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“THE MEDICAL IMPORTANCE OF THE WORK OF
THE HOME HELP IN GREAT BRITAIN”
Lecture given to the International Conference of Home Help Organisers in Paris,
October 1962
Introduction
In order to understand our present system of social and medical organisation, we
must look at the past. This has influenced the way the services have developed and has
been responsible for the home help service in Great Britain being a "medical" service.
History
The history of the various attempts of the State and/or the Local Authorities to care
for the citizen in a personal way can be traced back to the Statute of Elizabeth I in 1601,
when the first official efforts were made to differentiate between those who were in need
and sick and those in need but well.
This was responsible for the system of outdoor relief and so made each small parish
responsible for its own unemployed. No stranger was welcome to settle in any parish
even in times of prosperity because if he became unemployed he would be a charge on the
local citizens. The Poor Law Commission of 1832 which initiated the Poor Law Amendment
Act of 1834, created the Boards of Guardians. They were elected, and administered
a larger area than the parish councils, in which they were responsible for operating the
provisions of the Poor Law.
Workhouses were built, and an attempt was made to discontinue payment of outdoor
relief, although this was a failure. During the next 50 years or so sanitary reforms
brought a change of attitude. By 1909 the principle of payment of allowances by way
of outdoor relief had been accepted. By this time also, workhouses provided some medical
treatment for the inmates who became sick but they would not normally admit a sick
person from outside.
In the year following the report of the Royal Commission of 1909 the principle of
the state being interested in personal health problems of the people came to be accepted.
The Midwives Act of 1918 initiated the setting up by local supervising authorities of the
domiciliary midwifery service. It was to meet the need of this service that the home
helps were called in to take charge of the household during the lying-in period. They
were mainly provided by voluntary societies although some local authorities attempted
to organise services of this kind.
As a result of the 1929 Local Government Act the hospitals were taken over by the
local authorities and the Medical Officer of Health, who was responsible for the administration
of the hospitals, faced up to trying to provide some solution to the shortage of
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