- Email: [email protected]
CARE OF MOTHERS AND BABIES
539 done
as
to
persuade those
in
control to
apply
the
results. Mr. A. E. BENDER, PH.D., referred to the pessimists v. ttptimists approach to the problem : Castro said that <-unng 300 million sufferers from malaria would provide that many pairs of hands for food production, whereas Vogt said that curing the sufferers would mean 300 million more mouths to feed. He suggested that progress ill Israel was largely due to the early application of eientific findings, fostered by close association between the government and the research centres, and willingness to
make
use
of
new
methods.
DISTRIBUTION OF MEDICAL MAN-POWER THE fourth report of the Medical Practices Committee for England and Wales deals with the 18 months up to Dec. 31, 1952. For the first time the committee has published as an appendix to the report an analytical survey illustrating the movement of medical man-power throughout the country since July, 1948. The uncertainty of the post-war years contributed much to the flow of doctors on and off the medical lists during the first months of the National Health Service ; and this influence is still apparent today. But it was clear that the introduction of the Working Party’s plan for ,allocating the Danckwerts award would have rapid effects on the distribution of medical man-power, and the committee knew that the survey would have to be completed before these effects had developed if it was to give a proper indication of the results of the National Health Service Act and its amendments as originally planned. Between July, 1948, and July, 1952, the number of principals on medical lists in England and Wales increased from 16,864 to 17,383. The average number of patients per principal was 2461 in 1948 and 2430 in 1952. The main change, however, has been the levelling-up of average lists in different parts of the country. In 1948 variations were wide : for example, in one part of Wales the average list per principal was 1120, and in another over 8000 ; but in 1952 the corresponding figures for the In general, where same areas were 1320 and 2832. average lists have been high they are coming downin other words, additional principals are working where their services are most needed. Turning to the low-list areas, the committee finds that there has been a con"iderable decrease in the number of principals in practice ; in 1948 the total in these areas was about one-third greater than it was in 1952. The report continues : " It appears doubtful... whether the number of doctors in these areas will or should be much further reduced. A number of these practitioners have held during their more active years busy practices in other areas and have preferred to take smaller practices later in life rather than carry on work that had become too heavy for them or to retire completely. It is right that they should still be permitted to do this. Since 1948 some Executive Councils and Local Medical Committees have, not unnaturally, been reluctant to allow this position to continue and have dispersed practices which such doctors might have taken. Now that ’here is no longer a question in this type of vacancy of the practitioner being entitled to claim a fixed annual payment at the expense of the other doctors practising locally, it is probable that the attitude of the local bodies will be more tolerant towards the doctor seeking a semi-retired vacancy in their area."
practising
Following the Danckwerts award and the Working Party’s report, the committee’s proposals for classifying the country into three main categories instead of four were accepted by the Ministry of Health and by the General Medical Services Committee. The new classification was published last October, and the latest amendment.- are issued as an appendix to the fourth report.
area with an average list of patients of between 1500 and 2500 for each effective unit of medical manpower is classified as "doubtful" or "intermediate." With an average above the upper limit the area would be " designated " and below the lower limit it would be " restricted." Of the position in " designated " areas, the committee says : It appears probable ... that, while there will be a number of new practices started in ’designated’ areas, particularly
Any
"
in those where building projects begun or planned involve an influx of population, the majority of additional new principals will enter general practice as partners to established practitioners. Already there is evidence to support this view as the rate of admission of new partners to the list since July has increased considerably and appears likely to continue to do so during the next few months. The stimulus of the Danckwerts Award and the Working Party’s plan should lead to an improved service where it is most needed. Our experience so far suggests that it will do so speedily."
CARE OF MOTHERS AND BABIES THE Ministry of Health has called on hospital authorities, local health authorities, and general practitioners to cooperate in order to ensure continuity in the care of mothers and babies (B.H.B.[53]19). The following steps are suggested : (1) the hospital authority should inform the family doctor and the medical officer of health of all imperiding discharges of maternity patients ; (2) mother and child should be visited by the appropriate officer of the local health authority as soon as possible after discharge ; (3) the hospital staff should supply the family doctor and, where appropriate, the M.o.H., with information regarding any matters that seem to need special attention ; and (4) the hospital authority should consult with the family doctor or the M.o.H., whichever is appropriate, where there is any doubt, having regard to the home circumstances, about the advisability of discharge. Hospital authorities are asked to ensure that in maternity cases the patient is retained in hospital until she is ready to resume home life (here the home circumstances should be taken into account) ; and she should not be discharged, except in very special circumstances, before the tenth day.
VISITS TO CHILDREN IN HOSPITAL THE Ministry of Health has urged all hospital authorities to allow daily visiting of children by their parents, with adequate safeguards against the introduction and spread of infection (R.H.B.18). In 1949 hospital authorities were asked to arrange for parents or guardians to visit children in hospital, under adequate safeguards, with reasonable frequency and, if necessary, by appointment. An inquiry by the Ministry last year showed that of the 1300 hospitals which admit children only 300 were at that time allowing daily visiting. The majority of the remainder allowed visiting more than once a week, but there were still about 150 (only half of which were fever hospitals) which prohibited visiting of children altogether. ,.
Recent communications to medical journals have sugthe danger of visiting has been over-emphasised in the past and that there are important advantages to the child in maintaining contact with its home. At the Minister’s request the subject has therefore been re-examined by the Central Health Services Council and it is in accordance with their advice that the Minister now urges all hospital authorities to allow daily visiting of children by their parents, with adequate safeguards against the introduction or spread of infection. The Minister is advised that the advantages to the child in maintaining real contact with its parents outweigh any of the objections which have been advanced against daily visiting and he hopes, therefore, that all hospital authorities will accept and put into practice the advice given by the Central Health Services Council."
gested that
as
to
persuade those
in
control to
apply
the
results. Mr. A. E. BENDER, PH.D., referred to the pessimists v. ttptimists approach to the problem : Castro said that <-unng 300 million sufferers from malaria would provide that many pairs of hands for food production, whereas Vogt said that curing the sufferers would mean 300 million more mouths to feed. He suggested that progress ill Israel was largely due to the early application of eientific findings, fostered by close association between the government and the research centres, and willingness to
make
use
of
new
methods.
DISTRIBUTION OF MEDICAL MAN-POWER THE fourth report of the Medical Practices Committee for England and Wales deals with the 18 months up to Dec. 31, 1952. For the first time the committee has published as an appendix to the report an analytical survey illustrating the movement of medical man-power throughout the country since July, 1948. The uncertainty of the post-war years contributed much to the flow of doctors on and off the medical lists during the first months of the National Health Service ; and this influence is still apparent today. But it was clear that the introduction of the Working Party’s plan for ,allocating the Danckwerts award would have rapid effects on the distribution of medical man-power, and the committee knew that the survey would have to be completed before these effects had developed if it was to give a proper indication of the results of the National Health Service Act and its amendments as originally planned. Between July, 1948, and July, 1952, the number of principals on medical lists in England and Wales increased from 16,864 to 17,383. The average number of patients per principal was 2461 in 1948 and 2430 in 1952. The main change, however, has been the levelling-up of average lists in different parts of the country. In 1948 variations were wide : for example, in one part of Wales the average list per principal was 1120, and in another over 8000 ; but in 1952 the corresponding figures for the In general, where same areas were 1320 and 2832. average lists have been high they are coming downin other words, additional principals are working where their services are most needed. Turning to the low-list areas, the committee finds that there has been a con"iderable decrease in the number of principals in practice ; in 1948 the total in these areas was about one-third greater than it was in 1952. The report continues : " It appears doubtful... whether the number of doctors in these areas will or should be much further reduced. A number of these practitioners have held during their more active years busy practices in other areas and have preferred to take smaller practices later in life rather than carry on work that had become too heavy for them or to retire completely. It is right that they should still be permitted to do this. Since 1948 some Executive Councils and Local Medical Committees have, not unnaturally, been reluctant to allow this position to continue and have dispersed practices which such doctors might have taken. Now that ’here is no longer a question in this type of vacancy of the practitioner being entitled to claim a fixed annual payment at the expense of the other doctors practising locally, it is probable that the attitude of the local bodies will be more tolerant towards the doctor seeking a semi-retired vacancy in their area."
practising
Following the Danckwerts award and the Working Party’s report, the committee’s proposals for classifying the country into three main categories instead of four were accepted by the Ministry of Health and by the General Medical Services Committee. The new classification was published last October, and the latest amendment.- are issued as an appendix to the fourth report.
area with an average list of patients of between 1500 and 2500 for each effective unit of medical manpower is classified as "doubtful" or "intermediate." With an average above the upper limit the area would be " designated " and below the lower limit it would be " restricted." Of the position in " designated " areas, the committee says : It appears probable ... that, while there will be a number of new practices started in ’designated’ areas, particularly
Any
"
in those where building projects begun or planned involve an influx of population, the majority of additional new principals will enter general practice as partners to established practitioners. Already there is evidence to support this view as the rate of admission of new partners to the list since July has increased considerably and appears likely to continue to do so during the next few months. The stimulus of the Danckwerts Award and the Working Party’s plan should lead to an improved service where it is most needed. Our experience so far suggests that it will do so speedily."
CARE OF MOTHERS AND BABIES THE Ministry of Health has called on hospital authorities, local health authorities, and general practitioners to cooperate in order to ensure continuity in the care of mothers and babies (B.H.B.[53]19). The following steps are suggested : (1) the hospital authority should inform the family doctor and the medical officer of health of all imperiding discharges of maternity patients ; (2) mother and child should be visited by the appropriate officer of the local health authority as soon as possible after discharge ; (3) the hospital staff should supply the family doctor and, where appropriate, the M.o.H., with information regarding any matters that seem to need special attention ; and (4) the hospital authority should consult with the family doctor or the M.o.H., whichever is appropriate, where there is any doubt, having regard to the home circumstances, about the advisability of discharge. Hospital authorities are asked to ensure that in maternity cases the patient is retained in hospital until she is ready to resume home life (here the home circumstances should be taken into account) ; and she should not be discharged, except in very special circumstances, before the tenth day.
VISITS TO CHILDREN IN HOSPITAL THE Ministry of Health has urged all hospital authorities to allow daily visiting of children by their parents, with adequate safeguards against the introduction and spread of infection (R.H.B.18). In 1949 hospital authorities were asked to arrange for parents or guardians to visit children in hospital, under adequate safeguards, with reasonable frequency and, if necessary, by appointment. An inquiry by the Ministry last year showed that of the 1300 hospitals which admit children only 300 were at that time allowing daily visiting. The majority of the remainder allowed visiting more than once a week, but there were still about 150 (only half of which were fever hospitals) which prohibited visiting of children altogether. ,.
Recent communications to medical journals have sugthe danger of visiting has been over-emphasised in the past and that there are important advantages to the child in maintaining contact with its home. At the Minister’s request the subject has therefore been re-examined by the Central Health Services Council and it is in accordance with their advice that the Minister now urges all hospital authorities to allow daily visiting of children by their parents, with adequate safeguards against the introduction or spread of infection. The Minister is advised that the advantages to the child in maintaining real contact with its parents outweigh any of the objections which have been advanced against daily visiting and he hopes, therefore, that all hospital authorities will accept and put into practice the advice given by the Central Health Services Council."
gested that