Not only did it witness the introduction of the National Health Act of 1959, the first completely modern legislation affecting the treatment of psychiatric illness for almost 60 years, but it also saw a vast expansion of clinical work, the annual admission rate increasing from 848 in 1953 to 1405 in 1963, whilst the total resident patient-population fell steadly from a peak of 1996 in 1954 to 1760 in 1960, with a more gradual fall to 1725 in 1962. 1963, however, showed a rise again to 1785 patients. A further feature of this decade was the flood of new and often very effective synthetic drugs which revolutionised the physical treatment of psychiatric illness, made deep Insulin Coma therapy virtually obsolete and, in conjunction with other factors (notably increased out-patient services), no doubt had a considerable bearing on the reduction of the hospital in-patient population.

Parallel to, but inevitably lagging a respectable but unfortunate distance behind this increase of turn-over of new patients was an increase in the medical staff from 3 Consultants, 4 Senior Hospital Medical Officers (a post abolished for new appointments in 1962), 1 Senior Registrar and 5 Juniors (a total of 13 doctors) in 1953 to 6 Consultants, 1 S.H.M.O. remaining in post, 1 Senior Registrar and 8 Juniors (16 in all) in 1963.

The period also saw the introduction, by majority demand, of a three-shift system for nurses, the inauguration in 1955 of a Pre-Nursing Cadet scheme for boys and girls selected at 15 or 16 years of age (the lower limit was raised to 16 in 1963) from applicants who seemed to show promise of eventually rising to the higher ranks of the nursing hierarchy.

A new Consultant Pathologist was appointed in 1959. For some years the hospital had had such an appointment in name, but not in fact, as the previous holder of the post did not visit the hospital for over four years! His arrival, however, put the Laboratory on a really efficient footing, one result of which was that it soon became evident that the laboratory buildings, in the Admission Unit and adjoining the mortuary separated by nearly half a mile, were inefficient in concept and time wasting in operation. Plans were made for an entirely new laboratory to be erected near the kitchens, and the foundations were laid at the end of 1963. A Psychological Department was also opened, operating at first in inadequate accommodation in the Staff Sick Bay, but later in the central block of the Admission Unit.

Apart from the use of the modern drug therapies already mentioned, a somewhat greater emphasis was put on the purely psychological approach to treatment and a centre for in- and out-patient Group Therapy was established in the Duchess of Kent Social Centre (infra). Several drug trials of new preparations were carried out in conjunction with the manufacturing chemists; Occupational Therapy and Social Therapy were expanded; an Electro-Cardiograph was purchased in 1953 and, following the introduction of a visiting Mass Miniature Radiographic team in 1957, the hospital aquired its own miniature x-ray camera in 1961.

Epidemics were few and short-lived, mostly outbreaks of intestinal infections, whilst the Tuberculosis problem, after a dramatic increase in 1953 to 52 cases, many of which were detected on the M.M.R., became steadily less and, in 1963, there were only 23 cases of which 6 were active.

In 1962, the geographical area for which the hospital was responsible was materially altered and became much more compact, though somewhat larger in population, whilst the old anomaly, with all its inherent difficulties, whereby the population of the Borough of Dagenham were treated as out-patients by the medical staff of Warley, but as in-patients at Severalls Hospital of Colchester was removed. This change did however sever a 109 year old connection with the Boroughs of Walthamstow and Leytonstoen and involved the closure, as far as Warley was concerned, of the out-patient clinic at Whipps Cross Hospital. A new clinic at Five Elms, Dagenham, was opened in its place pending the rebuilding of Barking Hospital, to which it was intended eventually to move it. The psychiatric services to Orsett Hospital, previously undertaken by Claybury Hospital, was also tranferred to Warley.

The Neurosis Unit at St. George's Hospital, Hornchurch became independent of Warley in 1956 and was renamed the Ingrebourne Centre.

As regards structural alterations to the hospital buildings, a long-term scheme was put into action for the internal and external modernisation of F Block, on a special grant from the Regional Board and carried out by contract while, concurrently, wards in the Main Building were similarly up-graded by the hospital's maintenance staff. One ward at a time on each side of the hospital was completely cleared of patients for periods of up to twelve months; this loss of an average of 120 beds at any given time aggravated the alraedy existing over-crowding, particularly of sleeping accommodation. At the same time, the sanitary accommodation throughout the hospital was brought up to modern standards and a small start was made on the installation of central heating. The existing boiler capacity, coupled with a lack of funds to build a completely new boiler house, limited the installation of heating to the Main Building; D and F Blocks remained unheated except for the old local installations. Over the years, very extensive alterations were made to the kitchens, which included the provision of lifts (still not installed) in the main building.

The central dining scheme in F Block proved to be, for various reasons, a costly failure and was abandoned after a year.

Other improvements included the glazing in of Watlington (F.B. 14B) verandah, the modernisation of the operating theatre and the installation of an autoclave and X-ray processing room, the removal of the old gates at Warley Hill and Crescent Road entrances and the demolition of the bulk of the brick walls and railings enclosing the ward gardens. An exception was made in that the "pepper pot" earth closet, originally built-in to the south side of the circumferential wall, was left in splendid isolation as a relic of the past and one cannot help hoping that future generations may perhaps be sufficiently sentimental to regard it as an "ancient monument" and resist the temptation to sweep it away in the sacred name of "progress."

Kavanagh Ward, the old Isolation Block, was reconstructed as a mixed male and female tuberculosis unit; a Roman Catholic chapel seating 80 persons was constructed on the foundations of the old library and opened and dedicated to St. Dympna, the Patron Saint of the Mentally Ill, in 1962 by the Bishop of Brentwood.

Through the generosity of the King Edward Fund for Hospitals, (who, it will be remembered, financed the enlargement of the hall in F Block, known thereafter as the Centenary Hall), funds were made available to add a block to the male occupational therapy department in 1955. Later, £40,000 was provided for the erection of the Duchess of Kent Social Centre, completed in 1960 and housing the Social Therapy Department, the hospital shop, the library and a new tea lounge for patients and their friends.

During this decade, more wards were "opened" and this led to the necessity of establishing 30-bedded, completely self-contained "top-security" unit, with its own occupational and recreational facilities on the male side. The old dormitory "Davis/Fortescue" (F.B.3) was ear-marked for this purpose and its conversion was started in late 1963.

From 1954 onwards, all wards were supplied with television, the old institutional number of wards was abandoned in favour of names in 1957 and a wide-screen cinema was installed in the Centenary Hall.

A new building housing a specialised occupational therapy unit for the male and female admission units was designed and built by the hospital maintenance staff in 1959.

In 1962/5, the Nurses' Training School was moved from its site in the original hospital kitchen to much larger and redesigned premises in what was the first laundry building and, until the opening of the Duchess of Kent Centre, the Social Therapy Department. The vacated school premises were then converted into a new and enlarged Physiotherapy department incorporating a room for chiropody and the optician.

The high-light of the decade was, however, without doubt the first visit to the hospital of a member of the Royal Family when, on the 11th July, 1960, H.R.H. The Duchess of Kent (later H.R.H. Princess Marina) opened the new Social Centre and allowed it to be named after her. Her arrival on the cricket field and later departure by helicopter to the dramatic accompaniment of a thunderstorm (fortuitous, but effective "noises off") added to the interest of the occasion.

In connection with the Centenary, a reception was held at the hospital at which the then Minister of Health (the Rt. Hon. Iain McLeod, M.P.) was the Guest of Honour, an At Home for hospital pensioners was a great success and a service was held in the hospital church at which the Bishop of Chelmsford preached.

Open days were held in 1955 and 1957 and evening meetings were organised from time to time for local General Practitioners.

Alderman C.E.S. Blackmore, who had been a member of the Visiting Committee and Management Committee for over 30 years, and its Chairman from 1946, retired in 1957. He was succeeded by Mr. P.C. Ford, a member of the Committee, who died in office in 1960. From 1960, this important post has been filled by Alderman K.E.B. Glenny.

Despite the prospect of a very real long-term advantages of this scheme, the process was painful, nesessitating the continued closing of wards, usually two at a time at least, for the whole of the five years, and preventing the development of several schemes which it had been hoped would have been put into operation - such as the proper use of Davis Ward, referred to in the last chapter, the use of D Block as an integrated male and female geriatric unit and the further use of mixed-sex wards for other patients. A small start was made in Lewis Ward (renamed Heatley) as a ward for long-term patients for both sexes.

The total number of patients in the hospital remained, on average, fairly constant, although the annual admission rate increased to over 1,600. The most noticeable change, was the increase in extramural activities - "taking psychiatry to the community". New out-patient clinics were started at Harold Wood Hospital, increased sessions were necessary at Orsett Hospital, and the old Five Elms Clinic was moved to the newly modernised and reopened Barking Hospital, and the sessions there increased. The total number of out-patients seen increased from under ten thousand in 1964 to fourteen-and-a-half thousand in 1968. In line with this activity, increased follow-up work was carried out with ex-in-patients, in the rather vain hope o reducing the high re-admission rate. In this connection a closer liaison was made with the Local Authorities, now three, since the Greater London Act (Essex County, and the Boroughs of Havering and Barking) and the Mental Welfare Officers were given their own office in the hospital and attended at least once or twice a week. Similarly, the Psychiatric Social Workers' and Psychologists' staff was considerably increased. The Medical Staff had, however, been increased by only one, there being in 1969 seven Consultants, one Senior Registrar (rotating with the North Middlesex Hospital and St. Bartholomew's), three Medical Assistants, four Registrars, and two Senior House Officers, plus one part-time Clinical Assistant for the geriatric wards, increased to six sessions in 1969.

Within the hospital, major changes took place in the Occupational Therapy Department, which were increasingly taken over by Industrial Therapy, and later by the starting of a Central Sterilised Supply Department, which served other outlying hospitals.

The Duchess of Kent Centre had by this time already proved to be inadequate in size, despite the building of a new Consulting Room and it was felt that the only solution was to consider the erection of a new building in the vicinity into which to remove the library, shop and tea-lounge, thus releasing valuable space in the Duchess of Kent Centre for, particularly, the growing number of day-patients.

A new problem at Warley as elsewhere was the increasing number of adolescenet drug-addicts coming in for treatment, reaching a peak in 1968. The total numbers were not, at any time, large but they did present a very considerable therapeutic problem and ad a considerable nusiance value in any given ward.

The nursing shortage remained acute and the intake of prenursing cadets fell to nil. However, a number of those originally selected had, by this time, proved their work and reached Ward Sister or Charge Nurse rank.

Post-graduate teaching was set on a more official basis and one Consultant was appointed as Honorary Clinical Tutor, under the guidance of London University. Not only were regular teaching sessions organised for the medical staff at Warley, mainly oriented towards the D.P.M., but a Weekend Refresher Course for General Practitioners and others was started in 1966, and became an annual feature. A very good liasion was made with St. Bartholomew's Hospital and pairs of students did an intensive fortnight's resident course ast Warley.

Despite all its difficulties, Warley, in comparison with some other large psychiatric hospitals, was fortunate in being able to retain its identity in an age of Hospital-Group mergers - it remained a Group on its own, unswamped by a grafted-on General Hospital.

[This chapter may well not be a complete record of the hospital's activities for 1969, as force of circumstances compelled its writing in the early months of the year.]

April, 1969.
G.S.N.