Tag: Maudsley Hospital

An Overview of South London and Maudsley NHS Foundation Trust

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Introduction

South London and Maudsley NHS Foundation Trust (also known as SLaM), is an NHS foundation trust based in London, England, which specialises in mental health. It comprises:

SLaM forms part of the institutions that make up King’s Health Partners, an academic health science centre. In its most recent inspection of the Trust, the CQC gave SLaM a ‘good’ rating overall, but a ‘requires improvement’ rating in area of safety. In 2019, Southwark Coroner’s Court ruled that SLaM was guilty of “neglect and serious failures” in relation to the death of a patient in 2018. In 2020, a further investigation into the Trust’s conduct was opened following the death of a patient in its care.

Overview

Each year the South London and Maudsley NHS Foundation Trust provides about 5,000 people with hospital treatment and about 40,000 people with community services. In partnership with King’s College London, the Trust has major research activities. This academic partnership enables the Trust to develop new treatments and to provide specialist services to people from across the UK such as the National Psychosis Unit at Bethlem Royal Hospital. The Trust forms part of the King’s Health Partners academic health science centre and together with the Institute of Psychiatry, Psychology and Neuroscience at King’s College London and University College London is host to the UK’s only specialist National Institute for Health Research Biomedical Research Centre for mental health. In 2009/10 the Trust had a turnover of £370 million.

The Trust’s work on promoting mental health and well-being, developed in partnership with the new economics foundation, has featured in the national media.

It was named by the Health Service Journal as one of the top hundred NHS trusts to work for in 2015. At that time it had 4218 full-time equivalent staff and a sickness absence rate of 3.74%. 58% of staff recommend it as a place for treatment and 59% recommended it as a place to work.

As of 2018, the trust employed 5,328 staff.

Select Chronology

The following are some important historical dates:

  1. The Priory of St Mary of Bethlehem, Bishopsgate, was founded on land given by Alderman Simon Fitzmary. It later became a place of refuge for the sick and infirm. The names ‘Bethlem’ and ‘Bedlam’, by which it came to be known, are early variants of ‘Bethlehem’. It is first referred to as a hospital for ‘insane’ patients in 1403, after which it has a continuous history of caring for people with mental distress.
  2. In 1867, the Southern Districts Hospital (or Stockwell Fever Hospital as it became known) opened on the site which is today known as Lambeth Hospital.
  3. Henry Maudsley wrote to the London County Council offering to contribute £30k towards the costs of establishing a “fitly equipped hospital for mental diseases.” The Maudsley initially opened as a military hospital in 1915 to treat cases of shell shock and became a psychiatric hospital for the people of London in 1923.
  4. Bethlem Royal Hospital moved to a new site at Monks Orchard, where it has been situated to this day.
  5. With the introduction of the National Health Service in 1948, the Bethlem Royal Hospital and Maudsley Hospital were merged to form a postgraduate psychiatric teaching hospital. The Maudsley’s medical school became the Institute of Psychiatry.
  6. Sister Lena Peat and Reginald Bowen became the first community psychiatric nurses, following up patients at home who had been discharged from Warlingham Park Hospital in Croydon.
  7. The Ladywell Unit, located at University Hospital Lewisham, was refurbished for use by adult inpatient mental health services. The development brought together inpatient services which had previously been spread across other hospital sites (Hither Green, Guy’s and Bexley).
  8. South London and Maudsley NHS Trust was formed – providing mental health and substance misuse services across Croydon, Lambeth, Lewisham and Southwark; substance misuse services in Bexley Greenwich and Bromley; and national specialist services for people from across the UK.
  9. South London and Maudsley became the 50th NHS Foundation Trust in the UK under the Health and Social Care [Community Health and Standards] Act 2003.
    2007 The Maudsley Hospital closed its 24-hour emergency mental health clinic, amidst protest from patient groups and politicians who continued campaigning for several years for a promised replacement at nearby KCL Hospital.
  10. South London and Maudsley is part of one of the five Academic Health Sciences Centres (AHSCs) in the UK to be accredited by the Department of Health. King’s Health Partners AHSC consists of SLaM, King’s College London, and Guy’s and St Thomas’ and King’s College Hospital NHS Foundation Trusts.
  11. South London and Maudsley is fined by the Parliamentary and Health Service Ombudsman for its failure to properly assess mental capacity.

Governance

The Chief Executive appointed in 2013 is Matthew Patrick, a psychiatrist with a background in psychoanalysis who was formerly head of the Tavistock and Portman NHS Foundation Trust.

Former Member of Parliament Sir Norman Lamb was appointed chair of the trust in December 2019.

Services

The Trust provides a wide range of mental health and substance misuse services. The Trust provides care and treatment for a local population of 1.3 million people in south London, as well as specialist services for people from across the country. The Trust provides mental health services for people of all ages from over 100 community sites in south London, three psychiatric hospitals (the Bethlem Royal Hospital, Lambeth Hospital and the Maudsley Hospital) and specialist units based at other hospitals.

In March 2016 it established a joint venture with the Macani Medical Centre in Abu Dhabi to provide child and adolescent services with specialisms in autism, Obsessive Compulsive Disorder and eating disorders. Maudsley International also signed an agreement with the Ministry of Public Health in Qatar for expert advice to help advance Qatar’s national mental health strategy.

It established a joint venture limited liability partnership with Northumbria Healthcare Facilities Management, run by Northumbria Healthcare NHS Foundation Trust in 2019. This will run its private and international work, develop its capital assets and employ its facilities staff. It will initially employ 192 existing staff. It plans rapid growth in the United Arab Emirates (UAE) and China.

Performance

255 patients were injured in 2016-17 through use of restraints on psychiatric patients in South London and Maudsley NHS Foundation Trust. This was the third largest number in England, There were more injuries in Southern Health NHS Foundation Trust and Mersey Care NHS Foundation Trust. Critics say restraints are potentially traumatic even life threatening for patients.

Research

The Trust’s research activities take place in close partnership with the Institute of Psychiatry, King’s College London and University College London. In the 2008 Research Assessment Exercise the Institute was judged to have the highest research power of any UK institution within the areas of psychiatry, neuroscience and clinical psychology.

Biomedical Research Centre

The Trust manages the NIHR Maudsley Biomedical Research Centre, the UK’s only Specialist Mental Health Biomedical Research Centre, in partnership with the Institute of Psychiatry at King’s College London. The Centre, which is based on the Maudsley Hospital campus, is funded by the National Institute for Health and Care Research (NIHR). Its aim is to speed up the pace that latest medical research findings are turned into improved clinical care and services.

The team at the Centre are working towards ‘personalised medicine’ – developing treatments based on individual need. The aim is to diagnose illness more effectively and much earlier, assess which treatments will work best for an individual and then tailor the care they receive accordingly.

The BRC’s development of an advanced computer programme to accurately detect the early signs of Alzheimer’s disease from a routine clinical brain scan was reported in the media in 2011. The ‘Automated MRI’ software automatically compares or benchmarks someone’s brain scan image against 1200 others, each showing varying stages of Alzheimer’s disease. Another study has concerned the reduced life expectancies of people diagnosed with different mental illnesses.

In 2011 the Department of Health announced that the Trust and the Institute of Psychiatry, King’s College London would receive a further £48.8m to continue running the Biomedical Research Centre for Mental Health for a further five years from 01 April 2012. An additional £4.5m was awarded to the Trust to launch for a new NIHR Biomedical Research Unit for Dementia.

King’s Health Partners

The Trust is a member of the King’s Health Partners academic health sciences centre, together with King’s College London, Guy’s and St Thomas’ NHS Foundation Trust and King’s College Hospital NHS Foundation Trust.

In December 2013 it was announced that a proposed merger with Guy’s and St Thomas’ and King’s College Hospitals had been suspended because of doubts about the reaction of the Competition Commission.

National Addiction Centre

In partnership with the Institute of Psychiatry, Psychology and Neuroscience, King’s College London, the Trust runs the National Addiction Centre (NAC), which aims to develop new treatment services for alcohol, smoking and drug problems. This work ranges from trials of new therapies and preventative treatments, to studies seeking to understand the genetic and biological basis of addictive behaviour. An example of research conducted is the Randomised Injecting Opioid Treatment Trial (RIOTT).

Media

The services provided by the Trust feature in a four-part observational television documentary to be broadcast on Channel Four in Autumn 2013. Produced by the makers of 24 Hours in A&E, Bedlam focuses on the work of the Anxiety Disorders Residential Unit at Bethlem Royal Hospital, the Triage ward at Lambeth Hospital, adult community mental health services in Lewisham and services for people over the age of 65.

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What is the Maudsley Hospital?

Published on by Andrew Marshall1 Comment

Introduction

The Maudsley Hospital is a British psychiatric hospital in south London.

The Maudsley is the largest mental health training institution in the UK. It is part of South London and Maudsley NHS Foundation Trust, and works in partnership with the Institute of Psychiatry, King’s College London. The hospital was one of the originating institutions in producing the Maudsley Prescribing Guidelines. It is part of the King’s Health Partners academic health science centre and the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health.

Brief History

Early History

The Maudsley story dates from 1907, when once leading Victorian psychiatrist Henry Maudsley offered London County Council £30,000 (apparently earned from lucrative private practice in the West End) to help found a new mental hospital that would be exclusively for early and acute cases rather than chronic cases, have an out-patients’ clinic and provide for teaching and research. Maudsley’s associate Frederick Walker Mott had proposed the original idea and he conducted the negotiations, with Maudsley remaining anonymous until the offer was accepted. Mott, a neuropathologist, had been influenced by a visit to Emil Kraepelin‘s psychiatric clinic with attached postgraduate teaching facilities in Munich, Germany. The Council agreed to contribute half the building costs – eventually rising to £70,000 – and then covered the running costs which were almost twice as high per bed as the large asylums. The hospital also incorporated the Central Pathological Laboratory, transferred from Claybury Hospital, run by Mott. Construction of the hospital was completed in 1915. An Act of Parliament had to be obtained, that year, to allow the institution to accept voluntary patients without needing to certify them as insane.

However, before it could open, the building was requisitioned to treat war veterans. After the war it was returned to the control of London County Council and it finally opened as the Maudsley Hospital in February 1923. The first superintendent was psychiatrist Edward Mapother, while Frederick Golla took over the running of the pathology lab from Mott. Both were more sceptical of the Kraepelinian categories of diagnosis, and took a more pragmatic and eclectic view on causation and treatment. Psychiatrist Mary Barkas worked here between 1923 and 1927 in the children’s department established by William Dawson.

In the interwar period the Maudsley Hospital engaged in widespread experimentation with animal hormones, both in small doses to rectify supposed deficits and in overdoses as a shock therapy. Numerous psychoactive drugs and procedures were tried out, in what has been described as ‘unconstrained experimentation’. One of those involved, as a trainee and then junior doctor, was the controversial William Sargant. The hospital’s nursing staff comprised a matron, assistant matron, six sisters and 19 staff nurses with at least three years general hospital training, supported by 23 probationers and 12 male nurses. It had a good reputation for training nurses and some applicants even travelled overseas to train there. A report (held at Bethlem’s Archives & Museum) from a nurse who trained at the Maudsley shows some of the work of a new trainee: “Apart from observation and simple treatment, nurses are trained in special investigations and therapy. They carry out many of the routine psychometric tests, help as technicians in the ward laboratories, and are instructors in occupational therapy”.

The Maudsley Hospital Medical School was established in 1924 and eventually became a well-respected teaching centre. In 1932, Mapother described it as “the main postgraduate school of mental medicine in England.” The Maudsley Hospital had initially struggled to secure funding from the Medical Research Council, and, to undertake further research and develop the Medical School, but a substantial grant was obtained in 1938 from American charity the Rockefeller Foundation. Originally, there was no provision for the treatment of children and the rapid growth in this patient population was unforeseen. A child guidance clinic was set up under the directorship of Dr William Moodie, the deputy medical superintendent, in 1928. The late 1920s and 1930s saw a rapid growth in the number of patients treated: this growth led to an ongoing building programme including a secure unit, completed in 1931, and an out-patients department, completed in 1933.

Links with Eugenic Research

Both Mapother and then deputy Aubrey Lewis supported involuntary eugenic sterilisation, unequivocally recommending it to the Brock Committee in 1932. Lewis was a member of the Eugenics Society and a 1934 chapter he authored is “remarkable for its total admiration for the German work and workers”. With the spread of National Socialist (Nazi) laws in Germany from 1933, however, they decried the Nazi conflation of therapy and punishment, a move partly attributed to political and funding expediency. The Maudsley maintained its links with Germany, taking on both pro-Nazis and Jewish emigres through fellowships provided by the Commonwealth Fund and, after 1935, large scale funds from the American Rockefeller Foundation. Eliot Slater continued to visit Munich through the 1930s and contributed to academic festivities honouring Nazi eugenicist Ernst Rudin. During this time, Maudsley psychiatry developed a distinctive combination of practical experimentation and intellectual scepticism. Influential psychiatrist Aubrey Lewis became clinical director of the Maudsley in 1936.

At the outbreak of the Second World War, and with the threat of air-raids, the Maudsley Hospital closed and staff dispersed to two locations: a temporary hospital at Mill Hill School in north London and Belmont Hospital in Sutton, Surrey. Staff returned to the Maudsley site in 1945 and three years later the Maudsley joined up with the Bethlem Royal Hospital to become partners in the newly established National Health Service (NHS).

Post-War

In the 1960s a group from the Maudsley Hospital attacked the use of lithium for mood disorders. The head, Aubrey Lewis, called it “dangerous nonsense”, and colleagues published that it was therapeutically ineffective. Their objections have recently been described as ‘poorly grounded’ and having steered practitioners away from a beneficial agent. In 1999, the Maudsley Hospital became part of the South London and Maudsley NHS Foundation Trust (“SLaM”), along with the Bethlem Royal Hospital.

Services

The trust manages one of the UK’s few biomedical research centres specialising in mental health. The centre, managed in partnership with the Institute of Psychiatry, King’s College London, is based on the Maudsley Hospital campus and funded by the NIHR.

Media

In 2013 South London and Maudsley NHS Foundation Trust (‘SLaM’) took part in a Channel 4 observational documentary entitled Bedlam. The final programme, “Breakdown”, focused on older adults, including those admitted to the Older Adults Ward at Maudsley Hospital.