Broadmoor Hospital

History

The hospital was first known as the Broadmoor Criminal Lunatic Asylum. It was built to a design by Sir Joshua Jebb, an officer of the Corps of Royal Engineers, and covered 53 acres (210,000 square metres) within its secure perimeter. The first patient was a female admitted for infanticide on 27 May 1863. Notes described her as being 'feeble minded;' it has been suggested by an analysis of notes that she was most likely also suffering from congenital syphilis. The first male patients arrived on 27 February 1864. The original building plan of five blocks for men and one for women was completed in 1868. A further male block was built in 1902.

Due to overcrowding at Broadmoor, a branch asylum was constructed at Rampton and opened in 1912. Rampton was closed as a branch asylum at the end of 1919 and reopened as an institution for "mental defectives" rather than lunatics. During World War I Broadmoor's block 1 was also used as a prisoner-of-war camp, called Crowthorne War Hospital, for mentally ill German soldiers.

After the escape in 1952 of John Straffen, who murdered a local child, the hospital set up an alarm system, which is activated to alert people in the vicinity, including those in the surrounding towns of Sandhurst, Wokingham, Bracknell and Bagshot, when any potentially dangerous patient escapes. It is based on World War II air-raid sirens, and a two-tone alarm sounds across the whole area in the event of an escape. It is tested every Monday morning at 10 am for two minutes, after which a single tone 'all-clear' is sounded for a further two minutes. All schools in the area must keep procedures designed to ensure that in the event of a Broadmoor escape no child is ever out of the direct supervision of a member of staff. Sirens are located at Sandhurst School, Wellington College, Bracknell Forest council depot and other sites.

Following the Peter Fallon QC inquiry into Ashworth Special Hospital which reported in 1999, and found serious concerns about security and abuses resulting from poor management, it was decided to review the security at all three of the special hospitals in England. Until this time each was responsible for maintaining its own security policies. This review was made the personal responsibility of Sir Alan Langlands, who at the time was chief executive of the English National Health Service. The report that came out of the review initiated a new partnership whereby the Department of Health sets out a policy of safety, and security directions, that all three special hospitals must adhere to.

This has resulted in upgraded physical security at Broadmoor from approximately category 'C' to category 'B' prison standards. Higher levels of security than this are then placed around certain buildings. New standards have also been formulated to increase procedural security and safety for the staff and other patients; these include procedures and equipment for reducing the amount of contraband smuggled into the hospital.

In 2003 the Victorian buildings at Broadmoor were declared 'unfit for purpose' by the Commission for Healthcare Improvement.

As well as providing patient care Broadmoor is a centre for training and research.

Therapies

Broadmoor uses both psychiatric medication and psychotherapy.

One of the therapies available is the arts, and patients are encouraged to participate in the Koestler Awards Scheme.

One of the longest-detained patients at Broadmoor is Albert Haines, who set a legal precedent in 2011 when his mental health tribunal hearing was allowed to be fully public, where he argued that he has never been given the type of counselling he has always sought; the panel urged the clinicians to work more collaboratively and clearly towards his psychiatric rehabilitation.

Misconceptions

Because of its high walls and other visible security features, and the inaccurate news reporting it has received in the past, the hospital is often assumed to be a prison by members of the public. Many of its patients are sent to it via the criminal justice system, and its original design brief incorporated an essence of addressing criminality in addition to mental illness; however, the layout inside and the daily routine are designed to assist the therapy practised there rather than to meet the criteria necessary for it to be run along the lines of a prison in its daily functions. However, nearly all staff are members of the Prison Officers Association, as opposed to health service unions like UNISON.

Jimmy Noak, Broadmoor's director of nursing in 2011, in response to concerns about the amount of resources going into the treatment of those in the facility given the harm some of them had caused to victims or their families, commented, 'It's not fair, but what is the alternative? If these people committed crimes because they were suffering from an acute mental illness then they should be in hospital.'

Historically

From its opening, until 1948, Broadmoor was managed by a Council of Supervision, appointed by and reporting to the Home Secretary. Thereafter, the Criminal Justice Act of 1948 transferred ownership of the hospital to the Department of Health (and the newly formed NHS) and oversight to the Board of Control for Lunacy and Mental Deficiency established under the Mental Deficiency Act 1913. It also renamed the hospital Broadmoor Institution. The hospital remained under direct control of the Department of Health - a situation which reportedly 'combined notional central control with actual neglect' until the establishment of the Special Hospitals Service Authority in 1989, with Charles Kaye as its first chief executive.

Alan Franey ran the hospital from 1989 to 1997, having been recommended for the post by his friend Jimmy Savile. His leadership was undermined by persistent rumours of sexual impropriety on the hospital grounds. Allegedly he ignored at least three sexual assaults that he had been informed about.

The Special Hospitals Service Authority was abolished in 1996, being replaced by individual special health authorities in each of the high-security hospitals. The Broadmoor Hospital Authority was itself dissolved on 31 March 2001.

Currently

On 1 April 2001 West London Mental Health (NHS) Trust took over the responsibility for the hospital. The trust reports to the NHS Executive through NHS England London. Leeanne McGee is Broadmoor's current executive director.

The former director, who then became the CEO of the Trust, quit in 2009 after Healthcare Commission/Care Quality Commission findings of serious failures to ensure patient safety at Broadmoor. In 2014 the director of specialist and forensic services resigned (and was employed elsewhere in the NHS) just prior to the conclusions of an investigation a bullying culture. The next permanent CEO retired in 2015 in the wake of poor Care Quality Commission findings and other problems in the Trust.

A new head of security was appointed in March 2013 - John Hourihan, who had thirty years' experience at Scotland Yard and had worked as a bodyguard for members of the royal family.

Meanwhile, the trust allowed ITV to film a two-part documentary within Broadmoor in 2014. Press releases stated that on average there are four 'assaults' per week on staff. Psychiatrist Amlan Basu, clinical director of Broadmoor since March 2014, promoted the documentary but then decided to leave the NHS in 2015 amidst funding and staffing problems - despite the Trust having just highlighted investment in his skills through its 'prestigious initiative to improve the quality of patient care in the NHS.'

Buildings

Much of Broadmoor's architecture is still Victorian, including the Grade 1 listed gatehouse, which has a clock tower.

Following long-standing reports that the old buildings were unfit for purpose (for therapy or safety), planning permission was granted in 2012 for a £242 million redevelopment, involving a new unit comprising 10 wards to adjoin the existing 6 wards of the modern Paddock Unit, resulting in total bed numbers of 234. Building company Kier reported in 2013 a sum of £115m for the new unit of 162 beds, ready to accept patients by the start of 2017, and £43m for a separate new medium secure unit for men nearby.[1][2][3][4][5]

A new unit called the Paddock Centre already opened on 12 December 2005 to contain and treat patients classed as having a 'dangerous severe personality disorder' (DSPD). This was a new and much debated category invented on behalf of the UK government, based on an individual being considered a 'Grave and Immediate Danger' to the general public, and meeting some combination of criteria for personality disorders and/or high scores on the Hare Psychopathy Check list – Revised. The Paddock Centre was designed to eventually house 72 patients, but never opened more than four of its six 12-bedded wards. The Dept of Health and Ministry of Justice National Personality Disorder Strategy published in October 2011 concluded that the resources invested in the DSPD programme should instead be used in prison based treatment programmes and the DSPD service at Broadmoor was required to close by 31 March 2012. The patients were transferred either back to prison, on to medium secure units to continue treatment, on to the residual national DSPD service at the Peaks Unit in Rampton, or to elsewhere in Broadmoor in the Personality Disorder directorate. The Paddock now, in 2013, provides general admission wards and high dependency wards for both the mental illness and personality disorder directorates, and all 72 beds are in use.

Abuse

From at least 1968 the television presenter and disc jockey Jimmy Savile undertook voluntary work at the hospital and was allocated his own room, supported by the CEO Pat McGrath who thought it would be good publicity.

In 1987 a minister in the Department of Health and Social Security (DHSS), Jean Lady Trumpington, appointed Savile to the management board in charge of Broadmoor. He was now being referred to as 'Dr Savile' by both the DHSS and Broadmoor, despite Savile having no medical qualifications or training. In August 1988, following a recommendation by Cliff Graham, the senior civil servant in charge of mental health at the DHSS, Savile was appointed by the Department's health minister Edwina Currie to chair an interim task force overseeing the management of the hospital following the suspension of its board. Currie privately supported Savile's attempts to 'blackmail' the Prison Officers Association and publicly declared her 'full confidence' in him.

After an ITV1 documentary Exposure: The Other Side of Jimmy Savile in October 2012, allegations of sexual abuse by Savile were made or re-made by former patients and staff. The civil servant who first proposed Savile's appointment to the task force at Broadmoor, Brian McGinnis, who ran the mental health division of the DHSS in 1987 before Cliff Graham, has since been investigated by police and prevented from working with children. A Department of Health investigation led by former barrister Kate Lampard into Savile's activities at Broadmoor and other hospitals and facilities in England, with Bill Kirkup leading the Broadmoor aspects, reported in 2014 that Savile had use of a personal set of keys to Broadmoor from 1968 to 2004 (not formally revoked until 2009), with full unsupervised access to some wards. 11 allegations of sexual abuse were known, thought to be a substantial under-estimate due to how psychiatric patients in particular were disbelieved or put off from coming forward. In five cases the identity of the alleged victim could not be traced, but of the other six it was concluded they had all been abused by Savile, repeatedly in the case of two patients.

The investigation also concluded that 'the institutional culture in Broadmoor was previously inappropriately tolerant of staff–patient sexual relationships,' and that when there were female patients they were required to undress and bathe in front of staff and sometimes visitors. A 'shocking' failure to ensure a safe or therapeutic environment for female patients had already been revealed in a 2002 inquiry prior to Broadmoor becoming male-only.

In 2010 a female charge nurse received a suspended prison sentence for engaging in sexual activity with a patient at the hospital.

Violating patient confidentiality

Journalists invading the privacy of patients or reporting false information about them have been the subject of dozens of complaints from Broadmoor. Healthcare assistant Robert Neave took payments from The Sun for several years to provide them with information, including copies of psychiatric reports, which has subsequently been investigated by Operation Elveden. Mental health nurse Kenneth Hall was imprisoned in June 2015 for having repeatedly sold stories to the tabloids based on stolen medical notes and fabricated documents.