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supplemented by discussion, were considered by the divisional nursing officers in each
division, who were appointed reviewing officers, to assess the factors and to grade
families concerned. Health visitors made a note of the time actually spent for a period
of four weeks on the families finally selected. Finally a central team, principal medical
officer (maternity and child welfare), statistician and chief nursing officer, visited a
number of centres in the divisions and interviewed the health visitors. Ten centres
were visited and 39 health visitors were interviewed. The centres were chosen to represent
a cross section of the London population so far as social class was concerned.
The assessments were studied and a careful inquiry made into the work of the
health visitors with the families concerned during the month under review. The relationship
of health visitors with other field workers of both voluntary and statutory bodies
called in to assist the family, the attitude of the family towards advice and help and the
limitations imposed by their willingness or ability to accept advice were all taken into
consideration in forming an estimate of the amount of time which should be spent on
these families.
Numbers
Families with a child or children under Jive years of age (public health department)
Table 1 sets out the number of families surveyed by the public health department;
the number and percentages of families in the two categories of problem family,
excluding those in halfway houses and homeless family units, sub-divided into those
families in which all the children are under five years of age and those where there is a
mixture of both school and pre-school children. The figures shown will tend to be an
underestimate, because constant immigration will inevitably mean that at any given
moment there will be new families in the County whose circumstances are not fully,
if at all, known; additionally, with the turnover of health visitors there were some who,
at the time of the assessment, could only judge from case papers, which, however
well kept, were no real substitute for personal and comprehensive knowledge of the
family.
The average and maximum numbers of problem families in the care of a full-time
health visitor are also shown in the table—some health visitors had no such families
in their care. The difference between the average and the maximum confirmed the
impression that problem families tend to be grouped in small areas. This had an
important bearing on the time factor to which reference is made later.
Problem families tend to move about—for example, out of 30 families in the case
load of one health visitor, six had moved out of her district in three months. They may
also move in and out of the various categories as their circumstances change—for
example, in one division of the County there were at the time of the survey 314 problem
families in all, whereas some six months later the total had fallen to 303. The net fall
of 11 families was made up of a much larger fall in the number of potential problem
families offset by a rise in the number of hardcore.