EDITORIAL COMMENT

Following the first flush of success which attended the publication of The Standard, the past few weeks have seen us drop from the crest of the waves of enthusiasm into the trough where contributions dropped to the point where in competition with other pressing and urgent work we were bound to forego publication last week.

The re-action to this was as one would expect and comment varied from the cynical to the appreciative and adulatory, the latter type being without doubt in the ascendancy. The Publications Committee have examined the situation and are to keep it under close review. The wisdom of less frequent issues, the content and format of the magazine will be matters which will engage their attention, but meanwhile it has been decided to continue for the time being with a weekly issue, and to use endeavours to recruit a wider "staff" (volunteer of course) of reporters for current news items, and to introduce other features which will tend to further the original purpose of making The Standard a real live organ of communication.

The magazine is yours - news is its life blood - be a donor.

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In response to many requests it has been decided that whilst we cannot generally publicise the full report left by the Hospital Advisory Service after their visit to the hospital, the "advice section" will help staff towards the formulation of clear concepts of service aims and how individual effort can contribute towards their ultimate attainment. The section is reproduced in full and it will be seen that many of the recommendations have already been given effect and others are in the processing stream.

HOSPITAL ADVISORY SERVICE - WINWICK ADVICE

An industrial manager be appointed.

A rehabilitation objective of resettlement of 100 patients in the community within the next year be set.

2. CLINICAL TEAMS

The medical and nursing staff and the available para-medical staff be re-organised into stable clinical teams and from the outset include the appropriate Mental Health Social Worker as a member.

Each clinical team be the special administrative and clinical concern of a designated nursing officer.

Each clinical team provide a psychiatric service for an appropriate portion of the catchment area.

The service provided by the medical records department be expanded to provide a flow of information to individual consultants or "firms" separately showing an analysis of data associated with all patients admitted or discharged during the previous month, and showing details of individual patients transferred from admission areas to other wards.

3. PSYCHO-GERIATRIC SERVICES

The Liaison Committee established by the Liverpool Regional Hospital Board with Local Authorities which meets every three months be asked to carry out an immediate survey of existing facilities provided by the Hospital Service and Local Authorities for psychogeriatrics. It is suggested that the Liaison Committee should also assess long term needs for psychogeriatrics and develop plans which should be complementary to those now being prepared for the geriatric services.

As a psychiatric hospital contribution towards meeting the geriatric and psychogeriatric needs for the catchment area a specific number of beds be allocated for the treatment of acute psychiatric disorder of the elderly and also a specific number for the chronically ill, elderly and mentally infirm who require psychiatric nursing.

A Consultant Geriatrician be appointed to participate in the assessment and management of recent admissions and to advise on the treatment of long term patients.

Consideration be given to the use of Winwick Hall partly as a day patient facility for psychogeriatrics and partly as long stay accommodation in support of the existing purpose built acute psychogeriatric wards.

Plans be made for the provision of separate acute psychogeriatric hospital facilities for the distant western part of the catchment area.

4. COMMUNICATIONS

The Hospital Management Committee should look to the Medical Advisory Board as the committee responsible for taking the initiative in formulating policy for all medical and associated matters within the Group. Since proposals from the Medical Advisory Board invariably have nursing and general administrative implications it is important that the Heads of Nursing Services and the Group Secretary should be invited to attend all meetings of the Medical Advisory Board. The involvement of senior nurses and administrators in policy making at this level will have the added advantage of increasing the participation of medical staff in general management problems within the hospital.

A system of tripartite management should be developed with regular meetings between the Medical Superintendent, Heads of Nursing Services and Group Secretary to resolve current problems and to discuss future plans and policies for the hospital before their submission to the Medical Advisory Board and Hospital Management Committee. The top management team should be responsible for developing communications on a multi-professional basis and should consider the setting up of multidisciplinary groups to examine specific problem areas so that their findings are available to those who have executive authority to make decisions. It should be emphasised that the relationship between the communications system and decision making is extremely important. If decision making and communication processes are not identical, they are so interdependent that they become inseperable in practice. The function of the top management team is therefore to facilitate the information flow within the hospital in order that appropriate decisions can be made. Staff at all levels must be made aware of the hospital's objectives, of the plans for implementing them, and be provided with regular progress reports.

The Joint Consultative Staff Committee should have a fixed date for their meeting with the Management Side Representatives. The Staff Side should be made aware of proposed developments within the hospital and should be encouraged to keep the Management Side informed of the views of staff about internal management problems which are not being resolved through the normal decision making process.

There should be a comprehensive review of each of the departments at least once a year covering internal organisation, procedures, staffing, accommodation, etc., so that improved methods and objectives are agreed with the Management Committee and progress reports are submitted at regular intervals.

The Senior Nursing Officers and Group Secretary should develop a joint personnel system for the Group which would include recruitment, in-service training, induction, staff welfare, staff development, etc. This service would have an important bearing on the development of an improved communications structure and would assist in bringing about a multi-professional approach to common problems.

5 NURSING SERVICES

The nursing services should be unified immediately in order to effect a better deployment of staff, and organised on the basis of a Salmon structure.

Approval of the Regional Hospital Board be sought with a view to implementing a Salmon Structure.

The Regional Hospital Board works study team should examine the clerical work at present undertaken by nursing staff in order that nurses are wholly engaged on nursing duties.

Under a unified nursing structure, student nurses should have regular meetings - at least monthly - with senior administrative nurses and tutorial staff.

The student male nursing staff, at present in unsuitable accommodation, should be accommodated in the female nurses home - used on an integrated basis.

Ward accommodation be reduced by re--organisation and the installation of a lift service to 1st and 2nd floor.

All infirm patients to be accommodated on the ground floor.

Consideration be given to re-organising the teaching staff on comprehensive lines to incorporate educational facilities for the hospital.

The General Nursing Council be invited to review the existing accommodation of the Teaching Department.

6 DOMESTIC SERVICES

The work study division of Liverpool Regional Hospital Board be asked to carry out a comprehensive survey of cleaning services at Winwick Hospital so that the existing staff are brought under the control of the Domestic Superintendent.

7 LAUNDRY AND SUPPLIES

A central linen room be established as soon as possible and wards and departments supplied on a topping-up basis. An immediate review should also be carried out to ensure that wards have an adequate supply of linen and night clothes whilst allowing for reasonable "turn round" period for the laundry.

The present supplies procedures and distribution systems be reviewed in order to provide an improved service to wards and departments. Although there must be strict control of the goods in the system because of the high cost involved, the aim should be to make supplies more freely accessible with the minimum amount of paper work and with responsibility for the economic use of supplies vested in the ward staff or unit nursing officers.

The responsibility for the effectiveness of the supplies systems should rest with the supplies officer who should establish a review machinery to assess whether the service provided to the users is adequate and reliable. The review machinery should include representatives of ward nursing staff.

MAINTENANCE

The present system of visits to wards and departments by the group engineer with senior nursing officers be extended and carried out on a regular basis so that there is a constant review of maintenance work and ward staff have an opportunity of expressing their needs and difficulties to the maintenance manager.

8 CATCHMENT AREA CONSIDERATIONS

Day patient facilities at Winwick and outpatient services at the Warrington Hospital, and Newton-le-Willows should be increased to make more provision for patients from Warrington C.B. (72,000), Warrington R.D. (41,006), Newton-le-Willows U.D. (22,000), Golborne U.D. (26,000) and Lymm U.D. (8,600). A specified. portion of these areas should be served by each of the three consultants who at present jointly deal with the whole area.

The practical possibility of establishing a Mental Health Centre and/or a Day Hospital at Widnes to provide day patient treatment for Widnes and Runcorn patients should be explored because patients from these areas have a difficult journey to Winwick and the psychiatric facilities associated with the proposed District General Hospital at Runcorn do not seem likely to materialise in the near future.

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The Hospital has an active Photographic Club which meets on Wednesday evenings at 8.00 p.m. - the club room is situated near to the hospital bank. Members of staff and their friends are invited to visit on club nights - all aspects of photography are dealt with in a relaxed, informal atmosphere. The club requires models for Portrait Nights (pretty girls, character studies, etc,) Anyone interested may contact one of the following for information:

Dr. R.R. Steinert
Mrs. D.M. Seager, Social Worker
Mr. E. Miller, Hall Porter
Mr. L. Anderton, c/o General Stores.

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It has been proposed again that all nurses should wear their Identification badges whilst on duty, do you not think that this is a danger to the patients and staff on wards nursing fractious patients. If it is compulsory for badges to be worn a better design would be advisable than the present one which has sharp corners and a pin. We propose a round lapel type badge with a stud fastening.

G Mannion
J. F. Mugan

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Basic Firemanship

I would like to express my appreciation to the Hospital Management Committee for affording me the opportunity of attending the above course, which was held at the Lancashire County Fire Brigade Centre, Chorley. It was a five day course, consisting of classroom lectures, discussions, films and practical demonstrations.

Our reception was most cordial, and we were quickly put at ease and allotted army-style billets, clean, warm and very comfortable. The catering was really first-class - I must have put on half a stone over the five days.

A typical day's time-table was as follows:

08.00 Breakfast
09.00 The Fire Section of the Factories Act, 1961.
   (Lecture by Deputy Commandant)
Tea Break
10.15 Provisions and Siting of Fire Appliances.
   (Staff Officer)
12.15 Lunch (3 courses) in the Officer's Mess.
13.15 Use of Fire Appliances
   (Centre Instructor)
Coffee Break
15.30 Maintaining Appliances
   (Station Officer)
17.30 Tea-.time. End of day's official activities.

The Training Centre has a pleasant Social Club with colour T.V., and a quite adequate BAR. And last, but not least, there was evidently a very high degree of comradeship. All of which adds up to a most enjoyable and beneficial course.

J. A. Jolley
A. Yates
P. Lucey.

Owing to shortage of material, we were unfortunately unable to go to press last week.

At a meeting of the Publications Committee held this week, it was felt that wider staff involvement in the production of the magazine was necessary.

Accordingly, we should like to hear from anyone, with or without experience, who could help in the collection of news items.

This is your magazine, and depends upon your contributions and interest to ensure its success.

J. A. Jolley
D. McKendrick

At their meeting yesterday, Thursday, 21st October, 1971, the Hospital Management Committee, regretfully said "Au Revoir" to Dr. J.E. Howie on his retirement from Committee service, paying tribute to his integrity and dedication to the wellbeing of the hospitals within the Group.

Long serving members of the staff, of course, know Dr. Howie well as a respected colleague, and on their behalf - and indeed on behalf of all at Winwick - we wish Dr. and Mrs. Howie long life, and a happy fulfilled future.

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WELCOME TO:

Nursing Assistants

Margaret McCarrick
Jean McCarrick
Kathleen Green
Mrs. C. Norman

Staff Nurse

Nora Radley

FAREWELL TO:

Patricia MacDonnell

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Sister Lythgoe, Female 6 Up, would welcome odd balls of wool, knitted or crocheted unused garments, etc, for unravelling and rewinding. These would help with her plans for Christmas festivities.

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