Few people with direct experience of mental hospitals expected a bright new dawn on the Appointed Day, 5 July 1948, but they can hardly have envisaged the nature of developments over the next decades. Overcrowding in mental hospitals nationally was estimated at 14 per cent in 1950; there was an acute shortage of nursing staff and, with an increasing proportion of elderly patients, some form of expansion was seen as a priority. Yet annual spending on mental hospitals averaged only £ million between 1948 and 1954, compared with £. millions in 1938–9. More invasive physical and electric treatments were used before the pharmacological revolution began, but renewed attention was also paid to occupational and recreational therapies, psychopathology and behavioural training. If the role of mental hospitals was not yet controversial, their modernisation or replacement costs already occupied Ministry and Regional Board officials and hospital administrators and soon became a public issue. Therapeutic and economic considerations assumed additional significance after the 1959 Mental Health Act, which superseded previous legislation and related arrangements and specified informal treatments without stigma in district general hospitals or under new community agencies.

One emerging certainty in this vague future was the running down of mental hospitals, which featured prominently in the 1962 Hospital Plan. Wholesale closures and a halving of the sector's bed capacity was envisaged by 1975, ensuring that further spending upon target institutions would be minimal. St Andrew’s, with accommodation dating from 1814, carrying deficiencies acknowledged in the 1930s and compounded by wartime experiences, inevitably came under scrutiny. Until then the hospital offered a range of treatments and good standards of care in rather outmoded conditions and within financial limits suggestive of indifference at regional and ministerial levels. Meanwhile, admissions, readmissions and the proportion of the elderly long-term residents all increased.

By the early 1960s St Andrew's had completed a merger with the former naval institution at Yarmouth, renamed St Nicholas’ Hospital. The 1959 Act was operative and the Regional Hospital Board had responded to the Hospital Plan by incorporating both hospitals within an enlarged Group 8 in 1964. Hospital annual reports, already less informative, then changed radically and coverage of St Andrew's diminished. Board inspectors’ reports ceased with the abolition of the Board of Control under the 1959 Act but medical superintendent's reports continued beyond the regrouping and McCulley's own resignation through ill-health in 1964, as did visitors’ reports.