From closure to pioneer: Mildmay Hospital in the 1980s
In 1982, Tower Hamlets Health Authority determined that Mildmay should be closed down. By 1985, it had reopened - no longer part of the NHS, but as a voluntary charitable hospital outside it.
Within three years, it had become the first AIDS hospice in Europe and a global model for compassionate HIV care. This is the story of how it survived.
Closure
In 1980, a working group set up by Tower Hamlets Health Authority examined Mildmay's future. The verdict was that as a cottage hospital with fewer than 200 beds, the hospital's 62 beds, A&E, and outpatient services didn't fit local needs.
A compromise was proposed: three specialist units focusing on chronically sick young patients, continuing care for children with disabilities, and day surgery, alongside GP training. Mildmay was already doing all of this.
The compromise lasted less than two years. In 1982, Tower Hamlets Health Authority concluded the plan wasn't financially sound and began shutting down the wards one by one.
A second proposal was put forward: Mildmay could continue as a community hospital with GP training. While the proposal was being considered, over 400 supporters marched from Mildmay to Trafalgar Square in January 1983. The march bought time, but not enough.
On 14 July 1983, the decision came again: Mildmay Hospital should close.
The Hospital Advisory Committee sought a meeting with the Secretary of State, Norman Fowler. The meeting, which finally took place in November, was with Kenneth Clarke, the Minister for Health.
Mildmay waited four months for a decision. When it came, the answer was no. The remaining wards and services began to close, probably by late 1983 or early 1984.
Reopening
The committee of supporters wasn't finished. If the NHS didn't want Mildmay, they would run it themselves, as a wholly voluntary hospital outside the NHS.
Within a month, the Minister gave a positive response, subject to approval from the Regional Health Authority and Tower Hamlets Health. The Friends of Mildmay would be allowed to continue running the hospital on a voluntary basis.
In early 1985, through donations and volunteer support, the hospital began to be refurbished. On 2 May 1985, Kenneth Clarke announced in Parliament that he had approved the reopening of Mildmay on a voluntary and charitable basis, to be funded partly by churches and Christian charities. The hospital would be leased to the Friends of Mildmay at a peppercorn rent.
In October 1985, the hospital reopened — initially providing GP services, then as a hospital nursing home. A thanksgiving service was held at St Paul's Cathedral on 20 November 1985.
Helen Taylor Thompson, who joined the Board of Mildmay in 1952, later became Chair and played a pivotal role in securing the hospital’s survival.
The Hansard Record :
Kenneth Clarke's Announcement, 2 May 1985
Hansard is an edited verbatim record of what was said in Parliament. It also includes records of votes and written ministerial statements. The report is published daily covering the preceding day, and is followed by a bound final version.
House of Commons: Written Answers: Social Services
Mr Tom Sackville
asked the Secretary of State for Social Services whether agreement has been reached on the transfer of the Mildway Mission Hospital in Shoreditch, to the hospital's League of Friends; and if he will make a statement.
Mr. Kenneth Clarke
Yes. In May 1984 the principle of leasing the hospital to the League of Friends on a concessionary basis was agreed, subject to the fulfilment of a number of conditions relating to use and assurances of adequate financial support. The North-East Thames regional health authority has negotiated with the League of Friends on our behalf and we are satisfied that the conditions and assurances sought have been met. We have therefore agreed to lease the hospital to the friends on a long-term basis at a peppercorn rent. The hospital will be run in accordance with the original Christian objectives for which it was established last century. It will provide a range of services, including nursing home beds, GP beds and day facilities for the elderly. It will, I believe, complement NHS services in Shoreditch in the same way as other voluntary or religious foundations have complemented the work of the National Health Service since its inception. We wish the Mildmay well in its new role.
What Made It Possible: Peter Frymann's Account
Peter Frymann, who joined the Board of Mildmay at that time, shares his recollections.
I'm going to pick up from the book by Derek Taylor Thompson, The Birth and Rebirth of a Unique Hospital, at paragraph 51, which is where I came became involved.
The legal argument that saved Mildmay
In April 1984, Helen Taylor Thompson contacted me to see if I would be interested in getting involved with Mildmay with a view to preparing a business plan or feasibility study for the Mildmay Mission Hospital as a voluntary charitable Hospital. This I did, and this document was indeed put to Kenneth Clarke, who was Health Minister under Norman Fowler, Secretary of State for Health.
What impressed him more than anything, was the fact that in the 1948 National Health Services Act, there was a stipulation that the Minister of Health or his successor was responsible for maintaining the denominational nature of hospitals where that was appropriate. Mildmay was one of six hospitals covered by this provision, and it was pointed out very strongly to Kenneth Clarke, that closing a hospital was definitely not maintaining its denominational nature. The Hospital Advisory Council, in that sense, offered to do the job for him if he would grant a lease at a peppercorn rent to the HAC to reopen the hospital. Those were the legal grounds on which the hospital was reopened in 1985."
Raising the Money
One of the great heroes of the hospital, mentioned in the book, is actually Dr Kenneth Buxton. He was chairman of the League of
friends, having been a medical director at the hospital. He it was who persuaded the League of friends in 1984 that without the hospital in operation the raison d'etre of the nursing home had gone. Accordingly, the only way to support the hospital they were all committed to was to close the nursing home, to sell it and donate the proceeds back to the hospital.
It was that donation of that £300,000 that gave the hospital reserves, which enabled it to sign the contract for the redevelopment of the ward for caring for people with AIDS. The contract might have been £300,000 but the cost worked out at £600,000. In part, the increase was down to the developing level of knowledge in the Local Authority and their changing requirements.
Later, Helen Taylor Thompson asked me whether, if we'd known in advance it would cost so much, we would have signed the contract. I replied that it was a matter of faith that we did sign that contract. I also pointed out that if we hadn't signed the contract we would almost certainly have lost the hospital because we have not been able to open, providing services that agreed with the DHS strategy and priorities. That was one of the terms of the lease that we should work with the DHA to complement them or not compete with them.
It was a matter of faith that we did sign that contract. If we hadn't, we would almost certainly have lost the hospital."
The Early AIDS Years
"I remember in 1984 we had lots of meetings with the local community and representatives of it, to assess the support locally for the Mildmay. Indeed, there was a lot of support.
A lot of people said that even though they are a Christian hospital, they would not push their Christianity, but it was the love that came through.
There was a lot of support locally, provided in the form of pubs that collected change to donate to Mildmay. One of the local businesses, which supplied leather goods, offered to provide a jacket or something if a patient needed it. And we had one AIDS patient, a young lady who had been a drug addict who desperately needed some clothes, and she was absolutely thrilled to be given a superb leather jacket from this company (whose name I can't remember).
One of the most useful features of the hospital in the early days was the roof garden; because so many people with AIDS enjoyed working with the plants - because they were working with something to do with life.
I remember that as a board, we decided that if we didn't know enough about AIDS, we would organise a time when, board members and one or two other volunteers could meet with one or two patients, just to discuss their experience of living with AIDS and living within Mildmay.
The person we spoke to said that the day he was diagnosed with AIDS was one of the most liberating days in his life because it meant he knew that he was going to die and it meant that he focused on what was important in his life. So often we can go through life, too busy to think about what's important, But he said that they made him realise what was important and made him free to pursue the important things in life and not the fripperies."
Nurse Joyce and a patient in the rooftop garden
Other people who were involved at the hospital in the 1980s included David Brownnutt, who was pastor of the Free Church next to the hospital, and the Reverend Eddie Stride, who was the vicar of Shoreditch parish church.
In paragraph 92 in his book, Derek Taylor Thompson talks about the gathering in Buxton Hall when Bishop Maurice Wood gave an address at the dedication service. One of the comments he made about AIDS was seeing it as the 20th-century equivalent of leprosy in the Bible, in terms of people's attitude to sufferers.
It's also interesting to note that, whilst Mildmay was closed because the NHS said there was no place within the current NHS for a unit the size of Mildmay, within 10 years, it was cited in Hansard as the model of care for people with AIDS in the UK."
Meetings, Bloody Meetings
"In the late 1980s the Hospital Advisory Council in whatever name you want to call it used to meet once a month to conduct the appropriate business.
In the early years, we would take something like three hours. And as I had a full-time job. I said to Helen Taylor Thompson that this was just becoming unacceptable. In 1989 I started working for a training organisation and I borrowed two training videos called "Meetings, Bloody Meetings" and "More Bloody Meetings". When we implemented some of the techniques, we found that we were conducting far more business in little more than an hour per month. That was a real blessing, and it meant that the meetings became much more professional and business-like and the business of the hospital was well conducted.
I was involved throughout the Centenary Appeal and the building of the new unit designed to care for mothers and children. It is interesting to note that one of the first patients was a man in his 20's and his mother, who came to stay with him. Not quite what everybody expected, but the hospital has always catered for the unexpected.
During my time with Mildmay, its Christian ethos and heritage were always very strong. The faith was never
aggressively pushed to patients and visitors, but it was always there when questions were asked by patients. Many did ask those questions and found a faith (and peace within themselves and with others) before they died. One early patient with AIDS was so ill on arrival that Dr Veronica Moss wondered how they were still alive. A few days after arrival, they spent time with the Chaplaincy Team and made their peace with God and died a few days later.
A Life's Work
My involvement with Mildmay ended in 1997 when I moved to Zambia on a three-year contract. It meant that I was unable to attend the opening of the Mildmay unit in Uganda, but I can certainly look back with a lot of pride and satisfaction. The fact that we took Mildmay from being a defunct and dead hospital to being a world leader in the care of people with HIV/AIDS and in research for healthcare for people with AIDS, with units both in the developed and the developing world, remains an enormous source of satisfaction to me personally."
Peter D Frymann
September 2021
AIDS and Transformation
Health Secretary Norman Fowler, in London in 1986, in front of a poster reading "Aids Don't Die Of Ignorance," which was part of the Government's £20m warning campaign against the disease.
In 1988, the government asked Mildmay to do something that almost no one else was willing to do: care for people dying of AIDS.
At the height of the epidemic, fear and stigma around the condition were overwhelming. Some healthcare workers refused to treat patients. Families were sometimes too frightened to visit their dying relatives.
AIDS was understood to be caused by a virus, HIV, but public understanding was limited, misinformation was rampant, and the disease carried a weight of social shame that compounded the suffering of those who had it.
Mildmay said yes.
Princess Alexandra officially opens Mildmay
19th May, 1988
On 19 May 1988, Princess Alexandra returned to Mildmay to officially open Europe's first dedicated AIDS hospice at the hospital.
Her visit that day was the latest in a relationship with Mildmay stretching back more than two decades.
Princess Alexandra first visited Mildmay in 1965 to open a new hospital extension.
Princess Alexandra meeting patients in 1965.
Princess Alexandra meets with Mildmay staff and patients during the opening of Britain's first AIDS hospice in May 1988.
Thames News filmed the event.
Archive clip from Thames News YouTube channel
Bishop Maurice Wood, speaking at the dedication service, described AIDS as "the 20th-century equivalent of leprosy in the Bible, in terms of people's attitude to sufferers."
Mildmay Family Care Centre advertised on the London Underground, late 1980s . A sign of how quickly the hospital had established a public profile.
Princess Alexandra returned again in 2005 for the 20th anniversary of Mildmay's reopening.
During her visit, she spent time talking to patients and staff
In 2005, she visited again with Kenneth Clarke to mark the 20th anniversary of the reopening, a full-circle moment connecting the minister who made it possible with the hospital that survived.
Spencer House Family Care Centre in Austin Street
In the late 1980s, Mildmay opened Spencer House in Austin Street
It was the first and only residential family care centre in the world for families affected by HIV.
As Baroness Masham of Ilton said in Parliament:
Mildmay was not only the first hospice in Europe for people with AIDS; it was the first and only residential family care centre in the world available to care for the whole family."
Diana, Princess of Wales (1989–1997)
Diana is welcomed to the hospital by Chair of the Board, Helen Taylor Thompson.
Diana, Princess of Wales, made seventeen visits to Mildmay between 1989 and 1997 - three official, fourteen unofficial, sometimes arriving at eleven at night and staying into the early hours.
The press coverage of Diana's visits helped to shift public understanding of AIDS in Britain in ways that no public health campaign could have achieved alone.
Within ten years of its closure by the NHS, Mildmay was cited in Hansard as the model of care for people with AIDS in the UK.
Martin was so excited about Diana's first visit in 1989 that he bought a new pair of spectacles for the occasion. He died not long afterwards.
From Hospice to Rehabilitation
In 1996, the arrival of highly active antiretroviral therapy - combinations of drugs that could suppress HIV to undetectable levels - changed everything.
For the first time, AIDS was not necessarily a death sentence. For Mildmay, that meant becoming a different kind of institution almost overnight.
The hospice became a rehabilitation centre. Patients who had arrived expecting to die were, against all expectation, leaving, sometimes slowly, sometimes startlingly quickly.
The practical and emotional reality of that shift is difficult to overstate. Staff trained in end-of-life care were now helping people plan for futures they had stopped believing in. Patients who had said their goodbyes were learning, painstakingly, to walk again.
By 2008–09, there were just two deaths at the hospital in a single year.
When Mildmay opened in the Eighties it was very much a hospice. Life expectancy was very limited. With advancements in treatment and also with our focus on rehabilitation, patients are getting better."
Simon Rackstraw FRCP
Mildmay's Medical Director
2012
Through this period, Mildmay developed particular expertise in HIV-associated neurocognitive disorder (HAND), the damage HIV can cause to the brain.
For some patients, this means losing the ability to walk, speak, or feed themselves: the kind of profound impairment that demands skilled, sustained, multidisciplinary care. Helping someone relearn those abilities or adapt to living without them, is slow work, and it requires a very specific clinical environment.
Mildmay built that environment, and the knowledge that goes with it, over decades. It remains the only specialist HAND rehabilitation unit in Europe.
Learning to play the guitar again: occupational therapy at Mildmay
The story of Mildmay's transformation during this period was covered in the Evening Standard, April 2012. The original article, 'AIDS sufferers given new life by Diana clinic's pioneering work' is linked below rather than reproduced here, due to copyright.
