136
they
’
are ready to be discharged from hospital, and who will very often need help of various kinds when they return home. A project on continuing care of elderly patients carried out by Age Concern in Liverpoolfound that many of the needs of discharged elderly patients were not being met, and came to the conclusion that the situation could best be improved by the appointment of aftercare coordinators in all acute hospitals caring for elderly patients. The reasons found for the failures in the provision of services are all too familiar-weaknesses in the organisation of services, confusion caused by the multiplicity of procedures necessary for obtaining different services, lack of communication and coordination between different branches of the health and social services, ignorance by staff of what services are available and of the limits of their own responsibility and of that of other workers, and failure to keep comprehensive and accurate records and to pass on relevant information to others. The elderly present particular because problems simply they often have a multiplicity of needs which are hard to untangle, and because there are no services designed solely and specifically to cover all their needs; and the study found that staff attitudes to the elderly sometimes reflected these difficulties. The collection of full and accurate information on all elderly patients is a prerequisite for the provision of adequate aftercare services for them, and in a test programme run during the project it was proved that pressure of other duties meant that hospital staff simply could not be relied upon to collect the necessary data and then see that it was acted on. Case conferences are obviously an ideal way of coping with the aftercare problems of patients who are being discharged, but except in geriatric units they are not feasible for every elderly patient. The aftercare coordinator envisaged by Age Concern would have specific responsibility for finding out about all the services (statutory and voluntary) that are available, collecting information from all relevant sources on the kind of aftercare problems that might arise for every elderly patient admitted, where necessary referring patients to the agencies providing the services, and following up to make sure that the services actually materialise. The authors of the study point out that the cost of appointing aftercare coordinators (reckoned at between E8000 and 10,000 a year for an average-sized general hospital) could be set against the benefit to the patient, the saving in time for medical, nursing, and social-work staff, the improved relations between hospital and community, and reduced rates of readmission. All the same, it seems unlikely that many hospitals will be in a position to appoint aftercare coordinators in great numbers, but the study will doubtless have done some good simply by making people more aware of the problems of elderly patients going home from hospital.
STERILISATION SENSE FROM THE SOUTH-WEST
SABRINA, fair river-goddess who presides over the river Severn and those who dwell by it, has done it again. For a number of years, in her other capacity as muse, she has inspired public-spirited citizens in the South Western Region, not only to study problems of hospital crossinfection and to apply the lessons learned, but also to make their advice available to others. The muse, clearly approving of the N.H.S. reorganisation, has transferred her patronage to the new Regional Health Authority, the third and enlarged edition of whose Notes on Disinfection and Sterilization has just been published.2 The first two 1.
2.
Going Home ? The Care of Elderly Patients after Discharge from Hospital. Report on the Continuing Care Project, Age Concern, Liverpool, Liverpool Old People’s Welfare Council, 6 Stanley Street, L1 6AF. £1 (postage 9½p). Notes on Disinfection and Sterilization, 3rd edition, 1975. Obtainable from the Treasurer, S.W. Regional Health Authority, 27 Tyndalls Park Road, Bristol BS8 1PJ. 30p, post paid.
1961 and 1968, proved most valuable to those skill or energy to prepare their own policies. This new edition will spare them the trouble of bringing these up to date. It deserves a wide circulation at home and abroad; it cannot fail to do good. At 30p, post paid, it is a bargain not to be missed.
editions, in lacking the
Royal College of Surgeons of England Sir Rodney Smith has been re-elected president for the coming year, and Mr R. H. Franklin and Mr R. S. Handley have been re-elected vice-presidents. Mr Wallace M. Dennison will give this year’s Alex Simpson Smith lecture at 5.30 P.M. on Friday, July 25, at the Institute of Child He?Ith, 30 Guilford Street, London WC1N lEH. The title is Osteomyelitis-an Historical Survey.
CORRIGENDA.-Nomenclature of Thyroid-stimulating Antibodies.-In our issue of May 24 (p. 1201) we published a letter Prof. D. S.’ on this subject by Dr D. D. Adams and others. Munro and Dr P. Kendall-Taylor ask us to state that their names should not have appeared among the 14 signatories, and we apologise for allowing this error to pass into the journal. Salt and Hypertension.-An important word was left out of this editorial (June 14, p. 1325). The fifth sentence should read: " Her beliefs are (apparently) in direct conflict with three textbooks of medicine mentioned by Dr Smibert ... ". Prevention of Haemophilus influenzœ Meningitis.-A line was dropped from the bottom of the first column of this editorial last week (p. 65). The sentence should start: " Meningitis is most liable to develop in infants after they have lost their passive maternal antibody ... ".
Appointments BHOOMKAR, A. M., M.B.Osmania, M.R.C.P.B., D.I.H., D.P.H. : consultant physician with a special interest in chest diseases, North Derbyshire district, Trent R.H.A. DowsoN, J. H., M.B.Cantab., M.R.C.PSYCH., D.P.M. : consultant psychiatrist, Swindon health district, Wessex R.H.A. FLEMING, P. M., B.M.Oxon., M.R.c.psYCH., D.P.M.: consultant psychiatrist, Portsmouth and South East Hants health district, Hampshire A.H.A. (teaching). KENEFICK, J. S., M.CH.N.U.I., F.R.C.S., F.R.C.S.E.: consultant general surgeon with experience in vascular surgery, Barnet General Hospital, North West Thames R.H.A. MIKHAIL, J. R., M.R.C.S.: consultant physician with a -special interest in thoracic medicine, East Dorset district, Wessex R.H.A. THAVABALAN, P. B., M.B.Ceylon, M.R.C.P., D.D.M. : consultant venereologist, Colchester and Chelmsford districts, Essex A.H.A., North
East Thames
Northern
R.H.A.
Regional Health Authority:
ALLAN, DAVID, M.B., B.sc.Manc., F.R.C.S., F.R.C.S.E.: consultant general surgeon, South West Cumbria district, Cumbria A.H.A. BARBER, H. M., M.B.Durh., F.R.C.S., F.R.C.S.E.: consultant OrthOpe2dIC surgeon, East Cumbria district, Cumbria A.H.A. CooKE, W. M., B.M.Oxon., F.R.C.S.: consultant general surgeon, South Tees district, Cleveland A.H.A. MAJID, ABDUL, M.B.Dacca, M.R.C.PSYCH., D.P.M.: consultant in mental illness, St. Luke’s Hospital, Middlesbrough, South Tees district, Cleveland
A.H.A.
consultant in geriaPEARSON, J. D., M.B.L’pool, M.R.C.P., D.T.M.&H.: tric medicine, Lancaster district, Lancashire A.H.A., and Kendal hospitals, East Cumbria district, Cumbria A.H.A. ROSE, P. G., M.B.Edin., F.R.C.R., D.M.R.D. : consultant radiologist, Gateshead
area
and Newcastle
A.H.A.
(teaching).
WATSON, ANTHONY, M.B.Manc., F.R.C.S. : consultant general surgeon, Lancaster district, Lancaster A.H.A., and Kendal hospitals, East Cumbria district, Cumbria A.H.A.
they
’
are ready to be discharged from hospital, and who will very often need help of various kinds when they return home. A project on continuing care of elderly patients carried out by Age Concern in Liverpoolfound that many of the needs of discharged elderly patients were not being met, and came to the conclusion that the situation could best be improved by the appointment of aftercare coordinators in all acute hospitals caring for elderly patients. The reasons found for the failures in the provision of services are all too familiar-weaknesses in the organisation of services, confusion caused by the multiplicity of procedures necessary for obtaining different services, lack of communication and coordination between different branches of the health and social services, ignorance by staff of what services are available and of the limits of their own responsibility and of that of other workers, and failure to keep comprehensive and accurate records and to pass on relevant information to others. The elderly present particular because problems simply they often have a multiplicity of needs which are hard to untangle, and because there are no services designed solely and specifically to cover all their needs; and the study found that staff attitudes to the elderly sometimes reflected these difficulties. The collection of full and accurate information on all elderly patients is a prerequisite for the provision of adequate aftercare services for them, and in a test programme run during the project it was proved that pressure of other duties meant that hospital staff simply could not be relied upon to collect the necessary data and then see that it was acted on. Case conferences are obviously an ideal way of coping with the aftercare problems of patients who are being discharged, but except in geriatric units they are not feasible for every elderly patient. The aftercare coordinator envisaged by Age Concern would have specific responsibility for finding out about all the services (statutory and voluntary) that are available, collecting information from all relevant sources on the kind of aftercare problems that might arise for every elderly patient admitted, where necessary referring patients to the agencies providing the services, and following up to make sure that the services actually materialise. The authors of the study point out that the cost of appointing aftercare coordinators (reckoned at between E8000 and 10,000 a year for an average-sized general hospital) could be set against the benefit to the patient, the saving in time for medical, nursing, and social-work staff, the improved relations between hospital and community, and reduced rates of readmission. All the same, it seems unlikely that many hospitals will be in a position to appoint aftercare coordinators in great numbers, but the study will doubtless have done some good simply by making people more aware of the problems of elderly patients going home from hospital.
STERILISATION SENSE FROM THE SOUTH-WEST
SABRINA, fair river-goddess who presides over the river Severn and those who dwell by it, has done it again. For a number of years, in her other capacity as muse, she has inspired public-spirited citizens in the South Western Region, not only to study problems of hospital crossinfection and to apply the lessons learned, but also to make their advice available to others. The muse, clearly approving of the N.H.S. reorganisation, has transferred her patronage to the new Regional Health Authority, the third and enlarged edition of whose Notes on Disinfection and Sterilization has just been published.2 The first two 1.
2.
Going Home ? The Care of Elderly Patients after Discharge from Hospital. Report on the Continuing Care Project, Age Concern, Liverpool, Liverpool Old People’s Welfare Council, 6 Stanley Street, L1 6AF. £1 (postage 9½p). Notes on Disinfection and Sterilization, 3rd edition, 1975. Obtainable from the Treasurer, S.W. Regional Health Authority, 27 Tyndalls Park Road, Bristol BS8 1PJ. 30p, post paid.
1961 and 1968, proved most valuable to those skill or energy to prepare their own policies. This new edition will spare them the trouble of bringing these up to date. It deserves a wide circulation at home and abroad; it cannot fail to do good. At 30p, post paid, it is a bargain not to be missed.
editions, in lacking the
Royal College of Surgeons of England Sir Rodney Smith has been re-elected president for the coming year, and Mr R. H. Franklin and Mr R. S. Handley have been re-elected vice-presidents. Mr Wallace M. Dennison will give this year’s Alex Simpson Smith lecture at 5.30 P.M. on Friday, July 25, at the Institute of Child He?Ith, 30 Guilford Street, London WC1N lEH. The title is Osteomyelitis-an Historical Survey.
CORRIGENDA.-Nomenclature of Thyroid-stimulating Antibodies.-In our issue of May 24 (p. 1201) we published a letter Prof. D. S.’ on this subject by Dr D. D. Adams and others. Munro and Dr P. Kendall-Taylor ask us to state that their names should not have appeared among the 14 signatories, and we apologise for allowing this error to pass into the journal. Salt and Hypertension.-An important word was left out of this editorial (June 14, p. 1325). The fifth sentence should read: " Her beliefs are (apparently) in direct conflict with three textbooks of medicine mentioned by Dr Smibert ... ". Prevention of Haemophilus influenzœ Meningitis.-A line was dropped from the bottom of the first column of this editorial last week (p. 65). The sentence should start: " Meningitis is most liable to develop in infants after they have lost their passive maternal antibody ... ".
Appointments BHOOMKAR, A. M., M.B.Osmania, M.R.C.P.B., D.I.H., D.P.H. : consultant physician with a special interest in chest diseases, North Derbyshire district, Trent R.H.A. DowsoN, J. H., M.B.Cantab., M.R.C.PSYCH., D.P.M. : consultant psychiatrist, Swindon health district, Wessex R.H.A. FLEMING, P. M., B.M.Oxon., M.R.c.psYCH., D.P.M.: consultant psychiatrist, Portsmouth and South East Hants health district, Hampshire A.H.A. (teaching). KENEFICK, J. S., M.CH.N.U.I., F.R.C.S., F.R.C.S.E.: consultant general surgeon with experience in vascular surgery, Barnet General Hospital, North West Thames R.H.A. MIKHAIL, J. R., M.R.C.S.: consultant physician with a -special interest in thoracic medicine, East Dorset district, Wessex R.H.A. THAVABALAN, P. B., M.B.Ceylon, M.R.C.P., D.D.M. : consultant venereologist, Colchester and Chelmsford districts, Essex A.H.A., North
East Thames
Northern
R.H.A.
Regional Health Authority:
ALLAN, DAVID, M.B., B.sc.Manc., F.R.C.S., F.R.C.S.E.: consultant general surgeon, South West Cumbria district, Cumbria A.H.A. BARBER, H. M., M.B.Durh., F.R.C.S., F.R.C.S.E.: consultant OrthOpe2dIC surgeon, East Cumbria district, Cumbria A.H.A. CooKE, W. M., B.M.Oxon., F.R.C.S.: consultant general surgeon, South Tees district, Cleveland A.H.A. MAJID, ABDUL, M.B.Dacca, M.R.C.PSYCH., D.P.M.: consultant in mental illness, St. Luke’s Hospital, Middlesbrough, South Tees district, Cleveland
A.H.A.
consultant in geriaPEARSON, J. D., M.B.L’pool, M.R.C.P., D.T.M.&H.: tric medicine, Lancaster district, Lancashire A.H.A., and Kendal hospitals, East Cumbria district, Cumbria A.H.A. ROSE, P. G., M.B.Edin., F.R.C.R., D.M.R.D. : consultant radiologist, Gateshead
area
and Newcastle
A.H.A.
(teaching).
WATSON, ANTHONY, M.B.Manc., F.R.C.S. : consultant general surgeon, Lancaster district, Lancaster A.H.A., and Kendal hospitals, East Cumbria district, Cumbria A.H.A.
