present.
I therefore believe that the proposition to form a charity is genuine. Certainly at the meeting I went to last week, which was well attended by local residents, there was an absolute determination to give support and continued help to the people who live in that hostel. They are largely integrated in to the local community. They go to the local pub. Some of them do odd jobs such as labouring. One plays snooker with friends.
As I have said before, all of them treat the hostel as their genuine home. They have all settled there, and are immensely upset at the prospect of being moved away from a village environment into a mental hospital where they will not be able to leave the buildings and there is no contact with the local people. They will be entirely reinstitutionalised and degraded from the stage that they have now happily reached. I very much hope that my hon. Friend the Under-Secretary will be able to give me assurances about the future of this project.
In particular, I ask for five things. First, there should be a swift valuation of the premises by the district valuer so that those trying to raise the charitable funds can know whether it is a serious possibility. Secondly, we should be given three months from the date of receipt of the valuation in which to set up the charity, and no move should be made to close the mental hostel during that period. Thirdly, there should be no further harassment of the warden by the area health authority, and there should be no question of disciplinary proceedings against him, which will only upset the running of the home. Fourthly, no further steps should be taken to prevent the residents and the voluntary helpers giving everything they can to keep the hostel going. Fifthly, they should he allowed to hold their meetings there and take the steps necessary to create the charity.
If those assurances cannot be given, I ask for a public inquiry into the conduct of the area health authority. I say that particularly in view of often-stated Government policy that there should be a move to small, community-integrated homes. A move with such determination in the opposite direction is something that the public has a right to see investigated.
106 In the longer term, there should be a change in the law to make the new health authorities that are about to be set up more accountable to the Government and to this House, so that when lives are at stake and there has been suffering, as there has been in this case, those responsible are accountable for their actions.
§ The Under-Secretary of State for Health and Social Security (Mr. Geoffrey Finsberg)
I am grateful to my hon. Friend the Member for Nantwich (Sir N. Bonsor) for raising in such a clear way the proposed closure of Wrenbury hostel, Nantwich. This is an unusual closure proposal, involving as it does a small unit for the mentally handicapped with a surrounding community that has made clear its great support for the hostel's work. That support is not found everywhere. It is, therefore, right that we should consider carefully the proposals of the Cheshire area health authority.
In May 1980, the Cheshire AHA considered proposals from the Crewe health district to acquire premises at the former Soss Moss school for epileptics as a replacement for unsuitable accommodation at the adjacent Mary Dendy hospital for the mentally handicapped. Soss Moss consists of four residential homes, the former headmaster's house and assorted workshops and outbuildings.
The accommodation is largely on the ground floor and in good repair, and was likely to be available at a reasonable price. It was thought that it would be highly suitable for a number of elderly and frail mentally handicapped patients at present living in upper floor accommodation at Mary Dendy hospital. It was hoped that some patients in similarly unsuitable accommodation at Cranage Hall hospital might also go to Soss Moss.
However, it was recognised that acquisition of this property would entail a degree of rationalisation of mental handicap facilities in and around Crewe. In particular, Wrenbury and Tabley hostels and certain house units at Mary Dendy hospital were proposed for closure in order to contribute to the capital cost of acquiring Soss Moss and the subsequent revenue costs.
The Crewe community health council was approached for its views, although this was not at that time a formal closure proposal. On 14 May 1980, the CHC resolved:The Crewe Community Health Council agrees to the closure of Wrenbury and Tabley Hostels and the Moss and Ivy House units at Mary Dendy Hospital on condition that the capital and revenue monies are used to off-set the expenses of purchasing and running Soss Moss School as a unit for the mentally handicapped.It might be helpful at this stage to describe Wrenbury Hostel. It is a small, 17-bedded unit in hutted premises which were erected as a temporary Land Army hostel in the Second World War. Only 12 of those beds are currently occupied. It is in a somewhat isolated situation with minimum public transport facilities and no adult training centre in the vicinity. Patient accommodation is, in the main, in dormitories with combined dining and recreation facilities. It has an establishment of two wardens who work different shifts with a very limited amount of domestic support. Relief cover for the wardens is provided by nursing staff from Cranage and Mary Dendy hospitals, a somewhat difficult arrangement.
The hostel was originally intended as an agricultural hostel for the less severely handicapped. The patients used to obtain casual employment on neighbouring farms, but with the increased mechanisation of agriculture, fewer and 107 fewer were able to do so. Only one resident is now in regular outside employment. Others obtain casual employment or do domestic work in the hostel. A small amount of commercial work is undertaken at the hostel in the summer months.
Most of the hostel's residents are hospital long-stay patients and few have any connections of origin with the surrounding locality. Few of the residents require the constant medical or nursing attention which is the normal current criterion for hospital admission.
The role of Wrenbury hostel as part of the NHS is difficult to justify with conviction. A report in 1978 on mental handicap services in Crewe suggested that the hostel was serving no useful purpose in treatment, training or rehabilitation and recommended that discussions should be opened with the social services department with a view to its taking over responsibility for the hostel. Such discussions have taken place. The social services department recognises that most of the residents are probably their responsibility, but financial constraints and the fact that the hostel itself is not up to the normal standard of building expected of a social services facility have so far led to its declining to take on the hostel as it stands.
The future of Wrenbury if it were not to close is even more difficult to assess. Increasingly the sort of patient who would once be sent there is being discharged into social services hostels, group homes or the community. As a result, recent arrivals at the hostel have tended to be increasingly severely handicapped. To some extent, the hostel is beginning to function as an outpatient ward of Mary Dendy and Cranage Hall hospitals. The residents have to be transported to those hospitals for any rehabilitative work that has to be done.
It is very seldom that mentally handicapped patients from the locality of the hostel who would benefit from NHS treatment can be placed there. The number of long-stay NHS patients who could therefore benefit from the hostels will decline, while the number of handicapped and severely dependent patients who require ground floor accommodation in a hospital setting is growing. That means that while the utility of the hostel in a Health Service setting will decrease, the need for the acquisition and use of ground floor accommodation at Soss Moss is great. The proposed closure of the hostel is therefore, seen by the area health authority as instrumental in helping it to develop its proper responsibilities more adequately.
If the hostel is to close, eight of the current patients will move to the former headmaster's home at Soss Moss school, once a certain amount of building work there has been carried out. That house will provide facilities for semi-independent living. Two will go to Cranage hall hospital and the remainder to another block at Soss Moss school. The aim will be to provide the patients with an opportunity for more active rehabilitation—an opportunity they are largely unable to accept at present. It would then be possible for them to take advantage of Crewe health district's active programme of developing group homes so that ultimately some of the patients could be discharged to independent living.
The area health authority is of the view that the hostel is not suitable for alternative health service use. It intends that the hostel should be disposed of on the open market and the capital thus released committed towards the 108 purchase costs of Soss Moss. Soss Moss has been acquired at this stage through a capital loan from the regional health authority. That is within my Department's general policy, which is that the release of resources within a priority sector should be reinvested to enhance care within that sector. Similarly, the revenue released would be used to supplement the funds of Mary Dendy and Cranage Hall hospitals. It is not possible, in advance of the district valuer's valuation, to say what the capital saving from closure would be, but the running costs are around £55,000 a year.
As to staffing implications, the staff at the hostel will be offered alternative employment within Crewe health district, although it is recognised that this work may be of a slightly different nature to that which they currently perform.
That, therefore, is the case for closure put forward by the area health authority. As was required, the authority undertook consultations on the closure proposal. Two community health councils are involved—Crewe and Macclesfield. Wrenbury hostel is physically located in the Crewe district, while Mary Dendy hospital and Soss Moss are within the Macclesfield district. At present, the latter facilities are run by Crewe health district, but they are to transfer to Macclesfield district health authority on 1 April. Both community health councils agreed to the closure.
There were objections, and those concentrated on the suggestions that Wrenbury hostel, in particular, and as my hon. Friend clearly said, provided a happy and community-linked environment for existing patients and that the patients were to a considerable extert integrated into the Wrenbury community. The area health authority recognises the force of those objections. However, it argues the the current use of the hostel should be viewed not in isolation but against possible alternative placements most suitable for each individual client. It points to the arguments that I outlined earlier—that is, that the role of the hostel in providing active treatment, training or rehabilitation is extremely limited and that by placing patients in the pre-discharge unit at Soss Moss it would be possible for many of them eventually to move to group homes in the community. In that setting they would have an equally good opportunity to develop the local support and friendship which the Wrenbury villagers have already demonstrated.
In short, the great majority of the objections related to a concern that the family-type living closely linked to the community would be lost by the former hostel residents if they were transferred to large hospitals. In reply, the authority has suggested that the relocation of each patient would be considered in that patient's interest and that most of the patients would be rehabilitated to group homes or other independent or semi-independent living, where similar community contacts could be engendered. The Cheshire area health authority considered the results of consultation in December last year and agreed to close Wrenbury hostel as soon as alternative facilities at Soss Moss were completed. Because the closure proposal was not objected to by the community health councils involved, there was no requirement for it to be referred to Ministers for a final decision.
I now turn to more recent events. During the early part of January, the heating equipment at Wrenbury was continually breaking down in the extremely cold weather. This entailed continued repair work by the district's 109 engineers, who were also busy attending to breakdowns elsewhere. Eventually, the Crewe district management team decided that it was necessary to concentrate patients in as few locations as possible because it was becoming impossible to maintain services throughout the district. Accordingly, Wrenbury was to close on 15 January and the patients found alternative accommodation until the builders had completed adaptations to the accommodation at Soss Moss, which, as I said earlier, was earmarked for the Wrenbury patients. Fortuitously, the area health authority happened to be meeting that afternoon and endorsed the decision.
Meanwhile, a group of local residents in Wrenbury had gathered at the hostel with the intention of preventing the removal of any patients. The district administrator and the district nursing officer went to the hostel and, following a lengthy meeting with the local residents, agreed not to close the hostel on that day. This decision was taken in the light of two factors. First, the weather had become considerably milder and further trouble with the heating was not necessarily to be expected. Secondly, the residents announced their intention of holding a public meeting to see whether there was sufficient support to set up a trust fund to support the hostel outside the NHS.
In response to representations by my hon. Friend, my hon. Friend the Minister for Health has written to the chairman of the Cheshire area health authority asking for his comments. This is essentially an issue for the local health authority, which has operational and planning responsibility for the mental handicap services in Crewe, but it seemed to my hon. Friend that there were one or two issues which needed to be aired more fully. First, we wish to be reassured that the alternative placement of the Wrenbury patients is satisfactory.
My hon. Friend the Member for Nantwich has referred in correspondence to suggestions that some of the patients may suffer seriously as a result of any move. Those suggestions were not made during the consultation process and I am not in a position to express an opinion on them, but this is clearly a development which the area health authority will wish to consider most carefully.
Secondly, I am firmly of the view that time must be given to the local residents to see if they can raise the funds to establish the hostel outside the NHS. As my hon. Friend said, some support was forthcoming at a public meeting held on 22 January.
The chairman of the authority has now replied. I am glad to be able to tell my hon. Friend that no date will be fixed for closure until my ministerial colleagues and I have had the opportunity to consider the matter further. The proposal put forward by my hon. Friend that closure 110 should be deferred for three months from the date of a valuation of the site by the district valuer seems to me to be sensible. This means, of course, that the final decision on the future of the hostel will fall to be taken by the new Crewe health authority after 1 April.
As part of his five-point programme, my hon. Friend has called for a public inquiry into the proposed closure and into the authority itself. I hope that he will now feel that this may not be needed.
In conclusion, I congratulate my hon. Friend on raising the issue. Although the hostel is small and the number of patients affected few, it is entirely right that this House should devote the same degree of attention to those few patients as to a larger number affected by a major closure. I can see the force of the area health authority's argument that the balance of advantage for all mentally handicapped patients in the district lies in the proposed rationalisation of facilities, but I am equally concerned that the support which the villagers of Wrenbury have offered the hostel should not be lightly rejected. I am delighted that the chairman of the area health authority has agreed to allow time for further consideration of the matter. 1 think that the right course is now for all interested parties, including the Social Services Department, to use this breathing space to see how the local interest that the closure proposal has aroused can be harnessed to best effect.
My hon. Friend raised five points. He asked about the valuation. I hope he will agree that the area has met him on this, in that there will be three months' grace after the district valuer has reported to give time for the money to be raised.
I cannot answer my hon. Friend on the question of the warden, because that is a matter for local management, and it would be wrong for Ministers to interfere.
I hope that I have persuaded my hon. Friend that a public inquiry is not necessary now.
With regard to my hon. Friend's last point, all I cart say to him is that, while his suggestions about a change in the law is interesting, if I were to develop it at any length, he would rightly remind me that Adjournment debates are not intended for proposals that may change the law. If he cares to write to me in some detail I shall gladly have the matter investigated to see whether, on a more appropriate occasion—and if there is any proposal to change legislation—the pertinent points, which he has raised can be taken into account.
I compliment my hon. Friend on the deep interest that he has taken in these very unfortunate people, and I hope he will feel that his efforts tonight were well worth while.
§ Question put and agreed to.
§ Adjourned accordingly at half past Ten o'clock.