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SALARIES IN THE PUBLIC-HEALTH SERVICE
964 there are 173 women to every 100 men of over seventyfive on Merseyside, compared with 162 women to every 100 men in England and Wales (Registrar-General 1952). The high rate of increase in the age-groups over seventy-five affects the hospital services in two ways. First, because among the over-seventies there is a sharp increase in frailty, dependence on others, and demand for institutional care (Sheldon 1950, 1954). For example, the 1951 census returns (1% sample) showed that 48% of men remained in whole-time employment after the age of sixty-five, but only 20% after the age of seventy. Similarly, the Wolverhampton survey (Sheldon 1948) showed that the proportion of women undertaking the sole domestic care of their household remained fairlv constant at about 50% between the ages of sixty and seventy-four, but declined to 40% after seventy-five and to 18% after eighty years. As long as morbidity continues at present levels, any increase in these older age-groups must cause a disproportionate rise in the demand for hospital beds. Lowe and McKeown (1950) calculated age-specific rates for patients in hospitals for the chronic sick per 1000 of the Birmingham population : their rates show a remarkably sharp increase in the older groups :
This survev also suggests that an increase in the age of patients admitted to geriatric beds will tend to reduce turnover-both by increasing the proportion of long-stay patients and by lengthening the average stay of those
It is a pleasure to acknowledge the willing assistance of many members of the hospital staff. I am especially indebted to Miss C. Ledsham and others who helped in the tedious work of extracting the basic figures for this survey. REFERENCES
Amulree, Lord, Arnold, P , Polak, A. (1952) Lancet, ii, 191. Andrews, C. T., Wilson, T. S. (1953) Ibid, i, 785. Annual Abstract of Statistics (1952 and 1953) H.M. Stationery Office. Exton-Smith, A. N. (1952) Brit. med. J. ii, 182. Graham, W. L. (1951) Lancet, ii, 931. Greenwood, J. M. (1949) Ibid, ii, 1047. Lowe, C. R., MeKeown, T. (1950) Brit. J. soc. Med. 4, 61. Morton, W. (1952) Brit. med. J. ii, 715. Political and Economic Planning (1954) No. 364; see Lancet, 1954, ii, 278. Registrar-General (1952) Statistical Review of England and Wales. H.M. Stationery Office.
Royal Commission
on
Population (1949) Report. H. M. Stationery
Office. Sheldon, J. H. (1948) The Social Medicine of Old (1950) Brit. med. J. i, 319. (1954) Lancet, ii. 151. Thomson. A. P. (1949) Brit. med. J. ii, 243.
Age. London.
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SALARIES IN THE PUBLIC-HEALTH SERVICE UNDER an Industrial Court award which operates as from Jan. 1, 1955, medical officers of health, senior medical officers, and medical officers in departments (assistant medical officers) are to receive increases in salary ranging from JE175 to f 200. The new salary-scales are as follorE:s :
discharged. The Wolverhampton survey drew attention to the fact that the lower mortality of old women is accompanied by a morbidity higher than that of old men, and there has since been ample evidence that the proportion of hospital accommodation required for older women is far greater than can be explained by their greater numbers. Greenwood (1949), Exton-Smith (1952), Morton (1952), and Andrews and Wilson (1953) all quote examples of the disproportionate demand for female beds ; and in the Birmingham survey women had a higher age-specific rate than men at all ages after seventy-five. Estimates of future hospital scales based on the total numbers of both sexes, either in the whole population or in the combined age-groups over sixty or sixty-five years, can have only a short-term reliability. Long-term planning should take account of the changing agestructure and sex-distribution of the older population. The difficulties of long-term planning have been discussed in a P.E.P. study (1954), which reviews basic assumptions about trends in birth-rates and mortality, and suggests that previous estimates of the economic burden of old age may have been exaggerated. Fortunately changes in the birth-rate cannot directly increase the burden on the geriatrician for sixty years or more -though the size of the working population will influence the amount of the national income available for welfare services, including hospitals. The future demand on the hospital services will depend both on the numbers of old people alive, and on the incidence of disease among them. It is a melancholy thought that many of the problems of old age are a by-product of unbalanced medical progress. We can prevent or cure many of the diseases which used to kill : we cannot yet control many of the more insidious diseases which disable those who survive into an extended old the control of arterial degeneration would probably do more than any other scientific advance to reduce the social and economic problems as well as the suffering of old age. Extra longevity without lower morbidity is a doubtful blessing for most of us. Old age must be made healthier and more useful if it is to be anything but an increasing burden, both to the individual and to the community. ,
The court found againsta. proposal to introduce in Scotland a salary-scale for a medical officer of health with a group not exceeding 60,000.
population
WHOLE-TIME AND PART-TIME CONSULTANTS THE Joint Consultants Committees have had recent discussions with the Ministry of Health and the Department of Health for Scotland about whole-time and maximum part-time service for consultants in the National Health Service, and the following is an agreed statement of the position. It is recognised that some consultants, while prepared to devote substantially the whole of their time to hospital work and togive it priority on all occasions, would prefer a maximum part-time to a whole-time contract. Ever since 1948 it has been the -4Linistry’s view that, subject service, employing alwaysto the needs of the boards should in this matter take into account the circumstances and preferences of the consultants concerned. While, there has been no previous statement on this point as regards Scotland, the practice in that country has been similar. Where a new appointment is being made this means that, except where the board decides that the needs of the hospital service (considered in conjunction with those of the local health services where the consultant is to undertake duties on behalf of a local authority) demand a whole-time appointment, the competition should be thrown open to all applicants who are prepared to give substantially the whole of their time to the post, whether they prefer a whole-time or a maximum part-time contract. In such a case the successful candidate should not
hospital
This survev also suggests that an increase in the age of patients admitted to geriatric beds will tend to reduce turnover-both by increasing the proportion of long-stay patients and by lengthening the average stay of those
It is a pleasure to acknowledge the willing assistance of many members of the hospital staff. I am especially indebted to Miss C. Ledsham and others who helped in the tedious work of extracting the basic figures for this survey. REFERENCES
Amulree, Lord, Arnold, P , Polak, A. (1952) Lancet, ii, 191. Andrews, C. T., Wilson, T. S. (1953) Ibid, i, 785. Annual Abstract of Statistics (1952 and 1953) H.M. Stationery Office. Exton-Smith, A. N. (1952) Brit. med. J. ii, 182. Graham, W. L. (1951) Lancet, ii, 931. Greenwood, J. M. (1949) Ibid, ii, 1047. Lowe, C. R., MeKeown, T. (1950) Brit. J. soc. Med. 4, 61. Morton, W. (1952) Brit. med. J. ii, 715. Political and Economic Planning (1954) No. 364; see Lancet, 1954, ii, 278. Registrar-General (1952) Statistical Review of England and Wales. H.M. Stationery Office.
Royal Commission
on
Population (1949) Report. H. M. Stationery
Office. Sheldon, J. H. (1948) The Social Medicine of Old (1950) Brit. med. J. i, 319. (1954) Lancet, ii. 151. Thomson. A. P. (1949) Brit. med. J. ii, 243.
Age. London.
-
-
SALARIES IN THE PUBLIC-HEALTH SERVICE UNDER an Industrial Court award which operates as from Jan. 1, 1955, medical officers of health, senior medical officers, and medical officers in departments (assistant medical officers) are to receive increases in salary ranging from JE175 to f 200. The new salary-scales are as follorE:s :
discharged. The Wolverhampton survey drew attention to the fact that the lower mortality of old women is accompanied by a morbidity higher than that of old men, and there has since been ample evidence that the proportion of hospital accommodation required for older women is far greater than can be explained by their greater numbers. Greenwood (1949), Exton-Smith (1952), Morton (1952), and Andrews and Wilson (1953) all quote examples of the disproportionate demand for female beds ; and in the Birmingham survey women had a higher age-specific rate than men at all ages after seventy-five. Estimates of future hospital scales based on the total numbers of both sexes, either in the whole population or in the combined age-groups over sixty or sixty-five years, can have only a short-term reliability. Long-term planning should take account of the changing agestructure and sex-distribution of the older population. The difficulties of long-term planning have been discussed in a P.E.P. study (1954), which reviews basic assumptions about trends in birth-rates and mortality, and suggests that previous estimates of the economic burden of old age may have been exaggerated. Fortunately changes in the birth-rate cannot directly increase the burden on the geriatrician for sixty years or more -though the size of the working population will influence the amount of the national income available for welfare services, including hospitals. The future demand on the hospital services will depend both on the numbers of old people alive, and on the incidence of disease among them. It is a melancholy thought that many of the problems of old age are a by-product of unbalanced medical progress. We can prevent or cure many of the diseases which used to kill : we cannot yet control many of the more insidious diseases which disable those who survive into an extended old the control of arterial degeneration would probably do more than any other scientific advance to reduce the social and economic problems as well as the suffering of old age. Extra longevity without lower morbidity is a doubtful blessing for most of us. Old age must be made healthier and more useful if it is to be anything but an increasing burden, both to the individual and to the community. ,
The court found againsta. proposal to introduce in Scotland a salary-scale for a medical officer of health with a group not exceeding 60,000.
population
WHOLE-TIME AND PART-TIME CONSULTANTS THE Joint Consultants Committees have had recent discussions with the Ministry of Health and the Department of Health for Scotland about whole-time and maximum part-time service for consultants in the National Health Service, and the following is an agreed statement of the position. It is recognised that some consultants, while prepared to devote substantially the whole of their time to hospital work and togive it priority on all occasions, would prefer a maximum part-time to a whole-time contract. Ever since 1948 it has been the -4Linistry’s view that, subject service, employing alwaysto the needs of the boards should in this matter take into account the circumstances and preferences of the consultants concerned. While, there has been no previous statement on this point as regards Scotland, the practice in that country has been similar. Where a new appointment is being made this means that, except where the board decides that the needs of the hospital service (considered in conjunction with those of the local health services where the consultant is to undertake duties on behalf of a local authority) demand a whole-time appointment, the competition should be thrown open to all applicants who are prepared to give substantially the whole of their time to the post, whether they prefer a whole-time or a maximum part-time contract. In such a case the successful candidate should not
hospital