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in a parent—which has caused the health visitor to devote perhaps the whole of her
time for several days to the particular issue.
It may seem surprising that the minimum times are nil but they are due to such
causes as the absence of the family (hop picking), the temporary stability of the family
or the occasional unwillingness to accept the health visitor. The fact that a visit would
be unwelcome does not mean that the family is neglected. Quite apart from information
garnered from other social workers, health visitors learn a great deal about their families
as they go about their district which is not reflected in the times recorded—they may
meet the mother in the street, the children at school and they see friends, neighbours
and relations, and some mothers will seek out the visitor at the centre when they are in
trouble. Another reason for low times spent is that, as was shown in Table I, a few
health visitors had to deal with a concentration of problem families—a concentration
too great in some cases for them adequately to carry. The information revealed by the
survey has led to a certain amount of 'load spreading'. It is not possible wholly to
equalise this particular burden because of the location of the families and the demands
of other duties undertaken by health visitors.

A decision of the average amount of time that could usefully be spent on families
in the two categories was a matter of some complexity. There were variations in family
customs, outlook, size, age, structure, housing and constantly changing family circumstances
as well as the type of service provided for individual families. When all these
matters are taken into consideration it is clear that more time could usefully be spent
on both categories of problem family than the averages of 20 and 28 minutes a week.
Extra time is required to rehabilitate some families of both categories where the total
weight of these difficulties required intensive help but the number of health visitors is
unlikely to be increased markedly in the near future. If such selected families could be
passed to social case workers, who might on average give up to 90 minutes a week work
on them, further progress should be made. The health visitors would, of course, continue
to visit on health aspects but would be relieved of the intensive case work on these
selected families. The time thus saved by the health visitors could be devoted to the
balance of problem families for which they are responsible and should enable more
progress to be made with these families also.
Social case workers
It is estimated that 20 social case workers would be required to take over 400 families
nominated by the public health department and some 80 families nominated by the
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