Annual reports for the year 1st April 1950 to 31st March 1951 / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1951?]
Catalogue details

Licence: In copyright

Credit: Annual reports for the year 1st April 1950 to 31st March 1951 / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    decided by him. It was therefore necessary to review and amend the machinery which had been grown in the hospital and alter it to the shape required by the Minister. The Whitley Council refused permission to the hospital that patients’ delegates should continue to be included in the meetings, and the.staff represen¬ tation from working teams had to be replaced by new representation based on professional and trade classi¬ fications. The newly arranged consultative body has met regularly throughout the period, but it early became apparent that its official terms of reference were not sufficient for the hospital’s needs. Whereas the form of joint consultation hitherto practised in the hospital had the aim of co-operation between various teams of the hospital staff on weekly work matters, the Minister’s joint consultative machinery was de¬ signed to ensure the consultation of trade and professional groups of the staff with representatives of the Management Committee mainly on such matters as conditions of service. After trial it became apparent that there was still a need for technical con¬ sultation between representatives of working teams of staff and executives of the hospital, and the older conference was reinstated, now under a new name— The Medical Director’s Conference. It has had the task of discussing the weekly work of the hospital, of seeking ways of improving services, smoothing out difficulties of liaison, creating interchange of informa¬ tion about current work problems of various staff sections, suggesting procedures for dealing with new problems, and studying the relationship between patients and staff. Patient representatives were re¬ introduced to the Medical Director’s Conference, and the year ended with the official Joint Consultation machinery running smoothly under its own terms of reference, and the Medical Director’s Conference with different terms of reference helping in the planning and running of the hospital. However, the new terms of reference of the Medical Director’s Conference seemed to make it unnecessary to have a separate system of patient /staff liaison other than that of the conference, and the special patient/staff liaison com¬ mittee was dissolved by agreement, its members joining the Medical Director’s Conference. Towards the end of the period new ways and means were being sought and discussed by all concerned for resolving the unnecessary work-problems that the staff create for patients and the patients create for staff. The Whitley Council’s scheme of joint consultation between the Management Committee and representa¬ tives of the professional groups of the hospital has the goodwill of all those who operate it. However, there are grounds for believing that joint consultation de¬ signed from above, and not by those concerned, con¬ tains inherent contradictions, and certainly the Agenda at these early meetings have been remarkably short. The Committee has decided therefore to meet every two months. Perhaps it is still too early to report on the usefulness of this form of Joint Consul¬ tation. Treatment The demand for the hospital’s services for treatment has greatly exceeded its capacities throughout the year. It is one of the small handful of hospitals in the country which can offer intensive psychotherapy to some of the thousands who need it, and it was neces¬ sary to refuse many requests for admission. The waiting lists for treatment had to be closed for two months in the Autumn. Even requests for psychiatric assessment by the Triage Unit eventually created a situation where patients had to wait two or three months even before assessment of his or her suitability for the waiting list. This has tended to discourage the referral to the hospital of patients with acute or mild forms of neurotic upset, and many of these eventually admitted for Triage or treatment had a long history of illness. The waiting list for treatment varied according to the individual doctor, from a wait of three months to two years. Once again the requests by referring doctors for Psycho-Analysis for their patients were much more numerous than the hospital’s facilities could counten¬ ance. The medical staff were steadily faced through¬ out the year with the temptation to take on more patients than they could usefully treat. It is of course no economy of medical time to treat poorly a large number of patients rather than to treat fully a smaller number, and the danger of lowering technical stan¬ dards by attempting to treat too large a case-load had to be watched. Of the total patient case-load in the hospital about a quarter were seen three times each week, about a quarter were seen four times each week, about one- sixth were seen five times each week, and one-sixth twice each week. The usual length of time for a patient’s session was 50 minutes. General psychotherapy was the usual form of treat¬ ment offered, but one-fifth of the patients under treatment were offered psycho-analysis. One-fifth of all the patients under treatment were Day-patients, who had been discharged from the hospital and were continuing their treatment following their discharge. Many patients requesting out-patient treatment were refused help, for the hospital has no facilities for treating out-patients without first admitting them to hospital. The average medical case-load was 11 patients. This proved to be too high in view of the character of the patients now being referred to the hospital. A workable figure would be one doctor to nine patients. Fees In my last Report I drew attention to the danger to neurotic patients of the offer of free hospitalisation under the National Health Service. At the beginning of the period 45 per cent, of the beds were ruled to be free. Throughout the year the medical staff have been aware of unequivocal instances where the secon¬ dary gains of the offer of free hospital living for illness,