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47
be discharged to the care of the home nursing service, and patients
who had recently been admitted to hospital having previously been
under the care of the home nurses. These arrangements had the
advantage of bringing together the hospital and domiciliary nursing
staff and provided an opportunity for discussing mutual problems.
The project ended with an afternoon conference held in April at
the West Ham College of Technology to which general practitioners,
senior Medical and Nursing Officers from both hospital and Local
Health Authorities were invited together with participating nursing
staff, as well as other staff concerned such as Almoners and Home
Help Organizers. Useful information was exchanged and valuable
discussion took place. It was agreed there is an urgent need to
promote better liaison between the separate branches of the Health
Services for the benefit of the community.
As a result of contacts made during the joint study project,
where difficulties have arisen regarding the discharge of patients
from hospital to unsatisfactory home conditions, it has sometimes
been possible to find a solution by a direct approach to the Almoner
or Ward Sister concerned.
The provision of the various supportive services is essential in
many of these difficult cases, e.g. Home Help Service, Meals on
Wheels, the loan of sick room equipment, etc. The extension of the
Home Help Service to give more effective cover at weekends and Bank
Holidays for old people living alone would remove many difficulties
for both patient and nurse. This problem is almost impossible to
solve, since most domestic helps are prepared to work from Monday
to Friday only because of their family commitments. A handful of
volunteer domestic helps is available to provide help at weekends
for a few selected cases where the need is very great and when no
alternative arrangements can be made for the necessary care to be
given by families, neighbours or friends. The provision of
domiciliary physiotherapy for home bound patients would also improve
patient care to a greater degree and the domiciliary chiropody
service is also valuable although somewhat limited owing to the
shortage of qualified staff.
The pattern of patient care is changing; whereas nowadays there
are fewer Mersalyl and Insulin injections there is a corresponding
increase in the number of iron injections and steroids. More
children are being nursed at home, more post-operative cases are
discharged earlier and prediagnostic investigation is now part of
domiciliary work.
In order to make further improvement in the standard of equipment
Provided, various types of disposable catheters, syringes, needles
and sterile dressings have been tried out and some approved for
general use.