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In Tottenham and Hornsey there are known to be not less than 100
problem families, though some are naturally much worse than others.
The majority of these families continue to be problem families for
years and receive the attention of a number of social workers, voluntary
organisations and the assistance of local authority services. This support
is a heavy burden on the community involving the time of workers,
expensive residential accommodation and financial assistance of various
kinds.
Ministry of Health Circular 27/54
This circular to Local Health Authorities points out that:—
"Children in the 'problem families' where one or both parents are
often handicapped by physical ill-health or are of low intelligence
or suffering from mental instability, are peculiarly exposed to physical
neglect and risk of mental illness such as psychological disturbance
and retarded mental development. Problem families thus tend to
reproduce themselves in the next generation and cost the community
an expense out of all proportion to their numbers. Action to break
this vicious circle by preventive measures would, in the Minister's view,
be a proper exercise of the local health authorities'' powers under
Section 28 of the National Health Service Act, 1946.
"The health visitor whose work now extends to cover the whole
field of prevention of ill-health, including prevention of mental illhealth,
is by reason of her close contact with families with young
children, particularly well placed to recognise the early signs of failure
in the family which may lead to disruption of normal home life with
consequent risk to the mental health of the children."
The Minister also "suggests that authorities should consider whether
their health visiting service can be redeployed on a more selective basis
and if necessary increased so that more time is devoted to those families
where problems are likely to arise, or are known to exist".
The Scheme for this Area
The Circular adds considerable support to the following plan which
I had intended to submit for the Committee's consideration before
becoming aware of its contents:—
The health visitor, although the obvious person to tackle problem
families and to endeavour to improve their outlook and behaviour,
because of her many and varied duties, is normally unable to devote
sufficient time to this part of her work. As an experiment, therefore,
it is suggested that the following steps should be taken with the object
of re-educat ng families in their own homes instead of (as is often the
case) separating them:—
1. One health visitor in Hornsey and one in Tottenham shall be
detailed to take over specialised work with problem families.
2. The case load for each of the two health visitors shall generally
not exceed 15 families at one time.
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