One of the major problems in the care of chronic patients is the design of suitable long-term environments. Following from the work of Tizard and his colleagues, a study is described which investigated the aspects of the organization, management practices and social interactions in 4 local authority day centres for the care of chronic patients in the community. It was found that these centres differed markedly in terms of their organization and management practices and that these differences were correlated with the nature and quality of staff-client (although not staff–staff) interactions. Client-oriented management attitudes were correlated with a more personal approach to clients' problems and a warmer quality of interaction. These differences did not seem attributable to different kinds of clients being involved in each centre. The results are discussed in terms of the possible causal mechanisms involved and their implications for designing systems of long-term care.

The purpose of this note is to indicate how the disagreement between Tennant & Bebbington and Brown & Harris has arisen. The difference between the 2 pairs of authors is due, at least in part, to their use of different models for the analysis of the data in question. There can be no final answer as to which model is correct – the data are simply open to more than one interpretation. Nevertheless, it is interesting that the use of a multiplicative model, seemingly ignored by Brown & Harris, leads to a simple description of the data in which the ‘vulnerability factor’ and the ‘provoking agent’ may be considered to act independently on the response. Consequently, in stating that their data contain an interaction so obvious that it can be detected by ‘visual inspection’, Brown & Harris may have been somewhat rash.

Information regarding the physical and mental health of clients referred to social workers in a local authority intake team and to a general practice attachment scheme was collected over a 3-month period. Although returns to the Department of Health and Social Security during this period indicated that a very low proportion of clients were physically or mentally ill, it is clear that these figures greatly underestimate the extent of illness present. While social workers operating outside hospital and general practice attachments have been shown to have little contact with medical staff, in this study high proportions of their clients were ill and their social problems were often associated with their illness.