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THE NEW ADMINISTRATORS
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be isolated readily from phage-group 11 staphylococci derived from impetigo, and since it is known that other members of a family in which a case of T.E.N. has occurred can harbour the same strain of staphylococcus either as carriers or as cases of impetigo,23 it is likely that host factors chiefly determine the result of infection. The next step could be to compare the immunological status of T.E.N. and impetigo patients.
THE NEW ADMINISTRATORS
" WE do not claim ", says the Hunter Committee, to write on tablets of stone." Nobody, however, should be put off by this modest opening; the committee’s report 31 is an impressive account of the way community-medicine specialists will probably work in the post-1974 National Health Service. The committee sees a place for community-medicine
specialists at three levels. First, a team of administrative medical officers will almost certainly be needed at regional level. Headed by a chief administrative medical officer (C.A.M.O.), the team would advise the regional authority on development of services, coordinate and monitor health care, allocate resources (including manpower), and organise postgraduate medical education and research. One member of the regional medical staff would specialise in health-service evaluation, and might also help area authorities plan their services. Next, the area staff; they too would be much occupied with assessing local needs. As with the regional team, a C.A.M.O. would be in charge, and the community-medicine specialists would be experts on the demography, the health needs (as indicated by morbidity and mortality data), and the physical resources of the area. From this knowledge their task would be to manage, and perhaps reorganise, the area health services. Thirdly, community-medicine work at district level. " An important might specialists part of his role ", the report suggests, " will be akin to that of those clinicians, such as radiologists and pathologists, who provide a service to their clinical colleagues." He would also contribute to the input of health information for the area, promote integration of the health services, foster good relations between health services and public, and help administer some of the services organised on an area basis. This work will be demanding, says the report, and some districts will need more than one community physician. On training, the specialty faces considerable problems. To attract the best medical talents, the training programmes will have to be improved. Before entering the specialty, the Hunter Committee suggests, the doctor should have at least two years’ post-registration experience in clinical medicine, some of it preferably outside hospital. He would then embark on a three to four year period of specialist, mainly in-service, training, with time for formal academic study. At present the choice of academic training lies mainly between the D.P.H., which takes one year and is full-time, and the two-year M.sC. in social medicine, which includes practical field training. The com31. Report of the Working Party on Medical Administrators Dr. R. B. Hunter). H.M. Stationery Office, 1972. 47p.
(chairman
mittee believes, however, that the formal academic training could usefully be divided into a number of modular elements providing the equivalent of about one year’s full-time work. " It is obviously desirable that the in-service experience should relate as closely as possible to the academic component; this will be more readily achieved if the university departments involved in academic teaching have close contacts with the service authorities, and particularly if, as on the clinical side, university teaching staff hold honorary N.H.S. appointments for the provision of specialist services to the health service authorities." The courses would include instruction in medicine and human biology, epidemiology and environmental health, statistics, social and behavioural sciences, social administration, and health-services management. Doctors planning to do university work or to specialise further would need further training-those aiming at administrative medical careers, for example, would be encouraged to attend multi-professional courses in health and social services management. Some of the in-service experience, the committee suggests, should be in a university (or M.R.C.) department engaged in health-service research or intelligence. To advise on and to stimulate the growth of training programmes, the report suggests that the Council for Postgraduate Medical Education in England and Wales should convene a body representing all the interested parties. The main career grade in community medicine would be equivalent to that of the clinical consultant, with similar pay (and perhaps, the committee suggests, also with similar awards for distinction). Doctors would enter the specialty at registrar level, and would normally be receiving senior-registrar pay within two years. The committee thinks that the Civil-Service Departments should also establish training posts, and that there should be some interplay between these and the N.H.S. programmes. Because of the uncertainties about the structure of the unified health service, the Hunter Committee had an exceptionally difficult task. There were several areas in which it could not go into detail-for example, staffing requirements and job description. The committee sees a " vital and continuing task for doctors working full time in health service administration ", and envisages a total of perhaps a thousand communitymedicine specialists. " To a considerable extent ", the chairman says, " the success or failure of the health service will depend on their quality." Medical students and the newly qualified would do well to look at this report.
THE WORK OF W.H.O. IN 1971
THE most notable feature of the latest annual report from the World Health Organisation1 is the change of attitude displayed in it rather than any change in the work W.H.O. has been undertaking. Dr. M. G. Candau in 1971 repeats his opinion of ten years ago that no major change in the health of the world is likely without further intensification of medical 1. The Work of W.H.O. 1971. Annual Report of the Director-General, W.H.O., Geneva. Obtainable from the World Health Organisation, 1211 Geneva, 27, Switzerland. 83·75; £1·50.
be isolated readily from phage-group 11 staphylococci derived from impetigo, and since it is known that other members of a family in which a case of T.E.N. has occurred can harbour the same strain of staphylococcus either as carriers or as cases of impetigo,23 it is likely that host factors chiefly determine the result of infection. The next step could be to compare the immunological status of T.E.N. and impetigo patients.
THE NEW ADMINISTRATORS
" WE do not claim ", says the Hunter Committee, to write on tablets of stone." Nobody, however, should be put off by this modest opening; the committee’s report 31 is an impressive account of the way community-medicine specialists will probably work in the post-1974 National Health Service. The committee sees a place for community-medicine
specialists at three levels. First, a team of administrative medical officers will almost certainly be needed at regional level. Headed by a chief administrative medical officer (C.A.M.O.), the team would advise the regional authority on development of services, coordinate and monitor health care, allocate resources (including manpower), and organise postgraduate medical education and research. One member of the regional medical staff would specialise in health-service evaluation, and might also help area authorities plan their services. Next, the area staff; they too would be much occupied with assessing local needs. As with the regional team, a C.A.M.O. would be in charge, and the community-medicine specialists would be experts on the demography, the health needs (as indicated by morbidity and mortality data), and the physical resources of the area. From this knowledge their task would be to manage, and perhaps reorganise, the area health services. Thirdly, community-medicine work at district level. " An important might specialists part of his role ", the report suggests, " will be akin to that of those clinicians, such as radiologists and pathologists, who provide a service to their clinical colleagues." He would also contribute to the input of health information for the area, promote integration of the health services, foster good relations between health services and public, and help administer some of the services organised on an area basis. This work will be demanding, says the report, and some districts will need more than one community physician. On training, the specialty faces considerable problems. To attract the best medical talents, the training programmes will have to be improved. Before entering the specialty, the Hunter Committee suggests, the doctor should have at least two years’ post-registration experience in clinical medicine, some of it preferably outside hospital. He would then embark on a three to four year period of specialist, mainly in-service, training, with time for formal academic study. At present the choice of academic training lies mainly between the D.P.H., which takes one year and is full-time, and the two-year M.sC. in social medicine, which includes practical field training. The com31. Report of the Working Party on Medical Administrators Dr. R. B. Hunter). H.M. Stationery Office, 1972. 47p.
(chairman
mittee believes, however, that the formal academic training could usefully be divided into a number of modular elements providing the equivalent of about one year’s full-time work. " It is obviously desirable that the in-service experience should relate as closely as possible to the academic component; this will be more readily achieved if the university departments involved in academic teaching have close contacts with the service authorities, and particularly if, as on the clinical side, university teaching staff hold honorary N.H.S. appointments for the provision of specialist services to the health service authorities." The courses would include instruction in medicine and human biology, epidemiology and environmental health, statistics, social and behavioural sciences, social administration, and health-services management. Doctors planning to do university work or to specialise further would need further training-those aiming at administrative medical careers, for example, would be encouraged to attend multi-professional courses in health and social services management. Some of the in-service experience, the committee suggests, should be in a university (or M.R.C.) department engaged in health-service research or intelligence. To advise on and to stimulate the growth of training programmes, the report suggests that the Council for Postgraduate Medical Education in England and Wales should convene a body representing all the interested parties. The main career grade in community medicine would be equivalent to that of the clinical consultant, with similar pay (and perhaps, the committee suggests, also with similar awards for distinction). Doctors would enter the specialty at registrar level, and would normally be receiving senior-registrar pay within two years. The committee thinks that the Civil-Service Departments should also establish training posts, and that there should be some interplay between these and the N.H.S. programmes. Because of the uncertainties about the structure of the unified health service, the Hunter Committee had an exceptionally difficult task. There were several areas in which it could not go into detail-for example, staffing requirements and job description. The committee sees a " vital and continuing task for doctors working full time in health service administration ", and envisages a total of perhaps a thousand communitymedicine specialists. " To a considerable extent ", the chairman says, " the success or failure of the health service will depend on their quality." Medical students and the newly qualified would do well to look at this report.
THE WORK OF W.H.O. IN 1971
THE most notable feature of the latest annual report from the World Health Organisation1 is the change of attitude displayed in it rather than any change in the work W.H.O. has been undertaking. Dr. M. G. Candau in 1971 repeats his opinion of ten years ago that no major change in the health of the world is likely without further intensification of medical 1. The Work of W.H.O. 1971. Annual Report of the Director-General, W.H.O., Geneva. Obtainable from the World Health Organisation, 1211 Geneva, 27, Switzerland. 83·75; £1·50.