From Where I sit
EDITORIAL COMMENT Yesterdays news, tomorrow’s problem
Two mysterious press ‘leaks’ before the official date of publication did a great deal to lessen the impact of the report of the committee of enquiry into Whittingham Hospital. For obvious reasons?loss of news value, topicality and so on? even a partial press ‘leak’ results in an incomplete and ‘conditioned’ reaction when the full story is known.
When the Whittingham Report was published, its findings and conclusions blazed (well, burnt gently) in headlines for a day and were gone. In several cases the headlines were restricted to the back and middle pages of newspapers, whereas the reporting of previous committees of enquiry into allegations made about conditions and treatment in mental hospitals had merited full ‘front page coverage.
It is difficult to know to what extent the muted response to the Whittingham Report was because of the ‘sting’ being removed by the ‘leaks’ or whether it was the ?apparently natural and alarming fast way in which recurring news stories get devalued in the press because ‘it has all happened before’. No longer newsworthy
The devaluing of news is a common enough phenomenon?in its ‘quiet’ periods the obscene Vietnam war slips into a kind of ‘news oblivion’ through understandable weariness on the part of editors deciding what is ‘newsworthy’ and through frank boredom and detached disinterest on the part of the public.
Another Apollo moon mission hardly warrants an eye-brow raised in interest now, already we take for granted the incredible feats of technology involved in even the simplest aspects of the Apollo programme.
The imagination and the memory of the public is saturated, and dulled in the process, to such an extent that it is almost impossible to know what to invest with value what to consider important and what to discard and forget.
Obviously, the way in which the Whittingham Report flared and died in the national press was a blessing for the psychiatric nursing profession which has been selected ?unfairly?for special treatment in the newspapers. The nurses have taken a lot of ‘hammering’ in the public debate arising out of committees of enquiry even though the committees themselves have all been at pains to make it clear that the vast majority of psychiatric nurses do a marvellous job in wellnigh impossible conditions of work.
Condemned by ignorance
But, inevitably, it has been the allegations of cruelty and callousness which have been singled out for the greatest dose of righteous indignation and all nurses have been smeared by implication in the process. This amounts to a text book case of condemnation arising out of the ignorance of those doing the condemning.
So, although it is good that the nurses were not subjected to prolonged, morale-sapping criticism during the brief ‘stardom’ of the Whittingham Report, the problem of jogging the public memory and stirring its conscience remains. Whittingham has long since been overtaken by other, bigger issues? the Common Market, Vietnam escalation, threats of chaos on the railways and so on.
The comparatively blase’ way in which the press and the public now seem to react to the facts about many of our mental hospitals?not the allegations of ill-treatment but the simple cataloguing of the age of the buildings, the inhuman overcrowding, the impossible workloads, the apathetic mis management?is depressing to say the least.
Perhaps there just seems to be too much wrong, perhaps the whole issue is too unpalatable, but the MIND Campaign is pledged to lobby government and involve the public in constant and increasing pressure from all sides to bring about change, to rearrange our sense of priorities in public spending, to champion the ‘disadvantaged’ and speak on their behalf. The enormous problems arising from the neglect of our mental hospital service have to be placed (<and kept) in the forefront of the minds of every one of us.
It is for this reason that it is disturbing to see a gradual ‘immunisation process’ taking place over the issue of the quality of life within our mental hospitals. If there are more committees of enquiry (and some consultant psychiatrists would say that hospitals which have already been subjected to enquiry are by no means extraordinary), will the immunisation process simply be reinforced? Will people persist in thinking, ‘It doesn’t concern me?and I can’t do anything about it anyway’ ? Do we get the hospital services that we deserve ?
Communications breakdown Perhaps the most startling and least discussed aspect of the Whittin gham Report is the breakdown of communications within the hospital, the torturous chains of command and the general paucity of management method.
Although allegations of callousness and pilfering are more dramatic and immediate news copy, it is the Report’s comments about ‘administration by labyrinth’ and ‘vague policy formation, splintered decision-making, inadequate delegation to officers and no systematic monitoring of performance’ which are really the most telling.
The complaints and serious allegations about conduct within the hospital which were made by the student nurses in 1967 obviously should have been recognised as a danger signal and should have been ‘picked up’ and passed through clear channels of communication from the nursing administration to the Hospital Management Committee. In fact the complaints were suppressed, let drop and ignored.
Perhaps the management complacency is accounted for to some extent by the long tenure of several members of the Hospital Management Committee. Six of the 15 had been members for 10 or more years, of these three, including the Chairman, had been members for 15 years of more. One, the chairman of the Nurse Education Committee, had served since 1948. Six were over 65 and three over 70. Referring to minutes of Hospital Management Committee meetings the Report comments ‘it is possible to read some of them without discovering what subjects were under discussion and what decisions were reached’.
Co-ordination?and even communication ? between different parts of the management structure and between the administration and the medical staff appear to have been lacking and, again to quote the Report, ‘This failure of communications substantially contributed to the therapeutic inertia on long-stay wards which gave rise to the students’ complaints of July 1967’.
Posted into the background Out vast Victorian mental hospitals have been thought of as ‘back waters’ for so long that even those working in them have come to accept the fact in a resigned sort of way. Little has been demanded of management as long as the machinery ticked over resaonably well and as long as there was no trouble. Now that there has been ‘trouble’ in one or two cases, the lid has been prised off far enough for the basic and absolutely fundamental problems to be revealed. The nursing staffs have carried on over years during which they have been largely ignored by the rest of the medical world?the demands on them, in terms of patients’ needs, have been heavy and constant, But the demands made on the administration have been virtually non-existent unless they have been prepared to make demands on themselves, to set their own standards and establish their own priorities.
For more than 10 years administrators, staff and patients of hospitals like Whittingham have known that they are scheduled to be closed. Part of the blame for apathy and neglect in such hospitals must be shared by the declared policy of planned obsolescence for the large, isolated hospital. This policy has been disasterous for morale and recruiting and it has never been realistic.
Under sentence of extinction, the buildings are patched and cobbled: and, as new district hospitals develop their acute psychiatric units, the proportion of acute mental illness treated within the old hospitals declines still further? they are gradually relegated to the role of caring for the chronics, the aged, the patients that don’t fit into the neat pattern of care laid down by Whitehall. Little wonder that medical and nursing staff are hard to attract into institutions officially said to have no future and little wonder if such hospitals get the management they deserve.
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