fore, recommend that legislation to give effect to this should be introduced at an early date. 13. It remains now to consider the most suitable means by which such supervision can be made effective. Your Committee have had the advantage of hearing evidence as to the actual effect of registration and inspection in the case of maternity homes in both London and Manchester. It is plain from this evidence that while registration has proved no deterrent to the supply of maternity homes, it has had beneficial effects upon the standard of efficiency amongst those homes passed as efficient by the supervising authority. The figures also indicate that a number of general nursing homes are already subjected, in regard to their provision of accommodation for maternity cases, to inspection and supervision and are, therefore, already familiar with this process. 14. Your Committee have been much impressed by one result of applying the scheme of registration to only one class of home, to wit, maternity homes, while leaving other homes unregistered and uninspected. Homes that have applied for registration for the acceptance of maternity cases have, in certain cases, been refused upon the grounds that the owner, apart from technical qualifications, is an unsuitable person, or that the buildings are unsuitable and insanitary for the conduct of a maternity home. Some of these homes on being informed that their application for registration as maternity homes had been refused diverted their attention to the reception of medical and surgical cases only. This position is one which hardly needs comment, for it is obvious that where a building, or person, or both are unsuitable on general grounds for the reception of maternity cases, they are equally unsuitable for the reception of medical or surgical cases, and yet under the present anomalous conditions such homes can continue their activities unembarrassed by any form of control. Another effect of partial registration has been for the unsuitable homes to withdraw to just outside the limits of the registration area. 15. That there are special conditions which differentiate maternity cases from others received by nursing homes is fully recognised, and your Committee consider that the ideal arrangements would be to segregate all maternity cases into special maternity homes or special departments of combined homes. Although this policy is practicable in the larger homes, your Committee are informed that the smaller homes accommodating one or two patients would not be able to carry on if their activities were thus restricted. As can be readily understood, particularly in small areas, the demand for maternity accommodation is bound to be erratic in its incidence. Your Committee, therefore, while strongly recommending that Committee of the Privy Council on the question of Contributions to Imperial Funds from the Islands of Jersey, Guernsey and Man. Presented to Parliament by LONDON: PRINTED & PUBLISHED BY HIS MAJESTY'S STATIONERY OFFICE To be purchased directly from H. M. STATIONERY OFFICE at the following addresses: Adastral House. Kingsway, London, W.C.2; 28, Abingdon Street, London, S.W.1; York Street, Manchester; 1, St. Andrew's Crescent, Cardiff; or 120, George Street, Edinburgh; or through any Bookseller. 1926 Price 1s. 6d. net. 1 the aim of supervising authorities should be towards a policy of segregation, do not consider that it would be practical to enforce a condition of this kind. 16. Your Committee have had figures put before them, both Qs. 4, 2397, for London and Manchester, which indicate that in individual 3181. homes the amount of overlapping in functions, as between App. II. maternity and other cases, is not inconsiderable. Since it is impracticable at present to alter this state of affairs, and since the practice of registration and inspection of maternity accommodation is already established in certain areas and will probably become general, it is clear that, unless the authorities entrusted with the supervision of maternity accommodation are the same as those to be entrusted with the inspection of general nursing homes, duplicate inspection of the same premises by different authorities must ensue. Obviously such duplication is to be avoided. It is not only administratively expensive and unsound, but it is bound to result in unnecessary trouble and annoyance to the managers of these homes. 17. Careful consideration has been given to the question as to which bodies can most properly be entrusted with these supervisory powers. Certain witnesses have pressed the need for Qs. 505-512, centralisation under the Ministry of Health. Such a system 1935-1945, 3189-3195, could, in your Committee's opinion, only be cumbersome and 3543, 3546, expensive, as of necessity it would carry in its train the appoint- 3566-3570. ment of a number of new inspecting officers. On the other hand, Qs. 2978, it has been urged by the witness representing the Association of 2979, 2995-2999, Municipal Corporations that the supervising authority should 3012-3018. be the local authority. The result of such de-centralisation Cf. also Qs. would inevitably lead to a wide divergence in the standard of 1028, 1043efficiency. Local officers in small areas may, in all probability, 1047, 3880. be well known personally to the individual whose premises they have to inspect, and they may even have definite interests in and prejudices concerning certain homes in the district. 1224-1229, The general weight of the evidence from other witnesses, how- Qs. 223, 224, ever, seems to favour the limiting of such powers to the larger 1157, 1199, municipal authorities, i.e., the county councils, county borough 2473, 2507, councils, and in London the London County Council. Although 2642, 2643, from the number and variation in size of these bodies a level 2819, 2820, standard of efficiency is not likely to be reached, it is felt that 2836, 28802889, 3110most county council and county borough council areas are suffi- 3116, 3647. ciently large to eliminate to a reasonable degree the difficulties due to the personal equation. 18. Your Committee, therefore, recommend that powers of registration and inspecting in regard to nursing homes should be given to county councils and county borough councils, and, Qs. 2402in the case of London, to the London County Council. 2408, 2421. of 19. Your Committee have considered the advisability empowering supervising authorities to delegate the powers or duties conferred or imposed upon them to a committee appointed by them. Your Committee are of opinion that this suggestion Qs. 130-135. has many merits and they agree with the representation made by the British Medical Association that, if the need for such committees is found to exist, they should invariably include members of both the medical and nursing profession. 334-336, 2400, 2401, 2604-2607, 2842, 30943097, 31163141, 33063309, 3542. Q. 2409. Qs. 387, 388. 20. In view of the considerations set forth in the preceding paragraphs, your Committee further recommend that in any legislation arising out of this inquiry, the definition of the term Nursing Home," suggested in paragraph 3, should be extended so as to include those premises or parts of premises used, or intended to be used, for the reception of women in childbirth. Your Committee attach considerable importance to this recommendation. In spite of the recognised differences between maternity and other cases, your Committee consider that the practical difficulties of administration can only be adequately met by a scheme which includes all types of nursing home. Qs. 175, 199- 21. A number of witnesses have expressed their views as to 203, 291-296, the most suitable officer for carrying out the actual work of inspection. It has been strongly urged that inspections should be carried out by a qualified medical man, or woman, preferably by the medical officer of health or some similar officer on his staff and deputed by him. It has been pointed out that in many cases it would not be necessary to appoint special officers for the conduct of this work, in short, that it could be taken by medical officers of health in their stride. On the other hand, objections have been raised by a number of witnesses as to the ability of a medical man to inspect the efficiency of the nursing services and as to his capacity for criticising the domestic arrangements of a home. It is suggested that a medical man is not trained in the art of nursing, and that he would be slow to criticise or interfere with such matters, further, that he would not be likely to detect with the same ease, if at all, minor irregularities in the domestic arrangements, which although in themselves small, have a considerable cumulative effect upon the health and happiness of patients and nurses. A trained nurse, it is suggested, is the only person competent to inspect and criticise these details. Qs. 537, 1092-1097, 1933, 1968, 1979-1989, 3185-3188, 3271-3281. Cf. Qs. 176-183, 303, 397-404, 538, 1102-1113, 2400. 22. If a system of inspection is to react beneficially on the conduct of nursing homes the inspecting officer or officers must be qualified to express an opinion on the following, amongst other matters : (i) The suitability of the person in charge, both as regards |