Is there no escape from Alcatraz?

“No patient has ever absconded from the type of hospital we are
proposing.” This statement is not about a privately run US
correctional facility, but comes from an outline proposal to open a
private hospital for 54 children aged 13 to 19. They would be
confined to a redundant army camp in rural Northamptonshire, behind
a five-metre high anti-climb fence and with constant CCTV
monitoring.

The proposal gives details on design and environmental impact,
noting that all the houses are locked and have specially designed
windows and doors to maintain security. Two underground chambers
found on site are to be retained as archaeological features and
converted into shelters for hibernating bats. It’s OK for the bats
to move about freely – they, unlike the patients, do not have
challenging behaviour or learning difficulties, and have not been
sectioned under the Mental Health Act 1983.

Government policy for the past 30 years has been to close down
large, long-stay, learning difficulty hospitals. Deadlines have
been agreed with ministers for the closure of the remaining 16 NHS
institutions housing the final 556 people with learning
difficulties, with the last due to happen in March 2006.

Evidence shows that large institutions do not produce good results
for their patients. Yet here we have another large, specialist,
isolated institution being recreated, using a medical model of care
and offering little more than containment. The people buying into
these places – at prices ranging from £180,000 to
£230,000 a year – are all primary care trusts that should know
better and should be commissioning alternatives to such large-scale
services. Some of the patients will still be children, so how can
this be justified in terms of current policy?

What is the point of trumpeting hard-won closures of inappropriate
large hospital services in the public sector only to pour precious
resources into recreating them in the private sector? That money
should be used to create local, small-scale resources, offer
short-term placements, and support local services to cope better
with such clients. “Alcatraz” care is not the answer.

James Churchill is the chief executive of ARC, an
organisation that supports learning difficulty service providers.
He writes here in a personal capacity.