Contents -

Editorial

Attitude Survey II

Around the Hospital
  News Quarters
  Delph Library
  Chess Club
  Union News

Round the NHS
  Visit to Lancashire
  Psychiatric Admissions
  Manchester RHB
  Community Care
  Domiciliary Care

Letters to the Editor
Nursing News

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EDITORIAL COMMENT
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The amount of news we carry which stems from the Manchester RHB is not due to selectivity on our part . It is simply the case that they seem to provide more information than does our own RHB.

In view of the changes taking place over the next few years, and their importance to this hospital in particular, lack of information can hardly lead to the whole-hearted support from hospital personnel in general which is so oft called for.

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PSYCHIATRIC HOSPITALS VIEWED BY THEIR PATIENTS -
an attitude survey by W. Raphael and V. Peers
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PART 2

Validity of Survey Findings

"But can you get useful information from mental patients?" was the comment offered by many people on hearing of the survey. One of the most striking findings was that only 2% of the patients who sent in questionnaires failed to give rational answers and 3% handed in very incomplete questionnaires. It is not possible to guarantee the validity of any survey, but the remaining of the comments given expressed sensible appreciations or constructive criticisms. Generally there was fair similarity between the answers to the questions on factual natters in any one ward even though the patients responded to the questionnaire simultaneously so had no opportunity to consult with each other.

The proportion of patients who answered the questionnaire varied from 85% to 52% in the different hospitals. The figure depended on the proportion of long-stay wards with elderly patients, some of whom were senile, and on the interest promoted among the ward staff and patients. It was impossible for some of the patients to participate because they could not see to write, did not speak English or were too ill. Others were apathetic about joining in and were not pressed to do so, and others, mainly elderly people, tried but found the questionnaire baffling and returned blank forms.

The views listed after in the report are those given by the ;patients. Their factual basis has not been checked. On all topics some patients gave favourable views and some critical. This is to be expected because conditions varied from hospital to hospital and from ward to ward in the same hospital. Also, it must be remembered that patients came from all parts of the community and, naturally, had different tastes and standards for comparisons.

General Attitude to the Hospital

The question "Do you like your stay here apart from being away from home?" offered four alternative answers: "Very much", "In most ways", "Only fairly well" and "No". The fact that over half gave one of the first two answers is fairly satisfactory, considering that many of the patients were suffering from depression. The number of satisfied patients is, however, much lower than the number answering a similar enquiry in general hospitals, where it was 94%. As might be expected, patients in short-stay wards were much more critical than patients in long-stay wards. This was probably partly because they tended to be younger (and it is found in hospital surveys that the younger patients are more critical than their elders) and partly because they had not become habituated into accepting conditions.

At the first two hospitals surveyed the patients were asked "Would you be pleased if your doctor said you could leave next week?" but the question was subsequently dropped because the reasons for the answers were so complex that it was difficult to classify then. For example, a lot of people answered, "No, because I have no home to go to" or "Yes, although I like being here it would mean I was cured". The proportion who said they would be pleased to leave was 48% at one hospital and 63% at the other.

Another indication of the patients' overall attitude to hospital was gained from the 202 people who answered in general terms the questions on what they liked best and least about their hospital. While 158 gave general praise, "The hospital is a very good one", "The excellent way that the hospital is run", "I like the general atmosphere"; only 44 people, less than a third as many, gave general criticism, "Nothing to like here", "A feeling of becoming institutionalised". The popular press and general public often have a picture of patients being incarcerated in psychiatric hospitals against their will. With the great majority of patients the truth is very different and they are grateful that their mental illness is being treated. Nearly half would be sorry if they had to leave and indications are that this figure would be considerably higher if more of the elderly patients were included. Indeed, the proportion of patients who accept the hospital as their home where they can avoid the problems, personal or financial, of living outside its open gates, is sometimes a serious matter for concern.   TO BE CONT.

P.C.

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AROUND THE HOSPITAL
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NEW QUARTERS

Will staff please note that the Hospital Secretary is now sited on the front hospital corridor, internal telephone number unchanged 243.

R. French, Hospital Sec.

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LIBRARY NEWS

Delph Library

Newly-decorated, with a re-vamped stock of books this should be in full working order soon.

It will be open in the evenings as well as during the day, to both patients and staff. Precise times of opening will be shown on the door. If is doesn't contain the books YOU want -- say so.

R. Bruton

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SPORTS SECTION

Chess Club News

Our record to date in the L.R.H.B. League is Played one, Won one - a surprisingly easy victory over Rainhill. In the Warrington 1st Division we have played six matches - W 1, D l, L 4. And we just failed to make the 2nd Round of the K.O. by one half point.

Quite apart from the 'flu bug etc., we have had to field a five-man team on occasions. Evidently we should have campaigned sooner for new players - the anticipated post Fischer-Spassky boom has not affected Winwick yet. In the near future we shall announce our 1973 Competitions - each with a cup for the winner. Meantime - chess-players of Winwick Unite. Contact L. Bayliss, J. Jolley or

R. Bruton, lion. Sec.

UNION NEWS

The monthly meeting of the Winwick Branch of the Confederation of Health Service Employees will he held in the In-service Training room at 5.30 pm on Monday next, February 5th.

Subject for discussion will be 'Industrial Action by Hospital Workers".

B. McAuley, Branch Sec.

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ROUND THE NHS
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VISIT TO LANCASHIRE

On Thursday, January 25, Mr Michael Allison, Parliamentary Under-Secretary of State for Health, made a whistle-stop tour of Lancashire hospitals.

Included in his visit was a call to Wrightington Hospital, near Wigan, where Mr Allison had lunch with senior doctors and administration officials. Later he looked round four wards, the main operating theatre, and the bio-mechanical laboratory.

After seeing round the hospital's world-famous hip centre, he and his party left to visit Leigh Infirmary in the afternoon, and, on Friday, hospitals in the Manchester area.

PC

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PSYCHIATRIC ADMISSIONS CONTINUE TO INCREASE

In a report recently published (Psychiatric hospitals and Units in England and Wales. Inpatient statistics from the Mental Health Enquiry for the Year 1970) a trend already established in previous reports is confirmed: an increase in the number of admissions to mental illness hospitals and units combined with a decrease in the number of people in hospital at any one time.

The report also shows that while the number of admissions to mental illness hospitals shows a reduction, there is an increase in admissions to mental illness units in general hospitals. The decline in admissions to hospitals and units for the mentally handicapped which, for the first time since 1965, occurred in 1969 has not continued into 1970. But the number of patients resident at any one time continues to fall.

An article in the report by Dr Gerry Hill shows that on the basis of the experience in the period 1964-69 about 1 in 9 males and 1 in 6 females can expect to go into a mental illness hospital or unit at some time during their lifetime. The expectation of being admitted for the first time rises to a peak between the ages 30-39 and declines until the age-span 55-59 after which it rises sharply. Dr Hill concludes that the marked increase of elderly people in the population during the next few years will make heavy demands on mental illness hospitals and units unless other forms of care are provided.

PC.

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MANCHESTER RHB

A report on 'Nationwide' last week revealed that Manchester Regional Hospital Board's average cost for each in-patient was £71.O0 compared with the national average of £78.5O. The region now has 24,OOO nursing staff - an increase of 1,6OO in 18 months - and has vacancies for a further 3,000 nurses.

PC

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RADIO SERIES - 'COMMUNITY CARE'

At the moment the BBC is running a series of programmes under the title 'Community Care: Mental Illness and Handicap'. The series, which is broadcast each Wednesday evening on Radio 3, commenced on January 1O, and the aim of the programmes is to examine the range of care and support provided by community-based services for the mentally ill and handicapped. Each of the eight case-studies deals with a particular patient and consists largely of interviews with the patient and with those who are directly involved in his or her 'community care' - other members of the family, nurses, social workers, the general practitioner, the consultant psychiatrist and others involved in hospital, local authority and voluntary services. Overall, the case studies give an in-depth picture of the ways in which a range of mentally ill and handicapped people can be supported within the community and helped to live as normal a life as possible.

In addition, a special handbook is being published to accompany the programmes: it provides background material relevant to the particular case-studies and further information on the various community-based services dealt with in the programmes. 'Community Care - Mental Illness and Handicap' has been written by a team of experts in this area and will be available later this month (BBC Publications, 45p). It can be obtained either from booksellers or by writing direct to BBC Publications, London W1A 1AA.

PC

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DOMICILIARY PSYCHOGERIATRIC CARE IN BUCKINGHAMSHIRE

A recent article in the 'Nursing Times' discussed the difficulties of organising a psychogeriatric nursing service in the community in Buckinghamshire.

The author, Dr DMA White, was appointed consultant psychiatrist with a special interest in the problems of the elderly, at Tindal General Hospital, Aylesbury. He found the situation in the county difficult. Hospital beds were in short supply and so were places in local authority homes. Consequently, a great burden of care was being carried by the community, with little support. Dr White felt that it would be worthwhile to explore the possibilities of taking the expertise of the psychiatric nurse into the community.

He found that the county health authorities were very keen on the idea. The Oxford Regional Hospital Board were equally enthusiastic, and a joint steering committee was set up, comprising the director of nursing services, the PNO of St. John's Hospital, the principal medical officer to Buckinghamshire County Council, and Dr White.

Eventually an experimental scheme was introduced and the steering committee continued to meet to monitor progress. Within three months the committee were convinced of the value of the scheme, and began to make plans for a permanent service, to be jointly provided by hospital and local authority. The Department of Health and Social Security became interested in the scheme and encouraged its development.

The committee planned to create six full-time posts (Salmon grade 6). The hospital would be the employing authority (to give the best rates of remuneration and superannuation), and the Buckinghamshire County Council would reimburse half of the salaries, pay travelling expenses, provide county cars if required, and make housing available if possible. The hospital nursing officer to the Department 'of Mental Health of the Elderly would be regarded as a Salmon grade 7a, and given an honorary contract to the county council. For administrative purposes the nurses would be part of the county Mayston structure, relating to the hospital for clinical support and direction. Each nurse would be 'practice-based', or, rather, cover a group of practices.

Difficulties

These proposals were quickly endorsed by the county council. However, their progress through the hospital administrative machinery was not so smooth, partly because of a vague fear that the scheme might deplete the hospital of ward staff. GPs gave mixed comments to the hospital management committee; some felt the scheme to be excellent, and spoke highly of the initial experiment, while a few bitterly opposed the whole idea. There was another group which, while supporting the scheme in principle, was worried that it might be used as an excuse for not providing much-needed extra long-stay beds. Eventually the proposals were accepted and advertisements appeared. There was a good response, and shortlisted candidates were interviewed by a committee representing hospital and local authority.

Dr White finds that the new service has worked well, despite some initial teething troubles. By virtue of GP attachments the nurses see and handle many cases which do not get referred to the hospital department. During the first six months of 1972 they had 184 new referrals and made a total of 2,251 visits; roughly half of their patients are not officially known at the hospital, though they can discuss with the medical staff any patient worrying them.

Future plans

At the moment, the service is 9 am to 5 pm, five days a week. Two of the nurses have investigated the need for a 24-hour service by voluntarily providing this for three months in the north of the county. Their report is being produced at the moment, but it seems that expansion to give cover from 8 am to 10 pm, seven days a week would provide a tremendous increase in the value of the service. A tentative suggestion is to double the number of staff to 12 to provide such cover.

The possibilities of a general night nursing service and auxiliary district nurses are being investigated for Buckinghamshire, and it is felt that, when these are realised, the psychogeriatric service might have some relationship to these, rather than itself expand in these directions.

Though the administrative manoeuvres are often difficult, Dr White remains convinced that the results justify the effort. He considers that, with the enormous increase in the size of the problem of the elderly, any means of improving community facilities and enhancing the links between hospital and community are worthwhile.

PC

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LETTERS TO THE EDITORS ----------------------

Can You Help?

We launch an appeal to employ your assistance in recovering records normally held in the Social Therapy Dept.

It would be appreciated if all wards and departments would inspect their stock of records and inform the dept. of any not belonging to them.

This will enable us to complete our indexing of same and improve circulation. Tel. 339.
Thank you.

E. Villiers.

LETTERS

I would like to give my thanks to the Teaching Dept. for the welcome and friendliness I received during the last month in School. It was of great interest and advantage.

D.Hill, Dpty. Charge

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NURSING NEWS
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We were shocked to hear of the sudden death last week of John Wallace, a nursing assistant on the Male Infirmary Ward.

John started work here only last year, but in this short space of time here he made many friends among the staff and patients.

PCM

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WELCOME TO

Mrs L.N. Parsonage, Senior chiropodist within the Warrington Hospital Group, who is to undertake four sessions in chiropody here each week.

Miss C. Freeman D.W.S.
Mrs D. Darlington N/A

FAREWELL TO

Mr R. Emmerson, Deputy Charge Nurse
  (Returning to Saudi Arabia) Mr N. Kenny, Deputy Charge Nurse
Mrs M. Babbs, S.E.N.
Mrs Jean Mort, S.E.N.
Miss W. Evans, Student Nurse
Mrs M.H. Crerar, S.E.N.

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