The Transition to a State Medical Service
1942-08 1942 1940s 8 pages (J) HOSPITAL POLICY (53) It has been said, with some show of authority, that our future health services must be based upon the hospitals. As far as the Union is able to understand, the sentiments which underlie this phrase are utter nonsense. Our health services must be ba...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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August 1942
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| Online Access: | http://hdl.handle.net/10796/7B0715C7-0143-4143-9332-36AA4CD20275 http://hdl.handle.net/10796/3FC15B86-95FC-448D-A4D5-D2FD53488E5A |
| Summary: | 1942-08
1942
1940s
8 pages
(J) HOSPITAL POLICY (53) It has been said, with some show of authority, that our future health services must be based upon the hospitals. As far as the Union is able to understand, the sentiments which underlie this phrase are utter nonsense. Our health services must be based upon institutions which specialise on prevention of ill-health and not upon those which are concerned only with established disease. It is not surprising that general practitioners feel that extravagant claims made on behalf of hospitals are tainted with a class interest which reflects little credit on our profession. The hospital is indeed one of the largest, most showy and expensive of all the units in a health service, but it is not for any of those reasons a suitable centre from which the other branches of the service might be directed, any more than the striking facade and large expanse of a Metropolitan fire station makes it a suitable centre from which to direct the care and upkeep of household cooking-stoves. The non-teaching hospital performs a very small function in health matters. It is utterly remote from the prevention of ill-health and almost equally remote from everything but the cure or eradication of established diseases. In terms of national values the work which it does is, in the main, grossly disproportionate to the expense involved. As a monument to sentimental desires to prolong all lives, however useless and at whatever cost, the hospital is doubtless justified. As a useful health factor its activities require a considerable amount of re-orientation. These considerations should be borne in mind when hospital policy is considered. (54) We shall continue to have need of large general hospitals, of a thousand beds or so, and usually situated in our larger towns. Their most important purpose will be as centres of education and research, including in the latter terms the careful and statistical observation of a great variety of cases which could not be so observed in their own homes. These central hospitals would not necessarily be housed in a single building and, in the early days of the National Service, would probably be spread over the various existing hospitals in any one city. The classification of wards would not be very widely different from what it is to-day. But certain classes of disease should have allotted to them bed accommodation which must not be occupied in emergency by the demands of surgical colleagues. Among departments which ought to have bed accommodation within the walls of a general hospital we would include that of psychiatry. (55) The out-patient department would undergo more radical change. It would be purely consultative, and, in general, the patient would be accompanied by the practitioner who has recommended him and would attend at an appointed time to see a particular individual. Here again psychiatry would need to have a higher status than hitherto. It is undesirable that this speciality should be divorced from ordinary hospital work and it must be borne in mind that a few psychiatric cases can be properly dealt with without a preliminary general examination such as only a hospital can supply. On the other hand, much of the massage and electrical treatment which is now crowded into inconvenient basements could be carried out just as well in more spacious premises at a distance from the hospital, and this is equally true of practically all forms of remedial treatment for cases discharged from the accident ward. (56) The next type of general hospital which would be required is the local hospital of from 50 to 500 beds which has no immediate teaching duty (except in the nursing sphere), but which can deal competently with the whole of the non-specialised work in medicine and surgery. A certain number of new hospitals of this class will have to be set up, but the great majority of the voluntary hospitals would be used in this category. Unlike the central hospitals, they would not be served entirely by a whole-time medical staff, but, according to their size, would carry out their duties by means of varying proportion of (a) resident specialists in general medicine and general surgery; (b) visiting specialists in ophthalmology, children's diseases, etc.; and (c) local practitioners attending their own patients with complete responsibility for their treatment. It is unlikely that a hospital of less than 50 beds can be made an economical unit or can attract a nursing staff of the type which the health services so urgently require. (57) Many of the special hospitals would remain practically unchanged, particularly mental hospitals and sanatoria. Others would probably cease to exist. It is very doubtful whether special heart hospitals or chest hospitals or cancer hospitals can be justified, to give only a few examples. We find it difficult to lay down a policy for the future of special nerve hospitals. Their place in health policy will have to depend upon the developments of psychological medicine, many of which cannot be accurately foreseen. We are quite aware that organic nervous disease has not necessarily any connection with psychological practice more intimate than that of any other form of organic disease. On the other hand, it will probably be necessary to have psychiatric centres with bed accommodation, separate from the accommodation in general hospitals, because the city environment is often quite unsuitable for these cases. If such psychiatric centres are wholly divorced from organic nervous diseases they will tend to be regarded by the public as camouflaged asylums for the insane, and this is a development which must be avoided at all costs. Amongst special hospitals we may perhaps include such institutions as Papworth and the British Legion Village and hospitals for remedial treatment organised in a somewhat similar way. The proper remedial treatment of a severe fracture may require from three to six months, and it is often the case that this cannot be carried out in the city nor yet be divorced from practical wage-earning occupation. We hope that institutions of this latter type may be available before the wounded of this war have lapsed into a chronic and incurable condition. The Union feels that this question of remedial treatment requires very much more attention than any Government has yet given to it. (58) Research hospitals would be required for the investigation of certain types of disease and in particular for the study of such chronic conditions as arterial degeneration. We think that these might with great advantage be situated in the country although at no great distance from a country town, in which the staff and even the patients might find reasonable opportunities for recreation. The staffing of these special hospitals would be partly by specialists and partly by general practitioners. They will also require provision for visiting students, both pre- and post-graduate, from this country and abroad. 6
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