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The principal focus of clinical governance is intended to be at the level of the statutory organisation such as a Health Authority, Primary Care Trust or NHS Trust. This paper suggests that there are at least three levels (micro, macro and meta) at which clinical governance must operate if the original vision of flourishing excellence is to be fulfilled. These do not, regrettably, fit comfortably into the current organisational arrangements for the NHS in England and some cut across any traditional understanding of accountability relationships. With clinical governance at a relatively early stage of its development in many hospitals, and little better than vestigial in most Primary Care and Ambulance Trusts, it may be premature to take on such complex and challenging issues. However, the types of scenario described are typical of those that might create the next major system failure if they remain beyond the scope of clinical governance.

IT is evident from the numerous press cuttings which are reaching us, that we are once more afflicted with one of those periodical visitations of antagonism to Public Libraries, which occasionally assume epidemic form as the result of a succession of library opening ceremonies, or a rush of Carnegie gifts. Let a new library building be opened, or an old one celebrate its jubilee, or let Lord Avebury regale us with his statistics of crime‐diminution and Public Libraries, and immediately we have the same old, never‐ending flood of articles, papers and speeches to prove that Public Libraries are not what their original promoters intended, and that they simply exist for the purpose of circulating American “Penny Bloods.” We have had this same chorus, with variations, at regular intervals during the past twenty years, and it is amazing to find old‐established newspapers, and gentlemen of wide reading and knowledge, treating the theme as a novelty. One of the latest gladiators to enter the arena against Public Libraries, is Mr. J. Churton Collins, who contributes a forcible and able article, on “Free Libraries, their Functions and Opportunities,” to the Nineteenth Century for June, 1903. Were we not assured by its benevolent tone that Mr. Collins seeks only the betterment of Public Libraries, we should be very much disposed to resent some of the conclusions at which he has arrived, by accepting erroneous and misleading information. As a matter of fact, we heartily endorse most of Mr. Collins' ideas, though on very different grounds, and feel delighted to find in him an able exponent of what we have striven for five years to establish, namely, that Public Libraries will never be improved till they are better financed and better staffed.

My Lord, in this case, if you brush away—as I invite you to brush away—all the irrelevancies introduced by my friend, Mr. Hume‐Williams, I submit to you with confidence that this case is reasonably clear; but the elaborate argument he has delivered requires me, I am afraid, to repeat what I said in opening, that the only way to approach a case of this kind is to look at the Section of the Statute, and to see what the Section of the Statute was intended to prohibit. I am not going to trouble you with the earlier cases decided under the Food and Drugs Act. I know there have been decisions by the Divisional Court, but they cannot be looked to because the Act under which these proceedings were taken was avowedly intended to meet the difficulties that had arisen in the administration of the earlier Acts. The purpose of the Act is absolutely clear, especially in regard to Section 3, but let me remind you again that this Act contains several different offences, provided with appropriate defences, and guarded by certain specific conditions.

Local Government Board, Whitehall, S.W., 9th February, 1917. PUBLIC HEALTH (REGULATIONS AS TO FOOD) ACT, 1907. Amending Regulations with respect to Cream. SIR, I am directed by the President of the Local Government Board to transmit to you the enclosed copies of an Order which has been made amending the Public Health (Milk and Cream) Regulations, 1912.

The Equal Pay Act 1970 (which came into operation on 29 December 1975) provides for an “equality clause” to be written into all contracts of employment. S.1(2) (a) of the 1970 Act (which has been amended by the Sex Discrimination Act 1975) provides:

At a meeting of the Council of the Royal Borough of Kensington, on November 22, Councillor J. BROOKE‐LITTLE, Chairman of the Public Health Committee, brought up a report as follows:—

In his recent speech at the Bakers' and Confectioners' Exhibition at the Royal Agricultural Half Mr. Noel Buxton, the Minister of Agriculture, referred to the regulations for the application of the National Mark to all‐English flour, which will shortly come into force. For some years past competitions held in connection with the Exhibition have shown beyond question that bread and confectionery of the finest quality can be made of the flour produced from English wheat. The excellence of the home‐grown article has, in fact, been proved to the satisfaction of the best judges; and the Ministry of Agriculture consider that bakers and consumers, as well as the farmers who produce it, will stand to benefit by its more general use. It is, therefore, in the interests of all three parties that they propose to extend to English wheat the system of grading and standardization which has already been applied with marked success to other articles of diet, such as eggs, tomatoes, apples and pears, and cucumbers. So far as the farmers are concerned, everything that helps them to carry on the fight with their foreign competitors is advantageous to the nation as a whole, because it encourages them to produce more food, to maintain, and possibly to increase, the arable area of the country, and—a factor of real importance in dealing with the problem of unemployment—to keep more workers on the land. The more of his produce the farmer is able to sell, and—within limits—the better the prices he can obtain for it, the better will these ends be served. It is not, of course, to be expected that the public will invariably buy British in preference to foreign goods, simply because they are British. On the other hand, if they can be assured that they are of better quality than the same class of goods imported from abroad, then—as has been shown by the improved trade in British eggs since poultry farmers have been able, if they wish, to take advantage of the National Mark scheme—they are ready not only to make a practice of buying home‐grown rather than foreign produce, but also to pay higher prices for it. There are therefore good grounds for the expectation that the demand for English wheat flour will be improved by the definition of national standards of quality and the marketing of supplies of standard qualities under distinctive marks. The scheme for the voluntary grading and marking of this flour was introduced on October 1. A Trade Committee has been appointed to consider applications for permission to use the mark—a silhouette map of England and Wales—and all the flour bearing this mark will be sold under three standard grades and guaranteed as to type, flavour, and keeping quality. The designations of the three grades are All‐English (Plain), All‐English (Self‐Raising), and All‐English (Yeoman). All three are defined as being sound, free from taint or objectionable flavour, of good keeping quality, and unbleached by artificial means. The first and third are further guaranteed to be free from all added chemical substances, though the second may contain such ingredients, or mixture of ingredients, as may be required (under certain definite regulations) to make the flour self‐raising. The scheme is open to millers and other packers of English wheat flour, and every registered packer must allow his premises and all equipment and records to be inspected at any reasonable time by any officer of the Ministry of Agriculture authorized for that purpose, besides complying with other regulations the general effect of which is to make it impossible for any flour bearing the National Mark to fall below the certified standard of its particular grade. Mr. Buxton was able to say that the scheme is already receiving excellent support from the millers, and all that is needed to give it the success which it deserves is that the public should co‐operate by letting the bakers know that graded all‐English flour is what they want and expect them to use. It is in their power to create a demand which will provide them with a pure food of the highest quality, and will at the same time do the British farmers a much‐needed good turn.

AT last Mr. Baker's long announced “Descriptive Guide to the Best Fiction” is in our hands, and proves to be a bulky volume of over 600 pages, which must have cost its author many hours of arduous labour. Descriptive guides to literature of any sort are unfortunately too rare on this side of the world not to ensure for any decent attempt to compare with what the Americans are doing in this direction, the support of all librarians and bibliographers—at least we hope so—and Mr. Baker's book is a great advance on anything that has hitherto been attempted, here or elsewhere, to provide an annotated handbook to fiction. When the series of guides to literature, science, the arts, &c., announced by Messrs. Scott, Greenwood & Co., are published—which it is to be hoped will be soon—England will not be so desperately and humiliatingly “out of it,” as is the case at present, in the great task of selecting from and annotating the literature of the world.

An important report on the work carried out during the two years 1906–7 and 1907–8 by the Inspectors of Foods appointed by the Local Government Board has been drawn up by Dr. G. S. BUCHANAN, the Chief Inspector, and forms part of the report of the Medical Officer to the Board, Dr. ARTHUR NEWSHOLME, for the year 1907–8 (Appendix A, No. 10).

At the recent conference of the British Medical Association, Dr. Langdon‐Down, of South Middlesex, submitted the report of the Ethical Committee on behalf of the Council, upon the ethics of indirect advertising by the medical profession. The report mentioned a number of restrictions which it was thought advisable to impose as regards advertising by members of the profession. It was stated that in discussions in the Press on matters of public importance relating to the medical questions it was not necessary that the names of the medical writers or informants should be given. The newspapers, it was contended, could give the necessary assurance to their readers as to the professional standing of the authority quoted without mentioning names.—Dr. Fothergill moved that certain recommendations in the report be referred back for reconsideration, including that which related to medical men not attaching their signatures to letters and communications they sent to the Press on medical subjects. On that latter point he suggested that before the report was issued the council should approach the Press Association to get their views on the question. What the Press required was not the advertising of an inferior practitioner. What they desired was to get an adequate medical opinion. The Press said: “If you allow a doctor to go to the Church Congress and talk openly there of birth control, should you not allow that same doctor to put into the public Press a letter over his signature?”—Dr. Lyndon hoped the representative body would not be led away by Dr. Fothergill. The question of having a conference with the Press was brought before the council, who were all against it.—Sir Jenner Verrall said he did not think what was suggested would be a substitute for the indirect advertising complained of.—Dr. Bishop Harman expressed agreement with the contention that it was the name that really mattered in these contributions to the Press. An eminent medical man wrote to The Times a brilliant letter on an important medical subject, and signed himself “Veritas.” It never caused a ripple on the water. They thought it was a gas mantle or something, and there was no punch behind it. Three things mattered—what you say, how it is said, and who says it, and the last is the only thing that really matters.—The report was adopted with the exception of that part relating to medical men's names being attached to letters and communications sent to the Press. That section of the report was referred back for consideration, with the object of seeing how far it was possible to depart from anonymity.