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UNITY AMONG HOSPITALS
1403
meetings and make known their Its opinions. object is to unify the whole of the services within the city, and it is conhospital cerned not only with development of hospital work and accommodation but also with the training of medical students, the prosecution of research, and the principles that underlie the appointment of medical and surgical staffs. Unification, it is insisted, must and can be attained without destroying the spirit of enterprise, in individuals and in single hospitals, that has been so conspicuous in voluntary hospital practice ; and it is noteworthy that in the Manchester municipal hospital service the disadvantages of central control are already countered to some extent by throwing responsibility upon committees that serve only two or three institutions. In its first year the Manchester Joint Hospitals Board has begun to tackle the reduction of waitinglists and has worked on such various problems as the price of milk to hospitals, precautions against air raids, and the treatment of fractures. From the point of view of the medical profession, however, its most significant actions have been those relating to the selection of consultants. In Manchester, as in some other cities, the municipal hospitals are now visited often enough to ensure that visiting physicians and surgeons are actually responsible for the diagnosis and treatment of all patients who are acutely ill. At other times of the day many of these part-time paid consultants are members of the staffs of voluntary hospitals ; so that a large part of the personnel of the two kinds of hospitals is common to both. One advantage of this is that patients can sometimes be exchanged from one hospital to another, with continuity of care. More important, however, is the possibility that the principles governing selection of consultants may become the same for voluntary and municipal hospitals. One of the wise steps taken by the Joint Board has been to set up an independent advisory panel that will in future consider all applications for vacancies in the consultant service of the city and forward its recommendations to the public health committee. The suggestion is now made that this advisory panel should in future give similar assistance in the filling of appointments to the voluntary as well as the municipal hospitals. Once given a start the process of rationalisation sometimes goes ahead remarkably fast. to attend its
THE LANCET LONDON:SA T Z7RD. Y, DECEMBER 12, 19 3 6
UNITY AMONG HOSPITALS IT is
six years
since the poor-law hospitals gained popular respect by transference to the care of the public health authorities. The effect on their character has been excellent, and everywhere there are signs of success" in raising their standards. But the process of changing the more backward servants of the community does not in itself ensure that the domestic arrangements as a whole are sound. If the rescued poorlaw institution insists on doing the same jobs as the long-established voluntary hospital there will be times when neither is working to capacity, while important work remains undone. Recognising the need for planning the household tasks comprehensively, the Local Government Act of 1929 said that health authorities finding fresh work for their new proteges must consult a committee representing the voluntary hospitals of the area and their medical staffs. No obligation was placed on the old servants (the voluntary hospitals) to consult the new ones before planning their own activities, but the Minister of Health hoped that the procedure outlined would lead on to wider arrangements for the fullest consultation between the local authorities and the medical profession. He wanted the kind of cooperation that would prevent overlapping and allow the hospital services of each area, voluntary and municipal, to provide between them all that the public needs. The hope thus expressed has been realised more fully in Manchester than anywhere else-partly no doubt because the poor-law hospitals there were always wisely and humanely administered. In Manchester negotiation between representative committees has been abandoned in favour of something much more effective-namely, a Joint Hospitals Advisory Board-and its first annual report1 shows the sort of action that may be expected when collaboration between hospitals turns from theory into fact. By constitution the Board derives ten members, together with the medical officer of health, Dr. R. VEITCH CLARK, from the city council ; while eight represent the voluntary hospitals’ council, and five, including the chairman, Sir CHRISTOPHER NEEDHAM,are sent by the University. Though it is advisory in function the constituent bodies have agreed in general to accept its findings, on the understanding that hospitals affected by its proposals are invited now
or so
"
1 Obtainable, free of charge, from the joint hon. secretaries of the Board, at the Town Hall, Manchester, 2.
PROFUSELY BLEEDING PEPTIC ULCERS IN
section of
recent oration1 to the
Reading Pathological Society, Prof. J. A. RYLE returned to the problem of the treatment of acutely bleeding peptic ulcer. In the last few years widely varying estimates of the mortality of this condition have been published-anything from 1 per cent. to 25 per cent.-and those who have reported the larger figures have often wondered whether more radical methods of treatment, applied in appropriate cases, might not effect a net saving of life. one
a
1 Brit. Med. Jour., Nov. 28th, 1936, p. 1067.
meetings and make known their Its opinions. object is to unify the whole of the services within the city, and it is conhospital cerned not only with development of hospital work and accommodation but also with the training of medical students, the prosecution of research, and the principles that underlie the appointment of medical and surgical staffs. Unification, it is insisted, must and can be attained without destroying the spirit of enterprise, in individuals and in single hospitals, that has been so conspicuous in voluntary hospital practice ; and it is noteworthy that in the Manchester municipal hospital service the disadvantages of central control are already countered to some extent by throwing responsibility upon committees that serve only two or three institutions. In its first year the Manchester Joint Hospitals Board has begun to tackle the reduction of waitinglists and has worked on such various problems as the price of milk to hospitals, precautions against air raids, and the treatment of fractures. From the point of view of the medical profession, however, its most significant actions have been those relating to the selection of consultants. In Manchester, as in some other cities, the municipal hospitals are now visited often enough to ensure that visiting physicians and surgeons are actually responsible for the diagnosis and treatment of all patients who are acutely ill. At other times of the day many of these part-time paid consultants are members of the staffs of voluntary hospitals ; so that a large part of the personnel of the two kinds of hospitals is common to both. One advantage of this is that patients can sometimes be exchanged from one hospital to another, with continuity of care. More important, however, is the possibility that the principles governing selection of consultants may become the same for voluntary and municipal hospitals. One of the wise steps taken by the Joint Board has been to set up an independent advisory panel that will in future consider all applications for vacancies in the consultant service of the city and forward its recommendations to the public health committee. The suggestion is now made that this advisory panel should in future give similar assistance in the filling of appointments to the voluntary as well as the municipal hospitals. Once given a start the process of rationalisation sometimes goes ahead remarkably fast. to attend its
THE LANCET LONDON:SA T Z7RD. Y, DECEMBER 12, 19 3 6
UNITY AMONG HOSPITALS IT is
six years
since the poor-law hospitals gained popular respect by transference to the care of the public health authorities. The effect on their character has been excellent, and everywhere there are signs of success" in raising their standards. But the process of changing the more backward servants of the community does not in itself ensure that the domestic arrangements as a whole are sound. If the rescued poorlaw institution insists on doing the same jobs as the long-established voluntary hospital there will be times when neither is working to capacity, while important work remains undone. Recognising the need for planning the household tasks comprehensively, the Local Government Act of 1929 said that health authorities finding fresh work for their new proteges must consult a committee representing the voluntary hospitals of the area and their medical staffs. No obligation was placed on the old servants (the voluntary hospitals) to consult the new ones before planning their own activities, but the Minister of Health hoped that the procedure outlined would lead on to wider arrangements for the fullest consultation between the local authorities and the medical profession. He wanted the kind of cooperation that would prevent overlapping and allow the hospital services of each area, voluntary and municipal, to provide between them all that the public needs. The hope thus expressed has been realised more fully in Manchester than anywhere else-partly no doubt because the poor-law hospitals there were always wisely and humanely administered. In Manchester negotiation between representative committees has been abandoned in favour of something much more effective-namely, a Joint Hospitals Advisory Board-and its first annual report1 shows the sort of action that may be expected when collaboration between hospitals turns from theory into fact. By constitution the Board derives ten members, together with the medical officer of health, Dr. R. VEITCH CLARK, from the city council ; while eight represent the voluntary hospitals’ council, and five, including the chairman, Sir CHRISTOPHER NEEDHAM,are sent by the University. Though it is advisory in function the constituent bodies have agreed in general to accept its findings, on the understanding that hospitals affected by its proposals are invited now
or so
"
1 Obtainable, free of charge, from the joint hon. secretaries of the Board, at the Town Hall, Manchester, 2.
PROFUSELY BLEEDING PEPTIC ULCERS IN
section of
recent oration1 to the
Reading Pathological Society, Prof. J. A. RYLE returned to the problem of the treatment of acutely bleeding peptic ulcer. In the last few years widely varying estimates of the mortality of this condition have been published-anything from 1 per cent. to 25 per cent.-and those who have reported the larger figures have often wondered whether more radical methods of treatment, applied in appropriate cases, might not effect a net saving of life. one
a
1 Brit. Med. Jour., Nov. 28th, 1936, p. 1067.