Calderstones Hospital: seeking closure on a transformative journey

Calderstones Hospital turned things round after a damning report in 2013 but now it is scheduled to close. So what does the future hold for the staff and service users  there?

Calderstones Hospital turned things round after a damning report in 2013 but now it is scheduled to close. So what does the future hold for the staff and service users there?

An inspection by the Care Quality Commission (CQC) is never much fun, but it was a particularly ‘horrible experience’ when more than 60 inspectors descended on Calderstones Hospital for a week in 2013, according to the then chief executive, Mark Hindle.

Chief executive Joe Rafferty and service user Ian Eastwood. Picture: John Houlihan

The ensuing report was damning but, instead of prompting a collapse in staff morale, Mr Hindle says the negative feedback ‘galvanised us all. We had felt we were doing our best for patients and thought a lot of the criticism unfair. Some people decided to leave but, for those who stayed, it was the start of a journey of engagement. Things changed fundamentally.’


The year Calderstones was approved as a ‘certified institution for the mentally defective’

The culmination of that change was a rating of ‘outstanding’ from the CQC in March 2017 (see box). But, despite this, the hospital, now run by Mersey Care NHS Foundation Trust, is earmarked for closure, a symbolic event as it is the last of the old NHS long-stay learning disability hospitals to close as part of NHS England’s Transforming Care policy.

Lee Taylor: 'staff are passionate about 
empowering service users'
Picture: John Houlihan

As the site winds down, staff are creating a new clinical model in the community and the unit’s 130 remaining inpatients are moving out, most into a flat or shared accommodation. Lynsey Brown, forensic support service senior nurse, says: ‘We’ve had a rough time but now it’s exciting to be part of the change.

‘My team supports the community nurses, the police, third sector and social workers. We’re a bridge, bringing the multidisciplinary team together to manage an individual’s risk.’

Lee Taylor, the hospital’s chief operating officer, and a registered nurse, says all staff are passionate about empowering service users and working in partnership with them.


The number of patients it housed in 1950s

‘Transforming Care says people shouldn’t be in hospital any longer than they need to. Living in your own place is the right thing for most, though some with complex needs will require access to inpatient care. ‘As our specialist learning disability division becomes a community service the staff’s role will be to offer joined-up care and keep people out of hospital.’

They will have five goals: preventing admissions, discharge planning, 24-hour crisis support and wrap-around care, plus carrying out specialist forensic community assessments.

Lynsey Brown: 'it’s exciting to be part of the change'       Picture: John Houlihan

Ms Brown says she feels privileged to have worked in an inpatient and a community setting.

‘I’ve seen people admitted from prison, get treatment and then move out to the community and thrive,' she says. '

Sometimes services pull out too soon but we stay with people. We treat them as individuals and help them with the skills they need to have a meaningful life.’


Cost of new unit opened in December 2013. It was meant to be ‘a major new chapter’ but now faces demolition

Mr Taylor’s deputy Susan Wrathall, also a registered nurse, says staff ‘dared to dream’ they could get an outstanding CQC rating. ‘We didn’t say, “how are we going to get there?”, We said, “We’re delivering outstanding care – how do we demonstrate that?”’

Susan Wrathall: 'Staff dared to dream'
Picture: John Houlihan

The answer was to gather evidence of good practice. So, staff asked service users to do a presentation on what they were proud of in their ward or house.

Then, when the inspectors arrived, the patients repeated these presentations.

‘During the inspection, we tried to buoy everybody up to create a real buzz. Clinical staff, support staff, service users and carers were all involved. It was team work.’

Mersey Care chief executive Joe Rafferty is proud of what his staff have achieved. But though he supports the move into the community he fears it could lead to a fragmentation of the service and a loss of expertise.

‘People use the term “institution” as a negative when it’s learning disability,’ he says.

Number of inpatients with the specialist learning disability division

Medium secure unit: 34

Low secure unit: 65

Step down: 11

Enhanced services (for complex needs): 20

‘But when it’s a children’s hospital or a cancer centre it’s a positive. Why can’t you have a learning disability centre of excellence with a critical mass of skills to ensure patients get the intensive input they need?’

Some inpatients will be discharged to a new ‘state-of-the-art’ medium secure unit, to be built at Maghull, near Ashworth Hospital. But work is yet to start on the new unit and, for now, the focus is on building a high-quality community service and preparing service users to move out.

Mr Taylor says: ‘We’re proud of the way that staff have turned things around here but we’re not resting on our laurels.  We may be an outstanding division but we’re on a transformative journey and we’re always asking the question: “What next?”

What the CQC said

The Care Quality Commission inspected the learning disability and autism secure services at Whalley, Greater Manchester (formerly known as Calderstones Hospital), in March 2017. They rated the service ‘outstanding’.

This follows a critical report in 2013 which led to a local paper headline: ‘Horrifying autism hospital to close’.

The most recent report praised staff as ‘highly skilled at anticipating and de-escalating behaviour that might have led to violence or self-harm.’  Inspectors added: ‘staff used physical restraint and other restrictive interventions on many fewer occasions than in the past.’

They also highlighted person-centred therapeutic interventions, including a ‘Dr Feel Well’ health education initiative, plus the wide variety of activities available to patients on and off-site. This included a recovery college called ‘our shared college’ where individualised care is adapted to meet each patient’s specific communication needs.

The CQC said staff-patient interaction was built around ‘personalised collaboration, recovery-orientated care planning and all patients had a moving-on plan’.

Inspectors were also impressed by monthly ‘championing recovery meetings’ where designated patient recovery champions shared ideas from their ward for new recovery-focused activities.

The report noted the trust had a robust recruitment programme and all staff received mandatory training, specialised training, supervision and appraisals.

What service users say

Michael Burrows

‘I was here from 1995 to 2000 and I came back in 2012. The staff here give you a chance and they stick by you through thick and thin.

‘I moved to low secure and I’ll be going back into the community. The staff supported me to get where I am. What the papers wrote about this being a bad place was wrong.’

Service user Jennifer Cox. Picture: John Houlihan


Rachel Aldcroft

‘When I heard they were closing this place I was a bit scared at first. I thought I’d be homeless. But they’re going to find me a place. I want to live on my own. I’m only here so I can get my tablets.’

Ian Eastwood

‘I’ve been here five years and the staff have really helped me. But now I feel ready to go and live my life.’

Stephen Ellis

‘We got “outstanding” as everything we do here is run by service users and staff working together. I’ve been here six years and now I’m on a step-down which is the last stage of my recovery.  Over the next two years I’ll be moving into shared accommodation in the community with 24-hour support. There are lots of success stories like me here.

Janet Snell is a health writer

This article is for subscribers only