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ORAL ZINC IN WILSON'S DISEASE
393 ORAL ZINC IN WILSON’S DISEASE Dr T. U. Hoogenraad (department of neurology, State University Hospital, Utrecht, Netherlands) writes: "In our letter of Dec. 9 (p. 1262) the amount of zinc sulphate mentioned may be confusing. Schouwink gave 3 x 200 mg zinc sulphate/ dav, corresponding to 240 mg zinc/day. The 3 x 200 mg zinc sulphate we gave was in the form of the heptahydrate and corresponded to only 136mg."
Commentary from Westminster From
Parliamentary Correspondent Next Year’s Money for the N.H.S. THE Government’s cautious approach to the achievement of equity between the poorest and wealthiest regions of the National Health Service continued last week our
with the announcement of financial allocations for 1979-80. Sticking firmly to the formula drawn up by the Resource Allocation Working Party three years ago, Mr David Ennals, Secretary of State for Social Services, announced that the increase in revenue next year would vary from 1% for the North West Thames region to 3% for the North Western region. So, unlike last year, no region will have less than 1% growth in its budget, an important change because anything less represents an absolute cut in a region’s ability simply to meet demands from demographic changes. Announcing the figures, Mr Ennals said he recognised that no authority would be satisfied with its increased share. But he maintained that, with the latest allocation, the Government would have made a real impact on the longstanding imbalance between the relatively poor health facilities in the north of England and the much better-off southern part of the country. For instance, the North Western region’s budget three years ago was 14% below its fair share of the national budget. More than a third of that gap had now been closed and the region would have received an extra 16 million over the past three years. Equity between the regions was still the target for the mid-1980s. Meanwhile, the better-off regions are being urged to concentrate what additional resources they have on their deprived areas. As Mr Ennals pointed out, these regions have areas as deprived as those in the poorer regions. What he wants to see are these poorer areas getting the lion’s share of the increased revenue going to the betteroff regions, and the well-provided areas developing their priority services by a process of rationalisation and redeployment of resources. Mr Ennals said he had hoped to make certain refinements in the RAWP formula this year, particularly in order to take into account the differential effect of market forces on the cost of providing similar services in different parts of the country. But, after a careful departmental study, he had decided to wait until next year, because the changes would have had relatively little effect on actual allocations and without further modification they might not have carried the conviction which was essential to the success of the redistribution policy. The 4277 million share-out for next year represents
2% increase
on last year, or just over £ 80 million. But important for the authorities will be the outcome of the present N.H.S. pay disputes, which could still throw next year’s well-laid plans into disarray. The revenue allocation for England compared with last year a
more
Emergency Admissions QUESTIONS have been asked by M.P.s about the procedure for admitting emergency cases to hospital. They have been told by the Department of Health and Social Security that there is no need for central guidance on the issue. The Health Service Commissioner and the allParty Commons Select Committee which investigates his reports have been unhappy about the matter for some time. Their concern increased last year when a 64-year-old woman with pneumonia had to be admitted urgently to a private nursing-home because there were no beds for her at two local hospitals. Her G.P. had contacted the medical’ registrars at both hospitals and had been told there were no beds available in the wards under their control, although it was later discovered that beds were available in other parts of the hospitals. Instead of approaching the consultant designated as a referee for admissions to see whether or not other beds were available, the G.P. arranged for his patient to be admitted to a private nursing-home, arguing that appeal to a consultant would have caused delay. The Select Committee urged the D.H.S.S. to give further consideration to this system in order to ensure that decisions could be reached on emergency cases as quickly as possible. Last week the Department announced that it had looked at the matter and had decided that no further action was necessary. In a letter to the committee, Mr Ennals said he stood by the observation he gave three years ago: "We think it is right, and we believe it is the usual practice of health authorities, that a general practitioner should have-and know that he has-the right of a quick appeal to a senior doctor if his initial request for an immediate admission is refused by a junior doctor. How that appeal can most speedily be effected will depend on the nature of the area served and the functions and locations of the hospital services within it. It may well depend too on particular circumstances obtaining at the time-for example, a referral to the local emergency bed service might well achieve admission more quickly than an appeal to the consultant in charge if he is out on another call and cannot be contacted rapidly." A year after this advice was given the matter was discussed with regional medical officers, who confirmed that G.P.S were generally well aware of their right of appeal to the consultant if a junior doctor refused admission. The Department decided then that central guidance was not called for, pointing out that there were some 2tmillion emergency admissions each year and only two or three instances had come to the Department’s notice of possible misunderstanding by G.P.S of their undoubted right of appeal ’
are as
follows:
to
consultants.
Commentary from Westminster From
Parliamentary Correspondent Next Year’s Money for the N.H.S. THE Government’s cautious approach to the achievement of equity between the poorest and wealthiest regions of the National Health Service continued last week our
with the announcement of financial allocations for 1979-80. Sticking firmly to the formula drawn up by the Resource Allocation Working Party three years ago, Mr David Ennals, Secretary of State for Social Services, announced that the increase in revenue next year would vary from 1% for the North West Thames region to 3% for the North Western region. So, unlike last year, no region will have less than 1% growth in its budget, an important change because anything less represents an absolute cut in a region’s ability simply to meet demands from demographic changes. Announcing the figures, Mr Ennals said he recognised that no authority would be satisfied with its increased share. But he maintained that, with the latest allocation, the Government would have made a real impact on the longstanding imbalance between the relatively poor health facilities in the north of England and the much better-off southern part of the country. For instance, the North Western region’s budget three years ago was 14% below its fair share of the national budget. More than a third of that gap had now been closed and the region would have received an extra 16 million over the past three years. Equity between the regions was still the target for the mid-1980s. Meanwhile, the better-off regions are being urged to concentrate what additional resources they have on their deprived areas. As Mr Ennals pointed out, these regions have areas as deprived as those in the poorer regions. What he wants to see are these poorer areas getting the lion’s share of the increased revenue going to the betteroff regions, and the well-provided areas developing their priority services by a process of rationalisation and redeployment of resources. Mr Ennals said he had hoped to make certain refinements in the RAWP formula this year, particularly in order to take into account the differential effect of market forces on the cost of providing similar services in different parts of the country. But, after a careful departmental study, he had decided to wait until next year, because the changes would have had relatively little effect on actual allocations and without further modification they might not have carried the conviction which was essential to the success of the redistribution policy. The 4277 million share-out for next year represents
2% increase
on last year, or just over £ 80 million. But important for the authorities will be the outcome of the present N.H.S. pay disputes, which could still throw next year’s well-laid plans into disarray. The revenue allocation for England compared with last year a
more
Emergency Admissions QUESTIONS have been asked by M.P.s about the procedure for admitting emergency cases to hospital. They have been told by the Department of Health and Social Security that there is no need for central guidance on the issue. The Health Service Commissioner and the allParty Commons Select Committee which investigates his reports have been unhappy about the matter for some time. Their concern increased last year when a 64-year-old woman with pneumonia had to be admitted urgently to a private nursing-home because there were no beds for her at two local hospitals. Her G.P. had contacted the medical’ registrars at both hospitals and had been told there were no beds available in the wards under their control, although it was later discovered that beds were available in other parts of the hospitals. Instead of approaching the consultant designated as a referee for admissions to see whether or not other beds were available, the G.P. arranged for his patient to be admitted to a private nursing-home, arguing that appeal to a consultant would have caused delay. The Select Committee urged the D.H.S.S. to give further consideration to this system in order to ensure that decisions could be reached on emergency cases as quickly as possible. Last week the Department announced that it had looked at the matter and had decided that no further action was necessary. In a letter to the committee, Mr Ennals said he stood by the observation he gave three years ago: "We think it is right, and we believe it is the usual practice of health authorities, that a general practitioner should have-and know that he has-the right of a quick appeal to a senior doctor if his initial request for an immediate admission is refused by a junior doctor. How that appeal can most speedily be effected will depend on the nature of the area served and the functions and locations of the hospital services within it. It may well depend too on particular circumstances obtaining at the time-for example, a referral to the local emergency bed service might well achieve admission more quickly than an appeal to the consultant in charge if he is out on another call and cannot be contacted rapidly." A year after this advice was given the matter was discussed with regional medical officers, who confirmed that G.P.S were generally well aware of their right of appeal to the consultant if a junior doctor refused admission. The Department decided then that central guidance was not called for, pointing out that there were some 2tmillion emergency admissions each year and only two or three instances had come to the Department’s notice of possible misunderstanding by G.P.S of their undoubted right of appeal ’
are as
follows:
to
consultants.