904

The patient has lived permanently at Arosa (1800 m altitude)for several years because she can no longer endure the climateof her native town in Germany.

After the second plasmapheresis series, she was much im-proved for 3 months and could walk up to 6 h in a mountainregion. In the fourth month her breathing became worse andshe had to take cortisone again. We intend to treat her withanother plasmapheresis.

’

High Altitude Clinic Altein,CH-7050 Arosa, Switzerland J. GARTMANN

EMISSION TOMOGRAPHY

SIR,-We have developed an emission computerised axialtomographic (E.C.A.T.) system for the mathematical recon-struction of the cross-sectional radionuclide concentration in

patients and feel that the method has potential. However, theproblem of tissue attenuation for low-energy photons such as

1. Hale, T. I., Jucker, A. NucCompact, 1978, 9, 62.

99mTc is a serious limiting factor in the use Of E.C.A.T., as a diag-nostic tool. In the preliminary evaluation of the results froma commercial E.C.A.T. system Dr Ell and his colleagues (Sept.16, p. 608) give the impression the system may be comparablewith transmission computerised axial tomography (E.M.I.scanner type system) with the added advantage of low-radia-tion dose. We have found it very difficult to obtain a compar-able resolution to that of transmission computerised axial

tomography, and since the capital outlay is about the same forboth systems, we feel that the choice as a diagnostic tool is theE.M.I. type scanner.

Nuklear Medizin,Kantonsspital Schaffhausen,CH-8200, Switzerland

TERENCE I. HALEARMEN JUCKER

COPPER DEFICIENCY AND THE IMMUNE SYSTEM

THE title of this letter by Dr J. L. Sullivan and Dr H. D.Ochs and the names of the authors of the preceding letter (DrM. F. O’Rourke and colleagues) did not appear on the Con-tents page for our issue of Sept. 23.

Commentary from Westminster

From our Parliamentary Correspondent

The Conservatives’ Thoughts on the N.H.S.PRIVATE medicine, which has been doing very nicely

under a socialist government, can expect to fare evenbetter under the Conservatives. The boom in privatehealth insurance, which the phasing out of pay beds hasunintentionally brought about, will be eagerly fosteredby a Conservative government. A policy documentplanned for the new year will set out in detail the Con-servative approach to the N.H.S. Meanwhile, MrPatrick Jenkin, the Party’s spokesman on health and

social services, touched on the issue when he spoke tothe annual Conservative conference in Brighton a weekago. "We see no reason to curb the growth of the privatesector. Indeed, I believe the private sector can do more,far more, to help the N.H.S. Take the scandal of thewaiting lists. Already, two private hospitals are takingurgent heart cases off the Liverpool waiting-list. Givenproper encouragement, I am sure that the private sectorcan play a much bigger role in meeting the nation’shealth needs. But a real partnership is essential".

One approach which the party is considering hascome from Dr S. Balfour Lynn, director of the HarleyStreet Clinic. He has proposed that a massive hiving-offexercise should be undertaken in the N.H.S. In anarticle written for the Conservative Medical Society’sparty conference literature he suggests that 25 itemscould be taken out of N.H.S. hospitals and dealt withmore effectively by private enterprise. These includemedical laboratories, blood-banks, supplies of pharma-ceuticals, dressings, and cardiac pacemakers, food andlaundry, purchasing services, financial management,and all data processing. He says that hospitals shouldcontain only those services where the actual presence ofthe patient is required-operating-theatres, wards, radi-ology, physiotherapy and casualty departments, and daytreatment areas.

The immediate advantage of this would be to reduce

considerably the size of hospitals. As a result structuresand equipment could be modernised with much greaterease and at less cost. General maintenance work wouldalso be cut down considerably. But the more strikingchange would be that private enterprise could then pro-vide the services removed from hospitals. These servicescould be strategically placed in relation to several largehospitals. Dr Balfour Lynn cites as an example privateorganisations which already supply cleaning services tohospitals and one company in particular which dealswith over 200 N.H.S. hospitals.

Another example he cites is that of centralised path-ology departments. At the moment 520 pathology testsare availabie, but some of them are rarely used andothers are very costly and require either high technologi-cal knowledge or expensive equipment. So the averagelarge hospital can do only about 250 tests. However, ifprivate enterprise set up a central laboratory capable ofcarrying out all 520 tests, then every hospital within acertain radius, whether it was a 30-bedded private hospi-

tal or a large N.H.S. hospital, would have access to allpossible pathological tests. The transport system wouldbe supplied by private enterprise, with results beingtransmitted back to the hospital by machine. The hospi-tal would then contain only a small area for techniciansand for the storage of collecting bottles, and there wouldbe a considerable saving in laboratory technicians, per-sonnel and managers, and night-duty pathologists.Four representatives of the nursing profession went to

the Conservative Party conference to present what wasdescribed as a report from the shop floor. They attendeda meeting of the Conservative Medical Society as indi-viduals, although all were members of the Royal Collegeof Nursing, and the story they had to tell was a familiarone-increased bureaucracy strangling the profession,staff shortages, falling standards, and poor career pros-pects. They came from different areas of the profession—a community nurse, a ward sister, a theatre sister,and a psychiatric nurse-but their message was thesame. Nurses today were being asked to provide toomuch with too little to too many.Dr Gerard Vaughan, the Conservative Party’s spokes-

man on health, heard their complaints and gave them an