CONVALESCENT TREATMENT

611 staff and creates difficulties. If others take control is over, lost, misunderstandings arise, uneasiness sets in, the nurse wastes his detailed knowledge of his patients and resents losing the most interesting, therapeutic, and rewarding side of his work. When the work is done in the ward more patients can be drawn in. It is difficult for a lazy, apathetic, stubborn, or openly hostile patient to hold out for month after month, when taking part will earn the nurses’ approval and a place on the pay-list at the end of the week. Often a patient will refuse to start work at the regular time, but will become amenable to persuasion perhaps only a few minutes later. Such a delay cannot be tolerated where a party of workers has to be sent off under supervision to a separate place. The deteriorated schizophrenic does not easily form relationships with other people; but in the ward he can work under the guidance of the nurses he knows. We recognise that many patients gain from getting out of the ward and enjoying a change of environment, and we agree that " going to work " is an essential ingredient of real life; but we feel that patients as deteriorated as ours are not ready for this. To compensate we encourage and the fullest leave, parole, possible enjoyment of amenities outside the ward. Selected patients hospital also go regularly to the factories with which we deal, and are brought, under protected conditions, into contact with the outside world. We are indebted to Dr. George Somerville, physician-superintendent, for help, guidance, and encouragement. Mr. E. J. Latchford, chief male nurse, has given us continuity of staff and enthusiastic support. Miss M. D. Beldam, head occupational therapist, has placed her technical knowledge at our disposal and helped with her advice. Mr. E. V. Roxburgh, superintendent engineer, has met our persistent requests for apparatus. Mr. A. L. Lovell, the transport officer, has supplied us generously with his vans and lorries, so that

this

splits the

have not had to refuse any contract for lack of transport. To these and many others we gratefully acknowledge our debt.

we

CONVALESCENT TREATMENT IN 1956 the Minister of Health appointed a working party, under the chairmanship of Dr. N. M. Goodman, to examine how far convalescent homes in the National Health Service are meeting the demands placed on them in the light of advances in medicine and modern conceptions of treatment and nursing care. Though their

investigations were limited to four Metropolitan regional hospital boards their reportis of more than local significance, and their main recommendations are discussed in an editorial on an earlier page. These include proposals for regrading convalescent facilities into homes where active treatment is given (to be known as convalescent hospitals), which should be upgraded where necessary, and homes for recuperative holiday type of care which should no longer be the responsibility of the hospital service; increased accommodation for specially difficult groups; a convalescent information bureau to coordinate the exchange of information and advice on placing. They also propose experiments with accommodation in or near hospitals, with facilities such as physiotherapy provided by the parent hospital, day convalescent centres based on the department of physical medicine at general hospitals in large centres of population, and the use of convalescent accommodation for patients who need preventive treatment and preparatory care before active

therapy is begun. As a background to their main recommendations the working party discuss practical problems which they met in their survey and they also offer suggestions on these important points of small and large details. 1. Convalescent Treatment. H.M.

Stationery Office, 1959, Pp.

48. 3s.

Arrangements for the payments for convalescence contain patient at least often seem chaotic. The working party would like to see the system rationalised and the hospital service providing for all patients who need convalescent treatment, if necessary by altering or extending

many anomalies and to the

contractual arrangements. For many patients the first difficulty of convalescence is getting to and from the home and paying for their transport. Often they are faced with a long tiring railway journey without adequate reservations. The working party recommend that the hospital service should pay railway fares or provide transport on medical certification. Once the patient is in the home the main difficulties seem to turn on lack of medical liaison. The doctor at the home is sometimes reluctant to take full responsibility, yet the hospital consultant is usually too distant to supervise an ordered sequence of treatment. Local consultant treatment is seldom thought to be necessary by the doctors at the homes, and the cooperation of physiotherapy or occupational therapy departments is seldom sought. This divided responsibility means that the length of the period of convalescence is not reviewed when an extension is medically desirable. In the running of the homes themselves one of the chief problems, as so often elsewhere, is shortage of staff. The need for more trained nurses is particularly acute and is often the reason for the refusal to accept difficult cases and apparently unreasonable restrictions, such as lack of rest periods, too early getting-up, and the impossibility of breakfast in bed. One of the chief causes of the shortage of staff is a sense of isolation and detachment from other forms of nursing. The post of matron is often held by an older woman nearing retirement, and the working party feel the appointment of younger keen, and active nurses and closer medical supervision to be essential for a more active policy on convalescence.

DOCTORS IN PARLIAMENT IN last week’s General Election ten doctors elected to Parliament. One of them is a newcomer House of Commons-Dr. A. J. Glyn, Conservative ber for the Clapham division of Wandsworth.

were

to

the

mem-

R. F. B. and A. D. D.

BENNETT, V.R.D., M.A., B.M. Oxon., D.P.M. (C., Fareham), was first elected in 1950. BROUGHTON, M.A., M.B. Cantab., D.P.H., D.P.M. (Lab., Batley and Morley), entered Parliament in 1949 by winning a by-election. J. D. CRONIN, M.B. Lond., F.R.C.S. (Lab., Loughborough),

Gosport

first entered Parliament in 1955. A. J. GLYN, B.A. Cantab., L.M.s.s.A. (C., Wandsworth, Clapham), graduated B.A. with honours at Cambridge in 1939 and after the war qualified from St. George’s Hospital in 1948. He is in practice in Belgravia. He is also a member of the Middle Temple. CHARLES HILL, P.C., M.A., M.D. Cantab., LL.D., D.P.H. (L. and C., Luton), was secretary of the British Medical Association from 1944 until he entered Parliament in 1950. He has held office as parliamentary secretary, Ministry of Food, Postmaster-General, and Chancellor of the Duchy of Lancaster. D. Mcl. JOHNSON, M.A., M.B. Cantab. (C., Carlisle), qualified from St. Bartholomew’s Hospital in 1926. He is also a barristerat-law. J. D. MABON, M.B. Glasg. (Lab. and Coop., Greenock), was elected to his present seat at a by-election in 1955. Sir MALCOLM STODDART-SCOTT, O.B.E., M.D. Leeds (C., Ripon), was Conservative member for Pudsey and Otley from 1945 to 1950, since when he has represented Ripon. He was knighted in 1957. BARNET STROSS, M.B., M.sc. Leeds (Lab., Stoke-on-Trent Central), has been in Parliament since 1945. EDITH SUMMERSKILL, P.C., M.R.c.s. (Lab., Warrington), represented Fulham West from 1938 until 1955. Since then she has represented Warrington.