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ment, and the nurse will have no hesitation in questioningsome detail of architectural design. The planning isthrashed out at these joint meetings at officer level and it isleft to the representatives of the Board and HospitalManagement Committee to submit the scheme for formalapproval to their respective authorities. We are all veryconscious of the responsibility placed on us by ourauthorities, who freely delegate to their officers and staffthe detailed planning decisions. Undoubtedly we makemistakes, but we are willing to accept the blame for theseand not merely apportion them to others.

FUTURE PLANNING

Procedures are changing as more experience is gathered,and as more authoritative guidance becomes available.The methods used five years ago are now out of date, andthe lengthy processes of consultation can no longer beexpected, since to a large extent they are unnecessary.Individual boards and hospitals must be prepared toaccept greater standardisation of design and componentsso long as they can be assured that adequate research andtechnical knowledge has gone into the formulation of thesestandards.

If the programme foreshadowed in Command Paper3000 is to be attained, planning procedures must bedrastically streamlined. It is understood that the Ministryis actively engaged in drafting new proposals which will

Dogma Disputed

SURGICAL PAPERCHASE

How did the dogma arise that research was an essentialpart of a young surgeon’s training ? Presumably thisnonsensical idea stems from the far-off happy days whenan advertisement for a reasonable job would bring replies&om seventy or eighty first-class applicants. One pro-fessor of surgery used to say that he narrowed the list byinterviewing only left-handed men with red hair. Underthese conditions, a few papers published in the medicaljournals provided another factor for selection.However the dogma arose, it is now a firmly established

part of medical mythology that research is, intrinsically, agood thing. There are many places in Britain where thesurgical research is second to none, but it does not auto-matically follow that every surgeon should be given"

training " in this field.Consider the training and career of a professional

research-worker in non-medical disciplines. He will beone of a few selected from a group of graduates. For thenext two or three years he will work for a higher degreeunder the constant supervision of an experienced seniorresearch-worker. Even when he starts his first job, it isunlikely that he will work independently for some years.All this time, he will be surrounded by his peers andsubjected to their savage criticism. There will be justenough teaching or demonstrating to keep him up to the’Dark but research will occupy almost all of his time.There will be the constant stimulus from fellow workersand visiting lecturers. Of course, many training centresfall far short of this ideal, but even the best of them turnout a finished product that would raise howls of wrath froma consumer-protection society (" It takes a population ofone million to supply one good physicist a year"). The sadtruth is that, with the best training in the world, the com-petent research-worker is still a very rare bird. If you donot believe this, simply look round your own Institute.

reduce the amount of detailed scrutiny of schemes by thedepartment and give greater responsibility to regionalhospital boards for ingenuity in design so long as the costlimits are not exceeded. But boards and hospital manage-ment committees must continue to work in partnership.It is now reasonable to expect that the planning staffs ofboards should put forward sound operational policiesand serve the local hospital with well-documented pro-posals. Unless these can be improved upon in jointplanning meetings, the hospital staff must themselvesbecome fully committed to the proposals.We have much to learn in the acceptance of a building

into which tremendous thought, effort, and enterprisehave gone. To create something where nothing hasexisted before, on time, and at a cost which has beenagreed, is no small feat; many difficulties are encountereden route over which the planners have little or no control.

In the end, without concentration on slight faults,what matters is that an objective answer to the question" has the design accomplished what the planners in-tended ?" should be affirmative.

SUMMARY

In modern hospital planning there should be coopera-tion in planning between regional hospital boards, hos-pital management committees, and hospital staffs. The

design of hospitals is likely to be standardised in future.

If any part of this slightly overstated case is admitted,then it immediately becomes apparent that the thesis thatresearch is a necessary part of a surgeon’s training be-comes farcical. In the majority of centres almost everysingle factor is wrong. Supervision is non-existent or,worse, is supplied by a head of department who is less wellequipped to direct research than his students. The

apparatus is pathetic, not necessarily because of lack ofmoney but because it is bought in penny-packets to

satisfy the needs of an ever-changing stream of short-term victims. How many times does one see an isotopecounter that would hardly flicker if a hydrogen bomb fellbeside it ? In some departments of surgery there is nopossibility of mutual stimulation of ideas: indeed, theatmosphere is tomb-like. The victims of the system soonbecome etiolated since the combination of their normaland arduous hospital duties with their thesis on thedetermination of serum-uranium prevents them from ever

seeing the sunlight.There are, of course, brilliant exceptions to these

generalisations. They seem to arise by accident andstand out so brightly that the hundreds of duller stars arehidden in the background.

Is there a solution ? In a rational society (in which thecraft of surgery has never belonged) it might be possibleto equip, on a lavish scale, a few large centres. Theywould need to employ a disproportionate number ofpermanent research staff, many of whom would be,necessarily, " pure " research-workers. The few youngsurgeons with a taste for research would gravitate to suchplaces and could be trained in research (as far as this ispossible) with a minimum of routine hospital duties.

This is unlikely to happen. The custom is establishedand prestige is involved. Aspiring surgeons will still

appear at interviews clutching their statutory minimumof three reprints. The rest of us will have to put up withpapers describing the length of axillary hair in Peruvianpole-vaulters for a long time to come.

DIOGENES.