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74
of each home nursing organisation; (b) by direct personal contact (particularly divisional
nursing officer to superintendent); and (c) by joint membership of the divisional home
nursing voluntary committee. One of these committees has been set up in each of the
nine health divisions. They include representatives of all organisations administering the
home nursing service in the division; the principal divisional officers of the Council; and
representatives of all allied services with which co-operation should be maintained, e.g.,
general medical practitioners, nurses, midwives, hospital almoners and the British Red
Cross Society. There is still evidence that home nursing superintendents make insufficient
use of the divisional health office facilities and that some visits of a purely social nature
are paid by home nurses, and particular attention is to be given to these matters.
Consideration is being given to the possibility of extending liaison arrangements to
include field workers, i.e., by direct contact between district nurse and health visitor,
home help organiser, and care committee workers, etc.
There is a long-established tradition of co-operation with general medical practitioners
and hospitals. The Central Council for District Nursing supplies printed forms for use
by general medical practitioners and hospital almoners by which application may be
made for the services of a district nurse for any patient needing nursing care at home,
but the telephone is used at least as frequently as the forms. The majority of the cases
attended by district nursing organisations are referred by general medical practitioners,
somewhat under one-fifth being referred direct by hospitals. Maternity patients who
either develop some infection or are discharged from hospital before the last day of the
puerperium are referred to the general district nurses for home care unless they are
booked patients of one of the Council's midwives. Where a district nurse calls in response
to an application from other than medical services (e.g., from relatives of the patient) she
will not normally make more than two visits unless a doctor has been called in, and she
will work under the doctor's instruction.
Staff
The number of nurses employed at the end of 1952 was 455 whole-time and part-time
(whole-time equivalent 405 nurses). This compares with 341 whole-time and 114 parttime
nurses (397 whole-time equivalent) employed at the end of 1951.
The employment of state enrolled assistant nurses on a limited scale has been of
assistance in easing the work of the district nurses, but some organisations are reluctant
to use them and the Council has not so far seen fit to bring any pressure to bear. Where
these nurses are employed the view has been expressed that one S.E.A.N. working to
five trained district nurses is appropriate. Now that S.E.A.N.s are required to have
experience in the care of sick children it is likely that their services will be utilised to a
greater extent than hitherto. The use of nursing auxiliaries to supplement the work of
the trained staff has also been found to vary in extent, and here again the desirability of
enrolhng such workers where they were available has been left entirely to the discretion
of the individual organisations.
Transport
The bicycle remains the form of transport most widely used by district nurses,
although autocycles are increasingly in evidence, particularly among male nurses. Some
organisations possess cars, and the Council has embarked on a programme of supplying
cars on loan to those whose work justifies the provision of additional means of transport,
but who are unable for various reasons to acquire a car. The basis of the scheme is that
the Council licenses, insures and periodically overhauls the vehicles, running costs being
borne by the organisation and ranking for grant from the Council. At the end of the
year eight associations were operating Council cars under this arrangement. One car
was lent to an association until the delivery of a new car which the association had
ordered.
Consideration is being given, in association with the Central Council for District
Nursing, to the provision of a lighter nursing bag to ease the district nurses' work, but
the replacement of all bags by new types will necessarily be a long process.
Night service
Owing to the pressure on the staff, consideration of a night service has had to be
postponed until such time as more staff, and more accommodation for them, may be
available. Several of the district nursing organisations, however, are able to arrange