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REPRESENTATION OF COMMUNITY HEALTH COUNCILS IN HEALTH-CENTRE MANAGEMENT
571
which is unique among salaried employees anywhere. We may
come
and go
please and arrange our work, outside normal hours, entirely as we as we
whether inside or think fit. All but the
obtuse have now come to of this arrangement. However, if we continue to abuse our privileges we shall certainly lose them. We have already seen how abuses in the private sector by a small minority of consultants have caused the backlash against pay beds. Now that we are resolved to keep the present contract, it must be clear that the less it is modified the better. The more additional fees we accept for specific services, the greater the likelihood of scrutiny and control.
appreciate
the
most
advantages
Consultants have a strong case for a salary increase to compensate for the ravages of inflation over many years. This is widely recognised and our case is before the Review Body. To persist with sanctions before the Review Body has reported is both irresponsible and inexpedient. We shall have only ourselves to blame if we end up by forfeiting both our privileges and the respect of the community which we still enjoy. Department of Surgery, Sharoe Green Hospital, Fulwood, Preston PR2 4DU.
J. P. LYTHGOE.
REPRESENTATION OF COMMUNITY HEALTH COUNCILS IN HEALTH-CENTRE MANAGEMENT SIR,-On Oct. 22, 1974, health workers at Glyncorrwg Health Centre met members of the district health team, at the latter’s invitation, to form an advisory committee to help in managing the centre; this was a very welcome
development. In discussing composition of this committee it was suggested, with unanimous support of all local health workers, that the local community health council be represented. This was opposed by representatives of the district team, as setting a precedent requiring a decision from higher bodies; we were unconvinced by this argument, because we thought it was up to all of us to define the content of the 1974 reorganisation in terms of our local experience and instincts, and where no guidelines were already laid down, we felt their definition should be by local opinion. In spite of this a week later we received a letter advising us that in the district administrator’s opinion representation of the community health council would be inappropriate, as the meetings are intended to discuss matters of interest to the professional users of the Health Centre". Who actually runs health centres ? Who decides what is of interest to professional users and why should they not be interested in consumer opinion ? If those doctors who oppose consumer participation in the running of local health services have the right not only to refuse representation, but even a right of entry to their premises to the community health councils (as they have been reassured by the Department of Health) is there not also a right for those doctors who think otherwise to invite such participation ? We can hardly believe that we have gone so far along the "
road
to a corporate State that our experience could be universal, and we think it is time that more of us with either positive or negative experiences of attempts to involve patients or their representatives in some degree of control of local health services should pool their experience, and begin to build a progressive body of Case Law.
Health Centre, Port Talbot,
Glyncorrwg near
Glamorgan, Wales SA13 3BL.
J. TUDOR HART A. P. HAINES.
V.I.P.s IN HOSPITAL Donald Douglas (Feb. 15, p. 389) correctly SIR,-Sir draws attention to the fact that the leaders of our society need, and should have, privacy when in N.H.S. hospitals. All people are equal but some are more equal than others; we need to recognise a person’s status, not his purse, when he comes into hospital. This would be met by a substantial increase in amenity beds, and the fact that they are available should be widely advertised to the public. The cost of such a room should be nominal, and I see no reason at all why any Government should object to this paid-for
privacy. 24 North
Parade, Aberystwyth, Cards. SY23 2NQ.
JOHN H. HUGHES.
HOSPITALS FOR THE MENTALLY HANDICAPPED Medical SiR,—The Directory 1974 lists over 210 hospitals for the mentally handicapped in England and Wales; there are just under 20 hospitals for mental deficiency in Scotland. The number of beds in these hospitals ranges from 14 to 1954. Over half the hospitals for mental handicap in England and Wales have under 100 beds (17 with under 25 beds, 44 with 25-50 beds, 45 with 50-100 beds). No hospital now has more than 2000 beds; 5 have over 1500 beds, 8 hospitals have 1000-1500 beds, 24 have between 500 and 1000, over 30 have between 200 and 500, and over 30 have between 100 and 200 beds. The South Western Region and the Trent Region each have over 30 hospitals for mental handicap, many of which are small units. The North-West Thames, South-West Thames, Mersey, and North Western Regions each have a smaller number of hospitals, some of which are very large. Scotland has no very large hospitals and fewer small units; most of its hospitals are in the 100-500 bed range. In terms of their location, hospitals for the mentally handicapped fall into the following broad groups:
(1) Large hospitals (over 200 beds) on the fringe of a centre of population or conurbation; where these are situated within 5 miles of the centre, the majority of the population served lives near the hospital, but many others are more remote from the population served. (2) Large hospitals (over 200 beds) in or near country towns or villages; these usually serve large areas and are remote from most of the population served. (3) Small hospitals (under 200 beds) in country towns and villages; these units are often associated with larger hospitals, and most of them lack the range of facilities necessary to serve the local population near them. In the reorganised National Health Service the new area health authorities are generally coterminous with the reorganised local-government areas. The distribution of hospitals for mental handicap within these areas is very uneven-while one health district will contain many units, another will have none. Hardly anywhere do the present hospitals for the mentally handicapped meet in number, size, or location the current ideal of small units serving the local
population. Where small hospitals are near a centre of population there is the possibility of their continued use to offer a more locally based service. The large hospitals situated near to the centre of the population served could continue to provide a local service. But the retention of large hospitals in country areas remote from the population served is harder to justify, although many such hospitals have received relatively recent extensions and rerovation. To change the pattern of the present hospital provision for the mentally handicapped would, however, be an enormous and formidable task, in respect both of the financial implications
which is unique among salaried employees anywhere. We may
come
and go
please and arrange our work, outside normal hours, entirely as we as we
whether inside or think fit. All but the
obtuse have now come to of this arrangement. However, if we continue to abuse our privileges we shall certainly lose them. We have already seen how abuses in the private sector by a small minority of consultants have caused the backlash against pay beds. Now that we are resolved to keep the present contract, it must be clear that the less it is modified the better. The more additional fees we accept for specific services, the greater the likelihood of scrutiny and control.
appreciate
the
most
advantages
Consultants have a strong case for a salary increase to compensate for the ravages of inflation over many years. This is widely recognised and our case is before the Review Body. To persist with sanctions before the Review Body has reported is both irresponsible and inexpedient. We shall have only ourselves to blame if we end up by forfeiting both our privileges and the respect of the community which we still enjoy. Department of Surgery, Sharoe Green Hospital, Fulwood, Preston PR2 4DU.
J. P. LYTHGOE.
REPRESENTATION OF COMMUNITY HEALTH COUNCILS IN HEALTH-CENTRE MANAGEMENT SIR,-On Oct. 22, 1974, health workers at Glyncorrwg Health Centre met members of the district health team, at the latter’s invitation, to form an advisory committee to help in managing the centre; this was a very welcome
development. In discussing composition of this committee it was suggested, with unanimous support of all local health workers, that the local community health council be represented. This was opposed by representatives of the district team, as setting a precedent requiring a decision from higher bodies; we were unconvinced by this argument, because we thought it was up to all of us to define the content of the 1974 reorganisation in terms of our local experience and instincts, and where no guidelines were already laid down, we felt their definition should be by local opinion. In spite of this a week later we received a letter advising us that in the district administrator’s opinion representation of the community health council would be inappropriate, as the meetings are intended to discuss matters of interest to the professional users of the Health Centre". Who actually runs health centres ? Who decides what is of interest to professional users and why should they not be interested in consumer opinion ? If those doctors who oppose consumer participation in the running of local health services have the right not only to refuse representation, but even a right of entry to their premises to the community health councils (as they have been reassured by the Department of Health) is there not also a right for those doctors who think otherwise to invite such participation ? We can hardly believe that we have gone so far along the "
road
to a corporate State that our experience could be universal, and we think it is time that more of us with either positive or negative experiences of attempts to involve patients or their representatives in some degree of control of local health services should pool their experience, and begin to build a progressive body of Case Law.
Health Centre, Port Talbot,
Glyncorrwg near
Glamorgan, Wales SA13 3BL.
J. TUDOR HART A. P. HAINES.
V.I.P.s IN HOSPITAL Donald Douglas (Feb. 15, p. 389) correctly SIR,-Sir draws attention to the fact that the leaders of our society need, and should have, privacy when in N.H.S. hospitals. All people are equal but some are more equal than others; we need to recognise a person’s status, not his purse, when he comes into hospital. This would be met by a substantial increase in amenity beds, and the fact that they are available should be widely advertised to the public. The cost of such a room should be nominal, and I see no reason at all why any Government should object to this paid-for
privacy. 24 North
Parade, Aberystwyth, Cards. SY23 2NQ.
JOHN H. HUGHES.
HOSPITALS FOR THE MENTALLY HANDICAPPED Medical SiR,—The Directory 1974 lists over 210 hospitals for the mentally handicapped in England and Wales; there are just under 20 hospitals for mental deficiency in Scotland. The number of beds in these hospitals ranges from 14 to 1954. Over half the hospitals for mental handicap in England and Wales have under 100 beds (17 with under 25 beds, 44 with 25-50 beds, 45 with 50-100 beds). No hospital now has more than 2000 beds; 5 have over 1500 beds, 8 hospitals have 1000-1500 beds, 24 have between 500 and 1000, over 30 have between 200 and 500, and over 30 have between 100 and 200 beds. The South Western Region and the Trent Region each have over 30 hospitals for mental handicap, many of which are small units. The North-West Thames, South-West Thames, Mersey, and North Western Regions each have a smaller number of hospitals, some of which are very large. Scotland has no very large hospitals and fewer small units; most of its hospitals are in the 100-500 bed range. In terms of their location, hospitals for the mentally handicapped fall into the following broad groups:
(1) Large hospitals (over 200 beds) on the fringe of a centre of population or conurbation; where these are situated within 5 miles of the centre, the majority of the population served lives near the hospital, but many others are more remote from the population served. (2) Large hospitals (over 200 beds) in or near country towns or villages; these usually serve large areas and are remote from most of the population served. (3) Small hospitals (under 200 beds) in country towns and villages; these units are often associated with larger hospitals, and most of them lack the range of facilities necessary to serve the local population near them. In the reorganised National Health Service the new area health authorities are generally coterminous with the reorganised local-government areas. The distribution of hospitals for mental handicap within these areas is very uneven-while one health district will contain many units, another will have none. Hardly anywhere do the present hospitals for the mentally handicapped meet in number, size, or location the current ideal of small units serving the local
population. Where small hospitals are near a centre of population there is the possibility of their continued use to offer a more locally based service. The large hospitals situated near to the centre of the population served could continue to provide a local service. But the retention of large hospitals in country areas remote from the population served is harder to justify, although many such hospitals have received relatively recent extensions and rerovation. To change the pattern of the present hospital provision for the mentally handicapped would, however, be an enormous and formidable task, in respect both of the financial implications