At least four new high-security hospitals would have to be built to accommodate those released from the three existing hospitals and all should become NHS trusts, under proposals in the long-awaited report by a working group on high security and related psychiatric provision, published yesterday.
Officials and ministers at the Department of Health have been studying the report since it was completed a year ago, but the Government has delayed making a response for at least another six months, prolonging uncertainty over the special hospitals which are run by the Special Hospitals Service Authority (SHSA).
The inquiry, chaired by Dr John Reed, was set up after allegations of brutality to patients at Ashworth. The report stresses one of the overriding priorities in future developments must be to maintain public confidence and public safety.
Announcing publication of the report yesterday, John Bowis, parliamentary secretary at the Department of Health, said that another working group of officials from the department and members of the SHSA would consider the recommendations over the next six months. He would announce the Government's conclusions after hearing their advice.
Some insiders doubt whether the Government will agree to the proposals because of the cost implications and also the 'nimby' factor. Finding suitable sites that are acceptable to the local population, and the money to build them, could take years.
The three existing special hospital accommodate a total of 1,562 patients, including those on temporary trial. Rampton in Nottinghamshire and Broadmoor in Berkshire have just under 500 patients each, while Ashworth in Merseyside has 588.
A report published by the Department of Health last year estimated that 20 per cent of patients did not need to be kept in long- term high-security accommodation, but no alternative medium- security facilities were available.
The Government has already agreed to adopt two recommendations: arranging for regional health authorities to co-ordinate assessments of need for all levels of secure psychiatric provision; and requiring health authorities to ensure through their purchasing contracts for 1994-95 that special hospital patients who no longer require high security are placed in alternative care within six months. This will prove impossible for some health authorities who do not have suitable alternative accommodation.
Liz Lynne, the Liberal Democrats' health spokeswoman, said: 'If these secure units are allowed to gain trust status, my concern is the bed closures which could follow would lead to severely disturbed and dangerous people being a danger to themselves and others.'