WARDS AND DEPARTMENTS IN BEXLEY HOSPITAL circa 1970’s /1980’s
R1 - THE JAMES McLEAN UNIT - Flagship of the new order
The James McLean Unit - named after the chairman of the hospital management committee - of which perhaps R1 was the flagship, had developed and flourished over the years and remained a template for similar units to spring up all over the country. Ann McLean who worked at Bexley Hospital in 1973 and was ward sister of R1/The James McLean Unit when it was first established remembers;
‘In 1973 I worked at Bexley Hospital as a ward sister and was appointed member of the commissioning team to set up an acute 30 bed admission ward serving the catchment area of central and eastern Lewisham. The establishment of this ward was a relatively new innovation in the provision of care as it was to develop a multi professional approach to treatment, ensuring patients needs were being met in a holistic way and particular needs were being supported by the appropriate professionals’
R1 ward opened on 3rd November 1973 when a group of patients were transferred from Maplehurst ward (one of the outlying Villas in the grounds) which served the Lewisham and Southwark area.
The multi-disciplinary team consisted of a Consultant Psychiatrist, Dr Douglas Brough, Nursing Officer Patricia Burnett, Sister Anne MacLean and Charge Nurse Tom Owens, Psychologist, Richard Field and a Social Worker and Occupational Therapist, who changed and moved somewhat over the years.
R1, being situated in the T corridor was close to the art therapy department and a sizeable percentage of the patients used the open sessions in the department and a good relationship existed between the staff and art therapists.
Patricia Burnett, Nursing Officer in charge of the unit was interviewed by Community Care Magazine in February 1979 and emphasised the importance of training and education for her staff team. Miss Burnett, who had trained at the Maudsley and had been an Assistant Matron before the Salmon Reorganisation had worked in Bexley Hospital for nearly twenty years. She was concerned about the poor image psychiatric nurses had with some sections of the general public and the difficulties in recruitment. But her comments on Bexley Hospital echoed others over the years ;
‘Bexley was described recently as a happy hospital with a good morale and I think this unit is a good example of what this means. We have very little hierarchical autocracy on the the wards, we lose nothing be being informal and friendly with one another and everyone understands there are occasions when we have to be more formal and not use first names for instance’
Tom Owen, who was charge nurse on R1 at that time and worked with Anne MacLean also remembers the setting up of this unit and writes;
Back in November 1973 R1 ward opened as an acute admission ward of 30 beds. the sole medical responsibility belonged to the Consultant Psychiatrist Dr Douglas Brough. Until this time consultants had to share wards between them. the concept of a full multi professional team working on the ward was one of the first in the country. the team comprised of medical and nursing staff, a psychologist, a social worker and an occupational therapist. It was also a teaching ward for all disciplines.
On admission the patient was case conferenced. the family and other involved professionals from the community attended. A care plan was set up, and a key worker named to work with the patient. The patient also had a key nurse. Subsequently to the case conference the patient was discussed every week in a review meeting by the team.
In the early days, the psychologist, social worker, occupational therapist and nurses each took a small weekly patient discussion group. There was also weekly, a ward meeting for all patients and staff. This meeting was also attended by the Hospital Chaplain, the Rev. Frank martin’.
This was indeed a progressive step forward and quite in keeping with Bexley Hospitals tendency to be on the cutting edge of innovation.
Bexley Hospital also tended to be more open in other areas, for instance to the local press and residents alike. Community care Magazine in February 19769 attempted to find out what life was like inside a large psychiatric hospital and how the ‘interface’ between hospital and community was managed. Three large hospitals refused the journalists entry, but Bexley Hospital, in the spirit of openness (in which it had a certain reputation) allowed the journalists to discover what went on in the 1,300 bedded hospital at that time. The James MacLean Unit was chosen, with its mix of four wards (An Admission ward, R1, male and female rehabilitation wards R2 and S2 and a psycho geriatric long stay mixed ward, S1 ) plus its innovative multi professional working.
Elsewhere, the success of multi disciplinary working appeared slightly less certain, i.e. in the report of the committee of enquiry, St. Augustine’s Hospital, Chartham, Canterbury, it was said that staff felt the setting up of multi disciplinary teams would provide the answer to their problems, yet as the report progressed it became abundantly clear that the complete lack of interdisciplinary understanding and co operation was one of the key factors that led to the Enquiry being set up in the first place. Allegations had been made concerning the care and treatment of patients at the hospital.
Dr Brian Ankers, PhD (an organic chemist working as a nursing assistant and Olleste Weston RMN) had produced a ‘critique regarding policy’ in which a restrained but well founded criticism of the complete lack of policy for the care of patients in its long stay wards. Specific details of the neglect and abuse were successfully brought to public attention and resulted in recommendations being made as to future reforms and changes to hospital policy and management. i.e.;
‘laying down a watertight system for internal handling of complaints; more inservice training for ward staff and management; and - centrally important - a tiered system of multidisciplinary teams, from ward level up, to hold regular, minuted meetings to decide, revise and take joint responsibility for ward policy for the care and treatment of long stay patients ’.
(Sue Thompson; ‘New Psychiatry’ April 15th, 1976)
Undoubtedly there was pride therefore within Bexley Hospital and the James MacLean Unit with its multi disciplinary team in place. It was a successful innovation in that all were involved in the assessment of new patients, decisions about the treatment plan, the weekly follow ups and the roll call on Wednesday afternoons.
The one disadvantage at the James MacLean Unit and the population it served was its distance - 11 miles from Lewisham. To compensate for this, Dr Brough and his team established an ‘outreach’ team in the centre of Lewisham.
Undoubtedly it was a very promising start and certainly signalled the shape of services to come.
(Added to, edited and abridged from ‘The Village on the Heath’ by Britta von Zweigbergk and Michael Armstrong)