Operational Research and Geriatric Services in Belfast

"PRECISE determination of the optimal allocation of resources within the health service, and between the health service and other wants of society, may be impossible. But to think in terms of optimal allocation, instead of 'meeting needs,' will produce better decisions." This is a quotation fronm a critical review (Feldstein, 1963) of the recent Nuffield study of operational research in the health services (Davies et al., 1962). The authors of the Nuffield report emphasize that demand is not the same as need, and they define different types of 'need,' and methods of its assessment and measurement as a basis for the development of health services. Feldstein believes that it is wrong to approach health service decisions as though the problem were to meet specific community 'needs'; they may be fallacious guides because opinions on them change with medical knowledge, and with social ideology, and they may only reflect medical fashion. (In any event, it is too much to hope that enough resources could be made available to meet all needs that might be considered essential.) Instead, Feldstein suggests that the health service facilities to be provided, how to provide thenm, and how much to provide, should be decided from a search amongst alternatives, adopting the course that will ensure optimasl use, choosing the preventive, diagnostic, curative, and rehabilitation services to be offered from statistically derived estimates of probable benefits and costs. These studies must appeal to aniyone concernied wsith the medical care of old people. It has been well said that old age will provide the hospital service with its principal challenge in the next twenty years, but there are many who feel that the impact of an ageing population on the health services in general, and on hospitals in particular, does not claim the attention it seems to merit from those who direct policy. Conflict of opinion on whether to relate health service provision to 'demand,' 'need' or 'optimal use' may be part of the explanation for this apparent neglect. Where old people are concerned the general practitioner probably thinks in terms of demand, the nmedical and nursing staff of hospitals in terms of need, sand the adnministrator in termis of optimial use of the resources he has to offer within atnd outside the hospital. If the total resources provided are adequate, the family doctor and hospital staff may come to terms, with or wvithouLt some friction, and mav …