Part Two: The National Health Service

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NHS: Administration

On July 5th 1948 the National Health Service (N.H.S.) assumed the management for almost all the hospitals in the country; within their regions hospitals were formed into groups controlled by their Hospital Management Committees (H.M.Cs); on the Island there were two hospital groups - the first comprised all the hospitals save one; the second was the Royal National Hospital which being a specialist hospital and serving mainly patients from the mainland was made a separate group on its own; most of the members of its Management Committee had been on the Board of Management before the appointed day. It remained on its own for a decade and then, with its numbers dwindling and being by then almost entirely for Island patients with only a very few coming from the mainland, it was merged with the other Isle of Wight hospitals. This took place in 1958 at just about the same time as Wessex became a separate region rather than a sub-region of the South-West Metropolitan Region.

The larger group, perhaps rather surprisingly, included so many as 11 hospitals; St. Mary's and Ryde, the general hospitals; the Frank James and Shanklin Cottage Hospitals, and the two other small hospitals in Shanklin, the Arthur Webster Institute and Scio House; Fairlee, the Infectious Diseases Hospital, and the Ventnor and Undercliff Hospital for Infectious Diseases; Longford Sanatorium; the Ashey Smallpox Hospital; and the largest of all, Whitecroft Hospital.

For all these there was now one central management where before there had been about half a dozen more or less independent boards or committees. In this chapter, I endeavour to give an account of this central management and the development of the various aspects of the hospital service, - medicine, surgery, psychiatry, etc., - which necessarily involved all or most of the individual hospitals; and in a subsequent chapter to consider the larger hospitals separately and the way in which they were affected by the evolution of the service.

The H.M.C. managed the hospitals for some 26 years until 1974; the first Chairman was Mr. H.S. Saunders who saw it through the first year and was followed in the chair by Major General Sir H. Roome who carried on for ten years becoming towards the end of that time also Chairman of the R.N.H. Committee shortly before it merged with the other. Included in the H.M.C. were Dr Wallace, the C.M.O., Dr Dockray, Mr. Leisching, and Mr. O' Donoghue who were all senior consultants on the staff of Ryde or St. Mary's and others who had been on the Management Board of Ryde or of the other hospitals.

The first meeting of the H.M.C. was held before the appointed day (i.e. July 5th 1948) at County Hall; the County Clerk, Mr. Baines, served as Secretary, his offer to do so being gratefully accepted. Later the committee met on one occasion at Frank James Hospital and once at the Ryde Nurses Home, but then settled down to meet at St. Mary's until in 1950 they moved to Clatterford House where offices were available. Several years later a final move took place to what had formerly been the Nurses Home at Whitecroft. Applications had been invited at the start for the posts of Secretary and Finance Officer; there were 206 applications for the former, and 134 for the latter. In October 1948 Mr. J.E. Ray was appointed Secretary and Mr. H. Forshaw Finance Officer.

The former left after about a year and Mr. Forshaw for a while seems to have filled both posts. In 1951 Mr. G.F.R. Hardy became Assistant Finance Officer and from the beginning of 1954 he was the Finance Officer and Mr. F.L.W. Eade was Secretary. These two remained in their posts, in effect the professional heads of the administration, up to the close of this phase of the N.H.S. in 1974.

Major General M. Hext took over from Sir. H. Roome in 1959 and like him served for about a decade, and then Mrs. T. Margham became Chairman of the H.M.C. for its remaining years. The Chairmen were in all cases also members of the Regional Board.

There were of course a number of sub-committees including medical and nursing sub-committees. These were advisory and not executive; the Medical Committee met monthly and included all consultants. In those early years consultants did not expect to have their work interrupted by committee meetings and at first the Medical Committee met at 8.30 in the evening once a month; there was at least one occasion on which the meeting continued until 11 P.M.

There were in 1948 two farms, - at St. Mary's and Whitecroft - and the Central Farm Committee, a sub-committee of the H.M.C. dealt with these, and they were evidently looked upon quite seriously. Early in 1949 the H.M.C. agreed to spend £1,000 on a dairy herd to provide milk for St. Mary's, and Dolly, Blue Bird, Maisie, Jonah (!), Sally, Daisy and Susanne took up residence at St. Mary's and their yield of milk was duly reported each quarter to the H.M.C., as was that of the Whitecroft herd; pigs and poultry were kept at both hospitals (poultry also at Longford) and swill was collected from the kitchens; at Ryde swill had hitherto been sold locally and had brought the hospital £60 a year, but now was passed onto the piggeries at St. Mary's. Vegetables were grown at both hospitals, also at Fairlee and Longford. The staff for these activities included farm bailiffs at St. Mary's and Whitecroft; half a dozen garden and farm labourers at Whitecroft; a gardener, three labourers and a dairy maid at St. Mary's, and ten gardeners in all at the other hospitals.

At Ventnor in the other group, pigs, poultry and often geese were kept and there were large gardens which supplied much of the hospital's vegetables, apples and soft fruit; there was a farm bailiff and head gardener and a number of other gardeners.

In 1953 however the Ministry decided that hospitals were not to continue farming or market gardening (garden and farm products supplied to the hospital's kitchens were always debited at the market rates to catering accounts) and farms were abandoned and the stock sold off; a head gardener remained on the staff at Whitecroft and St. Mary's; in each of which there were fairly extensive grounds; and several other gardeners were retained full-time or part-time at other hospitals. It is convenient at this point to mention also the maintenance staff which for the whole group included two engineers in charge; a foreman/carpenter, and five carpenters; four brick layers and four brick layers' labourers; three electricians; one painter; four plumbers and fitters; and two and a half labourers.

The accommodation for infectious diseases was an early concern of the H.M.C.; the hospital at Ventnor (the Undercliff Isolation Hospital - not of course the R.N.H.) had been under-used for many years and Fairlee Hospital - the only one now used for infectious diseases on the Island, - was also usually lightly occupied, as is inevitable in a hospital which deals with sporadic epidemics. Dr Wallace was asked to report on the situation and to consider the possibility of using the Ventnor Hospital alone for the whole Island and converting Fairlee Hospital to some other use. He reported that additional building would be needed at Ventnor and that given that it would be possible to use it as the only Island isolation hospital, but it was out of the way and barely suitable in other ways and he did not think it would be a wise measure; this opinion was not disputed and that was the end of the Ventnor and Undercliff Hospital as such.

After the Poliomyelitis epidemic of 1950 there was rather little demand, (which is not to say there was none at all) for beds for treating infectious diseases in isolation. It was not long before, on the recommendation of the Medical Advisory Committee, half of the beds at Fairlee were taken over for the 'chronic sick'.

Hospitals and beds for the treatment of Tuberculosis, especially respiratory Tuberculosis, were in demand in the early years of the service and the hospitals and sanatoria were full and had waiting lists for admission; the rapid changes in this situation during the first decade of the N.H.S. was due, as already indicated, to the advent of effective drug treatment; it was only by chance that this coincided with the development of the N.H.S.. Longford Hospital as previously described was used for the Island patients and from 1948 Dr Easton was its Chest Physician and Superintendent at the sanatorium; the Catherine Bowen Home built in the grounds of Longford was available for children, but after the war it was in poor repair and was considered inadequate and in 1952, after it had been done up, it was used to provide beds for adults, and the few children who needed hospital treatment went to the White House Hospital at Milford. Before long with the use of effective drugs the problem of beds for Tuberculosis (on the Island anyhow) disappeared; and in 1955 Longford Hospital ceased to be a sanatorium; Dr Easton moved to an appointment in Scotland; and mentally handicapped women and girls were moved from St. Mary's to Longford, leaving more and better accommodation for the men; Longford Hospital was thereafter managed in conjunction with Whitecroft and the consultants there were in charge of the patients.

The senior medical staff were at the time of the take-over few in number compared with modern times. There were three Consultant Surgeons, and one Orthopaedic Surgeon who was graded at first as a Senior Hospital Medical Officer, - becoming a Consultant later; he had at the start the support of a Senior Orthopaedic Consultant, Mr. Ellis who took the place of Mr. Langston and who visited Ryde Hospital at first fortnightly and later at longer intervals; and later again the Consultant in post, Mr. E. Smythe had the help of a senior assistant.

The three surgeons were Mr. Leisching who before 1948 had concerned himself especially with Orthopaedic surgery, and had organised a mobile physiotherapy unit: Mr. F. Wilson Harlow, author of a textbook on Surgery For Nurses, well known and widely used for a time: and Mr. Gaynor who like his colleagues worked at both general hospitals but also had a particular association with Shanklin Cottage Hospital; he died in the early years of the N.H.S. and his place was taken by Mr. V. Gordon Walker.

Dr V. Clark and Dr Phoebe Harvey were the consultant anaesthetists and several G.P.s provided additional sessions, in particular Dr Bruce, Dr John Mackett, and Dr Hooker.

There were two physicians who shared the work at Ryde and St. Mary's; the need for an additional physician was soon recognised, but it was not until 1950 that Dr J.C. Harland was appointed. Arriving on the Island, he was almost immediately summoned to the Obstetric Ward at St. Mary's, being the only consultant available on the Island at that time to assist in a difficult delivery -the Consultant Obstetrician being temporarily at sea (literally); a somewhat unexpected and possibly embarrassing baptism; but with the help and support of the ward sister, a highly experienced midwife, a happy outcome was achieved. Dr Harland like the other physicians worked at both hospitals but tended to do more at St. Mary's and there also for some years he had charge of a large number of chronic sick patients in the Lower Hospital. Dr Dockray and Dr Firman-Edwards also worked at both hospitals; it has been said that they were reluctant to work at what had been the Infirmary, but I think this is quite untrue and unfair; both practised in Ryde and had worked at the hospital there for many years and for that and other reasons they tended to continue working more there than at Newport, but certainly both of them had patients at Newport and were perfectly ready to do their share of work there.

At Ventnor, Dr Miller besides being Superintendent was Consultant Chest Physician for the Island; he had access, if needed, to a couple of beds in St. Mary's, and he supervised the work at Longford visiting there weekly so long as it remained a Tuberculosis sanatorium. He had one senior assistant and two resident juniors, - another was added when more surgery was tackled.

At Whitecroft Dr Gordon Brown had a Deputy Superintendent, Dr Wood who had been there from about 1932, and one junior. Dr Davies-Jones who was the retired Superintendent for a time did a few out-patient sessions chiefly with children. Dr Gordon Brown was the Consultant Psychiatrist for the Island as had been his predecessors.

Mr. O'Donoghue was the Obstetrician and Gynaecologist, working at St. Mary's. Dr Barker had been Radiologist for several years before the N.H.S. and was now appointed the full-time Consultant Radiologist for the Island. Mr. Heckford also had been on the Island a long time, being Consultant Ophthalmic Surgeon since 1931, but the Island had not until now had a resident Consultant E.N.T. Surgeon and Mr. Philip Grimaldi was appointed to that post. Dr Thornton and Dr Darmady had been Visiting Consultant Pathologists since before the war, Dr Thornton retired soon after the war and Dr Darmady became Director of Pathology at Portsmouth, the service there incorporating the Pathology services for the Island where Dr Dobson was appointed a Consultant Pathologist; he covered the work at Ventnor also, visiting there once a week, and a technician was appointed at Ventnor; there were of course a number of technicians at Ryde laboratory and a small laboratory was opened at St. Mary's.

Resident staff were also few compared with later years. At Ryde there were at first two residents, H.S. and H.P., who had between them to cover the Casualty department and each other's time off duty. Before long a second H.S. was added for the duties in the Orthopaedic Wards and Casualty Department.

At Newport similarly a House Surgeon and a House Physician were later supplemented by an Obstetric House Surgeon and a casualty House Surgeon.

In 1951 the H.M.C. decreed that an H.P. or H.S. should have one half day a week off duty and one weekend in three off from 4 p.m. on Friday to Sunday (presumably in practice Monday morning). One must suppose that at that time there was no national or regional standard; no doubt other hospital groups also regarded this as an adequate arrangement and it is only fair to acknowledge that demands were very much less heavy in those days.

In the cottage hospitals General Practitioners in the locality provided a service and worked a duty rota so that one was always available if needed; some casualties were treated at the Frank James Hospital. In return for their services G.P.s had the right to admit patients to the beds in his hospital; later each of them was used to supplement, especially, the surgical services of the general hospitals.

At Frank James Hospital G.P.s and Consultants did regular operating sessions and later for a time there was a session in Orthopaedic surgery and in Gynaecology; and at Shanklin, the E.N.T. Consultant did a regular list of tonsillectomies and one of the practitioners functioning first as a Clinical Assistant and later as a Medical Assistant did a list of general surgery.

The Obstetric service was developed at St. Mary's; here the move of the chronic sick patients from the Infirmary to the Lower Hospital liberated some space for other things and Gynaecological and Obstetric wards were quickly set up in block A; in the course of time the upper floor came to be purely for Gynaecology and the lower floor for Midwifery. The small ward - Carisbrooke Ward - which had been previously the Obstetric Ward was after this used for various purposes. The Obstetric accommodation was increased to 35 which permitted the establishment of a school for midwifery. So early as 1949 there was a call for an Obstetric Flying Squad, but this was never established. In 1952 the Consultant Obstetrician, Mr. O'Donoghue, and the local Medical Committee agreed in principle that a General Practitioner wing at St. Mary's, independent of the Midwifery Training School, but under the general supervision of the consultant, should be set up; but this did not get further at the time and several years later in 1959 it was again recommended, but without any immediate action. The accommodation for midwifery was always regarded as somewhat unsatisfactory; among other difficulties all the traffic from the surgical wards to the theatre and back had to pass through this department. In 1964 Mr. O'Donoghue retired and later Mr. W. Edwards was appointed Obstetrician and Gynaecologist, but it was still a decade before the large new Obstetric Department was opened at St. Mary's.

The Orthopaedic surgery services were from the start naturally associated with the Casualty Department, and this had initially, both at Ryde and at Newport, to share common accommodation with the Out-patient Department.

By 1954 there was a full-time consultant in Orthopaedic Surgery and the department then and ever since has maintained an association with the Lord Mayor Treloar Hospital at Alton. In 1954 a Casualty House Surgeon was appointed at Ryde who would also serve in the Orthopaedic Ward. Later, a second Assistant Casualty Officer was appointed to the staff. The Orthopaedic beds were on the upper floors at Ryde, and later wholly in Beatrice Ward which was in two parts, one for men and one for ladies and was conveniently close to the theatre; but in the second half of the 1950s especially there was repeated call for more Orthopaedic accommodation, and along with this for more physiotherapy and more sessions by the Physical Medicine Consultant, Dr Saville, who came over from Portsmouth; and also for a Rehabilitation Unit and a Department of Daily Living. The shortage of beds was eased for a time by the transfer of a number of convalescent orthopaedic patients to the R.N.H. at Ventnor where, surgical sessions being ended by the close of 1958, there were now beds readily available.

Another arrangement was to borrow a few beds in the Military Hospital at Albany Barracks close to St. Mary's Hospital and this was organised by the Regional Board. Despite these measures at the end of 1961 most orthopaedic patients waited more than a year for their planned operation and many more than two years; it was arranged that extra operating sessions each week should be worked at the Frank James Hospital and also Shanklin Cottage Hospital; more beds were made available at each of these hospitals; and after six months a considerable improvement had been achieved and 24 extra operating sessions had been carried out at the Frank James Hospital; the waiting list was reduced from 189 to 109.

During most of this phase of the N.H.S., Casualty Departments functioned both at Ryde and at St. Mary's; at Ryde a new Out-patient Department was built very early on in the Health Service and improvements were made in the layout of the Casualty Department. In St. Mary's the two departments continued to have a common entrance, but in the 1960s additional building provided a new Out-patient waiting hall and three new sets of consulting rooms. Apart from considerations of space, shortage of staff made the casualty service difficult to maintain and in 1970 at St. Mary's it had for some time to be closed at the weekends and at night, and operate only in 'office hours', that is from 8 a.m. to 6 p.m. on five days a week.

It was in association with the Orthopaedic and Physical Medicine Departments that a school for spastic and other disabled children was started and was housed in the building immediately opposite the Forest Road which had formerly been first a porter's lodge and reception wards and later provided accommodation for a bailiff and others; it now became known as Forest Side School and flourished for several years; the construction of the relief road at the approach from Cowes to Newport involved the loss of land at the south-west corner of the hospital estate, a good part of which had been known as the cricket ground, and also the demolition of this building and the cultivated land immediately around it. The school moved, after consideration, to Watergate, and to the disappointment of the hospital service lost its connection with St. Mary's. The H.M.C. was moved to express its regret that at the opening of the new school at Watergate no representative of the Health Service was invited.

About the same time a hostel for handicapped children, Castle View, was opened close to Polars Blind Home on Staplers.

In 1973 a second Consultant in Orthopaedic Surgery, Mr. de Belder was appointed.

Victoria Ward at Ryde was to remain for the whole of the 26 years of the H.M.C.'s existence the principal, - and indeed almost the only ward available for children; at the beginning of this time, i.e. the start of the Health Service, Paediatrics was becoming a speciality, although it was a decade before any specialist Paediatrician was to be resident on the Island. In 1951 it was agreed that children admitted to Ryde would be under the care of Dr E. Firman-Edwards, and that Dr Moseley, Paediatrician at Portsmouth, would visit regularly to give advice or to take over a patient when necessary. Visiting was to be allowed every evening for child patients - at first as a trial for six months.

In 1958 Victoria Ward had to be closed for alterations; children with acute illnesses were then to be admitted when necessary to the medical wards at Ryde or Newport. Later in that year Dr Firman-Edwards retired, and Dr Miller became the first children's specialist to reside on the Island; he shared the duties with Dr Moseley and he also stood in for him at Portsmouth and did a session there; this was in addition to his work as a General Physician. The separation of the Children's Ward from the Obstetric Department was repeatedly deplored through these years, but it remained so until a later phase in the hospital's life. This was one aspect of the disadvantages of two general hospitals on the Island where there was really only scope for one. The two Consultant Physicians on the Island were heard to say that the only time they met each other was on Wootton Bridge when one was travelling from Ryde to Newport and the other from Newport to Ryde.

The Act of 1948 had imposed upon county councils the obligation to provide residential accommodation for old people in need of care, but not in need of hospital nursing; this provision was specified in Part Three of the Act and hence the homes came to be known, - and are often still known - as Part Three Homes. Several such homes were set up on the Island over the years, the first one being St. Lawrence Dene and Underwath; others followed - Inver House in Bembridge, Elmdon in Shanklin, Osborne Cottage in East Cowes, possibly the only Part Three Home in the country established in what had formerly been the regular residence of members of the Royal Family, Polars in Newport where a home for the blind was also provided; and later Steephill House in St. Lawrence formerly the nurses home of the R.N.H., and the Gouldings in Freshwater. Patients suitable for such homes were gradually moved from St. Mary's and from Whitecroft to the homes which of course took residents from the general population also. When this was done there was still a large group of old people left in St. Mary's, and in Whitecroft, who were not ill in any way that, in the state of medicine at that time,was thought likely to benefit from the services of a Consultant Surgeon or Physician, but who did need nursing care; that is, more care than could be expected at a residential home.

Such patients, recruited from the general population on the recommendation of their General Practitioners, or from the medical and surgical wards of the general hospitals, having been admitted to these general wards and thereafter failing to recover sufficiently to be discharged, made up here as elsewhere a large proportion of the whole hospital population. They came to occupy what was remembered by the Island population as the Workhouse, now known as the Lower Hospital, where there were four large wards for them, to these, later, was added one ward at Fairlee no longer needed for infectious diseases.

Among these patients ladies always outnumbered men by more than two to one; they were under the supervision of a Consultant Physician and in general it was not expected that they would be discharged, - although a few made sufficient progress to be transferred to their homes. These wards also included a number of younger patients, more or less severely disabled with incurable illnesses such as Multiple Sclerosis, severe Rheumatoid Arthritis and other long lasting illnesses. For these unfortunate patients who needed comprehensive nursing, there was for many years no better provision. When the writer took over the Geriatric service in 1963 there were still about 10% of 160 beds occupied by such young patients all under 60, and some of them still in their 30s.

In 1951 the Medical Advisory Committee urged that Physiotherapy and Almoning services for these chronic sick should be improved; and that the use of the garrets (i.e. the top floor) for patients should cease and that better arrangements for admission and discharge to Part Three Homes should be made. By 1952 still 18 patients considered suitable for Part Three Homes remained in St. Mary's where the wards remained full.

A large proportion of the whole number of these people suffered from what is now called, - or sometimes miscalled, - Alzheimer's Disease. The same was true of many of the older patients in Whitecroft Hospital. Such patients all over the country had tended to accumulate in hospitals or infirmaries and mental hospitals run by the county councils and were the cause of the indifferent reputation which these hospitals tended to have, always the poor relations of the voluntary hospitals; and that was because they had, without choice, to accept such patients. The Geriatric service, - inchoate at the time of origin of the N.H.S. - was gradually accepted by the administration of the N.H.S. and slowly brought about some improvement, so that in later years to an increasing extent it would be recognised that a proportion at least of the aged could be treated successfully and discharged and that measures to prevent premature invalidity were possible and worthwhile.

Here the Geriatric service began in 1961, when Dr Penman was appointed after the death of Dr Dockray; he was directed to initiate a service, having at the same time a share of the general medical work and doing his stint of dealing with medical emergencies; there was at that time still only one H.P. at St. Mary's to deal with all the medical cases and all patients in the Lower Hospital; moreover Physiotherapy and Occupational Therapy services in the Lower Hospital were extremely slender for many years to come. Dr Penman soon produced a report upon the wards and staff showing how much more could be used; but it was not until he had moved on, that a second House Physician was appointed and several years later the House Physician's job in the Geriatric Department became the first component of a two year appointment, which also included work in the Paediatric, Obstetric and Psychiatric divisions. The Geriatric wards were 'upgraded' and improved and a new reception ward was built (see below) and in time further additions of staff came about.

The Ophthalmic Department and the E.N.T. Department remained at the County Hospital although clinics were held at Newport; and Mr. Philip Grimaldi operated regularly at Shanklin Cottage Hospital and Dr Crosskey for a time did a regular session of Tonsillectomies at the Frank James Hospital.

Dental surgery had been available at both hospitals before the N.H.S. and it continued to be so, though reading through the minutes one cannot but feel that the Department of Dentistry was rather pushed around with many changes of location.

Nursing staff at Ryde did not have to undergo any major re-arrangement after the start of the Health Service; the King George VI Nurses Home had been opened just before the war and a Nurse Training School had been initiated also before the war. There were problems about accommodation for student nurses.

Two houses were involved, - the Towers in Partlands Avenue which was leased and was in use in July 1948 and which, at that time and for a while afterwards, the H.M.C. sought to purchase; agreement with the proprietors could not be reached and there was talk of compulsory purchase; however in 1950 it was decided to give up the Towers and a lease was obtained of St. Wilfred's, a house somewhat further away from the hospital, though not very far, which was to be used as a residence. Victor House in Partlands Avenue had been purchased before 1948 by the hospital and £5,000 of the total sum of £15,000 had been paid and this served as the actual training school.

St. Mary's Hospital was now to develop into a general hospital. In 1948 there had been 17 nurses there plus a number of nursing orderlies; by April 1952 there were 82 nurses, although 10 fewer nursing orderlies. Miss Roker was the first Matron, in office on the appointed day; she was succeeded by Miss Cooper, and in 1952 by Miss Sylvia White who continued until 1969, the last Matron of St. Mary's. In 1949 a training school for State Enrolled Nurses was opened and in 1950 in a report the King Edward Fund commented that St. Mary's gave exceptionally good opportunities for the training of assistant nurses.

Shortage of nurses was a problem from time to time in every hospital. In 1952 the appointment of non-resident nurses was encouraged, since there was a lack of residential accommodation, but student nurses were required to remain resident.

Before the Health Service ward orderlies had been appointed when nurses were not available; again in 1963 nursing auxiliaries filled the gap and made up 25% of nursing staff in the region; a plan for their duties and instruction was issued; introductory talks included those on courtesy, taking messages, and relationship with trained nurses and others, - an echo perhaps of 1849. In 1955 the G.N.C. had approved of the association of the R.N.H. and Ryde for nurse training; one year was to be spent at the R.N.H. and two at Ryde.

Numbers both of patients and nurses at the R.N.H. were dwindling soon after this and the number of nurses involved in this training was small; nevertheless some of them achieved an excellent record and high positions in the nursing world. In 1961 a further report from the G.N.C. confirmed the continuation of nursing schools at Ryde, St. Mary's and Whitecroft with various recommendations. Fairlee Hospital was to participate in the training, but not the Cottage Hospitals or Longford.

The appointment of 10 additional nurses in 1953 within the group was approved, but their salaries had to come from the existing allotment! And in 1960 the H.M.C. again sought a substantial increase in the senior nursing staff in the group by 9 sisters and 7 staff nurses.

In 1965 the appointment of a Group Tutor was recommended and the training of nurses was to be carried on at St. Mary's, Ryde and in the acute wards at Whitecroft.

Another nurses' home was built about 1966 and in 1969 a new Nurse Training School built at St. Mary's was opened by the Governor of the Island, Lord Louis Mountbatten. The year before this the Isle of Wight Society of Nurses had been founded.

Meanwhile, the whole system of nursing administration in the Health Service had been altered by the introduction of the 'Salmon Scheme'. In 1967 the H.M.C. agreed that the Island should be chosen as a group for a trial of this scheme. However, by the time the trial got under way, it was already quite apparent to the medical and nursing professions that the scheme was to be implemented nationally, and the outcome of the trial was a foregone conclusion. When the necessary changes in the nursing administration locally were expounded to the Medical Advisory Committee by the Group Secretary it is fair to comment that, when the question was put 'Is the success of this trial already established in the minds of those who are judging it?, the diplomatic answer was 'Naturally we should not embark upon a trial of this nature if we did not expect it to succeed'.

It is perhaps of some interest to give figures of the cost of the hospital service at the beginning and the end of this phase, a period of about 25 years.

I give here a brief summary of the figures for the first full year 1949-50 and the last 1973-74. These were the estimates agreed upon and submitted by the treasurer to the H.M.C. We have to remember that the value of money changed considerably during this period; according to Whitaker's Almanac the purchasing power of the pound in your pocket declined by about two thirds between 1949 and 1974 and it has declined about a further five fold since then so that a pound in 1949 would have bought approximately what £15 buys now or what 13 bought in 1973.

Table 2. Annual Expenditure

Item 1949-1950 1973-1974
Medical Salaries 4,031* 58,200*
Nursing Salaries 74,107 960,400
All other Salaries 13,425 71,300
Drugs, Dressing & Appliances 16,814 157,750
Provisions 42,207 122,000
Fuel, Light, Power & Water 22,368 94,600
Rates & Rent 29,700 45,200
Uniforms & Clothing 4,928 16,100
Laundry & Cleaning 2,116 16,750
Total (including items not tabulated above) 308,419 2,471,400

* The salaries of doctors above the rank of House-man and SHO were paid by the Regional Board, not the H.M.C.