Letter from . . . Chicago: Primary health-care crises.

1267 small homes with people with other handicaps and that elderly epileptics whose condition does not warrant hospital care should be placed in local authority homes for the elderly. A geriatric patient with severe epilepsy would not be best served in a geriatric ward or a district general hospital, where it is doubtful that his special needs would be met. I am quite certain that epileptics requiring long-term care are not likely to be well looked after with a group of other patients suffering from other handicaps. Wind of change Sadly it now seems inevitable that the recommendations of the regional health authority that St Faith's Hospital should be closed will be accepted by the Department of Health and Social Security. But this is only part of the wind of change that is blowing through our mini-field of epilepsy. For some time the epileptic colonies have suffered through the failure of the appropriate local authorities to fund the admission of suitable patients. Similarly, St Faith's has had its catchment area progressively reduced and the hospital is no longer viable because it has been directed to accept no more long-stay patients. It is now administered at district level, and clearly it is considered a financial embarrassment. I am quite certain that the hospital should be seen in a supraregional context and should be developed to become an important unit in southeast England. Some years ago, with the blessing of the then Ministry of Health, a Joint Consultative Committee (JCC), consisting of the staff of the epileptic colonies and, more recently, St Faith's Hospital was established. Its function was to serve as a channel of communication between the Ministry of Health, the colonies, and the special hospitals. All members of the JCC have naturally been concerned about recent changes, and at their last meeting representatives from the department of health, regional health authority, area health authority, and the district management team for the Brentwood area were invited to attend. In the event, no representative from any level of the Health Service hierarchy attended. I am wholeheartedly behind the Reid Report's recommendation that great efforts should be made to assess and rehabilitate patients with epilepsy before the often final admission to a long-stay institution has taken place. But it is irresponsible to run these hospitals down and close them before the perhaps Utopian alternatives devised by Reid and his colleagues have even begun …