Broadmoor is coming to the boil: Staff are seething - not the patients. Cal McCrystal on anger at a new, more open regime

BROADMOOR seethes. That may come as no surprise given the history of some of its past and present inmates: torturers, decapitators, arsonists, people who skin others alive, disembowel women, cook children in ovens. But today it seethes for different reasons.

It is among the 1,100 staff that one is alarmed by volatility, anger, suspicion and the occasional desire to abscond. This condition is proving very hard to treat.

The dispute between staff and management of the massive Victorian complex occupying a ridge of Berkshire countryside has crept up quietly on the nation. It is rooted in proposals to reduce the penitential atmosphere in what is, after all, a hospital rather than a prison (despite physical appearances to the contrary). Last week, the conflict entered its gravest phase, as management defended the proposals as 'morally right and humane', and staff representatives condemned them as 'revolutionary and dangerous'.

To a visitor arriving in mid- afternoon, Broadmoor's interior seemed not much more formidable than its facade, nor its annual budget - pounds 27m. Pigeons strutted peacefully on a terrace overlooking the village of Crowthorne. High, red-brick, perimeter walls blended with acres of dead bracken. Harry Field, director of nursing services, pointed nonchalantly to the spots where one patient climbed a wall and another sawed through bars (both were swiftly recaptured).

In the women's block (100 of the 500 patients are female), a middle-aged patient sat alone at a table, silently eating her lunch. A younger woman with short blonde hair helped herself from a buffet. Patients seemed keen to give one another space.

So did staff. Three nurses heading for the staff club would not talk about the dispute. One of them, his face twitching, mumbled: 'Members only.' There have been newspaper reports that 90 staff were attacked by patients this year alone as a direct result of Broadmoor's new 'non-seclusion' policy which allows patients more freedom within the hospital. Three senior consultant psychiatrists have threatened to resign. I was reminded of Sir Ian McKellen's words on bringing the Royal Shakespeare Company to Broadmoor three years ago: 'Was I alone, as I peered round the audience, in being unable to work out who was a patient and who was a nurse?'

Alan Franey, Broadmoor's general manager, explained. In 1988 he arrived in Broadmoor - not simply to share a roof with the Yorkshire Ripper and Ronnie Kray - but to begin to put recommendations for reform into practice. An inquiry had found patients undressing in corridors in preparation for bed; a drug and alcohol ring; too much use of 'restraint garments' and excessive influence being wielded by the Prison Officers' Association, the union representing most nurses.

'I remember the first day I arrived,' Mr Franey said. 'Two nurses were standing behind me and I heard one of them say, 'The SS are in'. Now the same things are being said again.'

Since Broadmoor was built in 1863, occupying 55 acres of a 412-acre estate, it has generated dread. Harry Field said: 'As you can see, it's a very gothic place. Patients experience fear approaching it. They have all seen The Silence of the Lambs. But it's not like that: no chains hanging against the wall and no padded rooms.'

On the other hand, it has proved harder to reform attitudes than to refurbish wards. In 1989 a patient died under sedation. In 1990 four nurses were arrested in connection with a police investigation into alleged bribery and corruption.

In the following two years two nurses left a patient locked in his cell for six hours as part of a dispute by the Prison Officers' Association, and a psychiatrist took early retirement after giving patients electric shock treatment without anaesthetic. Last year an independent inquiry into the death of a black schizophrenic found racism, low nursing skills and staff concerned more with control than care. It demanded a review of the solitary confinement regulations and got this dispute.

It is not an easy one to resolve. '(The management) are saying that some of these patients are going to be allowed to watch television all night,' said Brian Caton of the POA. 'People need to fully understand the nature of the patient base. All these people at the time of their apprehension were headline news - uncontrollable, violent and dangerous in a way that could turn your stomach.'

The POA wanted a Broadmoor regime that would keep the public safe, the staff protected and the patients medicated to prevent violence and disruption. 'By throwing open the (ward) doors over a 24-hour period, the treatment plan will be severely affected,' Mr Caton said. Mr Franey, on the other hand, saw 'institutionalised attitudes'. Reforms would provide patients with 'a more purposeful day to engage in therapy, workshops and one-to- one situations with nurses and psychologists'. Having abolished prison-style staff uniforms in 1990 (in favour of suits), he promoted education. 'We've a patient doing a university degree now.'

He acknowledged that a tilt from a custodial environment to rehabilitation brought risks. 'But this is a risk business. Anyway, the dispute is about who manages the hospital.' The non-seclusion policy means changes in established shift patterns of working. Consequent reductions in overtime are not welcomed by the POA.

Mr Field said that only 10 per cent of Broadmoor's patients were aggressive, dangerous and violent. But, while he did not agree with a POA prediction of 'police and bodybags', he conceded the reforms would stress staff.

'To talk to a psychopath all day is more stressful than telling him what to do and what and when to eat . . . He can be very manipulative and wants his own way. The boss-subject relationship was simpler, but less humane.'

Mr Franey dismissed staff assertions about security. 'The safety of the public is the first consideration; the treatment of the patient the second.' He even challenged the widespread use of the phrase 'non-seclusion'. 'There is no non-seclusion policy. It is a seclusion policy which gives more freedom to patients but allows them to be locked in their rooms if clinically necessary - in a medical emergency, not as a punishment.

'They have discos and cinema. Integration is normal; segregation not. We would not send out a high-risk patient on a rehabilitation trip (accompanied by two nurses)' - not, he might have added, since two dangerous murderers absconded from their 'rehab' escorts last December.

Perhaps in anticipation of further controversy, Mr Franey said: 'Broadmoor's no holiday camp.'

(Photograph omitted)