Annual reports for the year 1st April 1950 to 31st March 1951 / The Cassel Hospital for Functional Nervous Disorders.

  • Cassel Hospital for Functional Nervous Disorders (Richmond, England)
Date:
[1951?]
Catalogue details

Licence: In copyright

Credit: Annual reports for the year 1st April 1950 to 31st March 1951 / The Cassel Hospital for Functional Nervous Disorders. Source: Wellcome Collection.

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    complete the metering of all fires, and then to issue for each fire a monthly financial subsidy (which varied with the seasons) large enough to ensure a reasonable amount of heat. The user was of course free to use the fire as much as he desired—but any fuel over the subsidised amount was at his own expense. The question that needed deciding was—what was a reasonable subsidy per fire ? The fires were of different sizes and types and in rooms of different sizes and positions. An experiment was made with trial subsidies and after six months of regular meter reading an analysis of the basic cost of each heating unit was made, and the subsidies were revised after discussions with groups of the users. The final subsidies recommended to the Management Committee were lower than the experimental ones and a saving in the fuel costs to the hospital was made without hardship to any one. Every single item, no matter how small, on which money was being spent was scrutinised during the year by the executive staff. The policies, customs and habits that had in the past decided the need for any item of expenditure were all reviewed in the search for economies. Some of these were an accepted part of hospital life, but when closely examined were seen to have ceased to serve any markedly useful purpose, and w'ere small habits which, unless searched for, would be passed without comment. For example, the way in which the patients’ mail was delivered was extremely satisfactory, but was found on examination to be unnecessarily wasteful of staff time. It thus required a review of the folk-ways and the very culture of the hospital to find opportunities for making econ¬ omies, and many hours were spent discussing habit patterns and ways and means in which these could be altered without stress to allow certain economies to be made. The Management Committee, in turn, regularly asked for full explanations of expenditure of any one item, and by their patience in planning and executing economies, allowed the staff to design fundamental, non-disruptive economies at a pace optimal for the hospital community without sacrifice of essentials. The co-operation of the Management Committee and Staff in this matter permitted the overall significance to the hospital of each economy proposed to be carefully worked out, and the danger of piecemeal decisions was avoided. I am glad to report at the end of the year, that in spite of economies in staff and material, the medical, nursing and essential administrative and domestic services of the hospital are being maintained at an acceptable level. The capacity of the maintenance staff to maintain without reinforcement an adequate rota of ordinary maintenance for the building is doubtful; the running of the hospital with an unfilled establishment of nursing staff has presented no prob¬ lems of undue size this year, but it places a strict limit upon the number of difficult patients that can be nursed at any one time, and may need to be revised in the future ; the standard of amenities for patients has been lowered ; and yet I believe that the hospital has not suffered seriously from the economies made. I wish to pay tribute here to the staff of all grades and to patients whose co-operation and participation has been an essential factor behind the economies achieved. The attached diagrams show the total costs of the hospital to the National Health Service during the year, under classified headings. It will be noted that salaries and wages, provisions, and fuel and lighting are the major items of expenditure, and it was natural that the Management Committee gave special scrutiny to expenditure under these three headings. For the information of hospitals outside the United Kingdom, the expenditure by the Regional Board on senior medical staff has been added to that spent by the Management Committee in the column “ Salaries and Wages ”. The diagram, therefore, represents not moneys spent by the Management Committee only, but the total expenditure on the hospital .by all National Health Service authorities. I » - . Technical Selection Methods Technical selection of staff, as described in the 1946 Report of The Cassel Hospital has continued to be in use for all appointments of nursing, technical, admin¬ istrative, clerical and senior domestic and maintenance staff. It has created interest in workers in allied fields and visitor^ have attended the hospital to see the methods in Action. Review of the predictions made in the selection procedure up to two years ago has now been possible in the light of the subsequent performance of those selected ; while the numbers are not large enough to be statistically significant, the predictive value of this selection method had confirmed itself in general and to a remarkable degree in. detail. This selection method remains an important factor in the recruitment of workers of high quality and is an important contribution to the economy of the hospital and the morale of the staff. Medical Advisory Committee Hospital Management Committees were in January 1950 advised by the Regional Board to set up Medical Advisory Committees. This Committee of the senior Medical Staff would in the Regional Board’s terms of reference have the function of advising the Hospital Management Committee on medical matters. Advis¬ ing on these matters was, prior to 1948, the function of the Medical Director, and there thus arose during the year a need for the elaboration and clarification of medical advisory roles. Throughout the period my own weekly meeting with the senior Medical Staff and the seeking of joint decisions on policy have continued as the basis of medical team collaboration within the hospital, pend¬ ing the clarification just mentioned. I was obliged