Commentary: hospital can never be home

British Medical Journal, March 21, 1998 by Michael Saunders

The problem is that hospitals are not home, and never can be. The development of units for young disabled people in the 1960s and 70s raised hopes that homely environments could be created within the NHS. These aspirations were not realised; nor were they realistic. This has led to moves to create small family units in community settings and the provision of adequate facilities to maintain people in their own homes. Regrettably, facilities and resources remain limited and people are still admitted to hospital for respite care. Unless respite care involves assessment or treatment, hospitals of any sort are an inappropriate environment for most people with chronic neurological disease.

Underlying the question of the nature and use of hospitals is the wider issue of the purpose of the NHS. The NHS is probably not there to provide a "home," however much we may want to transport home life into an NHS hospital.

Mr K's habit might distress others

Cannabis is still illegal, although many people do smoke it. Whether it is a useful drug in multiple sclerosis is a matter for debate, but it is not prescribed officially. Although the ward staff may be sympathetic to Mr K's predicament, they cannot allow him to smoke cannabis. Public servants are obliged to stay within the law and making exceptions could lead them down the "slippery slope" of acquiescing to all sorts of illegal practices. Apart from this, the environment of many rehabilitation units would mean that Mr K's smoking of cannabis would impinge on the privacy of others, who might find his habit distressing.

Eating cake, however, seems harmless enough. The staff are certainly not detectives and if Mr K eats cannabis cake they should have no means of finding out. The relationship between Mr K and staff should be one of mutual trust, however, which places an obligation on Mr K and his mother not to deceive the unit once the matter has been discussed and permission refused.

Sexual relationships are important to disabled people

Sexual relationships in hospital are a problem because of lack of privacy. There is no reason why sexual relations should be barred in hospitals, providing the privacy and feelings of others are protected. This can be a very important part of the life of someone with a chronic disability. The failure to provide facilities for sexual relationships may be a reflection of the attitudes and perceptions of able bodied staff to people with disabilities.

Anandgiri, Thorpe Underwood, York YO5 9ST

Michael Saunders consultant neurologist

Michael.Saunders@ btinternet.com