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In total, 40% of the deaths of patients with learning disabilities have been classed as avoidable, and there is a known increased risk of harm while inpatients in hospital. This paper aims to look at the current experiences and treatment of people with learning disabilities within a general hospital setting to examine factors that affect their care.

A comprehensive literature search was conducted of primary research between 2013 and 2019 to evaluate what is known about the quality of care and treatment that learning disabled patients experience within a general hospital.

The research suggests that people with learning disabilities receive haphazard care in hospital settings, with inconsistent implementation of reasonable adjustments, insufficient arrangements to support family and other carer input, and poor knowledge of learning disability amongst hospital staff.

Previously, reviews focussing on hospital care have mainly focussed on access to health care rather than its delivery. This review has found evidence of significant failings in delivering care to this patient group, identifying a gap of knowledge in this field regardless of policies and laws already in place. There should be stricter monitoring of the Equality Act’s enforcement, along with improved and mandatory training for all general health-care staff. It is crucial that health-care professionals learn from mistakes to improve the care and experiences of learning disabled inpatients.

The purpose of this paper is to provide a commentary on Durrant’s paper “Factors influencing the quality of care learning disabled patients receive in hospital”.

The commentary identifies examples of practice in acute hospital provision consistent with the themes outlined in Durrant’s paper.

The themes identified in Durrant’s paper are easily recognisable. At the same time, there is a need to more fully understand the complexity of acute hospitals and to involve mainstream health-care staff in development and delivery of training on learning disability. Consideration should be given to the development of new specialist roles.

The commentary provides a practice perspective arising from wide clinical experience.

Returning now to the food and drug law itself, for an additional explanation of it. This law is broadly divided into two regulatory parts ; but they each have a common protective purpose, which has been defined. The first part of this law is a basic one just indicated. For it is a law to prohibit an injurious or deceitful adulteration, misbranding and false advertisement of all food and drugs ; and its last prohibition was added in the twentieth century, when the art of modern commercial advertising was developed. The major statute of this law is of course the 1938 Federal Food, Drug and Cosmetic Act, which is practically administered by the United States Food and Drug Administration ; and it has the supreme importance of being our national law to outlaw any food or drug that may kill or harm.

Chemistry as an applied science suffers from the fact that its necessarily close connection with various branches of industry is ill defined and generally very unsatisfactory in character. One result of this is that those who have made chemistry their profession find themselves more often than not in the position of having to subordinate their professional instincts to the temporary exigencies of some particular branch of trade and to find their professional status called in question and criticised by those who are not in the profession itself and who have no right to criticise.

THIS issue of The Library World marks the commencement of a new volume, and we take the opportunity of thanking our many readers for their continued good feeling and support. It is a pleasure to us to record the fact that we are able to enlarge this initial number of the volume and that we feel the time has come when we shall make such enlargement a permanency, without any corresponding increase in the subscription price.

The Conference to be held in London from 20th to 23rd September, 1960, to celebrate the centenary of the “Act for preventing the Adulteration of Articles of Food and Drink” promises to be an auspicious occasion. The celebrations are being sponsored by appropriate Government departments of England and Wales, Scotland and Northern Ireland and by the various professional bodies concerned. The fullest support of the Food Manufacturers' Federation is also being given to it. The proceedings are to open with a reception given by Her Majesty's Government at Lancaster House on 20th September and during the conference, which will be held at the Royal Institution of Great Britain, meetings, lectures, an exhibition and laboratory visits will demonstrate the progress made in the past 100 years and “show the part which the food chemist plays in improving the quality of food and providing better nutrition and better health.” We trust, however, that the part played by the food chemist will not be allowed to completely overshadow what others have done towards providing a pure food supply for the people. Not all of the chemists' activities have been to this end; the chemical “sophistication” of food in fact constitutes a serious problem.

The Medical Research Council's Committee has issued its Second Report on Hazards to Man of Nuclear and Allied Radiations. From time to time we report on the monitoring of foods for radioactive substances, mainly Strontium 90, by the laboratories of the Agricultural Research Council and a few local authorities. The “maximum permissible levels” of radiation for individuals to which these measurements are related are those contained in the Committee's First Report (1956). Since this much work has been done making increasing numbers of measurements. In particular, background radiation from natural sources has been measured in detail. This constitutes the largest dose of radiation to the ordinary population—an average annual doserate in millirads in the range of 85 to 106. In comparison, radiation from its increased use in modern life and also from radioactive fall‐out is extremely small. Medical radiological procedures, after a nation‐wide survey of hazards to patients, are not so important as was first believed, but nonetheless contribute a larger dose than any other source of man‐made radiation, approximately 19 millirads per annum. The Adrian Committee, which conducted the review of radiological practice, considered that the dose could be reduced to 6 mr., without curtailment of radiological services.

The outbreak of typhoid fever which had been traced to a “carrier” of the fever germs may be given as a reason for the following note on the regulations relating to the manufacture of ice cream. This brief re‐statement of the regulations will serve to indicate the nature of the control exercised by the health authorities over a widely spread trade. It need hardly be pointed out that cream in the usually accepted sense of that term or its substitute containing a certain proportion of milk powder or skim milk is peculiarly liable to act as an agent in the dissemination of certain types of disease. “New regulations, the “Ice Cream (Heat Treatment) Regulations, 1946,” at present in draft, but operative from May 1st, 1947, deal with the sterilisation of the raw material and the retail sale in the finished and frozen state. Registration of premises, inspection by the local authority, combined with the goodwill of the trade, are obvious safeguards. The term “ice cream” possibly suggests to the average consumer a frozen mixture of cream—as that word is usually understood to mean—flavoured with the fresh juice or fresh‐fruit pulp of the name fruit. Such a mixture, if made from wholesome materials under hygienic conditions, would be a good, palatable luxury, and from the nature of the case seasonal. Most of us at some December midnight have had something called strawberry ice. The name stands, but the composition is rather a matter for speculation by the uninitiated. The term “cream” has been for many years applied to substances which though wholesome in themselves are not cream—vegetable fats, milk powder and the like—but they form the basis, so to speak, either in whole or in part of ice cream. There is in fact no official standard to define what is meant by ice cream, and the definition which we have ventured to offer must obviously be extended to apply to a large number of substances that do not of necessity consist either partly, still less wholly, of cream or of any substance whose origin is to be found in fruit of any kind. Ice cream, in fact, is a substance whose composition it seems may vary within wide and undefined limits. Thus the Ice Cream (Prohibition of the Manufacture and Sales) Order, 1942, says “‘Ice cream’ includes water ices.” The Ice Cream Transport Order (No. 305, March 22nd, 1945), prohibiting the export of ice cream to Great Britain from Northern Ireland, says: “Ice cream includes water ices and any article, whether frozen or chilled, and under whatever description it is sold, which is sufficiently similar to ice cream as to constitute a substitute for ice cream.” The statements just quoted seem to imply that ice cream may be made of almost anything as long as price, temperature and taste suit the requirements of the consumer. However, our concern is less to do with its composition as with regulations that have to do with the hygienic requirements of its manufacture. It may be pointed out that as things stand at present registration relates to premises and not to persons employed therein. Anyone can be employed in an ice cream factory, as he can be employed in any other kind of food factory. The matter of engaging him is left to the heads of the factory. They, as commonsense business people, with the interests of their business at heart, are not likely to engage anyone who is at sight obviously unfitted for the job. On the other hand, habits and health, especially the latter, become of peculiar importance when such a substance as ice cream is the object of manufacture. To make regulations as to the registration and inspection of premises, is one thing. It is not too easy to enforce such regulations. In the case of persons it is more delicate and difficult. If the offence be of habit it can be readily detected and dealt with. If of health, it becomes a matter for the Medical Officer of Health and his professional colleagues. Under Section 14 of the Food and Drugs Act, 1938, which came into force on October 1st, 1939, all premises in which ice cream is sold, manufactured, or stored must be registered with the local authority. The purpose for which registration is sought—sale, storage, or manufacture—must be stated, and also the nature of other business, if any, that may be carried on on the premises. If the premises appear to the local authority to be unsuitable, registration may be refused, or, if previously granted, may be cancelled. Notice of the refusal to register, or to cancel registration, must be served on the applicant or tenant of the premises by the local authority, giving reasons for the act, and the applicant or tenant may then, if he wishes, request the local authority to show cause, for the reasons given by them, why they should refuse to register or wish to cancel registration.” It need hardly be pointed out that the sole reason for registration is to enable the local authority to satisfy themselves that hygienic conditions are complied with, such as cleanliness, light, ventilation, adequate water supply and sanitation in general. Though the conditions may be complied with there is still the more serious danger that may arise from “milk‐borne diseases,” a danger that is admittedly peculiarly acute when such a substance as ice cream is the subject of manufacture or storage. The Medical Officer of Health must therefore be informed by the manufacturer if any milk‐borne disease has occurred among persons living or working in or about the premises. We may hazard the guess that it may not always be easy for the manufacturer to obtain such certain knowledge. “Milk‐borne disease” means enteric fever (including typhoid or paratyphoid), dysentery, diphtheria, scarlet fever, acute inflammation of the throat, gastro‐enteritis, and undulant fever—a formidable list—and any other disease that may be declared milk‐borne by the Minister of Health. With the best will in the world on the part of everybody concerned the enforcement of this Order, and there can be obviously no half measures in doing so, presents difficulties that can only be adequately appreciated and discussed by medical practitioners who are conversant with the nature of the disease in general and with the particular conditions that led to its occurrence. Apart, however, from its purely medical aspect, and if we consider the manufacturer we find that if he has done his duty in this respect he may have his business brought to a standstill, or at least a part or even the whole of his stock destroyed. The Medical Officer of Health is very rightly empowered, in the interests of public health, which override all other considerations, to prohibit the use for human consumption of any substance likely to convey milk‐borne disease and to order either its removal or its destruction. Compensation can be paid to the manufacturer if the Medical Officer of Health, after further enquiry, be satisfied that the suspected substance is not injurious. His notice for destruction or removal must then be withdrawn. On the other hand, compensation will not be paid if the suspected substance was actually injurious, or was made on the premises while the order of the Medical Officer was still in force. If a person feels aggrieved by the decision of the local authority he may appeal to a court of summary jurisdiction. Any change in the occupation of registered premises must be notified to the local authority by the ingoing tenant if he intends to use such premises for the purpose for which they were registered. If at the commencement of the Act of 1938 a local Act was in force dealing with the conditions for registration of premises it may remain in force unless the Minister, at the request of the local authority, declares the 1938 Act, 14 (1), to be in place of it. The use of unregistered premises renders the offender liable to a fine not exceeding £20, and for a second offence a maximum penalty of £100 and for three months imprisonment. Every street seller of ice cream must have his name and address on the barrow or container. It may be added that hotels, clubs and inns are exempt from registration, and theatres, music halls and the like are also exempt unless they manufacture ice cream on the premises. The Order of 1942 prohibited the manufacture of ice cream in catering establishments or in institutions, meaning by these terms premises previously authorised to do so by licence from the Ministry of Food or by a Food Control Committee. Institutions or households were exempt from this Order if the ice cream manufactured was to be consumed on the premises. This Order was rescinded by an Order of November 16th, 1944, and manufacture was resumed from that date. This was certainly not due to any marked increase in the milk supply. The trade demand was and is at least in part met by a permitted substitute.

In view of the Regulations issued on October 4, 1906, by the Argentine Government with regard to the sanitary inspection of meat foods, the Local Government Board, at the request of the Foreign Office, have formulated a number of conditions to be complied with by traders in England and Wales who prepare or pack meat foods for export to Argentina, and who desire that such exportations should be accompanied by an official attestation of precautions taken to safeguard the wholesomeness of the foods in question.