- Email: [email protected]
ACCOMMODATION FOR THE AGED
44
anything to be given by mouth before operation, in order avoid inhalation of regurgitated stomach contents (Edwards et al. 1956). But trimeprazine is now widely given to children orally as a premedication (Cope and Glover 1959), and in this trial the small amount of water given had no untoward effects during induction and
less than 500 mg. of thiopentone given, but, despite the resulting low dose of atropine, salivation was not troublesome. The patients’ mouths were usually moist-which was a help rather than a hindrance when the pharyngeal airway or laryngoscope blade was inserted. maintenance of anaesthesia. Although of secondary importance to the comfort and In the same way as administration of morphine has safety of the patient, convenience of ward routine has some become a ritual, so has the giving of 0-6 mg. of atropine bearing on any new form of medication, especially in parenterally before operation. The rationale is twofold: understaffed hospitals. At the end of the trial all ward to suppress salivary secretion during anaesthesia, and to sisters and some of the staff nurses were interviewed and obviate harmful vagal reflexes. But the administration of were asked whether promethazine made patients so 0-6 mg. of atropine to prevent autonomic reflexes is useless. drowsy that they were difficult to prepare for operation. Block of vagal nerve-endings begins only when the dose of The nursing staff were unanimous in their approval of atropine is 1 mg. and is not complete until more than 2 mg. oral premedication. Primarily it was more convenient to is given (Goodman and Gilman 1955). The use of the give tablets than to prepare and give injections, but mornconventional 0-6 mg. of atropine represents no more than ing sedation also received approval. No-one had noticed lip-service, and the routine injection of atropine before any difference in the postoperative behaviour of patients operation has, in fact, been criticised (Holt 1962). given oral and those given parenteral premedication. For Undoubtedly the principal effect of atropine premedica- patients in pain or on gastric suction parenteral pretion is suppression of salivary secretions, but with the medication may be more suitable. But this trial suggests coming of intravenous instead of inhalation inductions that for most elective operations oral premedication is this is of less importance. Intravenous atropine acts preferable. rapidly, and, even when given in the same syringe as the REFERENCES thiopentone used for induction, salivary secretion is Anœsthesia (1963) 18, 1. Beecher, H. K. (1955) J. Amer. med. Ass. 157, 242. adequately suppressed. There seems no reason, in fact, British Journal of Anœsthesia (1961) 33, 599. for atropine ever to be given parenterally in the ward as a Cope, R. W., Glover, W. J. (1959) Lancet, i, 858. Edwards, G., Morton, H. J. V., Pask, E. A., Wylie, W. D. (1956) Anœsthesia, routine premedication. 11, 194. Goodman, L. S., Gilman, A. (1955) Pharmacological Basis of Therapeutics. At first in this trial, atropine 0-6 mg. was given intraLondon. Holt, A. J. (1962) Lancet, ii, 984. venously before induction. Later, the atropine was mixed Jolly, Brit. med. J. i, 1276. C. in the same syringe with 500 mg. of 2-5% thiopentone Kerr, M. (1962) (1962) Brit. J. Anœsth. 34, 347. used for induction.
to
Conferences ACCOMMODATION FOR THE AGED A CONFERENCE on this subject was held at the Hospital Centre of King Edward’s Hospital Fund for London on Dec. 15, under the chairmanship of Mr. P. H. CONSTABLE. Dr. C. A. BOUCHER (Ministry of Health) observed that hospital accommodation for the aged was still based on the Beveridge report (1943),1 and on the pioneer efforts of Dr. Marjory Warren and Dr. L. Z. Cosin. Until recently teaching hospitals had not concerned themselves with geriatrics because of the danger of blocking their beds, but they were now appointing geriatricians to their staffs. A geriatrician’s success depended on’ his ability to admit patients quickly, and this in turn on his power to secure prompt discharge despite the reluctance of relatives and the shortage of welfare accommodation. After the critical period of three months, discharge from hospital became almost impossible. The Hospital Planrecognised geriatrics as part of general medicine and of the new district general hospital, and laid down a bed-ratio for the chronic sick of 1-4 per 1000 population. But in twenty years there would be two million more old people, increase of over a third; and there would be nearly half as more over-85s. Dr. Boucher stressed that adequate staff, including physiotherapists, were more important than more beds. He hoped for extension of day hospitals (of which there are sixty at present), the provision of psychogeriatric assessment units to prevent patients being admitted to the wrong departments, and the establishment of a chair and perhaps an institute of gerontology. Mr. B. THAXTON (architects’ department, London County Council) described his local authority’s latest homes for old an
many
1. 2.
Beveridge Report. Social Insurance and Allied Services. Cmd. 6404. H.M. Stationery Office, 1943. A Hospital Plan for England and Wales. Cmnd. 1604. H.M. Stationery Office, 1962.
In many
cases
was
people. Variants of the figure-of-eight pattern were replacing the T-shape plan in an effort to produce a more lively community, and a more complete environment. Some bizarrelooking layouts were architecturally designed to ensure interest in the immediate surroundings of the home; and one, which had been given a Civic Trust award, allowed the inmates to see right through the dining-room and courtyard. Favoured sites were near schools and busy thoroughfares for the same reason. The aim was to accommodate three-quarters of the old people in single rooms, with a maximum of 60 residents in each home. Sliding-sash windows were now being fitted since they were less draughty, especially for night ventilation, and also safer than the hinged types. Dr. G. F. ADAMS’ geriatric wing at the Belfast City Hospital was the first built in Great Britain for the combined reablement and long-term care of the elderly sick. The 42-bed wards are constructed to take 11new patients, 12 for rehabilitation and 19 for long-stay, on the principle that every ward should have its quota of chronic sick. The bed-centres are 71/2 feet apart, and there is space for exercise and physiotherapy. Dr. Adams emphasised that the wards must be made attractive to first-class nursing staff who are otherwise difficult to obtain. Miss D. NORTON (nursing research unit, Edgware General Hospital) said that patients should be able to touch the floor with their feet while seated on their beds; this would prevent accidents when getting up at night. The normal bed-tables high to eat or wash from-ideally, washing-bowls should be oval for placing between the bed-patients’ knees, but none of suitable size were to be had. Patients floated away in a large bath, and the nurse’s back was strained by bending over a low one. The number of wash-hand basins was insufficient, being based on the requirements of bedfast patients and not of the ambulant ones of today. Patients often slipped out of chairs in trying to accommodate themselves to seats which were too deep for comfort. were too
Questions elicited the facts that the old people were not consulted about the type of homes they want, and that the
45
is E1250-f,1750 per person. The panel of speakers found it difficult to answer the query: What changes in equipment would you suggest if you were given all the requisite engineering and financial help ? Help in nursing the incontinent and more toilet accommodation were suggested. Mr. W. L. GRAHAM described the Lewisham 3 survey of the elderly.3 cost
Parliament N.H.S. Charges ON Dec. 17 Mr. KENNETH ROBINSON, the Minister of
Government tried to find some suitable methods of relieving solely those who suffered from hardship from prescription charges, but were unable to do so. We prefer to take this first major step towards restoration of the free health service which the Labour Government introduced after the war.
Bill for Abolition of Death
QUESTION
.
Health,
made the
following
statement on
National Health
Service charges:
Prescription charges comprise the ordinary 2s. charge for prescriptions and charges for elastic hosiery, which are payable both by the patients of general practitioners and by hospital outpatients, together with the charges payable by hospital outpatients for certain appliances. With effect from Feb. 1 next, we propose to abolish all these charges which, since 1952, have created a financial barrier between the patient and the treatment he needs. The Secretary of State for Scotland and I are starting at once the necessary consultations with the professions on amendment of their terms of service, with a view to making regulations for this purpose when the House reassembles after the Christmas recess. Until Feb. 1, the existing charges will continue to be
payable. There will remain the charges for dental treatment and appliances and those for spectacles. It is our aim to abolish these charges also, in due course, by means of legislation which will revoke the statutory powers authorising the levy both of these charges and of prescription charges. It will not be possible to introduce such legislation during the current session. Mr. R. F. WOOD: Can the Minister give any estimate of the increase in the number of prescriptions which this will cause and, particularly, can he assure us that the doctors will be able to cope with the increased load in the middle of the winter ? Mr. ROBINSON: There will, in all probability, be some increase in the number of prescriptions, which it is impossible to quantify at the moment, but there will also, I hope, be some reduction in the amounts prescribed by doctors now that they no longer have any need to consider the ability of their patients to pay the prescription charges. I am aware that some doctors are anxious about the possibility of an increased work load. I believe that their fears in this respect are exaggerated but, in so far as they will be meeting a need that has hitherto been deterred from emerging by the charges, I am sure that they will accept this load, and welcome it. Mr. E. R. LUBBOCK : Has the Minister made any estimate of the administrative saving that will result from the abolition of prescription charges ?-Mr. ROBINSON: It is difficult to estimate the precise administrative savings, but to set against the lost gross revenue from charges there is the amount of just under E3million representing National Assistance Board refunds to patients who qualify for refund on grounds of hardship, which will no longer be payable. Lord BALNIEL: While welcoming policies designed to bring benefits to people really in need-the chronic sick or the elderly -may I ask whether the Minister is really satisfied that this step, which will bring benefits to people of whom some are not really in need, is a higher priority than spending an additional E20 million, for instance, on improving the care of the mentally handicapped, the domiciliary services, or the hospital building programme ? As Minister in charge of the National Health Service, is he really saying that this is the highest priority that he can think of ?-Mr. ROBINSON: There are, of course, a number of things we need to do and would like to do in the National Health Service which were left undone by previous Governments. I can only say that, apparently, the previous 3. Report on Services for the Elderly in Lewisham, 1964. Copies obtainable from the King Edward’s Hospital Fund for London, 34, King St., E.C.2. See Lancet, 1964, ii, 1069.
Penalty
On Dec. 21, Mr. SYDNEY SILVERMAN’S Murder (Abolition of Death Penalty) Bill was given a second reading in the House of Commons. On a free vote 355 members voted for the Bill and 170 against it. TIME
Doctors’ Evidence in Court Mr. C. M. WooDHOUSE asked the Minister without Portfolio whether he would seek to amend the law which prevented doctors from declining to give evidence in court on matters which they had learnt in professional consultation with their patients, to release them from jeopardy of imprisonment for contempt if they did so decline.-Sir ERIC FLETCHER replied: This is a matter which will be considered by the Law Reform Committee in the course of. its review of the law of evidence. Mr. WOODHOUSE: Has the Minister given consideration to the case of a psychiatrist who was compelled in a divorce action earlier this year to give evidence, under the threat of proceedings for contempt, on matters he had learnt from one of the parties in the case in the course of his professional duties ? Serious anxiety is felt among doctors, particular psychiatrists, about the implications of such cases for their professional relationships with their clients.-Sir ERIC FLETCHER: I am aware of that case, and of the concern felt by the medical profession on this subject. I have no doubt these matters will be considered by the Law Reform Committee. Sir KNOX CuNNINGHAM: Will the Minister consider if it is wise to increase the classes of persons who can claim the privilege of not giving evidence in any court ?-Sir ERIC FLETCHER : I am aware, and I have no doubt the Law Reform Committee are equally aware, that if the privilege in respect of confidential communications, which at present is limited to those giving legal advice, were to be extended to doctors, there would be other professions who might make similar claims, such as priests, perhaps marriage-guidance officers, and there is the case of journalists which has been considered lately. Milk and Antibiotics Mr. J. S. R. SCOTT-HoPKINS asked the Minister of Agriculture, Fisheries, and Food when he would bring in a scheme to prohibit antibiotics in liquid milk.-Mr. T. F. PEART replied: I am advised that the presence in milk of an antibiotic might be held already to be an offence under section 2 of the Food and Drugs Act, 1955. Action under this provision is for the food and drugs authorities who have been given guidance in the matter. The milk industry is developing a scheme of control by testing at the dairies. I would hope that this scheme, which I want to see introduced as soon as possible, will provide the main solution to the problem of contamination of milk by antibiotics.
Hospital Building in Scotland From April 1 to Sept. 30, 1964, hospital capital works to the value of £3,171,000 were completed in Scotland; they provided 287 beds. At the end of September, 1964, schemes estimated to cost approximately E33,147,000, and to provide 3319 beds, in progress. The schemes completed in this period included the reconstruction of Seafield Hospital, Buckie, the’completion of the general redevelopment of Strathmartine Hospital, Dundee, and the new Queen Mother’s Maternity Hospital in Glasgow. Those started during the period include the Nuffield Transplantation Surgery Unit in Edinburgh (£215,000), a new plastic surgery hospital in Glasgow (£961,000), a new teaching hospital and medical school in Dundee (over E13 million), generalpractitioner maternity units at Clydebank (£116,000) and East Kilbride (£96,000), and major improvements to Cowglen Hospital, Glasgow, for use as a geriatric unit (£300,000).
were
anything to be given by mouth before operation, in order avoid inhalation of regurgitated stomach contents (Edwards et al. 1956). But trimeprazine is now widely given to children orally as a premedication (Cope and Glover 1959), and in this trial the small amount of water given had no untoward effects during induction and
less than 500 mg. of thiopentone given, but, despite the resulting low dose of atropine, salivation was not troublesome. The patients’ mouths were usually moist-which was a help rather than a hindrance when the pharyngeal airway or laryngoscope blade was inserted. maintenance of anaesthesia. Although of secondary importance to the comfort and In the same way as administration of morphine has safety of the patient, convenience of ward routine has some become a ritual, so has the giving of 0-6 mg. of atropine bearing on any new form of medication, especially in parenterally before operation. The rationale is twofold: understaffed hospitals. At the end of the trial all ward to suppress salivary secretion during anaesthesia, and to sisters and some of the staff nurses were interviewed and obviate harmful vagal reflexes. But the administration of were asked whether promethazine made patients so 0-6 mg. of atropine to prevent autonomic reflexes is useless. drowsy that they were difficult to prepare for operation. Block of vagal nerve-endings begins only when the dose of The nursing staff were unanimous in their approval of atropine is 1 mg. and is not complete until more than 2 mg. oral premedication. Primarily it was more convenient to is given (Goodman and Gilman 1955). The use of the give tablets than to prepare and give injections, but mornconventional 0-6 mg. of atropine represents no more than ing sedation also received approval. No-one had noticed lip-service, and the routine injection of atropine before any difference in the postoperative behaviour of patients operation has, in fact, been criticised (Holt 1962). given oral and those given parenteral premedication. For Undoubtedly the principal effect of atropine premedica- patients in pain or on gastric suction parenteral pretion is suppression of salivary secretions, but with the medication may be more suitable. But this trial suggests coming of intravenous instead of inhalation inductions that for most elective operations oral premedication is this is of less importance. Intravenous atropine acts preferable. rapidly, and, even when given in the same syringe as the REFERENCES thiopentone used for induction, salivary secretion is Anœsthesia (1963) 18, 1. Beecher, H. K. (1955) J. Amer. med. Ass. 157, 242. adequately suppressed. There seems no reason, in fact, British Journal of Anœsthesia (1961) 33, 599. for atropine ever to be given parenterally in the ward as a Cope, R. W., Glover, W. J. (1959) Lancet, i, 858. Edwards, G., Morton, H. J. V., Pask, E. A., Wylie, W. D. (1956) Anœsthesia, routine premedication. 11, 194. Goodman, L. S., Gilman, A. (1955) Pharmacological Basis of Therapeutics. At first in this trial, atropine 0-6 mg. was given intraLondon. Holt, A. J. (1962) Lancet, ii, 984. venously before induction. Later, the atropine was mixed Jolly, Brit. med. J. i, 1276. C. in the same syringe with 500 mg. of 2-5% thiopentone Kerr, M. (1962) (1962) Brit. J. Anœsth. 34, 347. used for induction.
to
Conferences ACCOMMODATION FOR THE AGED A CONFERENCE on this subject was held at the Hospital Centre of King Edward’s Hospital Fund for London on Dec. 15, under the chairmanship of Mr. P. H. CONSTABLE. Dr. C. A. BOUCHER (Ministry of Health) observed that hospital accommodation for the aged was still based on the Beveridge report (1943),1 and on the pioneer efforts of Dr. Marjory Warren and Dr. L. Z. Cosin. Until recently teaching hospitals had not concerned themselves with geriatrics because of the danger of blocking their beds, but they were now appointing geriatricians to their staffs. A geriatrician’s success depended on’ his ability to admit patients quickly, and this in turn on his power to secure prompt discharge despite the reluctance of relatives and the shortage of welfare accommodation. After the critical period of three months, discharge from hospital became almost impossible. The Hospital Planrecognised geriatrics as part of general medicine and of the new district general hospital, and laid down a bed-ratio for the chronic sick of 1-4 per 1000 population. But in twenty years there would be two million more old people, increase of over a third; and there would be nearly half as more over-85s. Dr. Boucher stressed that adequate staff, including physiotherapists, were more important than more beds. He hoped for extension of day hospitals (of which there are sixty at present), the provision of psychogeriatric assessment units to prevent patients being admitted to the wrong departments, and the establishment of a chair and perhaps an institute of gerontology. Mr. B. THAXTON (architects’ department, London County Council) described his local authority’s latest homes for old an
many
1. 2.
Beveridge Report. Social Insurance and Allied Services. Cmd. 6404. H.M. Stationery Office, 1943. A Hospital Plan for England and Wales. Cmnd. 1604. H.M. Stationery Office, 1962.
In many
cases
was
people. Variants of the figure-of-eight pattern were replacing the T-shape plan in an effort to produce a more lively community, and a more complete environment. Some bizarrelooking layouts were architecturally designed to ensure interest in the immediate surroundings of the home; and one, which had been given a Civic Trust award, allowed the inmates to see right through the dining-room and courtyard. Favoured sites were near schools and busy thoroughfares for the same reason. The aim was to accommodate three-quarters of the old people in single rooms, with a maximum of 60 residents in each home. Sliding-sash windows were now being fitted since they were less draughty, especially for night ventilation, and also safer than the hinged types. Dr. G. F. ADAMS’ geriatric wing at the Belfast City Hospital was the first built in Great Britain for the combined reablement and long-term care of the elderly sick. The 42-bed wards are constructed to take 11new patients, 12 for rehabilitation and 19 for long-stay, on the principle that every ward should have its quota of chronic sick. The bed-centres are 71/2 feet apart, and there is space for exercise and physiotherapy. Dr. Adams emphasised that the wards must be made attractive to first-class nursing staff who are otherwise difficult to obtain. Miss D. NORTON (nursing research unit, Edgware General Hospital) said that patients should be able to touch the floor with their feet while seated on their beds; this would prevent accidents when getting up at night. The normal bed-tables high to eat or wash from-ideally, washing-bowls should be oval for placing between the bed-patients’ knees, but none of suitable size were to be had. Patients floated away in a large bath, and the nurse’s back was strained by bending over a low one. The number of wash-hand basins was insufficient, being based on the requirements of bedfast patients and not of the ambulant ones of today. Patients often slipped out of chairs in trying to accommodate themselves to seats which were too deep for comfort. were too
Questions elicited the facts that the old people were not consulted about the type of homes they want, and that the
45
is E1250-f,1750 per person. The panel of speakers found it difficult to answer the query: What changes in equipment would you suggest if you were given all the requisite engineering and financial help ? Help in nursing the incontinent and more toilet accommodation were suggested. Mr. W. L. GRAHAM described the Lewisham 3 survey of the elderly.3 cost
Parliament N.H.S. Charges ON Dec. 17 Mr. KENNETH ROBINSON, the Minister of
Government tried to find some suitable methods of relieving solely those who suffered from hardship from prescription charges, but were unable to do so. We prefer to take this first major step towards restoration of the free health service which the Labour Government introduced after the war.
Bill for Abolition of Death
QUESTION
.
Health,
made the
following
statement on
National Health
Service charges:
Prescription charges comprise the ordinary 2s. charge for prescriptions and charges for elastic hosiery, which are payable both by the patients of general practitioners and by hospital outpatients, together with the charges payable by hospital outpatients for certain appliances. With effect from Feb. 1 next, we propose to abolish all these charges which, since 1952, have created a financial barrier between the patient and the treatment he needs. The Secretary of State for Scotland and I are starting at once the necessary consultations with the professions on amendment of their terms of service, with a view to making regulations for this purpose when the House reassembles after the Christmas recess. Until Feb. 1, the existing charges will continue to be
payable. There will remain the charges for dental treatment and appliances and those for spectacles. It is our aim to abolish these charges also, in due course, by means of legislation which will revoke the statutory powers authorising the levy both of these charges and of prescription charges. It will not be possible to introduce such legislation during the current session. Mr. R. F. WOOD: Can the Minister give any estimate of the increase in the number of prescriptions which this will cause and, particularly, can he assure us that the doctors will be able to cope with the increased load in the middle of the winter ? Mr. ROBINSON: There will, in all probability, be some increase in the number of prescriptions, which it is impossible to quantify at the moment, but there will also, I hope, be some reduction in the amounts prescribed by doctors now that they no longer have any need to consider the ability of their patients to pay the prescription charges. I am aware that some doctors are anxious about the possibility of an increased work load. I believe that their fears in this respect are exaggerated but, in so far as they will be meeting a need that has hitherto been deterred from emerging by the charges, I am sure that they will accept this load, and welcome it. Mr. E. R. LUBBOCK : Has the Minister made any estimate of the administrative saving that will result from the abolition of prescription charges ?-Mr. ROBINSON: It is difficult to estimate the precise administrative savings, but to set against the lost gross revenue from charges there is the amount of just under E3million representing National Assistance Board refunds to patients who qualify for refund on grounds of hardship, which will no longer be payable. Lord BALNIEL: While welcoming policies designed to bring benefits to people really in need-the chronic sick or the elderly -may I ask whether the Minister is really satisfied that this step, which will bring benefits to people of whom some are not really in need, is a higher priority than spending an additional E20 million, for instance, on improving the care of the mentally handicapped, the domiciliary services, or the hospital building programme ? As Minister in charge of the National Health Service, is he really saying that this is the highest priority that he can think of ?-Mr. ROBINSON: There are, of course, a number of things we need to do and would like to do in the National Health Service which were left undone by previous Governments. I can only say that, apparently, the previous 3. Report on Services for the Elderly in Lewisham, 1964. Copies obtainable from the King Edward’s Hospital Fund for London, 34, King St., E.C.2. See Lancet, 1964, ii, 1069.
Penalty
On Dec. 21, Mr. SYDNEY SILVERMAN’S Murder (Abolition of Death Penalty) Bill was given a second reading in the House of Commons. On a free vote 355 members voted for the Bill and 170 against it. TIME
Doctors’ Evidence in Court Mr. C. M. WooDHOUSE asked the Minister without Portfolio whether he would seek to amend the law which prevented doctors from declining to give evidence in court on matters which they had learnt in professional consultation with their patients, to release them from jeopardy of imprisonment for contempt if they did so decline.-Sir ERIC FLETCHER replied: This is a matter which will be considered by the Law Reform Committee in the course of. its review of the law of evidence. Mr. WOODHOUSE: Has the Minister given consideration to the case of a psychiatrist who was compelled in a divorce action earlier this year to give evidence, under the threat of proceedings for contempt, on matters he had learnt from one of the parties in the case in the course of his professional duties ? Serious anxiety is felt among doctors, particular psychiatrists, about the implications of such cases for their professional relationships with their clients.-Sir ERIC FLETCHER: I am aware of that case, and of the concern felt by the medical profession on this subject. I have no doubt these matters will be considered by the Law Reform Committee. Sir KNOX CuNNINGHAM: Will the Minister consider if it is wise to increase the classes of persons who can claim the privilege of not giving evidence in any court ?-Sir ERIC FLETCHER : I am aware, and I have no doubt the Law Reform Committee are equally aware, that if the privilege in respect of confidential communications, which at present is limited to those giving legal advice, were to be extended to doctors, there would be other professions who might make similar claims, such as priests, perhaps marriage-guidance officers, and there is the case of journalists which has been considered lately. Milk and Antibiotics Mr. J. S. R. SCOTT-HoPKINS asked the Minister of Agriculture, Fisheries, and Food when he would bring in a scheme to prohibit antibiotics in liquid milk.-Mr. T. F. PEART replied: I am advised that the presence in milk of an antibiotic might be held already to be an offence under section 2 of the Food and Drugs Act, 1955. Action under this provision is for the food and drugs authorities who have been given guidance in the matter. The milk industry is developing a scheme of control by testing at the dairies. I would hope that this scheme, which I want to see introduced as soon as possible, will provide the main solution to the problem of contamination of milk by antibiotics.
Hospital Building in Scotland From April 1 to Sept. 30, 1964, hospital capital works to the value of £3,171,000 were completed in Scotland; they provided 287 beds. At the end of September, 1964, schemes estimated to cost approximately E33,147,000, and to provide 3319 beds, in progress. The schemes completed in this period included the reconstruction of Seafield Hospital, Buckie, the’completion of the general redevelopment of Strathmartine Hospital, Dundee, and the new Queen Mother’s Maternity Hospital in Glasgow. Those started during the period include the Nuffield Transplantation Surgery Unit in Edinburgh (£215,000), a new plastic surgery hospital in Glasgow (£961,000), a new teaching hospital and medical school in Dundee (over E13 million), generalpractitioner maternity units at Clydebank (£116,000) and East Kilbride (£96,000), and major improvements to Cowglen Hospital, Glasgow, for use as a geriatric unit (£300,000).
were