The care of the chronic sick; social and demographic data.

Abstract

The transfer of responsibility for the care of the chronic sick in hospital from Local Authorities to Regional Hospital Boards has raised two important questions. First, Regional Hospital Boards have to decide on the location and number of beds to be provided for this class of patient. Their waiting lists indicate that more accommodation is needed, but more accommodation of the existing type would aggravate staffing difficulties which are already serious. The alternative possibility of catering for these patients in general hospitals has much to recommend it, but raises the objection that the apparent number of patients would prohibit the general application of such a policy. Second, Local Authorities have to agree on the interpretation of those sections of Part III of the National Health Services Act* (1946) and of Part III of the National Assistance Actf (1948), which refer to their responsibility for complementary facilities. The intention of the acts is evidently to leave to Local Authorities domiciliary and institutional care of persons who need not be admitted to hospitals, but the wording of the acts reflects the lack of informa tion about the numbers and types of patients for whom Local Authorities will be expected to cater. The fact that social as well as medical needs have in the past determined the admission and retention of patients in hospitals for the chronic sick suggested that the number of patients now in hospital is unreliable as a guide to future develop ments. Consideration of the medical, nursing, and social requirements of 1,005 patients in one hospital indicated that about three-fifths were not in need of hospital services and could have been cared for in their own homes or in institutions other than hospitals (Lowe and McKeown, 1949). One-fifth of the patients required institutional supervision because of their abnormal mental state, and only the remaining one-fifth were in need of services which could properly be considered the concern of general hospital authorities. Reduced to these dimensions, the problem of the chronic sick in hospital can be reconsidered in relation to the general hospitals. In this paper we examine other data which have a bearing on the commitments