975 meals failed to reach these standards. There was poor management with considerable waste, and a failure to apply some simple nutritional principles to the preparation of food. That the meals, subsidised or not, are needed is clear, for 5% of children were judged to be poorly fed and an increasing number come to school without breakfast. The poorly fed children were slightly smaller in height and weight. The Government has commissioned university departments to monitor the growth of children to detect any effects of changes in the provision of welfare foods. One of those responsible, Prof. J. C. Waterlow, of the London School of Hygiene and Tropical Medicine, in evidence given to the House of Commons Expenditure Committee4 judged that there had been no serious changes hitherto, but that with rising food prices the slight disadvantages of social classes iv and v and of families with more than three children might become serious. The educational value of school milk and meals, if they can be properly managed, is as important as any nutritional benefit. School meals have been called the sheet anchor of the child’s nutrition3 and free school milk one of the fundamental preventive measures of the public health service, providing a lesson in the nutritional needs of children which all could learn, including the teaching profession.s Teachers cannot be blamed for withdrawing from the supervision and management of milk and meals when Government policy vacillates. In the E. F. Armstrong Memorial Lecture, Food Policy and Health, delivered to the Royal Society of Arts, Dr R. G. Whitehead of the Dunn Nutrition Unit, Cambridge, referred to two recent Government papers-the First Report of the Expenditure Committee4and the Government’s response to its recommendations in the white paper Prevention and Health.7 These, he believes, could form the basis for a national food policy. The Government’s responsibility for nutrition, as stated in the white paper, should be the assembly, assessment, and dissemination of information, based on scientific evidence. The Government must educate the public about good nutrition so that people can form their own views and take their own decisions. As they do so, food production and manufacture will change in response to changing demand. Such a policy demands a well-informed public, and Whitehead is afraid that not nearly enough is being done to educate the public about food. He calls for a Nutrition Education Programme similar to that which succeeded so well during the 1939-45 war. The schools would have a major part to play in any such programme, and what better practical educational exercise than school meals could there be?
FIVE YEARS WITH LORD ROTHSCHILD Lord Rothschild, head of Mr Edward Heath’s "think tank", detected in Whitehall (he gave no sign of having travelled further Research Council 4. First
afield) was not
feeling that the Medical always supporting the sort of
a
Report from the Expenditure Committee 1976/1977:
N.H.S. required. The solution was to of the Council’s budget and return it commissions chosen by the Health stand any chance of success this "customer/contractor principle" required a strong, stable, research that the confiscate a slice in payment for Departments. To
independent commissioning organisation within the cusDepartment and powers over all the research interests of that Department; and preferably its work should not be accompanied by a major migration from
tomer
workbench to committee room. None of these criteria has been met. Prof. Tom Whitehead, in a pithy essay for the Nuffield Provincial Hospitals Trust,l shows how the chief scientist’s organisation remains deficient both in strength and in size. As to stability, since the whitepaper of July, 1972, the D.H.S.S. has had three chief scientists, many influential doctors on its staff have retired, the lay administrators involved have not stayed in one place long enough, and the organisation was soon to be rearranged after an inspection by experts from Brunel University (the kiss of death some might say). Some divisions seem to have remained outside the chief scientist’s influence. The duplication of effort is .also taking its toll. In the M.R.C.’s experience2the change has imposed "... heavy additional burdens, not only in terms of administrative work necessary to fulfil the requirement of detailed accountability but, of far greater significance to the organisation of Government research and development, in terms of a very great increase in calls on the time of expert advisers, who are limited in number and whose involvement in advisory activities-. however desirable-takes them away from the pursuit of research." Not surprisingly, nothing dramatic has happened to the way the M.R.C. slice of D.H.S.S. research funds has been spent. It has tended to go back to the Council as "broad commissions"-an effective way of disarming those whose views Rothschild seemed to have ignored, perhaps, but providing no reassurance to those who merely had doubts about the wisdom of what he said. Among the critics of the present arrangements are the heads of social-medicine units in receipt of substantial D.H.S.S. grants. Their collected thoughts follow Whitehead’s.1 Among their ideas is an old favourite-namely, a proposal that, for health-services research, there should be some independent body, operating along the lines of the M.R.C. and preferably outside the D.H.S.S. but certainly beyond the control of the Civil Service. (A health services research board at M.R.C. headquarters is probably not what these six professors have in mind.) If true independence in some form were achieved some autonomous D.H.S.S. research (parts of the computer programme, for example) would have to be moved with it; in the circumstances the transfer of funds could hardly be persisted with, the chief scientist’s organisation would then begin to look redundant, and the Rothschild plan would, in effect, be scrapped. We say this not to decry the efforts of the Nuffield think-tank but to warn them of the size of governmental climb-down that their sound idea would entail.
Preventive Medi-
cine; p. 169i. H.M. Stationery Office, 1977.
5. Davidson, S., Passmore, R., Brock, J. F., Truswell, A. S. Human Nutrition and Dietetics; p. 586. Edinburgh, 1975. 6. R. G. Whitehead Proc. R. Soc. Arts (in the press). 7. Prevention and Health. Cmnd. 7074. H.M. Stationery Office, 1977.
a review of health care research and management after Rothschild. Edited by GORDON MCLACHLAN. Oxford: Oxford University Press, for the Nuffield Provincial Hospitals Trust. 1978. Pp.85. £2·25. 2. Medical Research Council annual report for 1976/77; p.3. H.M. Stationery Office.
1. Five Years After:
FIVE YEARS WITH LORD ROTHSCHILD Lord Rothschild, head of Mr Edward Heath’s "think tank", detected in Whitehall (he gave no sign of having travelled further Research Council 4. First
afield) was not
feeling that the Medical always supporting the sort of
a
Report from the Expenditure Committee 1976/1977:
N.H.S. required. The solution was to of the Council’s budget and return it commissions chosen by the Health stand any chance of success this "customer/contractor principle" required a strong, stable, research that the confiscate a slice in payment for Departments. To
independent commissioning organisation within the cusDepartment and powers over all the research interests of that Department; and preferably its work should not be accompanied by a major migration from
tomer
workbench to committee room. None of these criteria has been met. Prof. Tom Whitehead, in a pithy essay for the Nuffield Provincial Hospitals Trust,l shows how the chief scientist’s organisation remains deficient both in strength and in size. As to stability, since the whitepaper of July, 1972, the D.H.S.S. has had three chief scientists, many influential doctors on its staff have retired, the lay administrators involved have not stayed in one place long enough, and the organisation was soon to be rearranged after an inspection by experts from Brunel University (the kiss of death some might say). Some divisions seem to have remained outside the chief scientist’s influence. The duplication of effort is .also taking its toll. In the M.R.C.’s experience2the change has imposed "... heavy additional burdens, not only in terms of administrative work necessary to fulfil the requirement of detailed accountability but, of far greater significance to the organisation of Government research and development, in terms of a very great increase in calls on the time of expert advisers, who are limited in number and whose involvement in advisory activities-. however desirable-takes them away from the pursuit of research." Not surprisingly, nothing dramatic has happened to the way the M.R.C. slice of D.H.S.S. research funds has been spent. It has tended to go back to the Council as "broad commissions"-an effective way of disarming those whose views Rothschild seemed to have ignored, perhaps, but providing no reassurance to those who merely had doubts about the wisdom of what he said. Among the critics of the present arrangements are the heads of social-medicine units in receipt of substantial D.H.S.S. grants. Their collected thoughts follow Whitehead’s.1 Among their ideas is an old favourite-namely, a proposal that, for health-services research, there should be some independent body, operating along the lines of the M.R.C. and preferably outside the D.H.S.S. but certainly beyond the control of the Civil Service. (A health services research board at M.R.C. headquarters is probably not what these six professors have in mind.) If true independence in some form were achieved some autonomous D.H.S.S. research (parts of the computer programme, for example) would have to be moved with it; in the circumstances the transfer of funds could hardly be persisted with, the chief scientist’s organisation would then begin to look redundant, and the Rothschild plan would, in effect, be scrapped. We say this not to decry the efforts of the Nuffield think-tank but to warn them of the size of governmental climb-down that their sound idea would entail.
Preventive Medi-
cine; p. 169i. H.M. Stationery Office, 1977.
5. Davidson, S., Passmore, R., Brock, J. F., Truswell, A. S. Human Nutrition and Dietetics; p. 586. Edinburgh, 1975. 6. R. G. Whitehead Proc. R. Soc. Arts (in the press). 7. Prevention and Health. Cmnd. 7074. H.M. Stationery Office, 1977.
a review of health care research and management after Rothschild. Edited by GORDON MCLACHLAN. Oxford: Oxford University Press, for the Nuffield Provincial Hospitals Trust. 1978. Pp.85. £2·25. 2. Medical Research Council annual report for 1976/77; p.3. H.M. Stationery Office.
1. Five Years After:
