Lamenting the passing of the age of clinical innocence

Dr. Dermot J Ward recalls a slightly bizarre ‘messenger boy errand’ to the Old Bailey at a time when he, as a trainee, was able to guarantee the judge of the supply of a mattress to admit an intellectual fitness patient
‘Ward, could you are taking those case notes up to the Old Bailey for me?”
The Old Bailey was the internationally-famed Criminal Court in London and that “Ward” turned into certainly me in my first psychiatric education job. It was the early Nineteen Sixties. The representative psychiatrist in the query (that made the request) turned into then well-known as a forensic psychiatrist.
Perhaps a little eccentric, he turned into recognized to ask gents approximately to escort a daughter had invited her out for an evening, to sign a word of criminal accountability, protective the daughter’s safety for that evening. Not against the law. He has long gone to his reward.
He has been quite near retirement. As it occurred, I became now not one in all his clinical crew. I thought the request of my messenger boy errand additionally a bit peculiar. Good education jobs inside the National Health Service (NHS) than have been more difficult to get. Mine turned into titled Peripatetic Registrar and worried 4, six-month schooling intervals in 4 special district fashionable psychiatric hospitals one among which become committed to what changed into then referred to as intellectual handicap.
The latter become no longer than the maximum famous career desire and people who would possibly overstay (voluntarily) their stint in mental handicap may want to discover it greater difficult to return to general psychiatry.
Driving to Old Bailey
But lower back to our major topic, the case notes for the Old Bailey. Being some thing of a minor petrolhead, I became now not unhappy to power up in my nearly-new Yellow/Black trim Austin Healey Sprite and parking the open sports activities car proper up close to the Old Bailey. That’s the manner parking turned into then (now a bar of gold might do best for starters). However, on entering the pubic region of the Court I discovered a respectable who confirmed me the right ready vicinity. With time to spare I glanced idly on the paperwork, looking forward to my contact. The accused guy changed into, superficially, a pleasing older chap who allegedly had in the path of a day cinema overall performance positioned a hand on a younger lady’s knee. An analysis of schizophrenia became cited. In passing, disinterestedly I thought it all psychiatrically slim but no skin off my return. The right psychiatrist, an idea I, could doubtless carry out properly for the Court hearing.
The witness container
Suddenly, the cozy atmosphere for me dissolved as a Court professional escorted me towards the witness box and it dawned on me that I turned into predicted to provide this case to the Court. What I don’t forget as I ascended the steps to what seemed almost the gallows, I observed a younger policewoman, bless her, smiling encouragingly at me possibly noting my exsanguinated face. But I needn’t have involved pretty so much. The Judge did now not ask me penetrating questions which could clearly have uncovered the self-esteem of my weak diagnostic information of the affected person. I too turned into aware of the Court’s preoccupation with “Disposal” i.E. Had I a psychiatric mattress into which the patient could be admitted. I had one such. And so off we set, the affected person and me in my golden yellow chariot for a health facility mattress in Horton Hospital Surrey.
Breakfast with Powell
It turned into around the time I had that breakfast with Enoch Powell. That healthcare flesh presser had already eroded medical institution affected person mattress numbers in all clinical specialties (however greater so in psychiatry). Eventually, the national stage became decreased to properly-nigh impossibly low ranges. Already, Powell, as later could turn out to be clear, had in thoughts his notorious Hospital Plan for England and Wales, 1962. Not for long after then should a younger trainee medical doctor in psychiatry country with self-belief, “Yes I even have a bed” as passed off on that Old Bailey summer’s day.
The Hospital Gazetteer
In my years as a trainee in the UK as much as senior registrar level among the early ’60s and the past due 1980s, I had practised in a single substantial vicinity (North Middlesex, nevertheless there a few few psychiatric) fashionable clinic, New End Hospital Hampstead, Horton Hospital (in which Henry Rollin was a renowned impact), then Roundway Hospital Devizes (for the Bath, Bristol scientific regions) and my remaining psychiatric health facility in England, Graylingwell in Chichester.
The British Medical Association, now not always appeared as a fearsome defender of NHS clinical personnel and the scientific profession, produced in 1962 an ebook titled The Hospital Gazetteer. It had a worthy goal of giving scientific trainees beneficial facts approximately each health center within the NHS. I even have my replica nonetheless!
But I point out it right here for just one reason. It lists the 1962 clinic bed numbers for each NHS sanatorium in that yr. Thus the lack of such a lot of hospital beds is discovered:
New End had 222 beds: Horton Hospital had 1,524; Roundway Hospital 1,213; and Graylingwell 1,210. These indexed hospitals (aside from the North Middlesex) no longer exist. Now primarily middle-elegance home architect-designed housing/apartments inhabit the old health facility foundations. This general health center mattress loss touches 6,000 beds for simply the areas mentioned.
Declining influence
They have an effect on that senior medical team of workers had in planning and working vital scientific services has alas declined. As an instance of this disempowerment, at first inside the NHS award couldn’t be closed without the agreement of the accountable consultant. When it passed off to me I protested strongly towards the closure of one among my wards, despatched a copy of the relevant correspondence to my medical defense agency. Any expectation that my endeavors might convey a few stays at the proposed ward closure changed into marvel, wonder, unnoticed.
Still, I even have the reminiscence of that Old Bailey summer season’s day: I become able to utter the paranormal guarantee to the decide, ‘Yes, we have a mattress’.