is not the case.
Case conferences, as suggested in the a family life of the kind that will ensure their growing
Tunbridge Wells Report (1973) are useful but
cumbersome and the author much prefers the
suggestion made by Smith et al (1973) that small
regional teams, hospital-based, consisting of paedia-
trician, psychiatrist, social worker and psychologist
should be formed. These teams should be mobile and
should be aware of all local facilities for families and
regional facilities to help the children. This would
fulfil the criteria proposed by the Tunbridge Wells
Report, that unilateral action should not be taken,
but would also fulfil the requirement that action
should be immediate and appropriate.
Such a team could not only visit families and
arrange treatment for the index case but could also
advise the provision of appropriate help, particularly
in the rehabilitation of injured children. It is essential
that the needs of the child should be paramount.
Frequently, those working with the mother may see
her needs to the detriment of the child. Not only
paediatricians, whose duty it is, but the community
should see that these children receive not only treat-
ment for their hurts but that they are introduced into
Briggs under review
During the past eighteen months, there has
developed among nurses a great deal of concern and
uncertainty about the future of the subnormality
trained nurse. While the majority accept that change
is inevitable, it is the type of change, the agency
through which changes are developed, and the nurse’s
future identity as a profession, which are causing
concern.
A day conference under the chairmanship of Dr.
Gwynn Roberts, Consultant Psychiatrist, Ida Darwin
Hospital, Cambridge. was arranged by the Institute of
Mental Subnormality for nurses working in the field
of mental handicap and was held at Lea Castle
Hospital on October 19th, 1973. The conference was
well attended (285) by nurses of all grades, and
representatives were present from Ireland, Scotland,
Wales and various parts of England.
The purpose of this conference was to bring nurses
in mental handicap up to date on recent events; to
provide an opportunity for debate on organisational
and training changes; and to give nurses a chance to
determine some means whereby they could be totally
involved in future changes and form 80-90 per cent
of any body, working party or committee set up to
bring about change within their own profession.
The morning session was essentially informative and
was opened by Mr. Jim Gardner, Chief Nursing
Officer, Leavesden Group Hospital Management
Committee. He outlined the historical background of
mental subnormality, brought the audience up to date
with the present trichotomy in the service which now
exists for the mentally handicapped, and painted a
picture of confusion. H e went on to explain the
objectives and targets that must be met in the near
future if any progress were to be made in the system
of care for the mentally handicapped.
Mr. Vince Gorman, Principal Nursing Officer,
Northgate Hospital and a member of the Asa Briggs
Committee talked about the present crisis. H e spelt
out loudly, and clearly the implications of Briggs and
the new caring profession, and laid stress on the
widening gulf between hospital and community care.
up to achieve their potential.
References:
British Medical Journal (1973). Deliberate injury of children.
IV, 61.
British Paediatric Association (1966). ’ihe battered baby: a
memorandum by the Special Standing Committee on
Accidents. British Medical Journal, I, 601.
Harcourt, R. B., and Hopkins, D. (1971). Ophthalmic
manifestations of the battered baby syndrome. British
Medical Journal, 111, 398.
Kempe, C. H. (1962). The battercd child syndrome. J o t i r i i o l
of Aiericcm Medical Association, 181, 17.
Kempe, C. H. (1971). Paediatric imdications of the battered
baby syndrome. Archives of DCe&e in Clrildhood, 46, 28.
Ministry of Health (1970). The Battered Baby. HM70 (49).
Mushin, A. S. (1971). Ocular damages in the battered baby
syndrome. British Medical Jozwnnl, 111, 402.
Smith, S., and Noble, S. (1973). The battered child. “A
problem ripe for review”. New Society (in press).
Smith, S., Hanson, R., and Noble, S. (1973). Parents of
battered babies-a controlled study. Btitislt A4edical Jotirnal
(in press).
Tunbridge Wells Study Group (1973). Non-accidental injury
to children. British A4edical Journal, IV, 96.
Mr. Andrew Hulbert, Chief Nursing Officer, Calder-
stones Hospital, listed some of the alternatives in the
form of an analogy which took account of the six
possible forms of change. He explained the
relationships they bore to each other and the effect
each would have on future patient care.
The afternoon session was opened to the audience
for expressions of views, questions and debate. A
great many emotive arguments were put forward and
much heated debate took place, but at the end of the
day no concrete conclusions were reached and no
clear-cut decisions were made. It was, however,
patently obvious that nurses had not been informed,
and had not taken very much trouble to inform
themselves of the issues at stake. Clearly there was
need for better communication between nurses at all
levels and between nurses and their official represe-
sentatives.
Of the 285 delegates present, only 124 completed
the voting forms and it is interesting to note how they
voted:-
1. Adoption of mainstream Briggs ... ... 7
2. Present service changed by evolution ... 8
3. Unified services controlled by education ... 2
4. Unified service controlled by Social Service. 5
5. Unified service under medico/ nursing control
within N.H.S. ... ... ... ... 27
6. Independent service staffed and controlled by
nurses with responsibility to central govern-
ment ... ... ... ... ... ... 75
Nurses need a platform upon which they can
express their views on the active care of the mentally
handicapped and from which they can receive
information and be kept up to date on the changes
taking place in the field of mental handicap. This
platform can be provided by the Institute through the
medium of this journal, should they desire it, and bv
means of an annual conference for nurses of all
grades working in subnormality.
D. G. McCullagh,
Principal Nursing Officer, Lea Castle Ilospital.