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Conference

PROGRESSIVE PATIENT CAREFROM A CORRESPONDENT

THE increasing complexity of scientific advances isseldom matched by flexibility of hospital administration.Too many hospital wards are organised to satisfy con-ventional routine rather than the rational needs of thepatient. It is imperative that we periodically cast a sharplycritical eye over current practices, secure in the know-ledge that Florence Nightingale would enthusiasticallyapprove. To that end a symposium on progressive patientcare was sponsored by the Birmingham Regional HospitalBoard, through its chairman, Sir ARTHUR THOMSON, andits senior administrative medical officer, Dr. CHRISTIE W.GORDON.The term progressive patient care is new, the concept is

old. The essence of the evolution-not revolution-is theabolition of the traditional medical or surgical ward withits haphazard mixture of acutely ill, moderately ill, andconvalescent patients, and its replacement by unitsstaffed and equipped according to degree of illness andirrespective of diagnosis. Intensive-care units deal withall critically ill patients, who are under constant audio-visual observation by trained nursing staff with essentialequipment immediately available. Non-intensive-careunits accommodate all other inpatients. In the UnitedStates a further subdivision into intermediate self-careand long-term care is common practice.

Dr. E. T. THOMPSON (Department of Health, Educationand Welfare, Washington, D.C.), Dr. HOWARD J.LOCKWARD, consultant physician, and Mr. E. T. THOMS,medical administrator (both of Manchester Memorial

Hospital, Manchester, Connecticut) gave an account oftheir five years’ experience of the development of thisinnovation. The philosophy of intensive units was fullyaccepted, with the emphasis that each hospital mustdefine its own needs and design its own units. Standardisa-tion was impossible. There was less agreement about theneed for subdividing non-intensive units, since it wasfelt that many of their aims were satisfactorily achievedin fact, if not in name.Nurses were " precious beyond Whitley ", as recognised

by Dr. J. C. HEATHER, chairman of the planning com-mittee of Birmingham Regional Hospital Board, and therecould be no doubt that planned units conserved nursingskills by concentrating them where they were mostneeded. Nurses must be relieved of all non-nursingduties. In intensive units they would perform onlyacute nursing. Nurses who preferred the less dramaticatmosphere of non-intensive units would have time forbasic nursing and purposeful guidance of patients,without the added tension and anxiety of caring for thecritically ill. Miss D. L. HALL, regional nursing officer,Birmingham Regional Hospital Board, emphasised therole of the nurse in a non-intensive-care unit as a teacherof the patient concerning his rehabilitation after dischargefrom hospital.

Miss J. M. LOVERIDGE, matron of St. Bartholomew’sHospital, London, disposed of the frequent criticism thatpatients and staff would lose the mutual comfort andsatisfaction of going through the illness together. She

pointed out that with off-duty, leave, &c., the nurse no

longer personally conducted a case. At any rate, patientsshould remain in an intensive unit for a short time only,normally a matter of hours.

Dr. A. BEAUCHAMP rightly emphasised the contribu-tion of the general practitioners in the total care of thewhole patient. The general practitioner must be a partof the clinical team in non-intensive units and the

domiciliary team when the patient returned home.Dr. K. R. D. PORTER, deputy senior administrative

medical officer of the Birmingham board, demonstratedthe system of intensive and non-intensive nursing unitsas incorporated in the plans for the new Coventry Hos-pital.* Miss L. PUGH JoNES, matron of that hospital,confessed to an enthusiastic conversion to the idea afterinitial apprehension about the effect on patients andstaff.

Intensive-care units are on the way, possibly acceleratedby the Minister of Health’s working party on the subject.It is, however, more than unlikely that " by 1970 anyhospital without an intensive-care unit will be as obsoleteas an ox-cart on a highway ", as was predicted for U.S.A.A feature of the conference were the discussion groups which

dealt with the application of progressive patient care withregard to the patient; medical aspects; nursing aspects; archi-tectural aspects; and hospital organisation. These discussiongroups were conducted in a lively atmosphere and were ledby Prof. F. A. R. STAMMERS, professor of surgery at Birm-ingham, Prof. A. L. D’ABREU, dean of the medical faculty of theUniversity of Birmingham, Miss K. A. RAVEN, chief nursingofficer of the Ministry of Health, Dr. HOWARD J. LOCKWARD,and Dr. D. S. TODD-WHITE, a principal medical officer of theMinistry. The chairs at the conference sessions were taken bySir ARTHUR THOMSON, Sir ROBERT AITKEN, Vice-Chancellorof the University of Birmingham, and Dr. ARTHUR BEAUCHAMP,chairman of the Birmingham Executive Council. The con-ference closed with an address by the Rev. A. S. REEVE, LordBishop of Lichfield.* An article on this subject by Dr. Porter appears on p. 35.-ED. L.

Parliament

Nurses’ Salaries

On June 28 Baroness SUMMERSKILL called attention to theinadequate salaries paid to nurses and midwives and to theshortage of recruits in these services and asking for immediateand substantial increases in their pay. She pointed out thatdockers, Service doctors, nearly half a million Civil Servants,hospital almoners, and psychiatric social workers had allreceived increases which exceeded the 2 1/2% which theGovernment proposed to offer the nurses.Viscount KILMUIR, the Lord Chancellor, for the Government

moved an amendment drawing attention to " the steady andcontinuing increase in nursing staffs of all kinds in the NationalHealth Service, the substantial real increases in their salariesover the last ten years ", and the Government’s desire to seethe salary structure reviewed within the framework of thepresent incomes policy. He also asked the House to note thatthe current claim might shortly be referred to arbitration. Hedescribed the increases which Lady Summerskill had mentionedas conflicting with the general view, and, in his opinion, weshould be unutterable cowards and fools to allow setbacks ofthis kind " to deflect us from the general path which we mustfollow of countering inflation". He added that the claimseemed now likely to go to arbitration, and, assuming that theIndustrial Court made an award to the nurses, and the WhitleyCouncil accepted it, the Health Ministers would implement it.The Lord Chancellor’s amendment was carried by 73 votesto 35.

Royal Society Research ProfessorshipsViscount HAILSHAM announced on June 28 that the Govern-

ment have agreed to provide the Royal Society with furtherdirect financial support to enable them to sponsor five research