- Email: [email protected]
Comments of the society of community medicine — The future of community medicine in Scotland
Notesfrom the Societies
307
represented within the Society. The Council of the Society should determine the activities of the campaign but would consider the views of the Public Health Alliance. After discussion it was considered that to campaign needs professional skills, time and availability, which need not all be present together within the membership of the Society at a time when a campaign was at a peak. It was, however, agreed that the Society would be represented on the Public Health Alliance once it was formed and had published its aims and objectives,
(l 2) Conferences The Hen. Secretary reported briefly on the conferences planned for the next i2 months and he reminded Council that assistance would be required for registration tasks at each, and that he hoped some volunteers would be forthcoming. 2 and 3 July, Cardiff- Of interest to Community Health Doctors (Child Health). 17 and 18 September, Manchester- Sports Injuries. 29 and 30 October, Grantham - Accident Prevention. November, Manchester-Community Care of the Elderly Psychiatrically Disturbed (with Help the Aged). (13) Correspondence Details had been received of the following: Re-use of Stairlifts and Home Lifts- 18 M a y - London, Kings Fund Centre. Details from Centre on Environment for the Handicapped, 33 Great Smith Street, London SWlP 3BI. Rethinking Public Health - 14 and ! 5 July- Birmingham. Details from Health Rights, 344 South Lambeth Road, London SWS. CMO(87)3 - Radon Levels in Houses. (14) Date of next meeting 17 July 1987 at I 1.00 a.m. NB Council and AGM - Friday 2 October 1987. (15) Any other business Dr Whittles reported that Age Concern were distributing packs 'Breaking the Sound Barrier' t,o Family Practitioner Committees and General Practitioners through the Royal College of General Practitioners and he hoped that the Society would continue to have good relationships with Age Concern. There being no other business the meeting was adjourned.
Comments of the Society of Community M e d i c i n e The Future of Community Medicine in Scotland Preface
The Society of Community Medicine, founded in 1856 and previously known as the Society of Medical Officers of Health, is the professional and scientific association for doctors and
308
Notes from the Societies
dentists working in the fields.of community medicine or community health, and is grateful for the opportunity to present its view. Comments
The Society's comments in relation to the specific paragraphs of the discussion document are as follows:(7) We agree with the definition that the functions of the specialty of Community Medicine include not only the control of infectious disease, but the assessment of needs of populations for health care, the planning and evaluation of health services and responsibility for prevention and health promotion, and that the specialty is analogous to other medical specialties, (12)The main functions of Community Medicine are derived from its special responsibility for improving the health and health care of the local community. These main functions, most of which are outlined in paragraph 12 of the document, are:(a) To determine the health needs of the whole population. (b) To identify needs etc (12b) and develop the medical aspects of quality assurance (I2i), (c) To contribute to planning of appropriate health services (12d). (d) To ensure the Boards are provided with medical advice of appropriate quality and as necessary (12b). (e) To control communicable disease and environmental hazards (12a). (f) To provide medical advice and support to Local Authorities in connection with their other environmental health functions, and their social services and housing functions and to liaise with voluntary organisations. (g) To ensure adequate health and surveillance of pre-school and school age children, and to provide advice and support to Local Education Authorities. (h) To monitor and interpret trends in maternal and child health (12b). (i) To be responsible for prevention, health promotion and health education (12c). (j) To co-ordinate and evaluate programmes which involve consultants, community health staff and primary care services (120. (k) To be involved in medical manpower planning and postgraduate and undergraduate medical education (12 g), and to participate in research. Although these activities remain essential, the range, and focus, must vary depending on the post held, but identification with the responsibilities of a particular post should not inhibit a change of direction in career development and the movement in and out of management posts, or others, would be as appropriate as in other specialties. (14)In answer to the specific questions listed in this section:(a) Essential Fttnctions See (12) above. Whilst other personnel can be trained to undertake tasks within those listed, only those trained in Community Medicine can integrate all these functions and apply the knowledge to the variety of necessary tasks. (b) Relationships with Community Medicine The CAMO should be sapiential head of a Department of Community Medicine (see below). With the arrival ofmanagemcnt structures some managerial relationships between the CAMO and individual CMSs may be necessary but the latter must retain their professional and advisory independence. The CAMO must be a member of a Board's management team, and must retain right of direct access to the Board itself. (c) Departments o f Community Medicine These should include all Community
Notes from the Societies
(d)
(e)
(g)
(h)
(i)
(j)
309
Medicine Specialists with a service role, Trainees in Community Medicine and Community Health Doctors. It is essential that these Departments have adequate resources and support staff, and of suitable gtadings, under the control of the CAMO. Epidemiology attd Management There is a distinction between the two, and it is not necessary to be a Community Physician to be able to manage, but the skills of Community Physicians, which include medical epidemiology, must take them into the fields of management. All administrative and clerical staffwith a Department of Community Medicine are already managed by Community Physicians, and the CAMO will manage CMSs for any delegated duties which are not connected with CMS's particular role and in the new era of General Managers, the CAMO will be managerially responsible for ensuring the CMSs actually do their work, Advice to Local Authorities There are a decreasing number of Community Physicians with a practical knowledge. All the larger Health Boards require at least one such individual full-time - the smaller Boards should, as in England, share a Specialist. The CD(S) Unit provides useful back-up but should not take over these functions. However, it could perhaps be expanded to provide an advisory service in matters of non-infectious control (environmental, pollutants etc.). Community Physician Establishment Currently determined by the Health Board, SHHD and availability. It is appropriate for all Units to have the presence ofa CMS and for each Board to have a CAMO and more than one other Community Physician, though the numbers will be influenced by geographical, demographical and health factors, say, 1 to 50,000 population (inclusive of CAMO). The emphasis of their work should be towards health needs and health promotion, monitoring and evaluation. Training All Community Physicians should have had a general training to enable them to provide cover for absent colleagues and this training should be available within all Boards - though some may only provide training in certain aspects of the specialty, This may be carried out by a full academic year, followed by broad based training in a Board, or Boards; or by a two-year academic period with 2 - 3 days release each week to Boards. In some quarters the latter method is thought to produce the better Community Physicians. Whichever, the trainees should not be confined to one Board for their in-service work, i.e. they should be rotated between trainers (whether CAMOs or CMSs) and between Boards. There should be refresher courses available and retraining for Community Physicians and perhaps a greater input into the type ofcourse(s) to be provided from the service Community Physicians themselves. Honorary Contracts The holders of these should be encouraged to be active within a Department of Community Medicine. Whilst they may supply expertise not necessarily available within the NHS, it is necessary that they have service experience. CAMO Report(s) Annual reports should be prepared, though more concerned with health needs/trends and the "State of Health" than activity measures. The CAMO should also be able to submit other independent reports from time to time on specific topics concerning the health of the public, and this should include comment on deficiencies in health care. Given adequate support staff, this could be achieved under the present arrangements.
310
Notes from the Societies
Forthcoming Events Society of Community Medicine- Conferences
17- i 8 September 1987, Manchester - Sports Injuries. 29- 30 Oetober 1987, Grantham - Accident Prevention. November, Manchester -Community Care of the Elderly Psychiatrically Disturbed (with Help the Aged). Further details available from Dr P. Gardner, Honorary Secretary, 31 Battye Avenue, Huddersfieid, HD4 5PW. 3987 National Society of Genetic Counsellors Eduction Conference - Strategies in Genetic Counselling: Tools for Professional Advancement, San Diego, California 4 - 6 October 1987 The seventh annual NSGC education conference will he held 4 - 6 October 1987, in San Diego, California. The Conference is designed for genetic counsellors and other health professionals interested in genetic services. The programme will focus on strategies for professional advancement, including further development of effective counselling skills, expanding areas of expertise, increasing job satisfaction and enhancing the position of our profession within the health care delivery system. For information regarding submission of abstracts and registration materials, please contact Nancy Zellers, MS, 1987 Conference Chairperson, Division of Genetic Counselling, MOO 13, The New York Hospital, 525 East 68 Street, New York, New York 10021 (212 472 6825). 13th Congress of the International Society for Research on Civilisation Diseases and on Environment ( SIRMCE) , Lausanne 14-17 October 1987 This will be organised by the 'Institute of the Built Environment' (IREC) of the Federal Polytechnieal School of Lausanne. The objective of the Congress is to redeem the relations between accommodation, environment and the housing on one side, and the human health on the other side; but also to present the results of researches and to exchange the knowledge (acquaintances) among specialists of varied disciplines and to propose solutions. Further information and correspondence to: Professor J. Csillaghy, Director oflREC, I4, av. de rEglise-Anglaise, Ch-1006 Lausanne. Public Health and Epidemiology in the Soviet Union, 17-31 October 1987 The UK-USSR Medical Exchange Programme invites specialists in community medicine and epidemiology to apply to take part in a study tour in the Soviet Union from 17-31 October 1987. The tour aims to look at the organisation of primary health care, the main areas of research in epidemiology, and preventive programmes, to include public health education. The tour will begin with four days in Leningrad. The following six days will be spent in the Ukrainian city of Kharkov looking at the health services of a district and a large factory and discussing these at the institute of public health. The final three days, in Moscow, will include
Notes from the Societies
311
a conference on the reconstruction of health services and education for public health administration. There will also be a cultural programme. Further details may be obtained from: The Hon. Secretary, UK-USSR Medical Exchange Programme, 9d Stanhope Road, London N 6 5NE. The First blternational Conference on the Place of Birth This will be held at the Wembley Conference Centre, London, 24-25 October 1987. It is being organised by Janet Balaskas (Active Birth Movement), Beverley Beech (Health Rights, AIMS), Melody Weig (Independent Midwives Association) UK and Rahima Baldwin (Informed Homebirth) USA. Further details from Place of Birth Conference, 65 Mount Nod Road, London SWl6 2LP. The International Union of Alpinist Associations, Thursday 19 November and Friday 20 November 1987 Medical Commission Meeting and Mountain Medicine Conference. Location: St Bartholomew's Hospital, London. Organiser: Dr Charles Clarke, UIAA Mountain Medicine Data Centre, Department of Neurological Sciences, St Bartholomew's Hospital, 38 Little Britain, London ECI. Theme: Dilemnas and Advances in Mountain Medicine. Brain damage at high altitude does it really occur? Deaths at extreme altitude - what can we do to prevent them? Severe hypothermia - who is really dead and how should we resuscitate them? Sit harnesses and Chest harnesses-is the sit harness reaUy a lethal piece of equipment? Free communications and contributions welcome: Please send 100 word abstract. We hope that the meeting will be followed by a climbing and walking weekend in the Lake District. Preliminary notices An International Conference on the 'Global Impact of AIDS' will be held 7-10 March 1988 at the Barbican Centre, London. The Conference will be organised by the London School of Hygiene and Tropical Medicine in association with the World Health Organisation, and will be administered by Ernap Maclaren Exhibitions Ltd. For further details please contact: P. J. Blinkhorn, Conference Department, Emap Macfaren Exhibitions Ltd, PO Box 138, Token House, 79-81 High Street, Croydon, Surrey CR9 3SS. Telephone 01 686 9200.
The XIII World Conference on Health Education,28 August to 2 September 1988 This is to be held in Houston, Texas, USA. Participation for all in Health is the theme. The Conference is the triennial meeting of the International Union for Health Education, and will address important health issues and resolutions dealing with such topics as child survival, access to health, mass communications, international networking, AIDS and other topics. The Conference organisers are the International Union for Health Education, The Centers for Disease Control, The National Centre for Health Education and the United States Host Committee. For further information contact the US Host Committee (713) 7928540, or write US Host Committee, PO Box 20186, Suite 902, Houston, Texas 77225, USA.
307
represented within the Society. The Council of the Society should determine the activities of the campaign but would consider the views of the Public Health Alliance. After discussion it was considered that to campaign needs professional skills, time and availability, which need not all be present together within the membership of the Society at a time when a campaign was at a peak. It was, however, agreed that the Society would be represented on the Public Health Alliance once it was formed and had published its aims and objectives,
(l 2) Conferences The Hen. Secretary reported briefly on the conferences planned for the next i2 months and he reminded Council that assistance would be required for registration tasks at each, and that he hoped some volunteers would be forthcoming. 2 and 3 July, Cardiff- Of interest to Community Health Doctors (Child Health). 17 and 18 September, Manchester- Sports Injuries. 29 and 30 October, Grantham - Accident Prevention. November, Manchester-Community Care of the Elderly Psychiatrically Disturbed (with Help the Aged). (13) Correspondence Details had been received of the following: Re-use of Stairlifts and Home Lifts- 18 M a y - London, Kings Fund Centre. Details from Centre on Environment for the Handicapped, 33 Great Smith Street, London SWlP 3BI. Rethinking Public Health - 14 and ! 5 July- Birmingham. Details from Health Rights, 344 South Lambeth Road, London SWS. CMO(87)3 - Radon Levels in Houses. (14) Date of next meeting 17 July 1987 at I 1.00 a.m. NB Council and AGM - Friday 2 October 1987. (15) Any other business Dr Whittles reported that Age Concern were distributing packs 'Breaking the Sound Barrier' t,o Family Practitioner Committees and General Practitioners through the Royal College of General Practitioners and he hoped that the Society would continue to have good relationships with Age Concern. There being no other business the meeting was adjourned.
Comments of the Society of Community M e d i c i n e The Future of Community Medicine in Scotland Preface
The Society of Community Medicine, founded in 1856 and previously known as the Society of Medical Officers of Health, is the professional and scientific association for doctors and
308
Notes from the Societies
dentists working in the fields.of community medicine or community health, and is grateful for the opportunity to present its view. Comments
The Society's comments in relation to the specific paragraphs of the discussion document are as follows:(7) We agree with the definition that the functions of the specialty of Community Medicine include not only the control of infectious disease, but the assessment of needs of populations for health care, the planning and evaluation of health services and responsibility for prevention and health promotion, and that the specialty is analogous to other medical specialties, (12)The main functions of Community Medicine are derived from its special responsibility for improving the health and health care of the local community. These main functions, most of which are outlined in paragraph 12 of the document, are:(a) To determine the health needs of the whole population. (b) To identify needs etc (12b) and develop the medical aspects of quality assurance (I2i), (c) To contribute to planning of appropriate health services (12d). (d) To ensure the Boards are provided with medical advice of appropriate quality and as necessary (12b). (e) To control communicable disease and environmental hazards (12a). (f) To provide medical advice and support to Local Authorities in connection with their other environmental health functions, and their social services and housing functions and to liaise with voluntary organisations. (g) To ensure adequate health and surveillance of pre-school and school age children, and to provide advice and support to Local Education Authorities. (h) To monitor and interpret trends in maternal and child health (12b). (i) To be responsible for prevention, health promotion and health education (12c). (j) To co-ordinate and evaluate programmes which involve consultants, community health staff and primary care services (120. (k) To be involved in medical manpower planning and postgraduate and undergraduate medical education (12 g), and to participate in research. Although these activities remain essential, the range, and focus, must vary depending on the post held, but identification with the responsibilities of a particular post should not inhibit a change of direction in career development and the movement in and out of management posts, or others, would be as appropriate as in other specialties. (14)In answer to the specific questions listed in this section:(a) Essential Fttnctions See (12) above. Whilst other personnel can be trained to undertake tasks within those listed, only those trained in Community Medicine can integrate all these functions and apply the knowledge to the variety of necessary tasks. (b) Relationships with Community Medicine The CAMO should be sapiential head of a Department of Community Medicine (see below). With the arrival ofmanagemcnt structures some managerial relationships between the CAMO and individual CMSs may be necessary but the latter must retain their professional and advisory independence. The CAMO must be a member of a Board's management team, and must retain right of direct access to the Board itself. (c) Departments o f Community Medicine These should include all Community
Notes from the Societies
(d)
(e)
(g)
(h)
(i)
(j)
309
Medicine Specialists with a service role, Trainees in Community Medicine and Community Health Doctors. It is essential that these Departments have adequate resources and support staff, and of suitable gtadings, under the control of the CAMO. Epidemiology attd Management There is a distinction between the two, and it is not necessary to be a Community Physician to be able to manage, but the skills of Community Physicians, which include medical epidemiology, must take them into the fields of management. All administrative and clerical staffwith a Department of Community Medicine are already managed by Community Physicians, and the CAMO will manage CMSs for any delegated duties which are not connected with CMS's particular role and in the new era of General Managers, the CAMO will be managerially responsible for ensuring the CMSs actually do their work, Advice to Local Authorities There are a decreasing number of Community Physicians with a practical knowledge. All the larger Health Boards require at least one such individual full-time - the smaller Boards should, as in England, share a Specialist. The CD(S) Unit provides useful back-up but should not take over these functions. However, it could perhaps be expanded to provide an advisory service in matters of non-infectious control (environmental, pollutants etc.). Community Physician Establishment Currently determined by the Health Board, SHHD and availability. It is appropriate for all Units to have the presence ofa CMS and for each Board to have a CAMO and more than one other Community Physician, though the numbers will be influenced by geographical, demographical and health factors, say, 1 to 50,000 population (inclusive of CAMO). The emphasis of their work should be towards health needs and health promotion, monitoring and evaluation. Training All Community Physicians should have had a general training to enable them to provide cover for absent colleagues and this training should be available within all Boards - though some may only provide training in certain aspects of the specialty, This may be carried out by a full academic year, followed by broad based training in a Board, or Boards; or by a two-year academic period with 2 - 3 days release each week to Boards. In some quarters the latter method is thought to produce the better Community Physicians. Whichever, the trainees should not be confined to one Board for their in-service work, i.e. they should be rotated between trainers (whether CAMOs or CMSs) and between Boards. There should be refresher courses available and retraining for Community Physicians and perhaps a greater input into the type ofcourse(s) to be provided from the service Community Physicians themselves. Honorary Contracts The holders of these should be encouraged to be active within a Department of Community Medicine. Whilst they may supply expertise not necessarily available within the NHS, it is necessary that they have service experience. CAMO Report(s) Annual reports should be prepared, though more concerned with health needs/trends and the "State of Health" than activity measures. The CAMO should also be able to submit other independent reports from time to time on specific topics concerning the health of the public, and this should include comment on deficiencies in health care. Given adequate support staff, this could be achieved under the present arrangements.
310
Notes from the Societies
Forthcoming Events Society of Community Medicine- Conferences
17- i 8 September 1987, Manchester - Sports Injuries. 29- 30 Oetober 1987, Grantham - Accident Prevention. November, Manchester -Community Care of the Elderly Psychiatrically Disturbed (with Help the Aged). Further details available from Dr P. Gardner, Honorary Secretary, 31 Battye Avenue, Huddersfieid, HD4 5PW. 3987 National Society of Genetic Counsellors Eduction Conference - Strategies in Genetic Counselling: Tools for Professional Advancement, San Diego, California 4 - 6 October 1987 The seventh annual NSGC education conference will he held 4 - 6 October 1987, in San Diego, California. The Conference is designed for genetic counsellors and other health professionals interested in genetic services. The programme will focus on strategies for professional advancement, including further development of effective counselling skills, expanding areas of expertise, increasing job satisfaction and enhancing the position of our profession within the health care delivery system. For information regarding submission of abstracts and registration materials, please contact Nancy Zellers, MS, 1987 Conference Chairperson, Division of Genetic Counselling, MOO 13, The New York Hospital, 525 East 68 Street, New York, New York 10021 (212 472 6825). 13th Congress of the International Society for Research on Civilisation Diseases and on Environment ( SIRMCE) , Lausanne 14-17 October 1987 This will be organised by the 'Institute of the Built Environment' (IREC) of the Federal Polytechnieal School of Lausanne. The objective of the Congress is to redeem the relations between accommodation, environment and the housing on one side, and the human health on the other side; but also to present the results of researches and to exchange the knowledge (acquaintances) among specialists of varied disciplines and to propose solutions. Further information and correspondence to: Professor J. Csillaghy, Director oflREC, I4, av. de rEglise-Anglaise, Ch-1006 Lausanne. Public Health and Epidemiology in the Soviet Union, 17-31 October 1987 The UK-USSR Medical Exchange Programme invites specialists in community medicine and epidemiology to apply to take part in a study tour in the Soviet Union from 17-31 October 1987. The tour aims to look at the organisation of primary health care, the main areas of research in epidemiology, and preventive programmes, to include public health education. The tour will begin with four days in Leningrad. The following six days will be spent in the Ukrainian city of Kharkov looking at the health services of a district and a large factory and discussing these at the institute of public health. The final three days, in Moscow, will include
Notes from the Societies
311
a conference on the reconstruction of health services and education for public health administration. There will also be a cultural programme. Further details may be obtained from: The Hon. Secretary, UK-USSR Medical Exchange Programme, 9d Stanhope Road, London N 6 5NE. The First blternational Conference on the Place of Birth This will be held at the Wembley Conference Centre, London, 24-25 October 1987. It is being organised by Janet Balaskas (Active Birth Movement), Beverley Beech (Health Rights, AIMS), Melody Weig (Independent Midwives Association) UK and Rahima Baldwin (Informed Homebirth) USA. Further details from Place of Birth Conference, 65 Mount Nod Road, London SWl6 2LP. The International Union of Alpinist Associations, Thursday 19 November and Friday 20 November 1987 Medical Commission Meeting and Mountain Medicine Conference. Location: St Bartholomew's Hospital, London. Organiser: Dr Charles Clarke, UIAA Mountain Medicine Data Centre, Department of Neurological Sciences, St Bartholomew's Hospital, 38 Little Britain, London ECI. Theme: Dilemnas and Advances in Mountain Medicine. Brain damage at high altitude does it really occur? Deaths at extreme altitude - what can we do to prevent them? Severe hypothermia - who is really dead and how should we resuscitate them? Sit harnesses and Chest harnesses-is the sit harness reaUy a lethal piece of equipment? Free communications and contributions welcome: Please send 100 word abstract. We hope that the meeting will be followed by a climbing and walking weekend in the Lake District. Preliminary notices An International Conference on the 'Global Impact of AIDS' will be held 7-10 March 1988 at the Barbican Centre, London. The Conference will be organised by the London School of Hygiene and Tropical Medicine in association with the World Health Organisation, and will be administered by Ernap Maclaren Exhibitions Ltd. For further details please contact: P. J. Blinkhorn, Conference Department, Emap Macfaren Exhibitions Ltd, PO Box 138, Token House, 79-81 High Street, Croydon, Surrey CR9 3SS. Telephone 01 686 9200.
The XIII World Conference on Health Education,28 August to 2 September 1988 This is to be held in Houston, Texas, USA. Participation for all in Health is the theme. The Conference is the triennial meeting of the International Union for Health Education, and will address important health issues and resolutions dealing with such topics as child survival, access to health, mass communications, international networking, AIDS and other topics. The Conference organisers are the International Union for Health Education, The Centers for Disease Control, The National Centre for Health Education and the United States Host Committee. For further information contact the US Host Committee (713) 7928540, or write US Host Committee, PO Box 20186, Suite 902, Houston, Texas 77225, USA.