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1125 should be appointed to prepare notes of general principles for the guidance of the courts. SUMMARY OF RECOMMENDATIONS Our recommendations can be summarised as follows : 1. A special institution should be provided by the Home Office or Prison Commissioners for the detention, observation, and treatment of offenders who, although not certifiable under the Lunacy or Mental Deficiency Acts, show abnormal mental characteristics. 2. The Home Secretary or Prison Commissioners should have power to transfer convicted persons from prison or Borstal to the special institution when they are satisfied that they are in need of the special treatment available in it. Conversely the Home Secretary or the Commissioners should have power to transfer from the special institution to prison or Borstal persons found to be unsuitable for treatment ; and the Home Secretary should have power to remit part of the period of detention ordered by the court. 3. Courts of Quarter Sessions and Assize should be given power to order a period of treatment in the special institution : the power should be in the court and not the jury. Where the offence can be dealt with summarily, the court of summary jurisdiction should be enabled to proceed to a conviction and to commit to Quarter Sessions if the Justices are not satisfied with the evidence before them that any of the methods of treatment which they can order are suitable. ’ 4. The new power to order treatment in a special insti- tution should only be exercisable where : (a) there has been a conviction for an offence for which the offender is liable to a sentence of imprisonment ; (b) the court is satisfied that having regard to the medical evidence the offender is in need of special treatment for his mental state ; and (c) the court is satisfied that having regard to the nature of the offence and the need to protect the public it is desirable that he should be detained. The court should have discretion to fix such maximum period of treatment as it thinks proper, having regard to the evidence as to the time required to cure or give a maximum benefit to the mental state, and to the nature of the offence, and the protection of the public. 5. The period of special detention should not be longer than the maximum sentence prescribed by law for the particular offence. 6. The Secretary of State or the Prison Commissioners should have discretion to release the prisoner when they are satisfied that he has obtained the maximum benefit from the treatment. It appears doubtful whether the Home Secretary’s present powers to recommend remission of sentences would be wide enough for this purpose, and special statutory provision might be necessary. 7. It is not possible to define the categories of persons who should be subject to a special order. The court should have discretion to order detention in the special institution in any case in which it is satisfied that the mental condition of the offender as shown by the medical evidence and the offence are such as to make him suitable for detention in the special institution, but not such as to justify certification under the Lunacy Acts or Mental Deficiency Acts. The court should have power to call for independent medical advice (which might be from the Prison Medical Service or from other persons) at public expense, and the defence should continue to have the right to call medical evidence. The court should be required to consider a report from the Prison Commis- sioners as to the suitability of the offender for treatment (as is provided in section 20(7) of the Oriminal Justice Act, 1948, in Borstal cases) ; and it should be a require- ment that before a special order is made, the Prison Commissioners must have signified to the court their willingness to accept the offender in the institution. 8. A working party should be appointed to prepare notes on the possibilities and limitations of psychiatric treatment, for the guidance of courts in the exercise of the new powers which would be conferred on them. We think it would be beneficial to find out from certain European countries whether they have institutions similar to that we suggest, and what their law and practice is regarding offenders having abnormal mental characteristics. It would be profitable later if members of the Council could have the opportunity of visiting foreign institutions. The experience of foreign countries might be valuable when it comes to considering the details of the legislation and administration required. If the project is accepted in principle we think the Magistrates’ Association should be asked for their observations upon it. KING EDWARD’S HOSPITAL FUND FOR LONDON The Duke of GLOUCESTER presided at the annual meeting of the general council of King Edward’s Hospital Fund for London, held on June 5 at St. James’s Palace. He said that the change-over from the traditional patterns to an entirely new and revolutionary system of hospital care had been accomplished smoothly and with- out serious dislocation of existing services. Indeed, there had already been improvements in some directions, notably in the staffing of hospitals. " Such a statement must, of course, be qualified at once. There is the cost of the service as a whole. The Fund has long foreseen a steep increase in cost. It has been conscious that a limit would have to be laid down-, and that when that point was reached, a new situation would arise : it would then be necessary to take stock, and decide how the total sum can be handled so as to provide the flexibility needed. This is the situation that confronts the hospitals today. We at the King’s Fund see no really satisfactory solution that does not involve a break with the established methods of controlling public moneys. Will the regional boards be given definite round sums on an annual basis which they can pass on to the hospital management com- mittees, and will the hospital management committees be given freedom to deal with these round sums as they think fit ? " As regards the accountancy of the hospitals, we believe that a departmental system of accounts is overdue, and that it is urgent in everybody’s interest that the old system should be replaced by one better adapted to the needs of today. The Minister of Health has on the recommendation of the Central Health Services Council asked the Fund, together with the Nuffield Trust, to conduct a costing investigation in a number of hospitals. This we are glad to do, for we believe that once the advantages of a depart- mental system are realised the whole scene will be trans- formed. It will then become possible to allocate money to hospitals rationally, and efficient administration will replace the hit-and-miss methods of today. " The new situation created by the standstill on expendi- ture sharpens the problems of hospital administration. There are divergencies of standpoint between the Ministry and the regional boards, between the regional boards and the hospital management committees, between the adminis- trative and financial sides in the hospitals, and between the medical and lay approach to hospital administration. It is obviously important that these friendly differences should not harden into friction, and that the right solutions should be found by discussion rather than the wrong solutions by force of circumstance." The Fund had embarked on the establishment of a staff college for hospital administrators. Sir EDWARD PEACOCK, the treasurer, in presenting the accounts for 1949, said that the Fund’s ordinary income stood at f262,000. Subscriptions and donations, which dropped on the nationalisation of hospitals, had increased slightly, and a number of important institutions which had dropped out in 1949 had renewed their subscriptions. Legacies received during 1949 amounted to over jE258,000. In 1949 :S150,000 had been received from the Nuffield Trust for the Special Areas. A further instalment of jEl 00,000 received in January this year brought the total so far from this source to ;CI,250,00. The total receipts for 1949 came to 671,432.
