For those involved in hospital closures


Eric Emerson and Chris Hatton



ISBN 0 11 321780 3

This is an analysis of 73 studies of services for people with
learning difficulties who used to live in hospital. The studies
compared the end results for people living in hospitals, in
large-scale settings in the community and in staffed houses in the

The book is highly relevant to anyone who is affected by the
present situation of the hospital closure programme through work or
personal involvement.

Un fortun ately, the excessive dryness of the academic
presentation means the findings are unlikely to have a fruitful
impact on opinion and debate.

The review raises serious questions about the validity of the
methods used in certain research. Can useful con clusions be drawn,
for example, by comparing scores using quantitative scales which
have been rated by different people at different times, who are
operating in different environments and have different attitudes
and expectations?

The book’s conclusions underline many of the arguments made in
the series of resettlement publications from Values Into Action
(strangely absent from the long list of references presented).

Particularly relevant are: community settings do not inevitably
lead to better quality of life; good resources do not automatically
produce high quality; organisation, management and staff attitudes
are key factors; and, outcomes need to be measured in terms of
quality of life for the rest of the population, and not only for
other deprived and impoverished groups of people, such as residents
of mental handicap hospitals.

The book’s recommendations emphasise the need for purchasers,
commissioners and providers to promote the quality of outcomes as
experienced by users. It also recommends that researchers examine
systematically the issue of user-outcomes. Never theless, the lack
of general accessibility will limit severely the extent to which
the book can influence purchasers, commissioners or providers.

Jean Collins

is director, Values Into Action, and author of When the Eagles
Fly (1992); The Resettlement Game (1993) and Still to be Settled

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