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food could hardly be expected to be of the highest quality. Homes of this type appear
to be on the border of solvency, and it may well be that few can survive. On the other
side of the picture are a few homes charging fees as high as 30 to 35 guineas a week.
These homes are in constant use by physicians and surgeons of high standing, and the
professional skill and care are matched by a service similar to that of a luxury hotel.
The introduction of the National Health Service came at a time when the falling
birth-rate was reducing the admissions to maternity beds in nursing homes, and
coincided with a period when maternity wards were being expanded in the hospitals.
The number of confinements taking place in nursing homes in London was 3,167 in
1947 : in 1952 this had fallen to 1,091. This large drop cannot be wholly accounted
for by the fall in the birth-rate from the exceptionally high figure of 20.9 per 1,000 of
the population in 1947 to 15.3 in 1952. Recent annual reports of the medical officers
of health of other large cities show the same trend. Most homes found that in the
post-war years less use was being made of their operating theatres and more beds
were being used for medical cases, particularly for the treatment of the chronic sick
or senile patients : in 1948 30 per cent, of the beds in nursing homes were occupied by
patients in those two categories. By 1953 this figure had risen to 44 per cent., and in
the same period the proportion of beds occupied by maternity cases fell from 10 per
cent, to 5 per cent., and of all beds occupied from 75 per cent, to 71 per cent.
State-registered nurses are not as a rule keen to work in private nursing homes,
and the comparatively uneventful nursing of the chronic sick does not greatly attract
them. It is the State-enrolled assistant nurses, or the older women, trained but without
State registration, who nurse such cases. The organization of comprehensive home
nursing and home help services under the local health authority, and the establishment
of old people's homes under welfare provisions, while in no sense a replacement of the
private nursing home, have added to the facilities available and undoubtedly had some
effect in reducing the numbers of those who might have gone into a private home.
The borderline between what constitutes nursing of the sick and caring for the old
and enfeebled is very ill-defined. Establishments which provide care for the aged by
ordinary unskilled staff fill a real need, and there are good reasons why some of the
smaller nursing homes should turn their attention to this type of elderly person who so
often fails to find the accommodation for which he or she is seeking.
Welfare Committee establishments
The Medical Officer of Health is responsible for the medical arrangements in all types
of establishments under the control of the Welfare Committee. These include large
and small homes for the aged and infirm, mother and baby homes, hostels for mothers
in work, reception centres for persons without a settled way of life and homes for the
blind. Medical officers and inspectors on the central staff visit periodically to supervise
the medical arrangements and hygiene.
Homeless
families
units
During the year two of the homeless famines units were closed and at the end of
the year 158 mothers and 300 children (of whom approximately 66 per cent, were
under five years of age and 21 per cent, under one year of age) were accommodated
in the remaining three units. Particular attention was given to the control of infection
which in communities of this type demands constant vigilance. Weekly visits were
made by health visitors to advise mothers on the care of their children and to give talks
on mothercraft. Mothers were encouraged to attend sessions at neighbouring maternity
and child welfare centres and a weekly child welfare session was held at one of the
units. Nursery classes under the direction of the Education Officer for children aged
between three and five years were conducted at two units.
Hostels for
mothers
in work
Medical officers on the central staff gave medical supervision to the two hostels
for mothers in work. In one of the hostels the children were cared for during
the day by the hostel staff and routine visits were made as to a day nursery by a medical
officer on the divisional staff. Mothers in the other hostel took their children to day
nurseries in the area.
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