I aim in these notes to share my experience of Cell Barnes Hospital in the hope they will be of use to people who were involved with the Hospital, or now live in the area where it was. This is not a history of Cell Barnes or of the care of people with learning disabilities.
I first came to Cell Barnes in 1986 when I took up my post as Unit General Manager for Mental Handicap Services in North West Hertfordshire Health Authority. In this post I was responsible for three large hospitals looking after people with mental health issues, all my previous career had been in Local Authorities working in Social Services.
In 1986 there were 650 people, mainly from Hertfordshire, living at Cell Barnes. They were all adults as the last few children had recently moved to homes in the community. The residents, some of whom had been in hospital for many years, were there for a large variety of reasons. Attempts had been made to make the care in the hospital more focused on the individual and their needs but this had not made much progress.
They lived in wards placed on either side of the central drive with approximately 30 residents. The accommodation was used as a living and dining area downstairs and dormitory sleeping upstairs, there were very few single rooms. The normal dress for residents was loose fitting uniforms and hospital provided underwear. Both hospital and personal items were washed in the hospital laundry. Meals were prepared and cooked in a central kitchen on the site before distribution to the wards in heated trolleys. As a result the food was not very fresh or appetizing when presented to the residents.
There was little opportunity for privacy and a strict daily routine, which included some day activity in centres away from the ward. The hospital farm, which had provided outdoor work for some no longer existed. There were few social events provided. There were periodic dances and film shows which were the only times when the two sexes mingled, under the watchful eyes of the nursing staff.
The care was provided largely by Nurses and Nursing Assistants, staffing levels were low and recruitment difficult. The Nursing staff were responsible to the Chief Nurse. Medical and psychiatric care was provided by consultants working both in the hospital and the community accountable to the Medical Director.
In summary it seemed that Cell Barnes was in much the same position as many other hospitals of this type were. Standards of care and accommodation were unsatisfactory. The many institutional practices seeing residents as groups rather than as individuals. The financial position of the hospital was very difficult, and worsening.
Care in the Community:
The policy of Care in the Community had been started in the 1950s and had the support of all major parties. The policy foresaw the closure of all long stay hospitals as community services developed. Although the Department of Health issued regular circulars and guidance the policy was not being implemented and a number of large hospitals like Cell Barnes had only reduced by very small numbers.
The number of people with learning disabilities in hospitals was 60,000 in 1970 and 31,000 in 1986, while in the NW Thames Region there were three of the largest of these in the country:
Leavesden 1,000 residents
Harperbury, 750 residents
Cell Barnes, 650 residents.
These three were very different but shared the fact they were in difficulty. In a number of ways as a result of slow progress being made in implementing Care in the Community. The most extreme and disturbing results of this was the exposure of serious neglect and ill treatment in hospitals of this type (Ely Hospital Cardiff, Farleigh Hospital Bristol, South Ockenden Hospital Essex).
The Department for Health was concerned about the lack of progress in the region and required the RHA to produce a plan to recover position. A similar message was given to Social Service Authorities across the RHA area. One part of the response was to bring the three hospitals together under one management concentrating on managing the programme of change. This unit of management was established in 1986 and became Horizon NHS Trust in 1991.
The Next Steps:
The newly established unit started work in 1986 and agreed a number of policies and actions, including key policy decisions:
- Resettlement became high priority from all three hospitals
- based on individuals needs/wishes
- view of family would be taken into account
- no restriction of priority for one group over another
- links with all LA’s established (20+) to ensure they take leadership of resettlement as new facilities/homes used for resettlement attract permanent funding.
- capital funds available from RHA on understanding that this would be recouped when hospitals closed and land could be sold. Principle was any money raised by land sale was for the benefit of hospital residents.
- Hospitals would release revenue funding as numbers dropped with help from RHA transition funding to ensure standards maintained.
What Happened Next:
- Progressive introduction of Individual Care Plans for all residents.
- Establishment of Ward Manager role to carry 24/7 responsibility for ward/department.
- Establishment of strong links with Hertfordshire.
- Ward closures as numbers reduced.
- Investment in staff training to improve effectiveness in current work and prepare for work in new services (IIP Award).
- Hospital closure in 1998.
Using these approached the rate of resettlement increased in a way which benefitted the individuals and helped the development of local community services across the region.