In this chapter
Aerial view of Queen Mary’s pre-1967 building of BRADU
Joining the Westminster
In the first phase of the NHS (1948-74) not all hospitals were run by Hospital Management Committees under the Regional Boards. The teaching hospitals had kept some of their former independence by retaining their Boards of Governors, which were responsible directly to the Minister. The Minister came to feel that inclusion in such a group with Board members appointed to represent the special interests such as those of disabled ex-servicemen, would be the most appropriate way to bring Queen Mary’s into the NHS. Informal discussions evidently took place between members of the Medical Committees of Westminster Hospital and Queen Mary’s during 1959-60. The Westminster Group, which included Westminster Children’s Hospital, The Gordon and All Saints’ as well as the parent institution, was a comparatively small one, comprising 687 beds in 1959. The group was under pressure from the General Medical Council and the University of London to review its bed allocation policy to meet teaching needs and particularly to establish medical, surgical and gynaecological professorial units. The possibility of amalgamating with another institution in order to help develop its facilities was being discussed in various committees at the time, and Queen Mary’s was felt to be very suitable. Agreement was reached towards the end of 1960, and the plan was announced by Enoch Powell, Minister of Health, in the House of Commons on December 12th. The handover was scheduled to take place a year later. Only the Hospital was to be transferred: the Limb Fitting Services remained under the direct control of the Ministry. This separation was deeply regretted by St. John Buxton, the orthopaedic surgeon, in his reflections on the history of Roehampton. He felt an opportunity to provide an integrated service under the control of the hospital had been missed:
“The addition of this unit to a teaching hospital is of paramount importance. Those of us who have watched the changes over the years feel a great satisfaction that Roehampton is now part of so great a teaching hospital as The Westminster, so well suited to administer the somewhat lonely unit, to provide a high level consultant staff and make use of the wards not only for the care of the patients but for the education of medical students, nursing staff and ancillary staff in training… The link of hospital is now forged but the artificial limb service remains an entity administered by the Ministry of Health. The supply of a splint, backbrace or leg iron is part of a hospital service. Surely the day has come when it should be appreciated that the advice regarding amputation, the care of the stump, the supply of the artificial limb and the subsequent rehabilitation is a clinical affair and should be divorced no longer from the hospital organisation. This point is stressed in the report of the British Medical Association’s Planning Committee, entitiled ‘Aids for the Disabled’ (1968). In this attention is directed to what is considered an unsatisfactory separation of the administration of the artificial limb service. The integration at Roehampton would be easier than in many parts of the country.”
The Board of Governors elected a House Committee with Lord Nathan as Chairman and Sir Arton Wilson and Sir Charles Norton as Vice-Chairmen. Lord Nathan’s memories of the original Roehampton House were vivid as he recalled marching at the head of an army platoon in 1914 to take over the House for soldiers’ billets.
At the first meeting of the House Committee, Lord Nathan said that the policy for the development of Queen Mary’s Hospital would be one of ‘going slowly at first’. Prompted by the Ministry of Health plans, the Hospital was to be completely re-built and a scheme was prepared and included in the development plan for the Group then under consideration at the Ministry.
At this time there were 403 beds in 18 wards and the daily average of War Pensioners in the wards was 288. The nursing establishment was 277 including 17 pupils in the recently opened Pupil Nurse Training School. The nurses were assisted by 30 orderlies and 6 theatre attendants.
The management of Queen Mary’s was now in the hands of the members and staff of the Westminster Board of Governors, who faced a daunting task. The Hospital was a national institution which did not serve the local community. It had no out-patient or casualty facilities and only a limited range of specialties, and it had previously treated very few women or children. As the last of the Ministry hospitals it had none of the usual infrastructure; for example, in medical records or supplies, and its standards, most particularly in nursing, were recognised as falling short of those of a teaching hospital. The Board had to develop its strategy very quickly during 1961 in order to submit a 10-year plan to the Minister in preparation for the appearance in 1962 of the Hospital Plan for England and Wales, one of the milestones in the history of the NHS. The Hospital Plan was positive and optimistic in tone, looking forward to a decade of “rapid increase in the capital sums available annually for hospital building.” For the first time, services were to be related to the size and needs of local populations. A new concept, that of the district general hospital, was defined as “the most practicable method of placing the full range of hospital facilities at the disposal of patients…”
Princess Royal 24th October 1963 opens casualty and out patients department
A shortage of nurses and the League of Friends
The Plan predicted that the first phase of development at Roehampton would begin during the period 1966/67-1970/71.
This was a disappointment to the Westminster Board, who had hoped it would start immediately. The Board had a frustrating time trying to develop services at the Hospital, as the Ministry appeared to expect those developments to come out of the Board’s general financial allocation and not the special funds it felt were necessary. After much hard bargaining, the improvements began to appear. The new casualty and outpatient department was opened by the Princess Royal on 24th October 1963; the new pathology department was opened in February 1964.
Provision of nursing services posed an immediate problem. After an investigation in 1962 the number of available beds was reduced from 373 to 333 because of the shortage of nurses. Staff nurses were transferred from Westminster, which then had to rely more heavily on agency staff. In 1963 the General Nursing Council ruled that Queen Mary’s was suitable for nurse training, provided that more obstetric and gynaecological beds were available. A temporary ward was opened in January 1963, but the delay in funding for the Professorial Obstetric Unit was one of the Board’s major frustrations at this stage. The Group’s nurse education was based at the Wolfson School of Nursing in Vincent Square, newly opened in 1960.
Also in 1963, the League of Friends was formed to provide the services for NHS patients that charities such as the Not Forgotten Association did for war pensioners. The members of the Westminster Board appointed to protect the interests of this group monitored the waiting time for pensioner patients and raised the issue if this became extended, because their right to priority of treatment remained. Nevertheless, the Roehampton Trustees were able to state at their Annual General Meeting in 1969:
“The function of the Trust was to ensure that the position of war pensioners was preserved, but in view of the very friendly attitude of Westminster Hospital to the war pensioner community this responsibility was a light one.”
Large capital sums were expended from Ministry grants, notably on: a clinical measurement department, a new casualty and outpatients block, upgrading of wards, a unit for congenitally deformed children, a new gynaecological and maternity ward unit, residential quarters for staff which was named ‘Sir Arton Wilson House’ and a new pathology department.
In 1967 Kenneth Robinson, Minister of Health, opened the Biomechanical Research and Development Unit (BRADU) erected by the Trustees at a cost of £63,000, but administered by the Department of Health and Social Security. The building was 26,000 square feet distributed over 3 floors. The Royal Fine Arts Commission was consulted about the design, as Roehampton House was a Grade 1 listed building. Special facilities for research into artificial limbs were provided in addition to fitting rooms and workshops.
It came under the general administration of the Ministry of Health and the fitting rooms were leased to Vessa Ltd, and Chas. A. Blatchford & Son Ltd, the limb contractors.
Leon Gillis and thalidomide
During this period, two other developments took place which reflected the Hospital’s traditional concern for the limbless and demonstrated a quality of treatment and rehabilitation beyond the experience of its founders. In February 1963 the Board was requested by the Minister of Health to establish a special unit “for the provision of prostheses, and especially of powered arm prostheses for children with severe skeletal defects.” Children with congenital deformities had been treated at Roehampton for some years, but their numbers had been increased by the “thalidomide babies” of 1959-62, victims of the drug given to their mothers during pregnancy. The new powered limbs demanded an intensive programme of limb-fitting and training; for the children much of this took place in the playroom which formed the centre of the Unit (named after Leon Gillis). This unit treated over 80 per cent of all the babies affected by thalidomide in this country. In later years, the Unit was adapted to cope with the needs of adolescent patients.
A long planned 12-bed Limb Surgery Unit, which aimed at an integrated and comprehensive programme of amputation, limb-fitting and rehabilitation which would surely have gladdened the hearts of Perkins and Buxton, was finally opened in 1974.
In spite of the frustrations, much progress was being made in the development of Queen Mary’s as a hospital serving its local communi ty. The long promised Obstetrics and Oral Surgery Units were both officially opened in 1968, and psychiatric services were added in 1972. The site which had seemed so extensive was shrinking fast. In 1964 an estimate was obtained for moving Roehampton House on rollers to another location; it would have cost £58,000. This scheme was one of many which never came to fruition. In spite of its successes, the Board felt that such improvements were piecemeal. What was really needed was an overall plan for the development of Queen Mary’s as a district general hospital of 1100 beds. As the second half of the decade and the projected redevelopment date approached, the Ministry began to hedge. When in 1965 the Board was considering purchasing some more land in Roehampton Lane with a view to redevelopment, the Ministry would not commit itself to what size of hospital would eventually be planned, nor whether it would be the only one in the area, and because of this uncertainty the projected purchase was abandoned.
1965 patients of the Leon Gillis Unit
Negotiations and reorganisations
1965-74 was a period of much discussion and a plethora of reports and plans concerning the future of hospital services, medical education and NHS reorganisation ensued. Would Westminster Hospital and Medical School move to the Roehampton site (as seemed likely in the late 1960’s) or to Richmond or to Croydon (a proposal being discussed in 1974)?
When the shape of the 1974 reorganisation became known, it was evident that the Westminster Group was to be dissected. The London division would be part of Kensington, Westminster and Chelsea Area Health Authority and the Roehampton division (augmented by the addition of Putney Hospital in 1971 and St. John’s Battersea in 1972) part of Merton, Sutton and Wandsworth. The management link with Westminster was to be broken, though the teaching link survived.
Once it had been accepted, however reluctantly, that the break with Westminster was inevitable, representatives of Queen Mary’s entered some fierce negotiating and campaigning to secure its future. The new area health authorities were to be sub-divided into districts, and it was initially proposed that Queen Mary’s be part of an enormous district also including St.George’s Hospital, newly rebuilt in Tooting. Rumours of take-over and closure were rife. A local campaign was mounted to press for the Hospital’s independent survival. The Merton, Sutton and Wandsworth Joint Liaison Committee (set up to prepare for NHS reorganisation locally) recommended that there should be a Roehampton District serving the Putney and Roehampton parts of Wandsworth and the Barnes part of Richmond with Queen Mary’s as the district general hospital. The argument that this formed a natural catchment area, in which hospital, GP and community health services could work closely together to meet local needs, was eventually accepted by Dr David Owen, Minister of Health.
The Area Strategic Plan produced in 1976 by the Merton, Sutton and Wandsworth Area Health Authority envisaged that a population of 130,000 would be served by the Roehampton District with Queen Mary’s being supported by in-patient hospital provision at Putney and St. John’s. The Plastic Surgery and Burns, Limb Surgery and Leon Gillis Units were confirmed as regional specialties serving a much wider geographical area. The teaching of Westminster Hospital Medical School students at Roehampton would continue. The eventual redevelopment of the district general hospital was implicit in the Strategic Plan.
Accordingly a new accident and emergency department with accommodation for medical and nursing school teaching on the first floor of a purpose built two-storey building was opened, and permission was given to proceed with the construction of a larger modern burns unit complete with its new operating theatre suite, and for the replacement of the antiquated operating theatre complex serving the Hospital generally. While these developments were underway the battle for the District, won in 1974, had to be refought in 1981 prior to the NHS reorganisation in 1982. Public pressure was rewarded by the formation of the Richmond, Twickenham and Roehampton District Health Authority, with an increased population of 160,000 relating to Queen Mary’s.
A new District Strategic Plan was approved by the Regional Health Authority. Queen Mary’s was to meet regional specialty needs in the fields of burns and plastic surgery associated with maxillofacial surgery, severe limb malformation in children, and specific protein laboratory estimations. The latter work was undertaken in the Specific Protein Reference Unit which was initially set up in 1974 under the direction of Dr Jim Kohn. Close links were developed with the Charing Cross and Westminster Medical School which came into being in 1984, followed by an expansion of medical student training in general medicine and surgery, obstetrics and gynaecology, orthopaedic and traumatic surgery, pathology, paediatrics, psychiatry and, most recently, geriatrics.
A development plan for the Queen Mary’s site was agreed with the Regional Health Authority to incorporate the new Theatre Complex, Burns Unit and Accident and Emergency Department. In the meantime another significant development was the opening of a purpose-built 29 bedded Elderly Assessment Unit (acute geriatric assessment and rehabilitation ward).
Also in 1987 the provision of new District Headquarters and Acute Unit administrative accommodation was completed by major conversion work on Roehampton House thus enabling separate and much improved postgraduate medical education and library facilities to be provided within the former prefabricated District offices. Princess Alexandra visited Roehampton on 15th June 1987 to open the Burns Unit, the Theatre Complex and the newly refurbished Roehampton House.
Throughout the 1974-1987 period a close working relationship was maintained between the Limb Fitting Centre and the Hospital, cemented through the creation of honorary consultant appointments for senior medical officers of the Roehampton ALAC (Artificial Limb and Appliance Centre) contributing to the work of Queen Mary’s. Worthy of mention in this rehabilitation context is the designation in 1983 by the DHSS of the Physiotherapy and Occupational Therapy Departments at Queen Mary’s as a Demonstration Centre, a confirmation of the long-established centre of excellence in this field.
Against this background of change the role of the Roehampton Trust continued to evolve. In the 1980s land and property comprising the Hospital, Limb Centre and Factories were transferred in stages to the ownership of the National Health Service, after a financial settlement had been reached between the Department of Health and Social Security and the Trustees (formerly called Governors) of the Queen Mary’s Roehampton Hospital Trust. The last of these transactions took place in 1990, thus concluding the interests of the Trust in the property after a period of 75 years. However the Queen Mary’s Roehampton Trust continues to carry out its much needed benevolent work by making financial grants to worthy organisations who care for war disabled ex-servicemen and ex-servicewomen.
Lord Montgomery Garden Party 1963
