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Examines the application of total quality management (TQM) in hospitals, where the patient takes on the aspects of a business organization′s customer. Discusses ways of implementing TQM through top management and empowerment, and their effects. Examines three examples of TQM already at work within the health care system. Concludes that the quality initiative can be effective in encouraging formal standards of care, which are important in improving a patientbased system.

The budgets of NHS Trust Hospitals are continually under scrutiny in an endeavour to reduce operating costs. Skill mix, the balance of professional staff to non‐professional staff, is a part of this process and the NHS has introduced a new level of staff called “health care assistants” (HCA). Examines the role and training of the HCA, and the reaction of professional nurses to their introduction into the area of patient care. Highlights areas of concern in relation to HCA training, selection techniques, and the absence of national guidelines which would ensure the quality level of HCAs produced. There is evidence of some managements leaning towards “cheaper” staffing, i.e. using HCAs to replace professional nurses, and the conclusions give rise to some concern in quality of patient care and in the falling morale of professional nurses.

The budgets of NHS Trust Hospitals are continually under scrutiny in an endeavour to reduce operating costs. Skill mix, the balance of professional staff to non‐professional staff, is a part of this process and the NHS has introduced a new level of staff called “health care assistants” (HCA). Examines the role and training of the HCA, and the reaction of professional nurses to their introduction into the area of patient care. Highlights areas of concern in relation to HCA training, selection techniques, and the absence of national guidelines which would ensure the quality level of HCAs produced. There is evidence of some managements leaning towards “cheaper” staffing, i.e. using HCAs to replace professional nurses, and the conclusions give rise to some concern in quality of patient care and in the falling morale of professional nurses.

FEW workers display greater concentration than the man creating delightful glass objects on a seaside pier during the summer months. He is so intent on his work that he has small interest in the fascinated onlookers. Here is living proof that to the average worker nothing is more important than the nature and content of his job.

ALL the auguries for the Bournemouth Conference appear to be good. Our local secretary, Mr. Charles Riddle, seems to have spared neither energy nor ability to render our second visit to the town, whose libraries he initiated and has controlled for thirty‐seven years, useful and enjoyable. There will not be quite so many social events as usual, but that is appropriate in the national circumstances. There will be enough of all sorts of meetings to supply what the President of the A.L.A. describes as “the calling which collects and organizes books and other printed matter for the use and benefit of mankind and which brings together the reader and the printed word in a vital relationship.” We hope the discussions will be thorough, but without those long auto‐biographical speeches which are meant for home newspapers, that readers will make time for seeing the exhibitions, and that Bournemouth will be a source of health and pleasure to all our readers who can be there.

THE changes in London local government which came into operation on 1st April, 1965, cut across the existing regional library bureaux organisation.

We are growing accustomed to shock tactics of the US Administration in dealing with toxic residues in food or additives which are a hazard to man, as well as the daily press infusing sensation, even melodrama, into them, but the recent action of the FDA in calling in from the food market several million cans of tuna and other deep sea fish because of the presence of mercury has had the worthwhile effect of drawing world attention to the growing menace of environmental pollution. The level of mercury in the fish is immaterial; it should never have been there at all, but it stresses the importance of the food chain in the danger to man and animal life generally, including fish beneath the sea. Without underestimating risks of pollution in the atmosphere from nuclear fission products, from particulate matter carried in the air by inhalation or even skin absorption, food and drink, which includes aqua naturale would seem to be the greatest danger to life. What these recent events illustrate in a dramatic manner, however, is the extent of pollution.

The findings of the Steering Group on Food Freshness in relation to the compulsory date marking of food contained in their Report, reviewed elsewhere in this issue, has brought within measurable distance the Regulations which were, in any case, promised for1975. The Group consider that the extension of voluntary open date marking systems will not be sufficiently rapid (or sufficiently comprehensive) to avoid the need or justify the delay in introducing legislation.

IN devoting this number of The Library World in the main to county libraries, we shall not, we think, be guilty of producing what the journalists call “stale matter.” There was a time when county libraries appeared to dominate all small meetings of librarians and even appeared to obsess conferences; a new thing always creates in its advocates and workers an enthusiasm which, to some, appears to be out of proportion. We say “appears to be” because many town librarians felt that their own work was being by‐passed and occasionally belittled. Cooler minds, however, realised from the beginning that the first stages of county library development were as acorns from which oaks would inevitably grow. Few movements have the social importance that the county libraries undoubtedly have. Speaking from the librarianship point of view, it can now be said that the county libraries have proved themselves. The service as yet is uneven, as is inevitable; the movement began and grew in times of great stringency; and even those who advocated it, and it may be those who financed it, did not see its full possibilities. Growth will continue and in time the county library movement will be as fully organised as that of the great city libraries.

The way of thought and vision and memory is that they often come upon you unexpectedly, presenting nothing new but usually with a clarity and emphasis that it all seems new. This will sometimes happen after a long period of indecision or when things are extremely difficult, as they have long been for the country, in most homes and among ordinary individuals. Watching one's life savings dwindle away, the nest‐egg laid down for security in an uncertain world, is a frightening process. This has happened to the nation, once the richest in the world, and ot its elderly people, most of them taught the habit of saving in early youth. We are also taught that what has been is past changing; the clock cannot be put back, and the largesse—much of it going to unprincipled spongers—distributed by a spendthrift Government as token relief is no answer, not even to present difficulties. The response can only come by a change of heart in those whose brutal selfishness have caused it all; and this may be a long time in coming. In the meantime, it is a useful exercise to consider our assets, to recognize those which must be protected at all costs and upon which, when sanity returns, the future depends.