Mental Welfare at the Public Health Congress
The C.A.M.W. were responsible for two well-attended Sessions at the Public Health Congress held in November at the Agricultural Hall, Islington, as well as for an Exhibit of Work done by defectives, which we note below.
The paper given by Dr Tylor Fox on the ” Need for Community Care of Epileptics,” which is published on another page, was followed by a speech from Dr Ralph Crowley briefly outlining the next steps which the C.A.M.W. were proposing to take to deal with this matter, such steps including a further investigation in the districts of Tottenham and Wood Green with special reference to possibilities of suitable occupations and trades for Epileptics. In regard to this question of employment, Dr Crowley drew attention to the great value of the co-operation which the Association was receiving from the Council for the Provision of Occupational Industries for the Physically Handicapped, which had a Centre in one of the areas investigated. It was hoped, in these and other ways, to gain practical experience which would be useful to the whole country, and pave the way to the formulation of a scheme which could be generally applied.
Mr. L. W. Greenhalgh, Public Assistance Officer, Ipswich, referred to the large number of epileptics in Public Assistance Institutions where conditions were quite unsuitable for them. He considered there was an urgent need for an After-Care organisation on the lines suggested.
Referring to the question of Out-Relief for employable epileptics, he pointed out that Public Assistance Committees have wide discretionary powers which should make it possible for them to ignore at least a proportion of any small amount an epileptic might be able to earn. This should be borne in mind by any After-Care organisation for Epileptics which might be set up, and Public Assistance Committees should be urged to amend their Out Relief Regulations accordingly.
The second subject dealt with at this Session was that of Holidays for Wording Patients in Mental Hospitals. Mr. E. W. Cemlyn Jones presented a paper urging the claims of such patients and explaining the facilities which could be offered by the C.A.M.W. for them in its Holiday Homes. Sir Laurence Brock, Chairman of the Board of Control, who was in the Chair, warmly commended the scheme, and Dr Davies Jones, Medical Superintendent of the Isle of Wight Mental Hospital, pleaded that it should be supported with enthusiasm.
The Saturday morning session, presided over by the Rt. Hon. Lord Justice Scott, on The Mental Testing of Children in Elementary Schools, attracted a number of teachers and educationalists and following on the papers given by Dr S. J. F. Philpott and Miss Grace Rawlings (C.A.M.W. Educational Psychologist), a lively discussion took place. It was generally agreed that the services of educational psychologists were needed if mental testing was to be scientifically and systematically carried out in the schools, and Miss Gardner, representing the National Union of Teachers, testified to the willingness of teachers generally to receive advice given by such an expert. As, however, the employment of Educational Psychologists by Education Authorities was only just beginning, it was pointed out that the facilities for training teachers to give mental tests in their own schools should be increased and that much useful work could be done in this way despite its inevitable limitations.
Miss Ross, Inspector of Special Schools, Birmingham, urged the importance of discovering retarded children whilst still in the Infant School, and referred to the immense value of the services of an Educational Psychologist in the work of ascertainment.
Dr J. Lumsden, H.M.I., said that the Board had shown their interest in the appointment of Educational Psychologists by allowing expenditure on such appointments to rank for purposes of grant. They also regarded the instruction of teachers and of school medical officers in mental testing as being very desirable.
In another Session of the Congress the subject of the Organisation of Recreations and Amusements in Mental Hospitals was dealt with, and a number of Medical Superintendents took part in the discussion. The paper given by Dr Rolf Strom-Olsen on this occasion will be found on another page.
What Low-Grade Defectives Can Do
The C.A.M.W. arranged, at the Public Health Congress, an attractive exhibition of work done by defectives attending the Middlesex Occupation Centres for which the Association is responsible, and by those who are receiving instruction from the Home Teachers working in the same area.
The Exhibits must have been a revelation to those who are sceptical as to the results which can be achieved by the training of low-grade defectives living in their own homes. All sorts of articles possessing not only value as ” occupational therapy ” but in themselves useful and pleasing, e.g., jewellery, embroidery of all sorts, pewter boxes, knitted goods, furniture, toys, educational apparatus, raffia baskets, rugs, sea-grass stools,- were on show and for sale and all had been made by defectives who are under training only a few hours a day, and indeed?in the case of those being visited by Home Teachers ?only an hour or two once a fortnight.
C.A.M.W. Travelling Staff
Local Authorities and Local Education Committees have continued to show their appreciation of the services offered by the C.A.M.W. through its travelling staff, which has been kept fully occupied during the past year. We are glad to note that in two cases this pioneer work has resulted in the permanent appointment of a psychologist or specialist teacher on the staff of the Local Authority.
Educational Psychologists.
Following on the appointment of Miss Rawlings, three other Educational Psychologists have had to be appointed to meet the great demand for workers in this branch of educational service.
Miss Rawlings has worked during the year at Jarrow, and in Bradford, where she will continue until Easter. She will go to Somerset for the Summer Term of 1937.
Miss A. D. Paterson was engaged by the Swansea Education Authority during the summer term of 1936, and will return there for the Spring Term x937* ^ is hoped that a permanent appointment will be made there as a result of her work, During the autumn term of 1936 she has been carrying ?ut a survey in Rotherham, and her services have been booked for the Summer Term by the Edmonton Education Committee.
Miss Hill was sent by the C.A.M.W. to carry out a survey in Southendon-Sea, at the request of the Education Committee there; her work was found to be of such value that she has since been appointed as Educational Psychologist on the permanent staff.
Miss M. Dunsdon has been working in the schools of Dewsbury during the autumn term of 1936, and goes on to Preston, after Christmas, to work there during the Spring Term of 1937.
Travelling Speech Therapist.
Miss Kathleen Jones, the C.A.M.W. Speech Therapist has been fully employed, and has engagements lasting until December, 1937.
She has worked during the year in the schools of Dudley, of the Rhondda Valley and of Wolverhampton, besides lecturing at the various Training Courses arranged by the Association. A permanent Speech Therapist is to be appointed in Wolverhampton as a result of Miss Jones’ work there. Organiser of Occupation’ Centres.
Through the generosity of an anonymous friend of the Association, the C.A.M.W. has been able to offer the services of Mrs. Anderson, the Organiser of Occupation Centres, to Local Authorities and Managing Committees of Centres who desire to have some advice and assistance in connection with the Centres in their areas.
This fund is not yet exhausted and further visits will be gladly arranged if desired.
During the year Mrs. Anderson, assisted in a few cases by one of her staff, has given help to Centres in the following areas: ?Devonshire, Oxfordshire and Oxford City, Leicestershire, Surrey, Derbyshire and Derby County Borough, Nottinghamshire and Nottingham City, Worcester, Walsall, Kent, Lincoln, Peterborough, Carlisle, Lancaster, Hastings, and Newport, I.O.W. Occupational Organiser.
Knowledge of methods of occupational training and craft work has now become so widespread that the demand for the services of Miss Price, the Occupational Organiser, is not quite so great as in past years. She has, however, done most useful work during the year, and has visited, for periods of a fortnight each, two Mental Hospitals and an Approved Home. She is booked for three months in 1937 to visit a large Public Assistance Institution in the North, and for a return visit to Wales.
C.A.M.W. Training Courses, 1937 The following Courses will be held under the direction of the C.A.M.W. during 1937: ?
For Medical Practitioners:
Course on Mental Deficiency and Allied Conditions in co-operation with the University of London Extension and Tutorial Classes Council.
Part I of the Course, which will be held at the University of London, South Kensington, from April 12th to 24th, is this year extended from one week to two. The second week is to be devoted to instruction and practice in Mental Testing.
Part II of the Course (dealing with Problems of Difficult Children) will be held separately, in the autumn.
For Teachers (a) A Nine Weeks’ Course to be held in London from May 24th to July 23rd. (b) Two Short Courses organised for the Board of Education, each of three weeks in length:
London (Advanced) … … … July 5th to 24th. Leeds (Elementary) August 27th to Sept. 16th.
For Occupation Centre Supervisors and Institution Staffs: London (Notcutt House, N.W.) July 5th to 24th.
For Enquiry Officers: London (Notcutt House, N.W.) July 5th to 24th. For further information about any of the above Courses, apply to the Educational Secretary, C.A.M.W., 24, Buckingham Palace Road, London, S.W.i.
Course on Mental Deficiency for Medical Practitioners taking the Diploma in Public Health at the London School of Hygiene and Tropical Medicine. February and March, 1937. The C.A.M.W. is also arranging the practical work connected with this Course, introduced for the first time into the syllabus of the Diploma in Public Health.
It will cover the same ground as the fortnight’s Course for Medical Practitioners held in co-operation with the University of London, and to it will be admitted, in addition to Diploma students, a limited number of medical men living in the London area.
Holiday Homes
During 1937, the C.A.M.W. will be able to receive defectives and mental hospital patients for holidays, either individually or in parties at four holiday homes. Three Homes, Redcar, Rhyl and Seaford are under the direct administration of the Association; that at Bognor is run by a trained, experienced worker, Mrs. Fisher, with whom the Association contracts to receive parties during the summer months.
Ivor House, Coatham, Redcar, is a new home, and is meant to meet the needs of patients from institutions in the N.E. area. There is accommodation for 30, with three supervisory staff. The house is detached, with a large, walled garden; it is about 7 minutes’ walk from the sea, across the golf links to extensive, firm sands. The town offers amusements and recreation in plenty. Both men and boys, and women and girls (in separate parties) will be welcome at this home.
Flint House, Seaford, with which a contract was made in 1936, has now been taken over by the Association. Bod Donwen, Rhyl, and Franklin House, Bognor, will be open for the reception of parties as before. Fees at all the Homes are ?1 per week for patients, 26/6 per week for staff. Applications should be sent to the Secretary, 24, Buckingham Palace Road, S.W.i, and not to the individual Homes.
Middlesex Occupation Centres
The arrangement by which the C.A.M.W. organises for the Middlesex County Council the Occupation Centres and Home Teaching Scheme in the County, has been continued for a further grant period, 1937-1942. Plans for the development of the work are in hand and will be recorded in our next issue.
Evening Clubs for Defectives
In their recent Annual Report, the Board of Control draw attention to the need for evening clubs for young adult defectives. The good work done by such Clubs at Darlington, Brighton and Liverpool is specially mentioned, and we think the following account of the last named, contributed by the Case Secretary of the West Lancashire Association, will be of interest to our readers:? The Silver Star Club, Liverpool, is a by-product of the handicraft classes which are an extension of the ordinary Occupation Centre work, and in which may be found boys and men, young and old (the ages vary from 16 to 46), every Tuesday and Thursday evening from 6 to 9 o’clock. The average attendance is round about 35.
The great idea of a Recreational Club for these men, which had been latent for a considerable time, came into actual and active being at our Christmas party 5 years ago. It was put forward as a suggestion, greeted with wild applause and before we knew where we were the Silver Star Club had come to stay.
The name was one of those chosen among others by a member of the club, voted on and passed unanimously. The emblem is a Silver Star on a dark blue background, and can be worn in a buttonhole. We are proud people when we get together on an outing or a party, all stars in our own wav, but making sure of recognition as such by wearing our badges.
Our Club Leader, a heaven-sent person, arriving from there via the Prince of Wales appeal for voluntary workers, and the Liverpool Council of Social Service, has been with us from the beginning. The three masters who teach our handicrafts have also been voluntary workers since the very start and we think this is a team that would be hard to beat.
We play billiards, having got, through an advertisement in a small local paper, the gift of a quarter-size billiard table from a country postmaster. We play every round of the Cup-Tie matches in table football, every member of the club and every male helper joining in. Darts may be seen flying to the bull’s eye, and cards, ludo, and tiddley-winks interest many of our members. Two tables have been made in the woodwork class for Table Tennis and it is almost a matter of queueing up for this game.
We have a small library, stocked by throw-outs from many private libraries and a donation from Boots’ Library; many of our higher grade boys enjoy the Thrillers that we rather specialise in. A cup of tea and a biscuit for one halfpenny always wind up these happy evenings. The refreshments pay for themselves.
New Occupation Centre at Portsmouth
The new Occupation Centre was formally opened by the Lady Mayoress of Portsmouth on 23rd October, 1936, though the classes had actually been in session since 5th October.
The new premises are in an open part of the City. As a result of arrangements made between the Mental Treatment Committee and the Public Assistance Committee one wing of a disused building belonging to the latter which had originally served as a Poor Law Children’s Home, was placed at the disposal of the Mental Treatment Committee for use as an Occupational Centre. Re-decoration and some small alterations have been carried out and a commodious and suitable Centre has been provided.
Uncertified low-grade children from S. Mary’s Hospital (the local Section 37 Institution), are taught with the children from outside in the Junior Mixed Centre; separate classes for the young adults, male and female, from S. Mary’s Hospital are held as they are mostly of a type unsuited to be associated with the young adults from outside. The total number of defectives on the Register at the present time is 138.
Northampton Handicraft Centre
On November 16th the new premises of Northampton’s Handicraft Centre for mentally defective boys and girls over 16 was officially opened by Miss Evelyn Fox. Alderman Smith, Chairman of the Mental Deficiency Committee, presided over the gathering which was also attended by the Mayor and Mayoress, the Town Clerk and other officials of the Council.
The beginning of this activity goes as far back as 1915, and Miss Fox reminded those who were present at the opening that Northampton was one of the first areas to start such work. Under the devoted guidance of Mrs. Cotton, a member of the Mental Deficiency Committee, who has been responsible for the work for many years past, the Centre has gradually increased its usefulness and the acquiring of these new premises marks a further stage in its career.
The new building, purchased by the Local Authority, consists of a large hall?divided into compartments, when necessary, by light moveable screens with a small scullery and cloakrooms. There is accommodation for 40 boys and girls and at present 25 attend on five afternoons weekly, for instruction in handicrafts of all kinds, physical exercises and speech training. The Hon. Supervisor of the Centre is Mrs. Cotton herself. There is one salaried worker, and a band of voluntary workers who attend on different days.
In addition, a Social Club has been opened for the girls once a week from 4-3? to 6 p.m., and for the boys on another evening from 6.30 to 9 p.m. For the latter, the Committee has been fortunate in securing the help of Toe H. This is a new venture started by a group of enthusiastic volunteers, and it should prove a valuable attribute to the work of the Centre itself. 26 MENTAL WELFARE The Diagnosis of Mental Deficiency In his Annual Report for 1935, recently published*, the Chief Medical Officer of the Board of Education devotes a chapter to ” The Diagnosis of Mental Deficiency.” In referring to the attention now being given to the educational needs of retarded children, the Report points out that ” preoccupation with them should not divert the attention of school medical officers from the ascertainment of mentally defective children,” and proceeds to summarise the responsibilities of School Medical Officers with regard to this group.
It is interesting to note that attention is drawn to the fact that as a result of school reorganisation with its new provision for teaching retarded children, some of those who formerly might have been deemed ” incapable of deriving proper benefit from instruction in an ordinary elementary school ” can now be satisfactorily dealt with there. School medical officers are therefore reminded of the advantage of keeping closely in touch with these educational developments so that they may more easily determine whether or not the children sent up for examination are capable of profiting by them.
In noting the points in connection with the examination of retarded children which have been specially observed by the Board’s Officers, the great importance of a really full and adequate investigation is urged owing to the seriousness of the question at issue. Dealing with the special difficulties attached to the making of a correct diagnosis in the case of blind children alleged to be mentally defective, the Report gives it as a considered opinion that they should not be certified unless it is found, after a trial, that they cannot be educated in a blind school, in which case they should be notified to the M.D. Authority. There is, it states, no advantage in certifying a blind child as ” mentally defective and educable.” Medical officers are reminded of the facilities offered by the School at Court Grange, Abbots Kerswell, Devon, managed by the National Institute for the Blind, which caters for children who have been unable to derive full benefit from an ordinary blind school through mental retardation. With regard to deaf children, the Report states that ” the Board are satisfied that the number who are sent in error to schools for mental defectives is small, but these errors excite an interest far out of proportion to their number, and are quite indefensible.” The same procedure as that suggested in the case of blind children is therefore recommended. The chapter concludes with some comments on Mental Testing and its technique and alludes to the various types of tests which have been found to be of most diagnostic value.
Care of Mental Defectives in Denmark
We have pleasure in announcing that we have received an interesting article on this subject from Dr H. O. Wildenskov, Medical Superintendent of the Keller Institutions, which will be published in our next issue. *The Health of the School Child, 1935. H.M. Stationery Office. 3/6.
Residential Schools for M.D. Children
In the Report of the Board of Education for 1935, the need of increasing the number of Residential Schools for mentally defective children is pointed out.
Referring to the Wood Committee’s estimate of the number of children needing such accommodation, viz. 7,000, and to the fact that there are actually only 2,000 for whom it is at present provided, the Report states:?
It is clear, therefore, that some further residential school accommodation is required for difficult or low grade educable mentally defective children living in rural districts who cannot properly be retained in ordinary public elementary schools.”
Day Special Schools are considered to be practicable only in the larger towns, and the Report expresses the opinion that: ?
it is probably desirable that the higher grade of educable mentally defective children should as a rule be accommodated within the ordinary public elementary school system by the establishment of classes for them together will dull or backward children.”
Defectives in Nottinghamshire
A graph published in the Annual Report of the Health and Health Services of the County of Nottinghamshire shows a striking rise in the numbers of defectives ascertained during the years 1934 and 1935. In 1933 the number of new cases reported under the Mental Deficiency Acts was 76; in 1934 the number rose to 347, and in 1935 it was 345.
This large increase is attributed to improved facilities for ascertainment which became available on the transfer of the administration of the Mental Deficiency Acts to the Public Health Department, and to the intensive efforts which have subsequently been made to accelerate the work.
Embroidery and the Feeble Minded
An interesting article on ” The Teaching of Embroidery in a Training Home for those Mentally Deficient ” is published in the December number of Embroidery, the Journal of the Embroiderers’ Guild.
The article describes the methods used at the Hermitage Home, Fairwarp, Sussex, where feeble-minded girls with fumbling fingers and untrained minds, are taught, by a series of ingeniously thought out stages each one attractive in itself and inducing a desire to progress still further?to produce pieces of embroidery which are of such high standard that the Embroiderers Guild have thought them worthy of a special exhibition.
The article, which is illustrated by clear photographs, should be read by all who are interested in the teaching of handicrafts to defectives. The Journal can be procured from the Guild, 74, Grosvenor Street, W.i, price 1/2.
Portsmouth Mental Treatment Committee
In our last issue we published an article describing the way in which the Mental Health Services are co-ordinated in Oxford. Portsmouth is another area in which co-ordination has been effected, and an interesting report on the work during 1935-36 has just been issued by the Medical Officer of the Mental Treatment Committee (Dr Thomas Beaton).
The final step towards co-ordination was taken in April, 1934, when the Portsmouth Voluntary Association for Mental Welfare was taken over by the Local Authority and constituted as a Social Service Department of the Mental Treatment Committee which had been set up shortly after the passing of the Mental Treatment Act, 1930. This Mental Treatment Department under Miss I. M. Brayn, its Organising Secretary, now deals with Mental Defectives and with the social work of the Out-Patient Clinic of the Mental Hospital, as well as with that necessary in connection with in-patients of the Hospital and of the Mental Wards of St. Mary’s (Municipal) Hospital. Miss Brayn acts also as Honorary Probation Officer for nervous and defective women and children.
The importance of Social Service in connection with the patients presenting themselves for treatment at the Out-Patient Clinic is emphasised by Dr Beaton in the Report under review.
” The stress of mind, bod}/ and social pressure must each be dealt with,” he writes, ” and while the physician can handle the first two, he is helpless against the last, unless he has an adequate social service at his command, and I cannot sufficiently emphasize the importance of this service and the impracticability of attempting serious out-patient psychiatric work without it.”
” It is clear,” he goes on to say, ” that with the development of the Out-Patient Department, a wide field of clinical work is being opened up in which practical sociological measures are as important as the more technical aspects of treatment, and, in time to come, the records which are accumulating will be of considerable importance in indicating the general principles underlying our understanding of mental and nervous failure.”
The immense value of the facilities that can be offered by a properly co-ordinated Mental Health Service has been clearly demonstrated by Portsmouth’s experience.
Institute for the Scientific Treatment of Delinquency
We are asked to announce that the Institute for the Scientific Treatment of Delinquency is arranging eight Seminars for Probation Officers and Social Workers to be given by Dr Denis Carroll at the West End Hospital for Nervous Diseases, Welbeck Street, W.i, on the subject of ” The Psychiatry and Psychotherapy of Delinquency.”
The Seminars will take place on Thursdays at 6.45 p.m., beginning on January 21st. Fees : 6/- for the Course, or 1/6 for single lecture. Applications for tickets should be sent to the Institute, 58, Grosvenor Street, London, W.i.
Falkirk’s New School for Defective Children
In November there was opened in Falkirk by the Convener of the Stirlingshire County Council, a spacious new school (to be known as Dawson Park School) for handicapped children who, on account of physical or mental disabilities need special educational treatment.
The premises include, in addition to nine classrooms, four rooms for practical work, a clinic, a dining room and a gymnasium equipped with special apparatus for remedial exercises.
In his speech, during the Opening Ceremony, Sir William M’Kechnie, late Permanent Secretary of the Scottish Education Department, referred to the great advantages offered by a joint school for physically and mentally defective children and congratulated the Stirlingshire Authority on their ” wisdom and fine feeling ” in calling the school simply by its name, without labelling it ” Special ” or ” Defective.” He also spoke of the advantage to be gained from the centralisation of this type of work, mentioning the experience of Edinburgh which had gradually abolished small Special Classes scattered throughout a number of schools and had now collected its defective children into large groups of 100 or more in buildings which allowed of proper classification and were specially adapted to their needs.
Child Guidance Council
The Council reports the opening of another Child Guidance Clinic in London at Bishop Creighton House Settlement, Fulham, which will meet a long felt need in the South West district. Dr Mitchell has been appointed as Director, Mrs. A. Nathan as Psychologist, and Mrs. A. A. Crosthwaite as Social Worker.
A Vacation Course on Child Psychology is being arranged by the CounC11 to take place from March 31st to April 9th, 1937, at Berridge House, Fortune Green Road, N.W.6. The Course is intended for doctors, teachers, and social workers, and the lecturers will include, Drs. Grace Calver, MacCalman, Moodie, Hamilton Pearson, J. R. Rees, and H. Wilson. On the psychological side, the lecturers will be: Miss L. G. Fildes, Dr Susan Isaacs, ?Miss M. MacTao-gart, and Miss C. Simmins.
00 7 The fee for the full course is Five Guineas resident and Two Guineas non-resident. Further particulars can be obtained from the Secretary, Child Guidance Council, Woburn House, Upper Woburn Place, London, W.C.i. The Third Biennial Child Guidance Inter-Clinic Conference for representatives and professional members of staffs of Child Guidance Clinics in Great Britain will be held on January 29th and 30th at Friends’ House, Euston Road, London, and at the British Medical Association House. Admission by Invitation only, price 5/-, which includes report.
The Annual Meeting of the Council has been fixed for Thursday, January ~8th, at County Hall, Westminster Bridge, S.E.i, at 5 p.m.
Mental Health Course, London School of Economics
The attention of readers is called to the advertisement of scholarships for the Mental Health Course in the Session 1937-38. Applications for these scholarships, generously offered by the Commonwealth Fund of America, should be made before May 1st. For admission to the Course applications may be received until the end of June.
During the last few years there has been a steadily growing demand for psychiatric social workers in Child Guidance Clinics, in Mental Hospitals and General Hospitals, and the training has also been found to be of value to probation officers, family case workers, juvenile employment officers, public health visitors and workers in institutions for children and adolescents. Six County Councils now employ fully trained pyschiatric social workers in their mental hospitals. As non-residential members of the staff, they help in the understanding and treatment of the patients by keeping closely in touch with their homes. Local authorities are also beginning to see the value of Child Guidance for children who cause anxiety to parents or teachers, and are either subsidising privately organised clinics, or starting their own service. The social worker at these clinics has an important function to fulfil, not only in the understanding of family relationships, but also in the co-ordination of all those social services which aim at providing conditions in which children may grow up into healthy, well-balanced individuals.
It is important that those who take up this work should have had responsible experience of other types of social service and the Tutor of the Course at the London School of Economics is always ready to consult with individuals who would care for advice as to the kind of preliminary experience which would be most useful.
Isle of Ely
A site in March, Cambs., for the erection of a colony for mental defectives has been purchased by the Isle of Ely Mental Deficiency Committee. The new institution will accommodate defectives of both sexes and all grades, provision in the first instance being made for approximately 100 beds, to be increased, if and when necessary, to 120 beds.
Bootle Public Assistance Committee and Mental After Care
A Mental Welfare Sub-Committee has recently been instituted by the Bootle Public Assistance Committee, to help rate-aided patients from its area who have been discharged from the County Mental Hospitals.
Patients, on discharge, are to be referred to the West Lancashire Mental Welfare Association who will give any care and guidance that may be considered necessary. The new Sub-Committee will also itself act as a link between the homes and the patients in cases of difficulty.
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