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A CENTRAL HOSPITAL FUND
1272
regarded
as
tuberculous if calcification.
certainly
foci of caseation
or
they
contain
A CENTRAL HOSPITAL FUND IT is inevitable that the war will make changes in the structure of British medicine, and throughout the recent discussion in our correspondence columns many must have felt, first that the problem should be considered from a national and not a local angle, and secondly that an ounce of experiment was worth a pound of speculation. To all such it must seem that Lord NUFFIELD, with that
nous
for which he has become
famous, has made possible just such
an
justly experi-
ment. The Nuffield Medical Scheme indicated that a modern clinical school should be based on the fundamental sciences, rather than that the preclinical school should be the poor sister of the hospital. Nuffield College came into being to develop social science in this country by bringing the academician and the entrepreneur in living contact with each other. The PEP report on the British Health Services (1937) made numerous references to the facts that health problems may involve a complex of social and economic considerations and that research on organisation is sorely needed. At present three separate groups are concerned in the supply of hospital services in this country-the voluntary hospitals, the public authorities and the Ministry of Health. The ministry’s incursion is the result of the war, which has enforced one of the main recommendations of the report of the Voluntary Hospitals Commission under the chairmanship of Viscount Sankey in 1937-the division of the country into hospital regions. The Sankey commission also recommended the formation of hospital regional councils to correlate hospital work and needs in the regions, and the formation of a central hospitals’ council to coordinate the work of these regional councils. It was realised that such a reorganisation of the hospital services of the country could not be undertaken or the regionalisation scheme be fully implemented unless accompanied by cooperation with the local authorities and the state. It can therefore be expected that such regional hospital councils would survey and coordinate the hospital services within their regions and consult the local authori-
the university, the medical school, the British It is Medical Association and other bodies. becoming the rule for all questions relating to the coordination or extension of hospital services or the development of institutional and clinical medical services in the Oxford district to be referred to this board. Contact has been made with the survey committee of Barnett House, which has already published two volumes of its’ survey-"The Economics and Government of a Changing Area," and " Mental Health Services in Oxford City, Oxfordshire and Berkshire and has a third volume in publication. It cannot be said that the reorganisation of hospital services is likely to be easy; they form a tangled skein and it will be hard to weave them into a harmonious whole. The working man, who has paid his share in rates, national insurance and contributory schemes, is in no mood to be considered the recipient of charity. Labour councils, who appreciate the power and efficiency of an organised community, are anxious to destroy the structure of patronage and nepotism which underlies the Florence Nightingale-Lady Bountiful tradition. The individualist fears the loss of the voluntary impulse, and the dead hand of the municipality and the state. The doctor suspects that he may become an unpaid public servant whose labours are exploited at the same time as his means of living are reduced. These are difficult problems and they can only be solved by experiment and by the creation of model schemes. The hope is that such regional experiments will show that it is possible to combine within an integral national framework all the vigour and variety of local patriotism and effort.
by
FOOTWEAR
failings of modern boots and shoes are now beginning to attract the attention they deserve. It is at last coming to be realised that the results in local and general ill health of such abuses as over-eating and intemperance pale into insignifiTHE
cance
beside those of the abuse of the feet, for ill-
fitting footwear is universal. The situation was regarded as serious enough by the group of industrial medical officers to justify a special meeting
in London last autumn,! at which the feet of the industrial worker were considered by recognised ties in matters of common interest. experts from various sides. The medical officer to The new Nuffield benefaction of a central fund a large industrial firm there gave convincing for financial regionalisation may in a sense be evidence of the prevalence of painful feet among regarded as a hospital fund for the provinces, workpeople, though a physiologist, while agreeing including Scotland and Northern Ireland, bhat footwear was responsible for much distortion analogous to the King’s Fund in the London of the arches, was not sure that all the blame But it is even more the endowment of a sould be laid at its door. The research director area. project for research in social organisation. Money )f the British shoe industry opened up the idea talks, and no social experiment can make progress )f occupational footwear, carefully designed for ts particular purpose, and he described an experiwithout a financial backing. The lines of advance are already evident from recent happenings in mental shoe and gave proof of its effectiveness. Oxford. The Oxford and District joint hospitals’ rhe war has stopped these investigations. board consists of members of the governing bodies In our present issue Dr. MARGARET EMSLIE and medical staffs of the associated hospitals, akes us a step further back. She describes representatives of the local authorities and theI leformities found in the feet of children between contributory schemes, and members nominated 1. See Lancet, 1938, 1, 1480.
regarded
as
tuberculous if calcification.
certainly
foci of caseation
or
they
contain
A CENTRAL HOSPITAL FUND IT is inevitable that the war will make changes in the structure of British medicine, and throughout the recent discussion in our correspondence columns many must have felt, first that the problem should be considered from a national and not a local angle, and secondly that an ounce of experiment was worth a pound of speculation. To all such it must seem that Lord NUFFIELD, with that
nous
for which he has become
famous, has made possible just such
an
justly experi-
ment. The Nuffield Medical Scheme indicated that a modern clinical school should be based on the fundamental sciences, rather than that the preclinical school should be the poor sister of the hospital. Nuffield College came into being to develop social science in this country by bringing the academician and the entrepreneur in living contact with each other. The PEP report on the British Health Services (1937) made numerous references to the facts that health problems may involve a complex of social and economic considerations and that research on organisation is sorely needed. At present three separate groups are concerned in the supply of hospital services in this country-the voluntary hospitals, the public authorities and the Ministry of Health. The ministry’s incursion is the result of the war, which has enforced one of the main recommendations of the report of the Voluntary Hospitals Commission under the chairmanship of Viscount Sankey in 1937-the division of the country into hospital regions. The Sankey commission also recommended the formation of hospital regional councils to correlate hospital work and needs in the regions, and the formation of a central hospitals’ council to coordinate the work of these regional councils. It was realised that such a reorganisation of the hospital services of the country could not be undertaken or the regionalisation scheme be fully implemented unless accompanied by cooperation with the local authorities and the state. It can therefore be expected that such regional hospital councils would survey and coordinate the hospital services within their regions and consult the local authori-
the university, the medical school, the British It is Medical Association and other bodies. becoming the rule for all questions relating to the coordination or extension of hospital services or the development of institutional and clinical medical services in the Oxford district to be referred to this board. Contact has been made with the survey committee of Barnett House, which has already published two volumes of its’ survey-"The Economics and Government of a Changing Area," and " Mental Health Services in Oxford City, Oxfordshire and Berkshire and has a third volume in publication. It cannot be said that the reorganisation of hospital services is likely to be easy; they form a tangled skein and it will be hard to weave them into a harmonious whole. The working man, who has paid his share in rates, national insurance and contributory schemes, is in no mood to be considered the recipient of charity. Labour councils, who appreciate the power and efficiency of an organised community, are anxious to destroy the structure of patronage and nepotism which underlies the Florence Nightingale-Lady Bountiful tradition. The individualist fears the loss of the voluntary impulse, and the dead hand of the municipality and the state. The doctor suspects that he may become an unpaid public servant whose labours are exploited at the same time as his means of living are reduced. These are difficult problems and they can only be solved by experiment and by the creation of model schemes. The hope is that such regional experiments will show that it is possible to combine within an integral national framework all the vigour and variety of local patriotism and effort.
by
FOOTWEAR
failings of modern boots and shoes are now beginning to attract the attention they deserve. It is at last coming to be realised that the results in local and general ill health of such abuses as over-eating and intemperance pale into insignifiTHE
cance
beside those of the abuse of the feet, for ill-
fitting footwear is universal. The situation was regarded as serious enough by the group of industrial medical officers to justify a special meeting
in London last autumn,! at which the feet of the industrial worker were considered by recognised ties in matters of common interest. experts from various sides. The medical officer to The new Nuffield benefaction of a central fund a large industrial firm there gave convincing for financial regionalisation may in a sense be evidence of the prevalence of painful feet among regarded as a hospital fund for the provinces, workpeople, though a physiologist, while agreeing including Scotland and Northern Ireland, bhat footwear was responsible for much distortion analogous to the King’s Fund in the London of the arches, was not sure that all the blame But it is even more the endowment of a sould be laid at its door. The research director area. project for research in social organisation. Money )f the British shoe industry opened up the idea talks, and no social experiment can make progress )f occupational footwear, carefully designed for ts particular purpose, and he described an experiwithout a financial backing. The lines of advance are already evident from recent happenings in mental shoe and gave proof of its effectiveness. Oxford. The Oxford and District joint hospitals’ rhe war has stopped these investigations. board consists of members of the governing bodies In our present issue Dr. MARGARET EMSLIE and medical staffs of the associated hospitals, akes us a step further back. She describes representatives of the local authorities and theI leformities found in the feet of children between contributory schemes, and members nominated 1. See Lancet, 1938, 1, 1480.