Medication for 127 randomly selected patients aged over 70 in a large group practice was examined in relation to the available supervision for this treatment. About half the patients were on long-term treatment, mainly drugs associated with heart disease, depression, or anxiety. Nineteen had had no recorded contact with the family doctor for six months or longer, and examination by nurse surveillance suggested that three might be suffering from drug toxicity. It was concluded that reliance on self-referral by elderly patients was unsafe.

This paper reports an investigation of the costs of domiciliary care for 139 elderly sick patients under the care of the home nursing service. The data suggest that there may be little economic advantage in home care for seriously disabled elderly people. The revenue cost of domiciliary care was equal to or greater than the average associated with residential or hospital custodial care in such patients. Even so, the cost of services received at home did not disclose the real need for domiciliary care, since at present this is obscured by compulsory rationing and the separation of responsibility between health and social services. It is suggested that the supposed economic advantage of domiciliary care will depend increasingly on restricting such services, thus increasing the degree of neglect to some patients.

Government policy continues to emphasise the commissioning and needs-assessment role of health authorities, local authorities and -to a greater extent -general practitioners. To date, much available information for this purpose has been based on service utilisation data or from registers based on case finding from service contacts.

This paper highlights the severity of disability, social context and care needs of stroke survivors living outside of institutional care. It provides an estimate of the prevalence of stroke in the community, and offers an operational rationale to purchasers of community care services.

SummaryIn a survey in Coventry of 1079 post-natal patients, 11% (104) of married women and 46% (32) of single women stated that this birth was unwanted and emotionally distressing. The married women with unwanted births were the same age as other married women, but had substantially larger families. The single women with unwanted births were younger and all had left school at 16 years or below. Ten per cent of married women and 28% of single women with unwanted births had no knowledge of contraception and 28% of married women and 78% of single women with unwanted births had not used any contraceptive methods. Seventy-six per cent of married women and 78% of single women with unwanted births would have liked further professional advice.