The Commission for Health Improvement has published a damning report on conditions at the high security psychiatric hospital, Broadmoor. The commission's clinical governance review of the West London Mental Health NHS Trust, which oversees Broadmoor Hospital, confirms the widespread public impression that the facility, built in 1863, is more of a prison than a hospital.
"The overwhelming majority of ward areas at Broadmoor Hospital are totally unfit for purpose and cannot be considered an appropriate, humane environment for modern mental healthcare delivery," says the report. "It is difficult to see, in spite of the endeavours of staff at all levels, how healthcare of a sufficiently high standard can be provided in many of the current buildings, which are poorly configured, decorated and maintained and lacking in basic standards of dignity, privacy, cleanliness and amenities."
While praising the efforts of most staff, the commission found that "a small number of staff at Broadmoor Hospital have difficulty in accepting the positive changes that are promoting a therapeutic environment over the old style custodial one. Service users and staff described how this resulted in a lack of respect and hindered therapeutic relationships."
Patients face many of the same problems as the prison population, including lack of access to fresh air. "In some areas the trust is unable to meet the nationally agreed standard of 10 hours of fresh air a week in summer and four in winter." With the construction of a new unit for dangerous patients with severe personality disorder, patients in the women's wards have lost their garden area, and a high wall has been erected in front of their windows.
The West London Mental Health NHS Trust, formed in 2001, employs about 3500 members of staff and provides about 1200 beds, of which about 650 are in secure units. The trust received a one star rating in the 2002-3 performance ratings.
The commission found that "service users and staff feel that the trust is forced to concentrate its efforts on forensic services, particularly Broadmoor Hospital, due to the need to meet the national agenda and deal with public interest, to the detriment of local services."
Broadmoor's bleak and forbidding aspect limits the trust's scope for improvement, however, and the commission has approved the trust's plan to relocate women patients to other facilities, such as Rampton. Broadmoor has only recently finished the process of segregating the sexes. Although the women say they now feel safer, they complain that this has had an adverse effect on on access to activities, social events, education, and relationships.
Some heterosexual relationships, thought to be beneficial, are encouraged at Broadmoor. Homosexual relationships are still actively discouraged. "However," says the report, "some service users and stakeholders feel that the trust is not addressing this adequately, leaving some service users vulnerable and at risk from other service users."
The trust will be producing an action plan based on the commission's report, which is expected to set a timetable for transforming Broadmoor into a male only institution.
The report is available online at http://www.chi.nhs.uk/eng/organisations/london/w_london_mht/2003/w_london_mht.pdf