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Medical auxiliaries in the national health service
~74
PUBLIC H E A L T H , June, 1951
w o u l d be of value to t h e A u t h o r i t y in t h e discharge of its duties, t h a t his attendance at t h e course w o u l d provide an adequate r e t u r n for t h e e x p e n d i t u r e involved, a n d that t h e Local H e a l t h A u t h o r i t y ' s decision to s e n d h i m could t h e r e b y be justified at audit, it does n o t a p p e a r to t h e M i n i s t e r t h a t a n y action on his part is r e q u i r e d to t h e paym e n t of t h e officer's reasonable expenses. I am, Sir, Y o u r obedient servant, S. F. KERSEY. T h e C h i e f Medical Officer, M i n i s t r y of H e a l t h , considers t h a t a t t e n d a n c e at this m e e t i n g will b e of interest to Medical Officers w h o m a y be a p p o i n t e d b y their authorities to attend. Applications s h o u l d be sent as quickly as possible to Dr. S t e p h e n Hall, 16, G r o s v e n o r Place, L o n d o n , S.W.I° Copies of t h e p r o g r a m m e a n d application f o r m can be obtained f r o m t h e E x e c u t i v e Secretary of the Society.
SALARY AWARDS Assimilation of Oflleers Commencing Duty Between October 1st, 1 9 5 0 , and March 31st, 1 9 5 1 C o m m i t t e e "C "' of t h e Medical W h i t l e y Council h a v e sent to all local authorities M.D.C. Circular No. 4 dated M a y 28th, in w h i c h they state t h a t t h e y have h a d u n d e r consideration the question of t h e application of t h e new (Award) salary scales in t h e case of Medical Officers who c o m m e n c e d d u t y in a first or new a p p o i n t m e n t on or after October 1st, 1950, a n d have r e a c h e d a g r e e m e n t on the following a r r a n g e m e n t s w h i c h they r e c o m m e n d all local authorities to p u t into e f f e c t : - 1. Officers who c o m m e n c e d d u t y after September 30th, 1950, b u t before t h e date of the first award of t h e Industrial Court (December 8th, 1950) should have t h e new salary scales applied to t h e m in the s a m e way as to officers in post on September 30th, I950, i.e., as laid down in Section III of A p p e n d i x B to M.D.C. Circular No. 2. 2. Officers who c o m m e n c e d d u t y on or after D e c e m b e r 8th. 1950, b u t before April 1st, 1951, s h o u l d be dealt with as follows : - (a) For the period f r o m the date of t a k i n g up d u t y to M a r c h 31st, 1951, t h e y s h o u l d receive t h e salary at which t h e y were appointed. (b) F r o m April 1st, 1951, onwards t h e y s h o u l d receive in full t h e new salary payable u n d e r the award. (c) Increments should be paid as laid down in Clause (iii) of Section III of A p p e n d i x B to M.D.C. Circular No. 2. 3. Officers ~5ommencing d u t y on or after April Ist, 1951, s h o u l d b e paid t h e new (Award) salary in full f r o m t h e date o f t a k i n g up d u t y . 4. W h e r e a r r a n g e m e n t s more favourable to t h e officer t h a n (1) a n d (2) above have already been adopted by the a u t h o r i t y those a r r a n g e m e n t s s h o u l d r e m a i n in force.
NATIONAL
MORBIDITY INQUIRY
M i n i s t r y of H e a l t h Circular R H B (51) 45: BG (51) 43 of M a y 3rd, 1951, p a r a g r a p h 8 of R H B (48) 70: BG (48) 59, w h i c h indicated t h a t t h e transcription f o r m s u m m a r i s i n g patients' records would u l t i m a t e l y be used to collect, centrally a n d regularly, t h e m i n i m a l statistical data required, either in respect of a representative sample of in-patients in all hospitals or hi respect of aI1 patients in a representative s a m p l e of hospitals. T h e M i n i s t r y states t h a t it is already clear f r o m t h e trial referred to in p a r a g r a p h 5 of t h e earlier m e m o r a n d u m t h a t this inquiry, if continued a n d extended to cover t h e hospital service as a whole, will produce results of considerable value for t h e compilation of national m o r b i d i t y statistics, t h e development of research a n d t h e general p l a n n i n g of t h e N a t i o n a l H e a l t h Service; a n d t h a t it is equally clear t h a t transcription f o r m s rel a t i n g to all patients in all hospitals would provide a m a s s of m a t e r i a l greater t h a n would be necessary to give results of statistical validity or could in practice be h a n d l e d by t h e General Register Office. T h e Minister is therefore considering t h e introduction of a s y s t e m of s a m p l i n g . T h e m e t h o d of s a m p l i n g is at present u n d e r discussion with the General Register Office a n d will p r o b a b l y require t h a t all or nearly all hospitals provide transcription f o r m s relating, to a proportion of their patients. Experience of the transcription f o r m now in use h a s s h o w n t h a t it would be of greater value if revised in certain respects. Hospitals who have been u s i n g t h e form wilt be aware of diffieuIties n o t at present known to t h e General Register Office or t h e Ministry. T h e former therefore proposes very shortly to send
to t h e hospitals who have been u s i n g t h e form a questionnaire from which it will be possible to devise f u r t h e r i m p r o v e m e n t s and, it is hoped, e l i m i n a t e difficulties. T h e Minister hopes t h a t it m a y be possible to b r i n g a revised form into use at t h e b e g i n n i n g of 1952 a n d t h a t at t h a t time all hospitals will be able to u n d e r t a k e tile preparation of the form in respect of a sample of their patients. A f u r t h e r m e m o r a n d u m on this will be issued in clue course. Meanwhile, hospitals who are already co-operating ill t h e trial by u s i n g Ihe existing form are asked to continue to do so on the present basis.
M E D I C A L A U X I L I A R I E S IN T H E NATIONAL HEALTH SERVICE T h e Reports of t h e Cope Committees on Medical Auxiliaries, p u b l i s h e d on April t3th as a W h i t e Paper,* r e c o m m e n d the setting u p of national registers. E i g h t c o m m i t t e e s were set up by tile Minister of H e a l t h a n d t h e Secretary of State far Scotland to consider the supply and d e m a n d , t r a i n i n g a n d qualifications of medical auxiliaries in the N a t i o n a l H e a l t h Service, viz., a h n n n e r s , chiropod'ists, dietitians, medical laboratory technicians, occupational therapists, p h y s i o t h e r a p i s t s ( i n c l u d i n g remedial g y m n a s t s ) , r a d i o g r a p h e r s a n d speech therapists. T h e committees sat u n d e r t h e same c h a i r m a n , Mr. V. Z a c h a r y Cope, v.a.c.s., a n d h a d two c o m m o n m e m b e r s , one medical a n d one lay, a n d a c o m m o n secretary. T h e reports of the commiztees are p u b l i s h e d together. In addition, there is a report on c o m m o n m a t t e r s presented by the c h a i r m a n a n d c o m n m n m e m b e r s , in c o n j u n c t i o n with which e a c h of the individual reporzs m u s t be read. Supply and Dernand.--On questions of supply a n d d e m a n d the c o m m i t t e e s were u n a n i m o u s . A distinction was d r a w n ill dealing with t h e d e m a n d between " need," t h a t is, t h e o p t i m n m r e q u i r e m e n t in a fully developed h e a l t h service, a n d " d e m a n d , " t h a t is, t h e n u m b e r of posts expected to exist within a reasonably short time. T h e c o m m i t t e e s consid'ered t h a t the s u p p l y in practically every case would be insufficient to meet t h e need, lint because tin'racial, economic a n d other considerations would have considerable effect, would fairly well meet the d e m a n d , except for a l m o n e r s a n d dietitians. T h e c o m m i t t e e s were u n a n i m o u s t h a t no one should be adm i t t e d to posts in the N a t i o n a l H e a l t h Service who was not suitably tr:;ined. T h e y agreed t h a t the proper test of t r a i n i n g was t h e h o l d i n g of a qualification, a n d they e x a m i n e d t h o r o u g h l y most of the oualifieations at nresent in existence, a n d comm e n d e d to the" Ministers those w h i c h t h e y t h o n g h t suitable for persons employed in the National H e a l t h Service. Registration.--The c o m m i t t e e s were u n a n i m o u s also in their r e c o m m e n d a t i o n t h a t all persons qualified for e m p l o y m e n t in the N.H.S. should be eligible for registration a n d t h a t no one s h o u l d be appointed to a post in the Service who was not on the national register. It would be unwise to limit t h e national register to persons w h o were in fact seeking e m p l o y m e n t in the Service, because of t h e risk t h a t there m i g h t be two standards, one for private practice a n d one for t h e N.H.S. T h e r e was a difference of opinion over t h e m e t h o d of regis tration. T h e report of t h e c o m m o n m e m b e r s is for t h e m o s t part concerned with it. T w o of t h e three m i n o r i t y reports were concerned with it. T h e c o m m o n m e m b e r s considered t h a t registration s h o u l d be the d u t y of a new body, a central council for medical auxiliaries set u p b y s t a t u t e and generally u n d e r the aegis of t h e Privy Council, to consist of medical practitioners. medical auxiliaries a n d l a y m e n , the first slightly in the m a j o r i t y . It would set u p professional c o m m i t t e e s to deal with m a t t e r s peculiar to each profession. On these the medical auxiliaries wmfld be in the majority. T w o m i n o r i t y reports offered alternative solntions to t h e problem of registration. T h e physiotherapists a n d remedial g y m n a s t serving on t h e c m n m i t t e e on p h y s i o t h e r a p i s t s suggested that there should be one b o d y to deal solely with oecuvational therapists, p h y s i o t h e r a p i s t s anti remedial g y m n a s t s , the " r e h a b ilitation " ~roilp. A council shou!d be set up to deal with this group. T h e other, presented by the almoners, occupational therapists a n d s p e e c h - t h e r a p i s t s serving on the respective committees, while agreeing t h a t there s h o u l d be m a e b i n e r y to deal with all t h e orofesslons, r e c o m m e n d e d t h a t t h e c o m m i t t e e s for the individua-I professions s h o u l d be the p r e d o m i n a n t partners and~ t h a t there shoutd be a small co-ordinating body. Both t h e majorizv a n d t h e m i n o r i t y reports conclude t h a t whatever b o d y is set ut~ to oversee registration it n m s t , as part of its duties, ensure that t r a i n i n g given in various institutions i~ * Reports of the C o m m i t t e e s on Medical Auxiliaries, Cmd. 8188, H.M. Stationery ()ffice, 5s. net.
175
PUBLIC H E A L T H , June, 1951 suitable for t h e N a t i o n a l H e a l t h Service, a n d as a result the council m u s t h a v e certain supervisory or inspecting functions. Provision is m a d e $o e n s u r e t h a t persons already e m p l o y e d in t h e N.H.S. who do not possess t h e qualifications w h i c h m a y later become a s t a t u t o r y r e q u i r e m e n t s h o u l d not thereby be penalised. T h e m a j o r i t y report also considered that, a p a r t from the medical laboratory technicians, students s h o u l d be responsible for p a y i n g their own fees a n d should look to t h e education authorities, r a t h e r t h a n to t h e M i n i s t e r of H e a l t h , for financial assistance. T h e M i n i s t e r s h o u l d h a v e the same responsibility in t h e t r a i n i n g of medical anxiliaries as in t h e t r a i n i n g of medical students, t h a t is to say, t h e provision of clinical facilities. Points from the individual c o m m i t t e e reports include:
Almoners T h e evidence sugges ed t h a t the hospital service in E n g l a n d a n d W a l e s alone probably needed between 2,500 a n d 3,000 almoners to provide a full service a n d in Scotland a b o u t 500. T h e prohable d e m a n d over t h e next five years was likely to he m o r e limited, b u t was e s t i m a t e d to be at least 150 a h n o n e r s each ",Tar (para 1211. T h e n m n h e r s of students in t r a i n i n g "'are hardly e n o u g h to m a k e good the wastage a n d it is evident that unless r e c r u i t m e n t is considerahlv increased it will be impossible to meet even existing demand's o( the H e a l t h S e r v ~ f'' (para 1251. Publicity in schools a n d filiancial assistance to%'students were r e c o m m e n d e d as aids to r e c r u i t m e n t . T h e r e were too few social science s t u d e n t s in the universities to meet t h e requirem e n t s of all t h e professions for which this t r a i n i n g is t h e basis. T h e t r a i n i n g a n d qualifications given b y t h e Institute of A l m o n e r s were suitable for a h n o n e r s in the N.H.S.
Chiropodists T h e c o m m i t t e e noted t h a t only 7~% of t h e hospitals h a d so far appointed chiropodists (para 173). As soon as possible there should be chiropodists at every general hospital a n d in certain special hospitals a n d clinics, a n d ' local authorities s h o u l d he enabled to provide chiropodg in the N.H.S. (para 219). T h e t r a i n i n g a n d qualifications of t h e Society of Chiropodist's were suitable for chiropodists in t h e N.H.S. Part-time t r a i n i n g could not eoual full-time t r a i n i n g in value.
Dietitians In December, 1949, only 139 dietitians h a d been appointed a m o n g 2,600 hospitals and convalescent honles in the National Health Service in E n g l a n d a n d Wales. E a c h hospital group will need at least one more (para 239). M e m b e r s of t h e British Die:etic Association were fitted fur e m p l o y m e n t in t h e National H e a l t h Service.
Occupational Therapists A b o u t 3,000 occupational therapists were needed' for the N.H.S. T h e n u m b e r actually e m p l o y e d was 980. Financial restrictions, etc., were likely to prevent the d e m a n d from rising to a n y e x t e n t for some time (paras 347-8 a n d 355). Occupational therapists h o l d i n g the diploma of the Association of Occupational T h e r a p i s t s or t h a t approved by the Scottish Association of Occupational T h e r a p i s t s were fitted for employm e a t in t h e N.H.S.
Physiotherapists A year ago j u s t over 4,000 p h y s i o t h e r a p i s t s were working wholeor part-time in t h e N.H.S. in t h e U n i t e d K i n g d o m , a n d some 1,500 m o r e would be required. T h e present o u t p u t was over 500 a year a n d it s h o u l d be possible to m a i n t a i n the present n u m b e r s a n d g r a d u a l l y b u i l d rip to t h e full d e m a n d . Supply a n d d e m a n d was fairly evenly balanced (paras 420 a n d 432). P h y s i o t h e r a p i s t s at present registered with t h e Chartered Society of P h y s i o t h e r a p i s t s a n d t h e F a c u l t y of P h y s i o t h e r a p i s t s were suitable for e m p l o y m e n t in the N.H.S. T h e general direction of studies in each school should be in t h e h a n d s of a medical practitioner, preferably a specialist in physical medicine, a n d t h a t facilities for t h e t r a i n i n g of m e n should be increased. Parttime t r a i n i n g t h a t was wholly in the h a n d s of n o n - m e d i c a l teachers a n d did not include a n y considerable anaount of varied clinical experience was not adequate.
Speech Therapists T h e r e were nearly 300 sT)eech ti~erapists prac'Asing in t h e United K i n g d o m a n d a total of :it least 750 were needed b o t h inside a n d outside the N.H.S. Local E d u c a t i o n A u t h o r i t i e s a n d hospitals s h o u l d work closely together so as to use t h e services of speech therapists as economically as possible. Speech therapists h o l d i n g t h e Diigloma of t h e College of Speech T h e r a p i s t s were suitable for e m p l o y m e n t in the N.H.S.
JOINT TUBERCULOSIS COUNCIL A m e e t i n g o[ t h e Joint Tuberculosis Council was held on F e b r u a r y 17th, 1951, u n d e r the c h a i r m a n s h i p of Dr. Peter W. Edwards, who opened the proceedings by p a y i n g tribute to the m e m o r y of t h e late Dr. A. P. Ford, who h a d died s u d d e n l y since the last meeting, a n d who h a d been a representative of the British M e d i c a l Association on t h e Council since 1942, and H o n o r a r y T r e a s u r e r of the Council since 1944. T h e following Officers were elected for the year 1951-52:-Chairman.--Dr. Peter W. Edwards. Vice-Chairmen.---Dr. N. Tattersall, Prof. F. R. G. Heal. Hon. Treasurer.~Dr. N. J. E n g l a n d . Hon. Secretary.--Dr. R. L. Midgley. It was reported t h a t specimen copies of the f o r m s o[ record for chest clinics w h i c h h a d been approved h y t h e Council h a d been sent to the appropriate Ministries, Senior A d m i n i s t r a t i v e Medical Officers of Regional Hospital Boards, British T u b e r c u losis Association, Scottish Tuberculosis Society, a n d others. T h e COuncil is s y m p a t h e t i c towards t h e British Students' H e a l t h C o m m i t t e e ' s efforts to set up at post-cure e s t a b l i s h m e n t where tuherculous students can conlinue their studies whilst u m l e r g o i n g rehabilitation, l)r. R. R. Trail a n d Mr. E. S. Evans were appointed as representatives of t h e Council on the Committee. T h e Council considered a request f r o m t h e M i n i s t r y of Health for a definition of tuberculosis in connection with the proposed new Notification Regulations. T h e Council s u b m i t t e d t h e following definition: " Tuberculosis m e a n s a n y condition diagnosed as d u e to t h e presence of a t u b e r c u l o u s lesion w h i c h is j u d g e d to need medical treatment, b u t t h e Joint T u b e r c u l o s i s Council considers t h a t acceptance of this definition s h o u l d be d e p e n d e n t on introduction of an i n t i m a t i o n procedure." It is t h e C m m c i l ' s intention to prepare a m e m o r a n d m n on this subject. It was reported t h a t the Council h a d s u b m i t t e d , at the req u e s t of the M i n i s t r y of H e a l t h , a m e m o r a n d u m of the Internal A d m i n i s t r a t i o n of Hospitals in so far as sanatoria a n d tubereulous wards of general hospitals were concerned. Annual Luncheon.~An enjoyable l u n c h e o n was held, followi n g t h e above meeting, at t h e Hotel R u b e n s , when t h e Council e n t e r t a i n e d special guests a n d friends a n d t h e editors of medical journals. T h e C h a i r m a n (Dr. Peter Edwards) said t h a t this occasion revived the J.T.C.'s old practice after a gap of 15 years; it also m a r k e d t h e 27th b i r t h d a v of the Council. Sir John Charles, C.M.O.. Ministry of H e a l t h . proposed t h e toast of the J.T.C. a n d gave some impressive figures a b o u t hospital bed a n d staff increases a n d t h e progress of nmss radiography. In a witty reply, Dr. Edwards said t h a t t h e Ministry of H e a l t h b a d become all t h e more h u m a n a n d effective even if it was now a " m i n o r '" one. T h e J.T.C. b r o u g h t together the various elements interested in tuberculosis prevention, care a n d after-care, a n d would continue to be at the service of the M i n i s t r y for technical advice. Sir Robert Y o u n g proposed, a n d Dr. H u g h Clegg (Editor, B.M.].) replied to the toast of the guests in graceful speeches. T h e occasion was m u c h enjoyed b y all present a n d appreciation was expressed to t h e Hon. Secretary, l)r. R. I , Midgley, for the arrangements.
BOOK
REVIEW
Modern Practice in Infectious Fevers.
Edited bv If. STANLEY"
BANKS, M.A,, ~t.D., F.R.C.P., D.P.H. ( P p . . x v I" 971 ; 2 vols.,
with illustrations. Price £ 5 p e r set.) L o n d o n : B u t t e r w o r t h & Co. (Publishers), L t d . 1951. T h o s e w h o were aware t h a t this work was in preparation were looking forward with interest to its appearance, a n d we o u g h t to say at once that t h e y will not be disappointed. It consists of two volumes, written, according to the editor in his preface, m a i n l y for clinicians, a n d while pathology a n d bacteriology are dealt with at length, only s u c h technical details of laboratory work have been included as are d e e m e d to be n e c e s s a r y a n d valuable to t h e clinician. C h i e f e m p h a s i s is on t h e infectious fevers of t h e t e m p e r a t e a n d semi-tropical zones, but, with certain exceptions, t h e m o s t i m p o r t a n t fevers of t h e tropics have b e e n included. H e t m i n t h o t o g y a n d certain parasitic infections h a v e b e e n excluded, as have tuberculosis (except t u b e r c u l o u s m e n in~itis) and venereal diseases (except l y m p h o g r a n u l o m a v e n e r e u m ) . T h e first volume, r u n n i n g to 478 pages of text, consists o f two parts, one being c o n c e r n e d with the oeeological a p p r o a c h to infectious disease, epidemiology, laboratory aids to diagnosis a n d i m m u n i s a t i o n , while t h e o t h e r consists of 18 c h a p t e r s dealing w i t h t h e bacterial fevers. V o l u m e fI, w i t h 472 p a g e s a n d an index of 65 page% contains six parts, in w h i c h are covered
PUBLIC H E A L T H , June, 1951
w o u l d be of value to t h e A u t h o r i t y in t h e discharge of its duties, t h a t his attendance at t h e course w o u l d provide an adequate r e t u r n for t h e e x p e n d i t u r e involved, a n d that t h e Local H e a l t h A u t h o r i t y ' s decision to s e n d h i m could t h e r e b y be justified at audit, it does n o t a p p e a r to t h e M i n i s t e r t h a t a n y action on his part is r e q u i r e d to t h e paym e n t of t h e officer's reasonable expenses. I am, Sir, Y o u r obedient servant, S. F. KERSEY. T h e C h i e f Medical Officer, M i n i s t r y of H e a l t h , considers t h a t a t t e n d a n c e at this m e e t i n g will b e of interest to Medical Officers w h o m a y be a p p o i n t e d b y their authorities to attend. Applications s h o u l d be sent as quickly as possible to Dr. S t e p h e n Hall, 16, G r o s v e n o r Place, L o n d o n , S.W.I° Copies of t h e p r o g r a m m e a n d application f o r m can be obtained f r o m t h e E x e c u t i v e Secretary of the Society.
SALARY AWARDS Assimilation of Oflleers Commencing Duty Between October 1st, 1 9 5 0 , and March 31st, 1 9 5 1 C o m m i t t e e "C "' of t h e Medical W h i t l e y Council h a v e sent to all local authorities M.D.C. Circular No. 4 dated M a y 28th, in w h i c h they state t h a t t h e y have h a d u n d e r consideration the question of t h e application of t h e new (Award) salary scales in t h e case of Medical Officers who c o m m e n c e d d u t y in a first or new a p p o i n t m e n t on or after October 1st, 1950, a n d have r e a c h e d a g r e e m e n t on the following a r r a n g e m e n t s w h i c h they r e c o m m e n d all local authorities to p u t into e f f e c t : - 1. Officers who c o m m e n c e d d u t y after September 30th, 1950, b u t before t h e date of the first award of t h e Industrial Court (December 8th, 1950) should have t h e new salary scales applied to t h e m in the s a m e way as to officers in post on September 30th, I950, i.e., as laid down in Section III of A p p e n d i x B to M.D.C. Circular No. 2. 2. Officers who c o m m e n c e d d u t y on or after D e c e m b e r 8th. 1950, b u t before April 1st, 1951, s h o u l d be dealt with as follows : - (a) For the period f r o m the date of t a k i n g up d u t y to M a r c h 31st, 1951, t h e y s h o u l d receive t h e salary at which t h e y were appointed. (b) F r o m April 1st, 1951, onwards t h e y s h o u l d receive in full t h e new salary payable u n d e r the award. (c) Increments should be paid as laid down in Clause (iii) of Section III of A p p e n d i x B to M.D.C. Circular No. 2. 3. Officers ~5ommencing d u t y on or after April Ist, 1951, s h o u l d b e paid t h e new (Award) salary in full f r o m t h e date o f t a k i n g up d u t y . 4. W h e r e a r r a n g e m e n t s more favourable to t h e officer t h a n (1) a n d (2) above have already been adopted by the a u t h o r i t y those a r r a n g e m e n t s s h o u l d r e m a i n in force.
NATIONAL
MORBIDITY INQUIRY
M i n i s t r y of H e a l t h Circular R H B (51) 45: BG (51) 43 of M a y 3rd, 1951, p a r a g r a p h 8 of R H B (48) 70: BG (48) 59, w h i c h indicated t h a t t h e transcription f o r m s u m m a r i s i n g patients' records would u l t i m a t e l y be used to collect, centrally a n d regularly, t h e m i n i m a l statistical data required, either in respect of a representative sample of in-patients in all hospitals or hi respect of aI1 patients in a representative s a m p l e of hospitals. T h e M i n i s t r y states t h a t it is already clear f r o m t h e trial referred to in p a r a g r a p h 5 of t h e earlier m e m o r a n d u m t h a t this inquiry, if continued a n d extended to cover t h e hospital service as a whole, will produce results of considerable value for t h e compilation of national m o r b i d i t y statistics, t h e development of research a n d t h e general p l a n n i n g of t h e N a t i o n a l H e a l t h Service; a n d t h a t it is equally clear t h a t transcription f o r m s rel a t i n g to all patients in all hospitals would provide a m a s s of m a t e r i a l greater t h a n would be necessary to give results of statistical validity or could in practice be h a n d l e d by t h e General Register Office. T h e Minister is therefore considering t h e introduction of a s y s t e m of s a m p l i n g . T h e m e t h o d of s a m p l i n g is at present u n d e r discussion with the General Register Office a n d will p r o b a b l y require t h a t all or nearly all hospitals provide transcription f o r m s relating, to a proportion of their patients. Experience of the transcription f o r m now in use h a s s h o w n t h a t it would be of greater value if revised in certain respects. Hospitals who have been u s i n g t h e form wilt be aware of diffieuIties n o t at present known to t h e General Register Office or t h e Ministry. T h e former therefore proposes very shortly to send
to t h e hospitals who have been u s i n g t h e form a questionnaire from which it will be possible to devise f u r t h e r i m p r o v e m e n t s and, it is hoped, e l i m i n a t e difficulties. T h e Minister hopes t h a t it m a y be possible to b r i n g a revised form into use at t h e b e g i n n i n g of 1952 a n d t h a t at t h a t time all hospitals will be able to u n d e r t a k e tile preparation of the form in respect of a sample of their patients. A f u r t h e r m e m o r a n d u m on this will be issued in clue course. Meanwhile, hospitals who are already co-operating ill t h e trial by u s i n g Ihe existing form are asked to continue to do so on the present basis.
M E D I C A L A U X I L I A R I E S IN T H E NATIONAL HEALTH SERVICE T h e Reports of t h e Cope Committees on Medical Auxiliaries, p u b l i s h e d on April t3th as a W h i t e Paper,* r e c o m m e n d the setting u p of national registers. E i g h t c o m m i t t e e s were set up by tile Minister of H e a l t h a n d t h e Secretary of State far Scotland to consider the supply and d e m a n d , t r a i n i n g a n d qualifications of medical auxiliaries in the N a t i o n a l H e a l t h Service, viz., a h n n n e r s , chiropod'ists, dietitians, medical laboratory technicians, occupational therapists, p h y s i o t h e r a p i s t s ( i n c l u d i n g remedial g y m n a s t s ) , r a d i o g r a p h e r s a n d speech therapists. T h e committees sat u n d e r t h e same c h a i r m a n , Mr. V. Z a c h a r y Cope, v.a.c.s., a n d h a d two c o m m o n m e m b e r s , one medical a n d one lay, a n d a c o m m o n secretary. T h e reports of the commiztees are p u b l i s h e d together. In addition, there is a report on c o m m o n m a t t e r s presented by the c h a i r m a n a n d c o m n m n m e m b e r s , in c o n j u n c t i o n with which e a c h of the individual reporzs m u s t be read. Supply and Dernand.--On questions of supply a n d d e m a n d the c o m m i t t e e s were u n a n i m o u s . A distinction was d r a w n ill dealing with t h e d e m a n d between " need," t h a t is, t h e o p t i m n m r e q u i r e m e n t in a fully developed h e a l t h service, a n d " d e m a n d , " t h a t is, t h e n u m b e r of posts expected to exist within a reasonably short time. T h e c o m m i t t e e s consid'ered t h a t the s u p p l y in practically every case would be insufficient to meet t h e need, lint because tin'racial, economic a n d other considerations would have considerable effect, would fairly well meet the d e m a n d , except for a l m o n e r s a n d dietitians. T h e c o m m i t t e e s were u n a n i m o u s t h a t no one should be adm i t t e d to posts in the N a t i o n a l H e a l t h Service who was not suitably tr:;ined. T h e y agreed t h a t the proper test of t r a i n i n g was t h e h o l d i n g of a qualification, a n d they e x a m i n e d t h o r o u g h l y most of the oualifieations at nresent in existence, a n d comm e n d e d to the" Ministers those w h i c h t h e y t h o n g h t suitable for persons employed in the National H e a l t h Service. Registration.--The c o m m i t t e e s were u n a n i m o u s also in their r e c o m m e n d a t i o n t h a t all persons qualified for e m p l o y m e n t in the N.H.S. should be eligible for registration a n d t h a t no one s h o u l d be appointed to a post in the Service who was not on the national register. It would be unwise to limit t h e national register to persons w h o were in fact seeking e m p l o y m e n t in the Service, because of t h e risk t h a t there m i g h t be two standards, one for private practice a n d one for t h e N.H.S. T h e r e was a difference of opinion over t h e m e t h o d of regis tration. T h e report of t h e c o m m o n m e m b e r s is for t h e m o s t part concerned with it. T w o of t h e three m i n o r i t y reports were concerned with it. T h e c o m m o n m e m b e r s considered t h a t registration s h o u l d be the d u t y of a new body, a central council for medical auxiliaries set u p b y s t a t u t e and generally u n d e r the aegis of t h e Privy Council, to consist of medical practitioners. medical auxiliaries a n d l a y m e n , the first slightly in the m a j o r i t y . It would set u p professional c o m m i t t e e s to deal with m a t t e r s peculiar to each profession. On these the medical auxiliaries wmfld be in the majority. T w o m i n o r i t y reports offered alternative solntions to t h e problem of registration. T h e physiotherapists a n d remedial g y m n a s t serving on t h e c m n m i t t e e on p h y s i o t h e r a p i s t s suggested that there should be one b o d y to deal solely with oecuvational therapists, p h y s i o t h e r a p i s t s anti remedial g y m n a s t s , the " r e h a b ilitation " ~roilp. A council shou!d be set up to deal with this group. T h e other, presented by the almoners, occupational therapists a n d s p e e c h - t h e r a p i s t s serving on the respective committees, while agreeing t h a t there s h o u l d be m a e b i n e r y to deal with all t h e orofesslons, r e c o m m e n d e d t h a t t h e c o m m i t t e e s for the individua-I professions s h o u l d be the p r e d o m i n a n t partners and~ t h a t there shoutd be a small co-ordinating body. Both t h e majorizv a n d t h e m i n o r i t y reports conclude t h a t whatever b o d y is set ut~ to oversee registration it n m s t , as part of its duties, ensure that t r a i n i n g given in various institutions i~ * Reports of the C o m m i t t e e s on Medical Auxiliaries, Cmd. 8188, H.M. Stationery ()ffice, 5s. net.
175
PUBLIC H E A L T H , June, 1951 suitable for t h e N a t i o n a l H e a l t h Service, a n d as a result the council m u s t h a v e certain supervisory or inspecting functions. Provision is m a d e $o e n s u r e t h a t persons already e m p l o y e d in t h e N.H.S. who do not possess t h e qualifications w h i c h m a y later become a s t a t u t o r y r e q u i r e m e n t s h o u l d not thereby be penalised. T h e m a j o r i t y report also considered that, a p a r t from the medical laboratory technicians, students s h o u l d be responsible for p a y i n g their own fees a n d should look to t h e education authorities, r a t h e r t h a n to t h e M i n i s t e r of H e a l t h , for financial assistance. T h e M i n i s t e r s h o u l d h a v e the same responsibility in t h e t r a i n i n g of medical anxiliaries as in t h e t r a i n i n g of medical students, t h a t is to say, t h e provision of clinical facilities. Points from the individual c o m m i t t e e reports include:
Almoners T h e evidence sugges ed t h a t the hospital service in E n g l a n d a n d W a l e s alone probably needed between 2,500 a n d 3,000 almoners to provide a full service a n d in Scotland a b o u t 500. T h e prohable d e m a n d over t h e next five years was likely to he m o r e limited, b u t was e s t i m a t e d to be at least 150 a h n o n e r s each ",Tar (para 1211. T h e n m n h e r s of students in t r a i n i n g "'are hardly e n o u g h to m a k e good the wastage a n d it is evident that unless r e c r u i t m e n t is considerahlv increased it will be impossible to meet even existing demand's o( the H e a l t h S e r v ~ f'' (para 1251. Publicity in schools a n d filiancial assistance to%'students were r e c o m m e n d e d as aids to r e c r u i t m e n t . T h e r e were too few social science s t u d e n t s in the universities to meet t h e requirem e n t s of all t h e professions for which this t r a i n i n g is t h e basis. T h e t r a i n i n g a n d qualifications given b y t h e Institute of A l m o n e r s were suitable for a h n o n e r s in the N.H.S.
Chiropodists T h e c o m m i t t e e noted t h a t only 7~% of t h e hospitals h a d so far appointed chiropodists (para 173). As soon as possible there should be chiropodists at every general hospital a n d in certain special hospitals a n d clinics, a n d ' local authorities s h o u l d he enabled to provide chiropodg in the N.H.S. (para 219). T h e t r a i n i n g a n d qualifications of t h e Society of Chiropodist's were suitable for chiropodists in t h e N.H.S. Part-time t r a i n i n g could not eoual full-time t r a i n i n g in value.
Dietitians In December, 1949, only 139 dietitians h a d been appointed a m o n g 2,600 hospitals and convalescent honles in the National Health Service in E n g l a n d a n d Wales. E a c h hospital group will need at least one more (para 239). M e m b e r s of t h e British Die:etic Association were fitted fur e m p l o y m e n t in t h e National H e a l t h Service.
Occupational Therapists A b o u t 3,000 occupational therapists were needed' for the N.H.S. T h e n u m b e r actually e m p l o y e d was 980. Financial restrictions, etc., were likely to prevent the d e m a n d from rising to a n y e x t e n t for some time (paras 347-8 a n d 355). Occupational therapists h o l d i n g the diploma of the Association of Occupational T h e r a p i s t s or t h a t approved by the Scottish Association of Occupational T h e r a p i s t s were fitted for employm e a t in t h e N.H.S.
Physiotherapists A year ago j u s t over 4,000 p h y s i o t h e r a p i s t s were working wholeor part-time in t h e N.H.S. in t h e U n i t e d K i n g d o m , a n d some 1,500 m o r e would be required. T h e present o u t p u t was over 500 a year a n d it s h o u l d be possible to m a i n t a i n the present n u m b e r s a n d g r a d u a l l y b u i l d rip to t h e full d e m a n d . Supply a n d d e m a n d was fairly evenly balanced (paras 420 a n d 432). P h y s i o t h e r a p i s t s at present registered with t h e Chartered Society of P h y s i o t h e r a p i s t s a n d t h e F a c u l t y of P h y s i o t h e r a p i s t s were suitable for e m p l o y m e n t in the N.H.S. T h e general direction of studies in each school should be in t h e h a n d s of a medical practitioner, preferably a specialist in physical medicine, a n d t h a t facilities for t h e t r a i n i n g of m e n should be increased. Parttime t r a i n i n g t h a t was wholly in the h a n d s of n o n - m e d i c a l teachers a n d did not include a n y considerable anaount of varied clinical experience was not adequate.
Speech Therapists T h e r e were nearly 300 sT)eech ti~erapists prac'Asing in t h e United K i n g d o m a n d a total of :it least 750 were needed b o t h inside a n d outside the N.H.S. Local E d u c a t i o n A u t h o r i t i e s a n d hospitals s h o u l d work closely together so as to use t h e services of speech therapists as economically as possible. Speech therapists h o l d i n g t h e Diigloma of t h e College of Speech T h e r a p i s t s were suitable for e m p l o y m e n t in the N.H.S.
JOINT TUBERCULOSIS COUNCIL A m e e t i n g o[ t h e Joint Tuberculosis Council was held on F e b r u a r y 17th, 1951, u n d e r the c h a i r m a n s h i p of Dr. Peter W. Edwards, who opened the proceedings by p a y i n g tribute to the m e m o r y of t h e late Dr. A. P. Ford, who h a d died s u d d e n l y since the last meeting, a n d who h a d been a representative of the British M e d i c a l Association on t h e Council since 1942, and H o n o r a r y T r e a s u r e r of the Council since 1944. T h e following Officers were elected for the year 1951-52:-Chairman.--Dr. Peter W. Edwards. Vice-Chairmen.---Dr. N. Tattersall, Prof. F. R. G. Heal. Hon. Treasurer.~Dr. N. J. E n g l a n d . Hon. Secretary.--Dr. R. L. Midgley. It was reported t h a t specimen copies of the f o r m s o[ record for chest clinics w h i c h h a d been approved h y t h e Council h a d been sent to the appropriate Ministries, Senior A d m i n i s t r a t i v e Medical Officers of Regional Hospital Boards, British T u b e r c u losis Association, Scottish Tuberculosis Society, a n d others. T h e COuncil is s y m p a t h e t i c towards t h e British Students' H e a l t h C o m m i t t e e ' s efforts to set up at post-cure e s t a b l i s h m e n t where tuherculous students can conlinue their studies whilst u m l e r g o i n g rehabilitation, l)r. R. R. Trail a n d Mr. E. S. Evans were appointed as representatives of t h e Council on the Committee. T h e Council considered a request f r o m t h e M i n i s t r y of Health for a definition of tuberculosis in connection with the proposed new Notification Regulations. T h e Council s u b m i t t e d t h e following definition: " Tuberculosis m e a n s a n y condition diagnosed as d u e to t h e presence of a t u b e r c u l o u s lesion w h i c h is j u d g e d to need medical treatment, b u t t h e Joint T u b e r c u l o s i s Council considers t h a t acceptance of this definition s h o u l d be d e p e n d e n t on introduction of an i n t i m a t i o n procedure." It is t h e C m m c i l ' s intention to prepare a m e m o r a n d m n on this subject. It was reported t h a t the Council h a d s u b m i t t e d , at the req u e s t of the M i n i s t r y of H e a l t h , a m e m o r a n d u m of the Internal A d m i n i s t r a t i o n of Hospitals in so far as sanatoria a n d tubereulous wards of general hospitals were concerned. Annual Luncheon.~An enjoyable l u n c h e o n was held, followi n g t h e above meeting, at t h e Hotel R u b e n s , when t h e Council e n t e r t a i n e d special guests a n d friends a n d t h e editors of medical journals. T h e C h a i r m a n (Dr. Peter Edwards) said t h a t this occasion revived the J.T.C.'s old practice after a gap of 15 years; it also m a r k e d t h e 27th b i r t h d a v of the Council. Sir John Charles, C.M.O.. Ministry of H e a l t h . proposed t h e toast of the J.T.C. a n d gave some impressive figures a b o u t hospital bed a n d staff increases a n d t h e progress of nmss radiography. In a witty reply, Dr. Edwards said t h a t t h e Ministry of H e a l t h b a d become all t h e more h u m a n a n d effective even if it was now a " m i n o r '" one. T h e J.T.C. b r o u g h t together the various elements interested in tuberculosis prevention, care a n d after-care, a n d would continue to be at the service of the M i n i s t r y for technical advice. Sir Robert Y o u n g proposed, a n d Dr. H u g h Clegg (Editor, B.M.].) replied to the toast of the guests in graceful speeches. T h e occasion was m u c h enjoyed b y all present a n d appreciation was expressed to t h e Hon. Secretary, l)r. R. I , Midgley, for the arrangements.
BOOK
REVIEW
Modern Practice in Infectious Fevers.
Edited bv If. STANLEY"
BANKS, M.A,, ~t.D., F.R.C.P., D.P.H. ( P p . . x v I" 971 ; 2 vols.,
with illustrations. Price £ 5 p e r set.) L o n d o n : B u t t e r w o r t h & Co. (Publishers), L t d . 1951. T h o s e w h o were aware t h a t this work was in preparation were looking forward with interest to its appearance, a n d we o u g h t to say at once that t h e y will not be disappointed. It consists of two volumes, written, according to the editor in his preface, m a i n l y for clinicians, a n d while pathology a n d bacteriology are dealt with at length, only s u c h technical details of laboratory work have been included as are d e e m e d to be n e c e s s a r y a n d valuable to t h e clinician. C h i e f e m p h a s i s is on t h e infectious fevers of t h e t e m p e r a t e a n d semi-tropical zones, but, with certain exceptions, t h e m o s t i m p o r t a n t fevers of t h e tropics have b e e n included. H e t m i n t h o t o g y a n d certain parasitic infections h a v e b e e n excluded, as have tuberculosis (except t u b e r c u l o u s m e n in~itis) and venereal diseases (except l y m p h o g r a n u l o m a v e n e r e u m ) . T h e first volume, r u n n i n g to 478 pages of text, consists o f two parts, one being c o n c e r n e d with the oeeological a p p r o a c h to infectious disease, epidemiology, laboratory aids to diagnosis a n d i m m u n i s a t i o n , while t h e o t h e r consists of 18 c h a p t e r s dealing w i t h t h e bacterial fevers. V o l u m e fI, w i t h 472 p a g e s a n d an index of 65 page% contains six parts, in w h i c h are covered