26th June, 1973Vol. 2. No. 52.

Contents -

Editorial Comment
Around the Hospital
Round the N.H.S.
In the Group
Letters to the Editor
Nursing News


Like the Queen, although for different reasons, The Standard has two birthdays. Our real one has passed quietly by; our 'official' one will be the occasion of Volume 3 No. 1.

Any little gift you would care to send along, like a contribution, will be greatly appreciated. No 'Get well soon' cards, please.

* * * *


Professional Hour

Mr. W. A. Wilson, Consultant Surgeon to the Warrington Hospital Group, was the speaker at the Professional Hour for ward sisters and charge nurses held in the In-Service Training Room on Thursday, June 21.

The subject discussed was "The Organisation of Cogwheel", an explanation of the Report on the Organisation of Medical Work in Hospitals, commonly known as the Cogwheel Report.

Mr. Wilson said that the recommendations embodied in the Report were at present being implemented in the Warrington Group. Last April, when amalgamation of local hospitals took place, an Interim Committee had been set up on the lines recommended in the Report. This was the present Medical Executive Committee, and Mr. Wilson had been elected Chairman.

He saw the purpose of the re-organisation of the medical staffing as providing a more efficient, integrated service to the patient. He explained that, in the nursing and administrative areas, a pyramidal management structure existed. In the medical field this was not the case. As all consultants are held to be equal, and responsible only to the patient, it was difficult to provide effective medical management under the traditional system. "Cogwheel" recommended the formation of a Medical Executive Committee, comprising a consultant from each Division within the Group, with one consultant elected 'primus inter pares' as chairman of the Committee. The Chief Nursing Officer and the Group Secretary would also be members of this Committee. Thus, not only would each specialty be represented, but there would also be direct access to the nursing and administrative areas. It was also proposed that a General Practitioner would be a member, to anticipate 1974.

Mr. Wilson went 'on to list the seven Divisions which have now been formed in the Group. These are:-

(a)Obstetrics and Gynaecology;
(c)Accident and Orthopaedic;
(f)Mental Subnormality;
(g)Services (Radiology, Pathology, etc.)

He said that each Division is responsible for forming its own constitution, and meetings of all medical officers and unit nursing officers are held regularly. The work of the Divisions would allow comparison of procedures between Units and Divisions, and facilitate planning and utilisation of resources. Each Division has its own Chairman, who is responsible for putting forward the views of his Division at the meetings of the Medical Executive Committee. Also minutes of every Division meeting are received by the M.E.C. which is then able to co-ordinate the work of the Divisions, decide priorities, control purchase of equipment, and review medical staffing. Between meetings, the Chairman of the M.E.C. acts as its executive officer in conjunction with the Division Chairman and officers involved in any particular case.

In addition, the M.E.C. has three sub-committees:

(a)the Control of Infection Committee;
(b)the Drug Safety Committee; and
(c)the Research and Ethics Committee

Mr. Wilson saw the Cogwheel developments as still being in their initial phases. As they progressed, there could perhaps be weekly meetings between the Group Secretary, Chief Nursing Officer, Treasurer and the Chairman of the M.E.C. to provide on-going administration of the Group. The re-organisation of the N.H.S. due next April would call for further adaptation, and the M.E.C. and nursing committees would supply the medical and nursing members of the District Management Team. He believed that now one discipline in the N.H.S. could function effectively without the others, and the implementation of "Cogwheel" would allow the public to receive the best service from the N.H.S.


* * * *


H.A.S. Annual Report

In their report covering 1972 the H.A.S. lay stress on a continuing gap between theory and practice in nursing communications, even in hospitals where Salmon schemes have been implemented for several years. Mental illness hospitals are highlighted in this area.

Suggesting that better multi-disciplinary consultation at ward level could help overcome this problem, the report notes that nurses appear to need constant encouragement to express their ideas constructively, and at junior level are not sufficiently assertive in their roles within multi-disciplinary teams.

Praising those hospitals which run effective community nursing services, the H.A.S. report says that they are attracting staff who are likely to refrain from applying for jobs in hospitals known to be 'backward' in this respect. It adds, 'Understaffing is less a matter of geography, which cannot be altered, but often one of staff attitudes which should be capable of modification'.

In both the geriatric and mental handicap services, shortage of staff, lack of training and overcrowding lead often to 'insoluble problems of patient care'.

On a brighter note Dr. Baker, the H.A.S. director, finds that the increased physical resources devoted to long-stay hospitals are beginning to show their effects, but is impelled to conclude that 'in some areas there is not the equivalent change in attitudes or in the skilled use of human resources that is necessary'.


Cowley Hill

The run-down of Cowley Hill Maternity Hospital, St. Helens will be completed next month when the new maternity unit at Whiston opens. All new patients from St. Helens will be sent to Whiston, and the staff will be offered alternative jobs in the hospital group. Cowley Hill is to be considered as a possible headquarters for the new St. Helens-Knowsley area health authority.


* * * *


Speaking at the inaugural meeting of the Warrington and District Mental Health Association last week, Mr. David Ennals praised the move to rent a new, nine-person house at Longbarn for mental hospital patients who can be discharged but are without a family to go back to. 'We need more group homes and boarding-out themes', he said. And he quoted figures which showed that already more working days are lost through mental illness than through accidents and colds/flu put together.


* * * *


On arriving in the Library one morning, we had the misfortune to discover that the roof had caved in. The accumulated dirt was nobody's business. After Peter had repaired the damage. on seeking the Domestic Superintendent's help, there arrived four charming ladies - namely Domestic Supervisors

Mrs. Hughes
Mrs. Cunliffe
Mrs. Railton and
Mrs. Baker

They enthusiastically cleared from top to bottom, making the place a credit to them. One so often hears moans from people in the hospital about their services, that it gives me much pleasure to see that the "Bosses" can take their jackets off too.

H. Appleton,
Education Officer.
Would you kindly express my most sincere thanks to all the staff at Winwick Hospital who have made my stay here such a happy one. Special thanks to the Sister and staff of Ward 14, also to everyone who made my leaving evening such a memorable occasion, the Entertainments Committee of the Staff Social Club for their kind gifts, and to all others for their gifts too numerous to mention.

Malcolm Barr.

* * * *



Second-hand Record Player.

Box 13.

For Sale

Volks Wagen 1200, 1971 'J' Registration.
12,000 Miles. Radial tyres, undersealed, seat covers, coat-hook, parcel shelves. Serviced by VW Agents all through. £650

Box No. 14

Union News

The monthly meeting of the Winwick Branch of C.O.H.S.E. will be held in the In-Service Training Room on Monday next, July 2nd, at 5.30 p.m.

B. McAuley,
Branch Secretary.

* * * *


Welcome to:

Mrs. S. E. Leonard N/A ND.
Mrs. A. M. Smith TN/A ND.
Mr. T. Dhowtall Deputy Charge Nurse.

Farewell to:

Mr. T. Lord Deputy Charge Nurse (Retirement)
Mrs. G. A. Morris S.E.N.
Mrs. E. Cawthron T/SEN.
Mr. M. Lintorn N/A.


Mr. T. Sutton, husband of the late MARY SUTTON Nursing Assistant, came to see me last week.

He asked me to convey his thanks to all those who visited his wife, sent flowers, or attended the funeral.

Miss. M. T. Downey,
Deputy Matron.

Technical Nursing Library

New books available on loan:-

'Methods of Treatment in Psychiatry' - Tallett & Walker
'Nursing the Incontinent' - E. Edmondson
'Pressure Sores: Prevention and Treatment' - K.A.Walker
'Personality and Personal Illness' - G. A. Foulds

** ** ** ** ** ** ** **