For the health of the community
The Westminster Memorial Hospital in Shaftesbury is Dorset’s northernmost community hospital. Tony Burton-Page tells its story.
Published in September ’10
In an age where large organisations seem to be swallowing up smaller ones in the manner of a whale gorging itself on plankton, it is refreshing to find that Dorset has as many as eleven small hospitals – what the Victorians used to call ‘cottage hospitals’ and what we now call ‘community hospitals’. This term was coined in reaction to the Hospital Plan of 1962, which pressed for resources to be concentrated into hospitals of 300 beds or more, an inevitable consequence of which was the closure of smaller ones. Opposition to this came from the newly-formed Association of General Practitioner Hospitals (now the Community Hospitals Association); it was their chairman, Sandy Cavenagh, who revealed that over half the patients treated in General Hospital beds could be cared for equally well or better in a small hospital near their homes.
community hospitals survived, especially in the south-west, which has eighty of the 300 remaining in the UK. Dorset’s eleven compares favourably with larger and richer counties, and one of the jewels of this hendecimal crown is in Shaftesbury.
There was no formal provision for the sick of the town until 1874. There had been an infirmary in the Abbey, but that disappeared along with the Abbey itself at the Dissolution of 1539. After that there was nothing until the building of the workhouse in 1840, and its sick ward was only for the inmates. So when the Marquis of Westminster’s widow and daughter wanted honour his memory, a Cottage Hospital for those in and around Shaftesbury seemed appropriate. The Marquis had owned large estates in the area and had done much to improve the lot of his tenants; this project was in keeping with his philanthropic attitude. His widow, the Dowager Marchioness, gave a site for the building on family land adjoining Abbey Walk and Park Walk. It was designed by J B Corby of Stamford in Lincolnshire, but the actual building work was done by a local man, C J Miles of Shaftesbury. The foundation stone was laid in May 1871 by the Marquis’s youngest child, Lady Theodora Grosvenor, and the hospital was formally opened by the Bishop of Salisbury three years later.
It was originally designed for a mere six patients, but nevertheless there were considerable running costs. These expenses were to be met by funds from subscribers, (who would contribute a guinea annually or a one-off payment of £20), together with the income from an endowment fund set up by the Grosvenor family, as well as the small fees charged to patients. The hospital was to be for the poor of the town and the neighbourhood, excluding those on ‘parish relief’, who would still go to the workhouse infirmary. There were no medical staff, as the understanding was that patients would be attended by their own doctors. The hospital was run by the Matron – as indeed it is today. Forty patients were admitted in that first year, and in the hospital’s first eighteen years, 910 patients came through its doors.
The first proposal to enlarge the building came in 1907 from the Marquis’s daughter, who had married into the family of Baron Wimborne of Canford Magna and was now Lady Theodora Guest. Wanting to perpetuate the memory of her mother, the Dowager Marchioness of Westminster, who had died some years ago, she had asked the hospital’s doctors if there was anything they needed and they had suggested an operating room. Lady Theodora duly ‘presented’ the finished room, complete with (as she said) ‘up-to-date fittings and the most necessary instruments’, to the hospital on the sixteenth anniversary of her mother’s death. It is still in use today, although not as an operating theatre, but its double lantern windows in the ceiling make it one of the lightest areas in the building.
This paved the way for further developments: central heating was fitted in 1909, and X-ray equipment would have been installed in 1914, but World War 1 delayed this until 1919. (The hospital has its own X-ray department to this day.) Inevitably the hospital’s running costs increased, and the Shaftesbury Carnival Committee stepped in: for many years the proceeds from the Carnival were donated to the Westminster Memorial Hospital.
The Committee was rather more powerful than would be expected of such a body nowadays – indeed, in 1923, it disapproved so strongly of the Matron that it refused to hold a carnival that year. The resulting loss of revenue meant that the hospital had to be closed from mid October to early December. The Committee had its way: the Matron resigned.
There was a further extension in 1930, as by then it was realised that there was insufficient accommodation to cope with the rise in patients brought about by the Hospital League, a sort of local forerunner of private healthcare: the hospital was for everyone who subscribed to the League. The new wing provided not only more bed space for patients but also accommodation for nursing staff, all of whom could now be housed on the premises.
An out-patients department was added in 1938, and a separate maternity unit at Castle Hill House in Bimport in 1948, but by then the hospital had been taken over by the new National Health Service. Almost immediately, there was controversy. The workhouse, now known as Alcester House, had been used to house chronically sick patients for many years. It was now proposed to demolish it, which brought protests that there would be no accommodation for the chronic sick within a twenty-mile radius of Shaftesbury. Questions were asked in the House of Commons, and Alcester House even featured in a radio programme called ‘The Week in the West’. Despite this, the demolition went ahead in 1949, and the problem went unsolved for more than twenty years. By the 1970s, though, it had a new name – geriatrics – and with it, fortunately, came a new attitude; and accommodation for elderly patients at the hospital has improved beyond all recognition over the last thirty years.
Extension to the building itself has continued over the decades, spanning a variety of styles – the most pleasing of which are, mirabile dictu, the most recent, free from the obsession with right angles which mars so much architecture of the 1960s and 1970s.
Like all small hospitals nowadays, it has had to adapt to circumstances to keep going. There is no longer an Accident and Emergency Unit, and most of the hospital’s in-patients today are elderly – although the Minor Injuries Unit, which is open from 8 am to 8 pm seven days a week, cares for young and old alike. There has been much fuss in the media about the proposed redevelopment of the hospital and the subsequent scrapping of the plan for financial reasons – the hospital was even described as being ‘not fit for purpose’; but Jane Silvester, the Matron, plays this down.
‘Yes, it’s an old building, but inside it we have up-to-date, modern equipment and a team of dedicated staff. We’ve got all the facilities we need – a busy outpatients department, a minor injuries unit and 25 inpatient beds. What makes the hospital special is the people in it: the nursing staff, the occupational therapists, the physiotherapists, the administrative staff, the facilities staff and volunteers – it’s a whole community. Not a large one – about a hundred, but every one of them goes over and above their remit, from helping to plant flowers in the hospital garden to coming in for the Christingle service on Christmas Eve.’
Jane worked in the acute sector (i.e. large hospitals such as Poole and Dorchester) before she left to work in a community hospital, and she does not regret the move. ‘Because we’re small, we can give the time and individual care that people value. In our Minor Injuries Unit, we manage to see and treat most of our patients within the hour, which saves time and travel for local people, who would otherwise have to go to the nearest Accident and Emergency Department – where they would inevitably have to wait rather longer. There’s a great deal of support for the hospital from the local community, who know about us through the use of our services and via the many fundraising events organised by our wonderfully supportive League of Friends. Residents of Shaftesbury and the surrounding area come to the Minor Injuries Unit from birth onwards – children are always having accidents! So we really are part of the local community.’
Much of the hospital’s work is the care of the older person, but the emphasis is on getting patients well enough to go home and be independent – hence not only the flourishing Occupational Therapy Department and Re-ablement Centre, but also the partnership with the Weldmar Hospicecare Trust, which has a day hospice at the hospital once a week – a partnership whose success was recognised with a major award last year. There are close links, too, with the Older People’s Community Mental Health Care team, which is also located in the hospital.
‘We have the facilities for palliative and end-of-life care – the John Lidsey Unit gives relatives the chance to stay with terminally ill patients,’ says Jane. ‘I think the way forward is to build on our existing excellent relationship with the local community and to develop further our facilities through more partnership working – and thus ensure that our community hospital continues to care for future generations of Shastonians.’