The exploratory survey to be described in this series of papers was designed in order to make a preliminary estimate of the service needs of people in prolonged contact with high dependence community services in Camberwell, including a spell in day or residential care. Patients who had been resident in hospital for a year or more were excluded, but the sampling scheme was otherwise directed towards generating a group who would formerly have been at high risk of staying in hospital for a prolonged period.

There is a considerable variation in the amount and type of care and supervision provided for people in the survey population. At one end of the spectrum, the in-patient ward provides skilled 24-hour medical and nursing care; at the other extreme, some homes are simply providing sheltered housing for ex-patients who would find it very difficult to obtain private rented accommodation in London. Although the sample is defined in terms of service utilization, it covers a broad range of types of treatment, care and social support.

Many patients depend on the care and support provided by relatives and friends as much as or more than on the help of services. In order to investigate this role and the burden that it might entail, interviews were sought with those who actually played a practical caring role. Members of the research team asked people in the series and staff whether (a) the patient shared a household with someone, or planned to do so in the near future if living in a residential unit; or (b) the patient regularly visited the relative; or (c) someone regularly helped with tasks such as laundry, washing up or cooking. There were 79 such helpers, all but two of whom turned out to be relatives. One exception was a landlady who had for years provided a very disabled patient with extensive motherly support. The other was a friend who visited the patient every evening in hospital. He used to visit her every day when she was living at home, and helped her round the house when she could not manage. For convenience the term ‘relative’ is used to include these two.

An assessment of need for services on the census day, and whether any identified need was being met, was made on the basis of all the information collected from patients, staff, relatives and case-records. Staff judgements that there was unmet need were given considerable weight, since they were usually made when the need was particularly serious or long-lasting. However, in several instances the team rated unmet need as present when staff had not mentioned it. Occasionally, it was necessary to reconcile conflicting information from different sources, as when a relative gave details of problems not known to staff.