correspondence what is
"community care"? The review of P.E.P.'s Mental Sub-
normality & Community Care in your Winter issue prompts me to offer further comments.
When comparing the merits of the new and old Acts, I find P.E.P. acceptable in general, but surely in error in arguing that the new Act improves on the old merely by abolishing "social inefficiency as the criterion by which mental defectives .became subject to be dealt with". The degree of medical or educational conception of care has little to do with the Acts but simply reflects the readiness of the community to devote expensive professional services to this particular
object. In recommending the familiar conception of optimum institution care as family-sized units, the report notes the success of an experimental unit with a staff ratio of one to four patients. Desirable as this may be, it is misleading to make the unsupported assertion that such units "would almost certainly be easier to staff". As for "the administrative rigidities of the National Health Service", is it not perhaps more the expert opinion to which the Ministry must defer which is to blame for lack of progress? Reference is made to the lack of significant information available as to the efficiency of various services. Here I looked for P.E.P. to offer guidance in resolving the question which bids fair to
torpedo any attempt to provide a prehensive service. The authors
com-
must
have found that the very term "Community Care" is raising ambiguities of thought. There is the fallacy that the necessarily postulates local phrase authority provision and control. There exists a desire to encourage this idea
merely to disembarrass the central government of this unglamorous burden. The question may not be resolved by logical or pragmatic argument. If the large institution is to be superseded by a more effective (and more kindly) small home, some disinterested recommendations must be made as to the best method of financing and administering an improved service. If a part of the national hospital service is to be dismantled instead of reformed, and replaced by a variety of local authority services, each subject to local political and economic pressures, it will be a political and economic decision as much as a humanitarian one. P.E.P.'s failure to make supported recommendations or to emphasize the risks inherent in maintaining or increasing the dichotomy cannot be retrieved even if their suggested experiment under one evaluating authority were achieved. This omission, the unsupported opinion about the feasibility of staffing a more satisfactory pattern of care and the tautologous use of the word "community" in the title are, I think, permissible criticisms of a valuable document. G. G
Sampson
CLEVEDON, SOMERSET
"community care"? The review of P.E.P.'s Mental Sub-
normality & Community Care in your Winter issue prompts me to offer further comments.
When comparing the merits of the new and old Acts, I find P.E.P. acceptable in general, but surely in error in arguing that the new Act improves on the old merely by abolishing "social inefficiency as the criterion by which mental defectives .became subject to be dealt with". The degree of medical or educational conception of care has little to do with the Acts but simply reflects the readiness of the community to devote expensive professional services to this particular
object. In recommending the familiar conception of optimum institution care as family-sized units, the report notes the success of an experimental unit with a staff ratio of one to four patients. Desirable as this may be, it is misleading to make the unsupported assertion that such units "would almost certainly be easier to staff". As for "the administrative rigidities of the National Health Service", is it not perhaps more the expert opinion to which the Ministry must defer which is to blame for lack of progress? Reference is made to the lack of significant information available as to the efficiency of various services. Here I looked for P.E.P. to offer guidance in resolving the question which bids fair to
torpedo any attempt to provide a prehensive service. The authors
com-
must
have found that the very term "Community Care" is raising ambiguities of thought. There is the fallacy that the necessarily postulates local phrase authority provision and control. There exists a desire to encourage this idea
merely to disembarrass the central government of this unglamorous burden. The question may not be resolved by logical or pragmatic argument. If the large institution is to be superseded by a more effective (and more kindly) small home, some disinterested recommendations must be made as to the best method of financing and administering an improved service. If a part of the national hospital service is to be dismantled instead of reformed, and replaced by a variety of local authority services, each subject to local political and economic pressures, it will be a political and economic decision as much as a humanitarian one. P.E.P.'s failure to make supported recommendations or to emphasize the risks inherent in maintaining or increasing the dichotomy cannot be retrieved even if their suggested experiment under one evaluating authority were achieved. This omission, the unsupported opinion about the feasibility of staffing a more satisfactory pattern of care and the tautologous use of the word "community" in the title are, I think, permissible criticisms of a valuable document. G. G
Sampson
CLEVEDON, SOMERSET
