STARCROSS HOSPITAL: what the voices tell us Foreword A case study about moving to Care in the Community, written by David King, was published by the Nuffield Trust in 1991. [1] It sought to describe how and why the institutions around Exeter, in Devon, were closed in the 1980s, and to inspire and enable other health areas to follow suit. It was written from the perspective of overseeing the push from hospital to community care, as David was at the helm of the Exeter Health Authority throughout this period, before moving to New Zealand where he would lead similar change. Before the first of the institutional hospitals in the Exeter area closed – the Royal Western Counties Hospital at Starcross – David set in train a project to create an oral archive. Now, the opportunity has come to publish extracts from the interviews alongside a commentary drawn from David’s words – from then (1988 and 1989), from 1991, and with fresh eyes from 2020. I hope this will be a useful companion to the 1991 publication but also a tribute to those who lived and worked at Starcross Hospital as well as a window on an important part of the social history of the village of Starcross. Caroline Hill [1] Moving on from mental hospitals to community care – a case study of change in Exeter, written by David King, published by the Nuffield Trust, 1991. - 2 - CONTENTS PART I Setting the scene: page 5 Introduction The move to community care The fervour was born Why Starcross existed… Why the Starcross era came to a close… Why Starcross should not be forgotten page 11 The oral history’s intended purpose The voices Limitations A portrait of the realities PART II What the voices tell us… about: page 17 Starcross as seen from the outside Going inside - first impressions How people came to be there Institutionalisation Dis-enabled How able? Unseen abilities Cheap labour? For life – no way out A job for life – a way of life Pride in the institution Aspects of the way of life page 37 Christmas Outings Absconding Pregnancies Side rooms Drugs Inspiration for a radical new approach page 45 The feelings about closure Why had it taken so long? The enormity of the task and the obstacles The belief in the need for the institution Disbelief that it could close How closure was achieved page 53 Focusing on the people Could it have been done better? Was it working? Mixed feelings and doubts Was it working? Positives and lessons Closing hospitals does not equal Care in the Community page 65 No going back Proof in the pudding – examples of community care provision - 3 - PART III In Their Own Words page 73 The Interviewees and more of what they said … Len Vaughan………… Charge Nurse Miss Ford…….……… Dressmaker Mrs Price……….…… Nurse Arthur Mortimore…. Hospital Secretary Stormy Adams……… Hospital Mechanic DC Hammond……… Acting Treasurer Marion & Pamela…… Former residents Sybil Sivyer………….. Assistant Matron Dr David Prentice….. Medical Superintendent Mary West…................ Nursing Officer Dorothy Davey……… Teacher Jack Leach…………… Charge Nurse Lady Mary Courtenay.. Governor Elderly Group members Former residents Stan …………………. Former resident Dr David Strange…… Medical Officer Frank Lovell………… Catering Officer Trevor Buckler……. Senior Nursing Officer Viv McAvoy………… Nursing Officer Geoff Bird…………... Parent Representative D Khadaroo………… Deputy Charge Nurse Sheila Easby………… Nursing Officer Dr Peter Easby……... Consultant Dr Mary Kemp…….. GP Tom Bush………….. Nursing Tutor Peter Nutley……….. Hospital Administrator Tom Harrison……… Director of Nursing Services Anon……………….. Night Nurse Peggy Cordell………. Volunteers’ Co-ordinator Dr Chris Williams…. Psychologist Jean Waldron……… Nursing Sister Nigel Pyart…………. Adult Tutor Organiser David King…………. District General Manager Epilogue Appendices page 153 David King The Editor and Interviewers The transcripts Written archive Artefacts Publications relevant to Starcross The Western Counties institutions Timeline and Numbers And finally… - 4 - PART I Setting the scene Introduction Starcross Hospital closed in 1986 after some 120 years as an institution through which hundreds of people passed – and many remained in until their death. Founded by public subscription to train backward children from pauper homes, it became an “Idiot Asylum” and a place where people with physical disabilities such as deafness or epilepsy rubbed shoulders with people who were judged morally defective. Instead of taking in children to improve their future chances in life in the outside world, it took children and adults to “protect” the outside world from them, and them from it. Opinions varied at the time of the closure as to the institution’s success, and whether it should ever have existed or ever have closed. Care in the community had taken its place and faced the test of time. The question then being asked was: How will it compare to the care in the hospital? How will it turn out and mature? The collection of recorded interviews - made at the time that Starcross Hospital started to become a memory - sought to breathe life into the relics of the past, so that the lessons learned should not be forgotten, and in tribute to the hard work and intentions of so many people who spent much of their lives within those walls. The words may remind us why those walls have been demolished. - 5 - - 6 - Setting the scene The move to community care In 1989, in the foreword to an unpublished description [2] of the move to community care, the then District General Manager of Exeter Health Authority wrote: … mental handicap institutions were designed to give their inmates a settled and permanent life isolated from ordinary society. This policy of “institutionalisation” was well motivated and intended for people considered to be incapable of fending for themselves in the hurly burly of life. It persisted from the mid nineteenth century to the 1960s when a new attitude emerged: that people with mental illness and mental handicaps were capable of treatment and rehabilitation and should not be compulsorily separated from society but given the opportunity of remaining within it… David King speaks of “mental illness” and “mental handicap” together because he was addressing how institutional care in several hospitals was transformed in the Exeter health district into care in the community. It is interesting to note that the terms “mental illness” and “mental handicap” were those still often used at the time – phrases which had been deemed far preferable to previous terminology such as “mental deficiency”, “idiocy” and worse. They became increasingly unacceptable, and better described as “mental health problems” and “learning disability”, “learning difficulty” or “special needs”. A pioneer in championing de-institutionalisation, David was passionate about giving people, whatever their special needs, an opportunity to be part of society, releasing them from regimental controls and intolerable living conditions. He explained: There are better ways of helping people than the system of institutionalisation. Ways which… can increasingly take into account the individual needs and wishes of people. [2] Recycling the mental hospitals – better care, better value, unpublished, written by David King, District General Manager of Exeter Health Authority, in June 1989. - 7 - The fervour was born It was in the 1960s that there were the first glimmers of the move to community care and for David King these were seen at the “mental handicap” hospital, Sandhill Park, in Somerset, which he wrote about in a chapter called Consumer satisfaction – the proof of the pudding. [2] King sets the scene: If you think that life in a mental hospital is a happy existence, it is probably because you have never lived in one. It really was “life” for so many residents, in a sense akin to a life sentence. Although hospital care was supposed to be beneficial, release from hospital has been as good as a cure for so many who were thought to be beyond hope. King describes the fervour with which a house was set up for a group from Sandhill Park: We all set about it with a degree of excitement and energy as if we were preparing them for a moon landing. The group were lifelong inmates of the mental handicap hospital and this would be their first taste of freedom. It was a success, as King put it: … within a short time the only remarkable thing about it was that anyone should ever have thought it remarkable. I was very keen to see how they were getting on and called in one day. As I knocked at the door I realised that it was wrong to be visiting uninvited, though I would have walked through their wards at the hospital without giving it a thought. - 8 - Why Starcross existed King explains the history: For about 120 years, from the 1840s to 1959, “lunatics” and “defectives” were considered to be indelibly marked as sub normal and sub human. The main objective of official policy was to bring them under control in a separate world designed for their care and protection. [2] Under the Lunacy and Mental Deficiency Acts “defectives” could be apprehended and placed in an institution. At Starcross Hospital… there was a policy, initiated in 1879, to select only those cases possessing sufficient intelligence “to warrant the hope that permanent improvement could be effected.” The “lowest types of idiocy” were not deemed suitable for admission. Reading between the lines, it seems likely that poor families were able to offer to the hospital authorities those children they neither wanted nor could afford to feed… …for a hundred years, all sorts of people were admitted… for the remainder of their lifetime. There were people with learning disabilities, physical disabilities, moral reprobates, people with mental health problems and social misfits… - 9 - Why the Starcross era came to a close With more and more admissions, but few discharges, of patients, the buildings became overcrowded and too full – not as intended by their philanthropic founders.