Cash in Hand

¹ Director of Rehabilitation, St. Wulstan's Hospital, Malvern, Worcs.
² Research Assistant, St. Wulstan's Hospital, Malvern, Worcs.
³ Patients' Personnel Officer, St. Wulstan's Hospital, Malvern, Worcs.

From 1958 to 1972, patients' earnings for work done in British hospitals were effectively limited to a maximum of £2. In October 1972 a change in the law allowed this ceiling to be raised to £4.50.

This paper examines the consequences of this change to a sample of 157 patients (each serving as his or her own control) over two consecutive periods of three months immediately before and after the change. Forty-one (26 per cent) of the patients increased their output significantly in the second period. Twenty-four of these patients were individually matched with others whose output did not increase substantially. The two sub-groups were remarkably similar clinically, showing that formal handicaps play a much smaller part than is commonly supposed in governing the work performance of handicapped people. Only two factors were associated with failure to increase output: a diagnosis of two or more different psychiatric conditions, and treatment with high doses of neuroleptic drugs (which is taken to indicate a more severe psychosis). Paranoid patients responded less enthusiastically than others to the change, but not significantly so. These results failed to reach significance when the whole population was studied.

From these results it appears that four groups of factors influence patients' motivation to work in hospital: their multiple handicaps, the total amount of work available, national and local regulations governing permitted earnings, and the atmosphere and organization of the workplace.