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Total Quality Management is becoming widely known in health care organisations, and one health authority′s methods of setting up such a scheme is explored. All departments and units were canvassed by letter to contribute ideas and suggestions, and subsequently programmes and agendas were established to implement these.

There are considerable differences between the USA and the UK in terms of the practice of in‐patient care, particularly in the use of restraint. The American legal system defines restraint in terms of physical, mechanical, and chemical restraints, of which only physical and chemical restraints are routinely used in the UK. There is a need to agree a standard definition of restraint as it is used in the UK, which may be valuable as one proxy for quality. Such information would enable nurses to make appropriate use of the published literature, make valid comparisons within and between institutions, and provide evidence about the kind of nursing education and nursing practice development needed to produce quality patient care.

Examines the developing importance of the quality issue in the service sector and highlights common barriers to the successful implementation of total quality management principles (TQM). Such information provides managers in complex service organizations such as the National Health Service (NHS) with valuable lessons for improving quality standards. Illustrates how TQM principles could and in a few cases are already being applied to the NHS in the light of the 1989 Government proposals for reform. Such efforts are in the early stages of development and therefore guidelines are proposed to assist management in sensitive areas for implementing change.

THE Woolwich Borough Council have made the retirement of Dr. Baker from the post of Borough Librarian the opportunity of adopting the reactionary policy of dividing the Woolwich library system into three independent parts. They do not propose to fill Dr. Baker's post, and have made three members of the staff librarians‐in‐charge of the Woolwich, Eltham, and Plumstead libraries. Within recent years West Ham and Lewisham have adopted a similar policy; while an opposite course has been taken by Southwark and Westminster. It is obvious that an already limited income will be even more inadequate when it is administered in three separate parts. A small temporary advantage may accrue to certain localities of the borough, but the library service of the borough as a whole is bound to suffer. There is plenty of evidence that the greatest library service can be given to a district when the libraries form one organic whole. So much for the present; now for the future. Woolwich is growing rapidly in some localities, and when the inevitable library extension is required, what is going to happen ? Each of the older districts is going to be mulcted of a part of its already far from adequate share in order to finance still another separate administration. Instead of the Borough library service under one administration becoming increasingly efficient with the growth of the district, it is going to remain a series of small and comparatively ineffective units. Then there is another aspect of the question which touches us even more closely professionally. If library systems are going to be divided in this way, men and women are not going to be found willing to go through the long and special training necessary for an administrative librarian, because the position of “librarian‐in‐charge” is no return for such training. In this way, if this policy is going to spread, a much more serious blow still will be struck at the library efficiency of the country.