Ashworth Hospital's top managers insist it has a future beyond its current problems. Dolly Chadda reports

Ashworth Hospital feels threatened. Chief executive Hilary Hodge thinks this is hardly surprising. It is the subject of a public inquiry sparked by allegations of pornography and paedophilia in the personality disorder unit.

To add to its troubles, the high-security hospital in Merseyside featured in a recent, much hyped Panorama programme, and it is dogged by claims that the new regime is alienating staff through its 'macho' management style.

Challenged on this latter allegation, Dr Hodge, who took over at Ashworth just weeks before the Fallon inquiry started last November, is incredulous.

On the day the Panorama programme was due to be broadcast, she and the hospital's chair, Paul Lever, held a series of impromptu meetings with staff and patients.

The programme had been trailed extensively, and there were widespread fears that it would concentrate on the possible closure of the hospital. She and Mr Lever wanted to reassure people, says Dr Hodge.

'I do not think that is a reflection of dictatorial management. It is a very involved style of management, ' she argues.

Dr Hodge claims, too, that the consultation about putting into place a new management structure 'is one of the most involving of people that you could possibly find in the NHS'. Not only staff, but patients, are being given a say in what kind of management structure there should be.

But a lot of staff feel threatened by the public inquiry - the latest of some half-dozen since 1989 - says Dr Hodge.

Some are anxious and resentful about being in the public eye again as well as about the changes taking place.

'Let's face it, ' she adds. 'If there wasn't a public inquiry going on, I wouldn't be here and nor would there be a need for a new management team.'

The current regime believes that a small minority of people, including some present and past staff, are campaigning 'actively and surreptitiously' to undermine the changes taking place.

Already aware of Journal inquiries, Mr Lever opened Ashworth's first public board meeting last week with a warning to beware of 'misinformation' about the hospital.

He told the meeting, attended by only two other journalists: 'There is an enormous amount of gossip, talk and disinformation about Ashworth. We have to be on our guard against that.'

But he added: 'We have to be. . . prepared to stand by the changes.'

The change agenda is massive. When Dr Hodge arrived she found a management system that had completely broken down, a recognition that patients were running parts of the PDU, and a demoralised workforce.

Developing a new management structure was a priority. The aim is to create a structure which allows devolved management at ward level but will not allow problems to build up without senior managers being aware of them.

Following the last major inquiry on Ashworth, conducted by Sir Louis Blom-Cooper in 1991, 'some things you need to run an organisation got lost', she says. 'One of them was this ability to have an overview.'

Proposed new arrangements will offer clear lines of communication between ward-level managers and executive directors.

A central clinical administrative office has been set up to give the 'overview'. As well as taking over administrative duties from clinical staff, it tracks such issues as staff sickness and patient movements 24 hours a day .

The office acts as a safety and security mechanism, which enhances patient care by allowing staff shortages to be tackled quickly, Dr Hodge says.

Ensuring patients get the treatment they need, which Dr Hodge admits has not always happened, is a driving force.

Hence a major review of rehabilitation services has just ended, with a pledge that this time it will be implemented.

There have been five previous reviews which for 'reasons I do not know and do not want to speculate on' have not been put into action, Dr Hodge reveals.

But the staffing and financial implications are enormous, and talks are underway to secure bridging funds for the changes to proceed.

On the long-term future of Ashworth and other high-security hospitals, Dr Hodge is adamant.

Talk about whether they should close, prompted by leaks of a report to ministers on their future role by the High Security Psychiatric Services Commissioning Board, is the wrong debate, she says.

Dr Hodge says inadequacies in other mental health services need to be tackled first. Only then, and when sufficient funding has gone into preventive measures, will it be possible to look at where high-security services fit in.

Dr Hodge attacks as unfair the adverse publicity Ashworth attracts, and pleads for recognition for the staff - some of the most talented she has come across - and sympathy for patients, of whom she says: 'Some have done horrendous things but they have had horrendous lives.'