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of nursing questions. A good example of such is theover development of university-ism in America, and itseffects upon nursing in the American hospitals. It is sadthat it should be accepted uncritically over here.

OPPORTUNITY

We in Britain have now an opportunity unparalleledin the history of nursing. We have the better elementsof the old tradition still with us, and we are now aboutto reverse one, if not both, of the two great mistakesmade thirty years ago. Nursing education was thentidied up without the .provision of educational funds,and thereby to a large extent stultified : and a singleState examination was adopted with scarce a thoughtgiven to the alternative policy of control through thetraining schools. Within the framework of the newAct we have the power to embark upon experiments.Are our minds sufficiently clear to make good use ofthis opportunity ? Or is our whole conception of what isopen to us so choked by a firm belief in progress since1919 that we cannot see that we may have to retraceour steps before we can advance ? ‘

THE WORLD’S HEALTH

AT the opening of the third World Health Assembly,at Geneva last Monday, Dr. Brock Chisholm, director-general of W.H.O., criticised governments for failing todevote enough of their resources to health services." What is lacking and what is urgently needed is a greaterdetermination on the part of all national administrationsto expand the health services of their countries and thusraise the health standards of their populations ..."The Organisation has itself been in difficulties through

failure of governments to pay their contributions. Ofthe 1948 budget, 15-5% is still outstanding, and in 1949it was necessary to defer final settlement of a loan fromthe United Nations and to draw on a special UNRRAfund. As it was, expenditure was restricted to$5 million.This first full year of activities is described by Dr.Chisholm in his annual report,l issued last week. Theyear was marked by progressive decentralisation of theOrganisation’s work ; by the end of the year regionaloffices were functioning in Alexandria for the EasternMediterranean region and in New Delhi for the South-East Asia region, while the Pan American SanitaryBureau in Washington is now serving as the regionaloffice for the Americas, as the first step towards inte-gration of the bureau with W.H.O. A special officewas set up for Europe to pave the way for the creationof a regional office in this area.The former practice of sending field missions to

countries has been discontinued ; field operations arenow carried out, instead, by demonstration teams andshort-term consultants. During the year the Organisationconcerned itself with only a small number of specialfields, such as the control of malaria, tuberculosis, andvenereal diseases, and the more general programmesdeveloped more slowly. Among the work carried outby the technical services has been the completion of theInternational Pharmaeopmia (announced last month) ;the sixth revision of the International Lists of Diseases,Injuries, and Causes of Death ; expansion of the

epidemiological warning system ; and progress towardsrevision of the International Sanitary Conventions.

Cooperation with other bodies is growing. Thus it is

expected that this year funds made available under theUnited Nations programme of technical assistance for

economic development will allow of extension of theservices to underdeveloped ar with intensification1. Official Records of the World Health Organisation, no. 24 :

Annual Report of the Director-General to the World HealthAssembly and to the United Nations, 1949. Geneva. Pp. 113. 6s.

of health programmes essential for the rehabilitation ofagricultural and industrial workers ; and last week it wasannounced that LTNICEF was to set aside nearly$6 millionto be spent, in conjunction with W.11.0., on improvinghealth conditions in various Asiatic countries.

Dr. Marcolino Gomez Candau (Brazil) has been appointedto the directorship of the division of organisation of public-health services. Dr. Victor Sutter (San Salvador) has beenplaced in charge of the division of communicable diseasesservices.

HOSPITAL ADMINISTRATIONPRONOUNCEMENT BY MINISTER

THREE new developments in the administration of thehospital service were announced by Mr. Aneurin Bevan,Minister of Health, when he addressed the annualconference of the Institute of Hospital Administrators,in London on May 5.

Mr. Bevan is reported by the Press Association as.

saying that a uniform system of hospital accounting-which he hoped they would soon be getting-wouldpave the way to a system of comparative costing." This system of comparative costing will show the red-light," he said, " and it will be our duty to find outwhy costs are higher in gross, or higher under any par-ticular heading, in some hospitals. Then the investigationstarts." Some of the voluntary hospitals appeared tohave had an extraordinary system of non-accountancy,because the Ministry had not been able to discover howthey added up or subtracted.

" Further we propose to have-because hospitals varyso much in ages and in their specialties-to have acompetent team not consisting only of administrativeofficials but also men of medical knowledge and withknowledge of hospital administration to visit hospitals.They will establish after an examination on the spotan agreed staff ceiling. After that has been agreed onit will not be possible to exceed that ceiling withoutconsent."

The third development mentioned by Mr. Bevan wasan investigation

"

to find out whether it is possible tohave a unit system of costing so that we can have amore refined check still." The Nuffield Trust and KingEdward’s Hospital Fund were helping towards that end.

ESTIMATES

Mr. Bevan continued : " I have given a pledge for1950-51 that there will be no exceeding the financialceiling that has been laid down in the estimates. A lotof foolish things have been said about the SupplementaryEstimates, and they have been regarded by some peopleas pieces of self-evident evidence that the finances ofthe National Health Service were not under effectivecontrol. That is a very silly thing to say because it isnot until at least one year’s experience has been obtainedthat it has been possible to find out what the expenseswould be.... Now our estimates are based on muchsurer foundations."

" Now " said Mr. Bevan, " we have to show that ouradministrative machinery is sufficiently gripping toenable us to say with some degree of predictability whatthe Health Service is likely to cost. Therefore we musthave economies in order to have expansions. If theHealth Service is to live within its estimates any improve-ment in any particular part of the service must necessarilycome out of the economies in some other part. Nextyear is an exceedingly important one. If at the endof it we can say-and I am sure we shall-that thisvast apparatus is entirely within our management andcontrol we shall have won the most important battle inthe development of the service."