Editorial Comment

We regret our inability to publish last week - pressures of ale and turkey were partly responsible. We have tried in this issue to have a more orderly presentation of material which can never be a bad thing.

If you have any comment or suggestions in this area please let us know. Our 'rules' remain the same - Deadline 12.30 Monday in the Library.

All articles and letters must be signed, although you may ask for your name to be withheld. Bits and pieces may be phoned to the Library 224.

Finally - thanks for your support during 1972, Keep the contributions coming and we'll do even better this year.

ORGANISATIONAL DEVELOPMENT

In America the study of social organisation in various systems has led to the development of a new specialty - the field of organisational development.

Of obvious relevance to the hospital service, organisational development is based on the idea that if systems have problems which manifest themselves in symptoms, such as depression, lack of motivation, or poor morale among the staff, then the cause or causes must be sought, leading to active planning, problem solving, and evaluation of the outcome.

To undertake such a system evaluation requires a new type of specialist, sometimes referred to as a process consultant. His task is to help the client to perceive, understand, and act upon process events which occur in the client's environment.

To clarify this role of process consultant effectively needs a fairly extensive exposure to group methods and the systems approach associated with the areas of communications, decision-making, and learning theory.

To give an example of the work of a process consultant, if he was invited to consult with, for example, a community mental health centre, he might find it appropriate to suggest a one-day meeting with the entire staff - usually about 20 professionals representing the various mental health disciplines.

In many instances the leaders have a vague idea that things could be better, or there may be identifiable symptoms, but the consultant avoids having any preconceptions. The role of the consultant is to help the system to help itself. By involvement (even temporarily) with the system he helps the participants to diagnose the problem or problems.

They must arrive at this point for themselves and be participants in the problem-solving process. A consultant operating on the medical model and telling the system his diagnosis would miss one essential learning component, that of involvement. Basically the consultant tries to be a facilitator of the group learning process but not the initiator or leader.

A problem-solving interaction with the group would involve a felt need, vaguely experienced as feelings cf frustration and tension. The consultant (facilitator) will then help the group to identify specific incidents which arouse feelings and help the group to analyse these incidents with a view to formulating a problem area. The aim should be to reach a consensus in which every team member identifies himself with a plan of action and feels some responsibility for its outcome.

Usually, consensus on some major issues affecting the whole staff can be reached only after prolonged interaction within the group and may be enormously time-consuming. Each team must decide for itself where its priorities lie, and if time spent on reachin consensus is seen by the team as time wasted, then this approach to decision-making may well die, and be replaced by a more 'efficient' - and more authoritarian - method.

Awareness of group dynamics and 'process' is an essential aspect of training in social learning.

In this context, 'learning' implies a self awareness, and willingness to listen to criticism about one's personality and performance, which modifies one's self image, as well as one's attitudes and beliefs. Such a process of change if eventually applied to the classroom might help people to learn about 'learning' from elementary school (and home environment) onwards.

In this context, learning can be equated with the concept of growth or social maturation. In such a brave new world, how much of what we now call psychiatry, would really be necessary?

PUBLICATIONS CTTEE.

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N.H.S. REORGANISATION

Staff information Bulletin No. 2

The main points of the second bulletin published in December are:
It is absolutely essential during the whole of this period of reorganisation that the staff should have the fullest possible knowledge of what is going on. We are actively engaged on a considerable amount of detailed work including the appointment of assessors. Interviews, appointment time-tables and salary scales for the top jobs will be notified as soon as possible.

These appointments are likely to be made during August and September 1973. In the meantime consideration has to be given to the filling of senior managerial and admin. posts which either fall vacant or are newly created in the period up to 1.1.71. We have recommended that on or after 31.3.73 such posts carrying a grade maximum salary exceeding £1,000 p.a. should not be filled. This does not apply to clinical posts. In the case of senior nursing staff the following grades are involved - Chief Regional Nursing Officer, Chief Nursing Officer, Principal Nursing Officer, Matrons of large hospitals and Directors of Nursing Services in the local authorities of more than 100,000 population.

In view of the uncertainties we shall issue further circulars. Under the proposals in the Bill all transferrable staff would be transferred to the new authorities by Transfer Orders or Schemes.

Staff will be consulted at the draft stage of existing authorities' proposals, and we hope soon to have field officers to help locally and keep us informed. We confidently expect that the great majority of staff will be doing the same job after the appointed day in the same place they are doing it today.

We hope that where movement has to take place account will be taken of individual preferences. The Cttee. will ensure that adequate appeals machinery exists to deal with cases of hardship.

P.C.

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INDEPENDENT RESEARCH GROUP SAYS: 'HELP OVERSEAS NURSES MORE'.

A report of a survey carried out by the independent research organisation Political and Economic Planning into the problems encountered by overseas nurses in Britain was published last week.

The two main issues dealt with in the report are the problems of choosing a course of training and choosing a hospital. It is generally critical of the way the N.H.S. treats overseas nurses, and finds that although the system of recruitment and placement is convenient from the point of view of both the hospital and the immigration authorities, it is 'wholly disadvantageous to the nurse.'

The survey found that one-third of overseas nurses who were in training in psychiatric hospitals (Mental and mental subnormality) said they would have preferred general nursing. One fifth thought at the time that they applied that the hospital where they were to train would be a general hospital. Most of those training for the SEN qualification did not know before coming to Britain that it would not be recognised in their own country.

The report also criticises as grossly inadequate the facilities for dealing with problems of language which some overseas students have. Yearly two-thirds of the overseas nurses interviewed for the survey claimed that English was the language they spoke at home. Of these, interviewers rated one-sixth as having 'an accent sufficiently marked as to cause problems of comprehension.' Some of the students who had difficulty with English appeared to have (not) received any formal help with the language at their hospitals.

In its investigation of the problem of morale among overseas student nurses the PEP survey found that 'a disturbing level of unhappiness' existed among overseas nurses. Only a quarter said that they were 'very happy in their work', compared with over half of the British nurses. Complaints were expressed about loneliness, unfair treatment by fellow students and hospital staff and unpreparedness for the English climate and food.

Although overseas nurses were on average at least as well qualified educationally as British-born nurses, the report noted that they were disproportionately to be found in the pupil grade and in the less popular types of hospital.

Recommendations

In the report's recommendations it is suggested that more information should be given to intending nurses before they come to Britain to begin their training and that they should not be placed in a particular hospital until after they arrived in Britain and undergone an orientation programme. It goes on to propose that a central body be set up which would deal with assessment, placement and counselling of overseas students.

In its conclusions, the report stresses that the problems to which it is addressing itself do not concern only a tiny minority of student nurses in training at any one time.

P. C.

ROUND THE N.H.S.
'FINESSA' FOR WRIGHTINGTON

A recent article in the 'Lancashire Evening Post and Chronicle' reported that Wrightington Hospital, near Wigan, has adopted a new style of catering. The Finessa system - hotel-style catering designed specially for hospitals - was developed in Switzerland and Wrightington is one of only 12 hospitals in the country so far to have adopted it, though others are giving consideration to it.

The main reason many are holding back is the cost. New Finessa cooking equipment, heated trolleys, food trays and the like for Wrightington's catering department cost around £15,000 and extra money had to be spent on alterations to the kitchen re-siting of existing equipment and the provision of a loading bay for the big trolley.

Choice

The advantages of the new system are many. Patients now have a choice of dishes from pre-prepared menus, the food they get is hotter and fresher than before and there is no waste, so swill bins are out. The menus - normally with two or three alternatives of main course for breakfast, lunch and supper - are printed on cards which are given to patients in the evening and they tick the items of their choice.

Patients with large appetites can put two ticks against one item to show they want a large helping and diabetics and patients on special diets get appropriate menu cards offering suitable alternatives.

When the cards are collected, they are taken down to the catering department and. digital adding machine totals the number of individual dishes required.

Because the catering officer knows exactly the amount of food required, he can order accordingly. Under the old system where one set meal was prepared, the food heaped into trolleys and served by nurses on the ward, much was wasted.

Assembly Line

When the food is cooked in the hospital's new jumbo-sized pans and ovens, it is loaded into heated compartments placed at intervals either side of a conveyor belt. When they are all loaded the belt is switched on, and a girl at the top puts a tray on complete with set of cutlery, salt and pepper pots and a very hot stainless steel plate holder.

Further along, a very hot plate is placed on each tray and at the other side of the 'assembly line' on goes the veg., the main course, the dessert... everything, including the menu.

A supervisor at the end of the belt checks that the meal is correct and another kitchen worker places the trays in a trolley, which is immediately wheeled away to its particular ward. The meal arrives at its destination in less than three minutes, still piping hot, and the nurses have only to distribute the trays.

Some 250 patients at Wrightington are catered for under the new system. Although they receive a superior service, the Finessa system requires more staff to run it, and the catering department had to take on an extra 11 staff in addition to the previous 23. These stafff had then to be trained to operate the new system. And afterwards.. there's a machine to do the washing up, sterilising and rinsing of the 32,000 plates etc. used each day.

P.C.

MAXWELL JONES AT DINGLETON

During his seven years as physician superintendent at Dingleton Hospital, Melrose, (1962-69) Dr. Maxwell Jones saw a consistent effort by the staff to empathise with the patients. His predecessor, the late Dr. George Bell, with the co-operation of the staff and the people of Melrose had, by opening all the hospital's doors, shown his trust in patients, staff and local community alike. This was in 1949 before the advent of tranquillisers, and this heroic step brought Dingleton to the notice of the whole world of psychiatry.

Maxwell Jones' previous background and training had prepared him to try and build a hospital social organisation around the needs cf the patients. George Bell had initiated a notable change by his open door policy and Maxwell Jones hoped to continue his work as an agent of change, knowing that change comes most readily if there are positive sanctions from those in authority.

When he started work at Dingleton in 1962, Maxwell Jones had some fairly clear goals in mind. These were:

1) Two-way communication at all levels of the social system.
2) Shared decision-making: individuals who would be required to carry out a decision were to be involved in the decision-making process. Thus, they would have an investment in the outcome.
3) Social values which reflected the attitudes and beliefs of the system: everyone in the system had to find out where they stood in relation to basic values such as limit-setting, punishment, social distance with patients, sexual behaviour etc. This meant much time and skill spent in meetings with staff and/or patients at regular intervals, consensus being reached usually as a result of hard work, skill and goodwill.
4) Leaders emerging as a result of their natural abilities of the social organisation was made sufficiently flexible. Instead of a formal authority structure with an undue regard for MDs, PhDs, etc. leadership potential was to be fostered in anyone who showed this regardless of his position in the hierarchy. This implied a flexible social organisation, roles and role-relationships.
5) Social interaction as a learning (growth) process, resulting in a changed awareness of self, both subjectively and as seen by others.

To impose such values and attitudes on a fairly traditional hierarchical hospital system would he a contradiction and anything but democratic. Somehow the hospital had to evolve as a total system and learn by day-to-day experiences. And this it did, with its progressive physician superintendent.

Community care

The shift in emphasis in recent years from the hospital to the community has been very apparent at Dingleton. As therapeutic community principles were developed the treatment system was gradually widened to include the social environment of the Border counties.

Instead of sitting in hospital waiting for an identified patient to arrive, staff began to go to the patient's home and enter into the social system of the family. Along with many other psychiatrists at the time, they realised how totally different such an assessment in the home environment was, compared with a similar interview in a ward office. They began tb focus as much attention on the social environment of people at risk, as on their symptomatology. In fact they began to suspect the symptomatology which psychiatrists use to descrihe their patients within the social organisation of the hospital. Most problems could be seen in terms of disorganisation within the family system, and this appeared to be as important an aspect of the problem as the patient's individual symptomatology.

It was in such a setting that Dingleton began to integrate its psychiatric, medical and social services for the Border counties.

Thus, with the guidance of Maxwell Jones, Dingleton underwent a process of change from a traditionml hierarchical hospital to one reflecting a democratic egalitarian structure emphasising the central role of the patient, and has already served as a useful model for change to hundreds of visitors from all parts of the world.

P.C.

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SPORTS SECTION

FISHING CLUB

We wish to thank all those of Social Therapy Department who donated to us the sum of £20. You can rest assured that this will go a long way to give our patient-members many happy hours fishing.

l would also like to point out that we still need any odds and ends in the way of fishing tackle. Cigarette coupons would also he appreciated. Any items donated can be handed in to Mr. J. Jolley's office by the Recreational Hall stage.

S. Jones
Hon. Sec.

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UNION NEWS
C.O.H.S.E.

The next meeting of the Winwick Branch of the Confederation of Health Service Employees will be held in the In-Service Training Room on Monday, January 8th at 9.00 p.m.

Amongst the items for discussion will be the Election of a Branch Chairman.

B. McAuley
Branch Secretary

IN THE GROUP

On Wednesday December 20th Mr. John Richardson, Chairman of the Warrington Hospitals' League of Friends, handed over furnishings, carpeting and other equipment worth £1,200 to Councillor Bernard Eaves, Chairman of the Warrington Hospitals' Management Committee. The equipment is intended for use in Thelwall Grange.

Later, Mr. Richardson, Coun. Eaves and Coun. Alan Humphreys, Chairman of Warrington Rural Council, accompanied the Mayor and Mayoress of Warrington, Coun. and Mrs Bill Avery, during their Christmas visit to hospitals in the area.

P.C.

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FOR SALE
1968 (Sept) G Registration Morris Mini Mk. II, 998cc. Taxed to August '73. Inertia reel safety belts and fitted radio. Immaculate. £350. Box No. 3.

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REHABILITATION DEPT.

I would like to thank all my senior nursing colleagues for their seasonal good wishes. I have not, myself, sent individual cards this year but have instead sent a contribution to the Society for the Provision of Guide Dogs for the Blind.

J.A. Jolley

TWELVE MONTHS AGO

The amalgamation of the Warrington and Winwick groups of hospitals was at hand, representing a new era in the life of our hospital...

Mr Tony Haughey and Mrs Chris Frith received their awards as Sports Personalities of the Year from Mr. Vardy...

T. Pilling wrote on the subject of Charity, and observed that life was never fair...

The Chess Club looked forward to promotion (justifiably, as it turned out)...

The League of Friends stocked a new fish tank on F.5Up.

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COLOURFUL CHRISTMAS

Female 1 Down became the first ward to possess a colour television set in the hospital, when a new set was delivered to the ward just in time for Christmas.

The set, which belongs to one of the ladies on 1 Down, is a Japanese model, and the colour reproduction is reported to be excellent.

P.C.

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SOCIAL EVENING
As the tickets for the Social did not show the times they are published below.

Commences 7.30
Finishes 11.30 - 12.00.

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NURSING NEWS

Welcome to -
P/N Susan Hayes	N/A Joan Hatton
S/N Magdalene Dickinson	P/N Jeffrey Donoghue
N/A Joyce Pucill	P/N Ann McCully
N/A Margaret Maher	N/A Yvonne Braithwaite
P/N Bernard Hall

Farewell to -
N/A F. Taylor	N/A B. Hoban
DWS B. Bradbury	T.S.E.N. E. Webster
S.E.N. J. Clarke

To send get-well wishes to all who are sick at the moment would take several pages. The acute shortage of staff has placed a lot of strain on the fortunate (?) people unaffected by the 'flu but we're surviving, and hope to have more extensive news next week.

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We were sorry to hear of the death last week of Edward Blackwell, who worked in the Joiners' Shop.

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