In 1965 the National Health Service cost the nation over £1300 million of which the Hospital Service absorbed almost £800 million. Where such very large sums of money are involved, almost all of which are spent out of public funds, it is obviously important that the expenditure should yield the greatest possible value. This paper reviews trends in hospital spending and describes measures being taken to examine efficiency in the Hospital Service as well as the problems inherent in such efficiency studies.
For many thousands of years man has sought and found artificial stimulants or sedatives to relieve the tensions of everyday living, to allay fear and worry or simply to increase his pleasure. These have ranged from cannabis, the opiates and the juice of a Mexican cactus to alcohol, tobacco, tea and coffee.
In England and Wales in 1963, 187,023 deaths were certified as due to diseases of the heart. These included 154,815 deaths due to arteriosclerotic and degenerative heart disease of which 107,856 were due to arteriosclerotic heart disease, including coronary disease.
In becoming aware of the size and severity of the problems of mental illness it is easy to overlook the great strides forward which have been taken in the lifetime of many of us towards the goal which I believe we can and will reach. That goal will be reached on the day when we shall have won against mental illness a victory as splendid and as much to the credit of mankind as the victory we have now won over tuberculosis — that adversary which for so long seemed unconquerable.
In 1964 there were estimated to be 55,000 doctors actively engaged in medicine in England and Wales. In addition to these probably some 8000 to 9000 qualified doctors were not practising of whom about half had retired on grounds of ill-health or age. The two largest groups of those professionally employed were the 22,000 general practitioners and the 21,000 hospital doctors.