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REGIONAL HOSPITAL ORGANISATION.
1133
REGIONAL HOSPITAL ORGANISATION.
dent for special services upon the more central institutions of the district. Those institutions would form the natural core of a regional system which would always have a head-centre to which it could turn when the highest skill or special equipment was necessary. To work successfully such a system would need a measure of elasticity which there is no need to LONDON: SATURDAY, MAY 24, 1930. The existing haphazard suppose would be lacking. and unsystematic state of things is always wasteful and sometimes dangerous. Either the costly equipment of a local metropolitan hospital is used for cases, REGIONAL HOSPITAL ORGANISATION. which do not require it, or its employment may be .’ THE Merseyside Hospitals Council, which organised perilously delayed in cases in which it is essential. and administers the contributory fund for the Results of practical importance to national hospital Liverpool hospitals, has issued a memorandum upon policy may be expected to follow the issue of this a subject which cannot fail at an early date to engage memorandum, which is intended to form the basis of the serious attention of every person concerned discussion at a series of conferences to be convened by with hospital policy. It deals with the organisation the Merseyside Hospitals Council. The difficulties of hospital services in south-west Lancashire, Cheshire, which are being so keenly felt at Liverpool are likely and North Wales, and has been called forth by the to be, if they are not already being, felt in other great heavy demands now made upon the Liverpool centres. It would seem that the contributory scheme hospitals, and especially the teaching hospitals, bids fair to be the financial basis of the voluntary from districts outside the scope of the fund. Patients hospital service for a long time to come, in the from those districts, which include the Isle of Man, absence of revolutionary changes of which there is at. last year cost the Liverpool medical institutions a present no sign. Wherever these schemes have been net sum exceeding £16,000, after allowing for contribu- established they have not only succeeded, but tions by them or on their behalf and subscriptions succeeded in a measure and with a rapidity that has known to have been received from their areas. That been startling. Sheffield and Birmingham, Leeds and is to say, the Merseyside contributors are paying part Liverpool, to mention only some outstanding instances, of the cost of hospital treatment and maintenance of to which the Hospital Saving Association in London "foreigners" in much the same economic condition may be added, are raising much of their hospital revenue as themselves. This, in itself, is a serious situation, from the pence of the artisan. But the benefits of but the financial is really less grave than the medical these pence are everywhere being claimed-and aspect of the matter. The swamping of beds results enjoyed-by those who do not subscribe them, and in the creation of waiting-lists which would otherwise there are large areas, even in the industrial north and be of comparatively small proportions. The Liverpool midlands, where there are no contributory schemes. beds would be inadequate in any event, but this Sometimes, too, there are large, but not teaching, pressure from areas distant more than ten miles from general hospitals just outside the area of a scheme Liverpool town hall intensifies congestion without which are yet not infrequently beholden to it. bringing compensation. The unfairness of the burden Sometimes, moreover, it has been complained that is obvious ; the difficulty is how best to remove it. a contributory scheme has invaded territory which It is essential to bear in mind that the object of the believes that, with its own excellent hospital, it Liverpool penny-in-the-pound fund, like all other is sufficient to itself. Regional coordination of contributory schemes, is not merely to improve contributory schemes will rapidly become imperative finance, but to increase the medical efficiency of the if they are not to be left suspended in mid-air. The hospitals. To ban the "outsider" is clearly unthink- delimitation of boundaries will not only be for the able. The smaller centres cannot possibly provide the i advantage of existing schemes but will be likely to resources either of personnel or equipment of a large encourage the formation of others. This step is, town which is the seat of a medical school; the indeed, a necessary part of that systematising of the avenues of access to these advantages must therefore voluntary hospital service which has been imposed be kept open to the whole of the region which looks upon it by recent events. The existence of a highly to a particular hospital centre. organised municipal service side by side with a casual In the opinion of the Merseyside hospital council and unsystematised voluntary service would involve the only way out of the difficulty is the establishment perils which grow in gravity the more closely they are of contributory schemes similar to its own in suitable looked at. centres of the outer zone. This need not be a very elaborate process, since four such schemes ought to suffice—West Lancashire, centring on St. Helens, THE FUNCTION OF THE AUTONOMIC
THE LANCET.
Widnes,
or
Runcorn; Deeside, centring
on
Chester ;
north-east and north-west Wales, centring the one upon Wrexham and the other upon Bangor. These regional councils might be federated, or affiliated, with the Merseyside council, and in dealing with their nnances they would necessarily take into account not only the cost of maintaining the patients they sent to Liverpool, but the overhead costs of the teaching hospitals. This, however, is to solve only a part of a problem which will rapidly grow more insistent. How can the best use be made of the hospital services, of varying importance, which already exist in these outside areas ?a If the Liverpool hospitals can do what even the larger local ones cannot do, the smaller ones, in their turn, are depen-
SYSTEM. arrangement
of the autonomic THE function and to be one of those branches of knowledge which the medical student was at liberty to forget as soon as he had passed his preclinical examinations. The system was known to play an important part in the internal economy of the body, but disorders of the autonomic nerves seemed so rare or the symptoms of them were so obscure that little interest was taken in them even by neurologists. The position has certainly altered to-day. It is true that it needs a bold man to diagnose vagotonia, that the surgery of the sympathetic is still in the experimental stage, and that the hypothalamus is still regarded as a region
system used
REGIONAL HOSPITAL ORGANISATION.
dent for special services upon the more central institutions of the district. Those institutions would form the natural core of a regional system which would always have a head-centre to which it could turn when the highest skill or special equipment was necessary. To work successfully such a system would need a measure of elasticity which there is no need to LONDON: SATURDAY, MAY 24, 1930. The existing haphazard suppose would be lacking. and unsystematic state of things is always wasteful and sometimes dangerous. Either the costly equipment of a local metropolitan hospital is used for cases, REGIONAL HOSPITAL ORGANISATION. which do not require it, or its employment may be .’ THE Merseyside Hospitals Council, which organised perilously delayed in cases in which it is essential. and administers the contributory fund for the Results of practical importance to national hospital Liverpool hospitals, has issued a memorandum upon policy may be expected to follow the issue of this a subject which cannot fail at an early date to engage memorandum, which is intended to form the basis of the serious attention of every person concerned discussion at a series of conferences to be convened by with hospital policy. It deals with the organisation the Merseyside Hospitals Council. The difficulties of hospital services in south-west Lancashire, Cheshire, which are being so keenly felt at Liverpool are likely and North Wales, and has been called forth by the to be, if they are not already being, felt in other great heavy demands now made upon the Liverpool centres. It would seem that the contributory scheme hospitals, and especially the teaching hospitals, bids fair to be the financial basis of the voluntary from districts outside the scope of the fund. Patients hospital service for a long time to come, in the from those districts, which include the Isle of Man, absence of revolutionary changes of which there is at. last year cost the Liverpool medical institutions a present no sign. Wherever these schemes have been net sum exceeding £16,000, after allowing for contribu- established they have not only succeeded, but tions by them or on their behalf and subscriptions succeeded in a measure and with a rapidity that has known to have been received from their areas. That been startling. Sheffield and Birmingham, Leeds and is to say, the Merseyside contributors are paying part Liverpool, to mention only some outstanding instances, of the cost of hospital treatment and maintenance of to which the Hospital Saving Association in London "foreigners" in much the same economic condition may be added, are raising much of their hospital revenue as themselves. This, in itself, is a serious situation, from the pence of the artisan. But the benefits of but the financial is really less grave than the medical these pence are everywhere being claimed-and aspect of the matter. The swamping of beds results enjoyed-by those who do not subscribe them, and in the creation of waiting-lists which would otherwise there are large areas, even in the industrial north and be of comparatively small proportions. The Liverpool midlands, where there are no contributory schemes. beds would be inadequate in any event, but this Sometimes, too, there are large, but not teaching, pressure from areas distant more than ten miles from general hospitals just outside the area of a scheme Liverpool town hall intensifies congestion without which are yet not infrequently beholden to it. bringing compensation. The unfairness of the burden Sometimes, moreover, it has been complained that is obvious ; the difficulty is how best to remove it. a contributory scheme has invaded territory which It is essential to bear in mind that the object of the believes that, with its own excellent hospital, it Liverpool penny-in-the-pound fund, like all other is sufficient to itself. Regional coordination of contributory schemes, is not merely to improve contributory schemes will rapidly become imperative finance, but to increase the medical efficiency of the if they are not to be left suspended in mid-air. The hospitals. To ban the "outsider" is clearly unthink- delimitation of boundaries will not only be for the able. The smaller centres cannot possibly provide the i advantage of existing schemes but will be likely to resources either of personnel or equipment of a large encourage the formation of others. This step is, town which is the seat of a medical school; the indeed, a necessary part of that systematising of the avenues of access to these advantages must therefore voluntary hospital service which has been imposed be kept open to the whole of the region which looks upon it by recent events. The existence of a highly to a particular hospital centre. organised municipal service side by side with a casual In the opinion of the Merseyside hospital council and unsystematised voluntary service would involve the only way out of the difficulty is the establishment perils which grow in gravity the more closely they are of contributory schemes similar to its own in suitable looked at. centres of the outer zone. This need not be a very elaborate process, since four such schemes ought to suffice—West Lancashire, centring on St. Helens, THE FUNCTION OF THE AUTONOMIC
THE LANCET.
Widnes,
or
Runcorn; Deeside, centring
on
Chester ;
north-east and north-west Wales, centring the one upon Wrexham and the other upon Bangor. These regional councils might be federated, or affiliated, with the Merseyside council, and in dealing with their nnances they would necessarily take into account not only the cost of maintaining the patients they sent to Liverpool, but the overhead costs of the teaching hospitals. This, however, is to solve only a part of a problem which will rapidly grow more insistent. How can the best use be made of the hospital services, of varying importance, which already exist in these outside areas ?a If the Liverpool hospitals can do what even the larger local ones cannot do, the smaller ones, in their turn, are depen-
SYSTEM. arrangement
of the autonomic THE function and to be one of those branches of knowledge which the medical student was at liberty to forget as soon as he had passed his preclinical examinations. The system was known to play an important part in the internal economy of the body, but disorders of the autonomic nerves seemed so rare or the symptoms of them were so obscure that little interest was taken in them even by neurologists. The position has certainly altered to-day. It is true that it needs a bold man to diagnose vagotonia, that the surgery of the sympathetic is still in the experimental stage, and that the hypothalamus is still regarded as a region
system used