243
Royal Society of Health Journal
DECEMBER 1978
VOLUME98N06
PROBLEM DRINKERS KESSEL Committee describe their report on Pattern and Range of Services for Problem Drinkers’ as &dquo;a modest and gradual approach&dquo;. This is the second report to have been produced by the Department of Health and Social Security Advisory Committee on Alcoholism and, as its predecessor did on the subject of prevention, the present document presents a thorough and workman-like review of the services available for problem drinkers. At the same time, however, its recommendations for future development are hardly likely to raise an outcry; indeed, it would be surprising if they raised so much as
HE
, ‘The
an
eyebrow.
The report has two principal themes: co-ordination of services and the early identification of problem drinkers. It recognizes that the present pattern of services is patchy and irregular, comprising, as it does in most areas, an ill-organized hotch-potch of statutory and voluntary bodies with disparate and, from time to time, incompatible aims. That this range of services requires to be co-ordinated is indeed a truism that few people involved in the alcoholism field would gainsay. The issue which has to be addressed is, therefore, how this miracle of co-ordination is to be achieved. They make a promising start, the Kessel Committee, by dividing treatment agencies into primary and secondary levels. Primary level workers are those whose responsibilities are of a general and non-specialized nature, they include members of the primary health care team, personal social services and voluntary workers from a wide range of bodies. Secondary level workers are those with special responsibilities for dealing with problem drinkers and, one would hope, special training in the knowledge and skills actually required, although this is perhaps less often the case than the Kessel Committee suggest. In any case, secondary level workers are either professional staff, such as psychiatrists and specialist social workers, or voluntary workers such as counsellors at local councils on alcoholism. This split of workers into primary and secondary, whilst hardly of startling originality in health services generally, is indeed a more rational approach to alcoholism services than those involved in the delivery of the services have been prepared to opt of their own volition. Similarly, the emphasis which the Kessel Committee place upon the crucial role of the primary level workers to identify and to provide substantial help for problem drinkers is a welcome recognition of the inevitability of more comprehensive service provision, if indeed alcoholism treatment is ever to do more than paper over the cracks. It is here too that the second major theme, that of early identification, is most persuasively argued. There can be no doubt that drinking
problems are
far
more
likely to be
resolved where
they
are recognized early and countered with effective treatment. Clearly, it will usually be the generalist (and
inevitably one is thinking here particularly of the primary health care team) rather than the remote ethanologist who is more likely to be the first point of contact for somebody whose drinking is beginning to cause them problems. Perhaps it is not the function of reports of advisory committees to excite their readers. One might have wished, however, for something to set the heart racing just a little over the central problem of how these neatly rationalized services are actually to be co-ordinated in practice. We are assured that this will vary according to local circumstances. It would have been encouraging to gain the impression that these variations would cluster firm model which the Kessel Committee least, backed to win. Instead, their approach is so modest and so gradual that it is always going to be difficult to know which development they have stimulated and which they have merely reflected. around
had,
some
at the very
DOCTOR MANPOWER 1975-2000
by the Royal Commission UBLISHED Health Service with the
the of JL ’stimulating and informing public discussion’ Doctor Manpower 1975-2000 - alternative forecasts and their resource implications examines in its first section the structure of the available medical manpower: the intake of medical schools, the choice of a career, the increasing proportion of women doctors, and immigration and emigration. In this section the authors, Alan Maynard and Arthur Walker, two economists of the University of York, are on firm factual ground, and if their jargon is penetrated, have provided a useful collection of information. The second and third sections are concerned with forecasting first the desirable and then the possible developments. The authors state that: ’The market for doctors is dynamic and responsive to policy changes. Consequently the interactions between supply and
National
on
object
Royal Society of Health Journal
DECEMBER 1978
VOLUME98N06
PROBLEM DRINKERS KESSEL Committee describe their report on Pattern and Range of Services for Problem Drinkers’ as &dquo;a modest and gradual approach&dquo;. This is the second report to have been produced by the Department of Health and Social Security Advisory Committee on Alcoholism and, as its predecessor did on the subject of prevention, the present document presents a thorough and workman-like review of the services available for problem drinkers. At the same time, however, its recommendations for future development are hardly likely to raise an outcry; indeed, it would be surprising if they raised so much as
HE
, ‘The
an
eyebrow.
The report has two principal themes: co-ordination of services and the early identification of problem drinkers. It recognizes that the present pattern of services is patchy and irregular, comprising, as it does in most areas, an ill-organized hotch-potch of statutory and voluntary bodies with disparate and, from time to time, incompatible aims. That this range of services requires to be co-ordinated is indeed a truism that few people involved in the alcoholism field would gainsay. The issue which has to be addressed is, therefore, how this miracle of co-ordination is to be achieved. They make a promising start, the Kessel Committee, by dividing treatment agencies into primary and secondary levels. Primary level workers are those whose responsibilities are of a general and non-specialized nature, they include members of the primary health care team, personal social services and voluntary workers from a wide range of bodies. Secondary level workers are those with special responsibilities for dealing with problem drinkers and, one would hope, special training in the knowledge and skills actually required, although this is perhaps less often the case than the Kessel Committee suggest. In any case, secondary level workers are either professional staff, such as psychiatrists and specialist social workers, or voluntary workers such as counsellors at local councils on alcoholism. This split of workers into primary and secondary, whilst hardly of startling originality in health services generally, is indeed a more rational approach to alcoholism services than those involved in the delivery of the services have been prepared to opt of their own volition. Similarly, the emphasis which the Kessel Committee place upon the crucial role of the primary level workers to identify and to provide substantial help for problem drinkers is a welcome recognition of the inevitability of more comprehensive service provision, if indeed alcoholism treatment is ever to do more than paper over the cracks. It is here too that the second major theme, that of early identification, is most persuasively argued. There can be no doubt that drinking
problems are
far
more
likely to be
resolved where
they
are recognized early and countered with effective treatment. Clearly, it will usually be the generalist (and
inevitably one is thinking here particularly of the primary health care team) rather than the remote ethanologist who is more likely to be the first point of contact for somebody whose drinking is beginning to cause them problems. Perhaps it is not the function of reports of advisory committees to excite their readers. One might have wished, however, for something to set the heart racing just a little over the central problem of how these neatly rationalized services are actually to be co-ordinated in practice. We are assured that this will vary according to local circumstances. It would have been encouraging to gain the impression that these variations would cluster firm model which the Kessel Committee least, backed to win. Instead, their approach is so modest and so gradual that it is always going to be difficult to know which development they have stimulated and which they have merely reflected. around
had,
some
at the very
DOCTOR MANPOWER 1975-2000
by the Royal Commission UBLISHED Health Service with the
the of JL ’stimulating and informing public discussion’ Doctor Manpower 1975-2000 - alternative forecasts and their resource implications examines in its first section the structure of the available medical manpower: the intake of medical schools, the choice of a career, the increasing proportion of women doctors, and immigration and emigration. In this section the authors, Alan Maynard and Arthur Walker, two economists of the University of York, are on firm factual ground, and if their jargon is penetrated, have provided a useful collection of information. The second and third sections are concerned with forecasting first the desirable and then the possible developments. The authors state that: ’The market for doctors is dynamic and responsive to policy changes. Consequently the interactions between supply and
National
on
object
