THE CONSULTANT IN THE N.H.S
1
360 THE CONSULTANT IN THE N.H.S. THE MINISTER ON THE FUTURE ON Feb. 3 the Central Consultants and Specialists Committee held a dinner at B.M.A. House to celebrate its first five years’ work. As chairman of the committee, Dr. T. ROWLAND HILL presided. Mr. D. W. C. NoRTHFIELD, in proposing The Guests, spoke of the presence of the presidents of the three Royal Colleges and of the British Medical Association, and praised Sir Russell Brain’s chairmanship of the Joint Consultants Committee. Sir RUSSELL BRAIN, p.R.c.r., said it might be thought that the Joint Consultants Committee was rather an illogical body, but in practice it worked extremely well. As with the nervous system, so here, there were overlapping fields. The Joint Committee and the staff side of Whitley Council had very great responsibilities, and their difficulties were not diminished by the fact that from time to time, for reasons outside their control, they were not able to say exactly what was going forward. The Minister of Health would agree with him that neither politics nor administration was an end in itself: the purpose of administration, and even of Whitley Councils, was to create conditions in which the best possible work could be done. The National Health Service had accomplished much during the few years of its existence, with its contribution to the rising standard of medicine throughout the country. But those who reached decisions today were legislating for the future. What happened to themselves did not matter so much as what happened to their successors-the conditions they would be called upon to work under, the sort of freedom they would enjoy. COMMITTEE AND MINISTRY Dr. J. D. S. CAMERON, who proposed the health of The Central Consultants and Specialists Committee, said that in the Joint Consultants Committee complete harmony existed between the representatives of the colleges and corporations and the representatives of the Central Committee. They might speak with varied accents but they had one voice. They had full discussions, and they had seen to it that there was no possibility of " mistaking the echo of the London coffee house for the voice of the kingdom." The motto of them all might be "with one aim," and the primary aim was to secure a smooth-running health service. Dr. ROWLAND HILL, responding, said it would be surprising if after five years some of the machinery did not need atten- tion, and a subcommittee was working under Mr. H. H. Langston with a view to strengthening its efficiency. During these five years an enormous amount of hard constructive work had been done by both bodies, and greater under- standing between the profession and the Ministry of Health had been achieved. But he felt at times that not enough attention had been given to the technique of joint consultation, and he pleaded for more systematic study of the art of thinking together. Too often, perhaps, consultation took place after, and not before, one or both sides had already made up its mind to a certain course of action or inaction. Another task of the representative consultant organisations was the hum- drum but very necessary work on terms and conditions of service and their modification from time to time. Many took the view that the Whitley machinery today was not working satisfactorily in the N.H.S. ; and it did seem to stir up the instinct of combativeness. He hoped that the necessary preoccupation with these material issues would not impair the growing intimacy of those concerned, and that as time went on something warmer and better than the cash nexus would unite the profession with the public administration of hospitals. Mr. T. HoLMES SELLORS, in proposing The Ministry of Health, referred to the pre-N.H.S. days as the bachelorhood of the profession, when it went along in a fairly happy-go-lucky way and managed its own affairs. Since its shotgun marriage, most of its housekeeping had been done for it. This had been enjoyable to some extent, but there had been argument and difference of opinion. Perhaps this was like the angry colloquy in Kim-" in my country we call that the beginning of love talk "-and greater harmony was in prospect. Certainly both sides realised that nagging and too much attention to detail was the easiest way to destroy unity. He expressed appreciation of the sympathetic attitude shown by the Minister and by the Permanent Secretary, Sir John Hawton, and other officials of the Ministry. THE MINISTER REPLIES Mr. IAIN MACLEOD said that the five years had seen an increase in consultants and specialists of something like 25%- i.e., an annual increase of about 6% compared with an increase of 11/2% in the number of beds brought into use-and the consultant service had been brought to all parts of the country. It was a reproach to us all that not a single new hospital had been built here since 1939 ; but within the limits of what was possible there had been a substantial increase in the ;. number of ancillary and specialist departments. Resources i had been largely concentrated on the provision of new operating-theatres, radiology departments, pathological laboratories, outpatient departments, and so on. It was greatly to the credit of the consultants and specialists that, often working in old and outmoded surroundings, they had achieved an important, almost a spectacular, increase of turnover, and that standards had been fully maintained. It was true that complaints and litigation had increased. One reason was that the hospitals had become, because they I were State hospitals, less personal to the patients. It was one thing to bring a case against Dr. Brown or Smith, whom you had known all your life, and quite -another thing to sue I the Minister of Health in Whitehall. Mr. Macleod did not 1 doubt that this change in the attitude of the people was to I some extent the root of the difficulty. But he had been interested to read that in America, where there was neither a National Health Service nor a free legal aid system, they too were worried about increased litigation. Therefore we must look a little more deeply into this problem ; and his own . solution-not a complete one-was that perhaps ’.’ today we are all too absorbed by detail to be conscious of the difference between the wood and the trees." In the House of ; Jommons, when there was a debate on education, Members iiscussed huts, playgrounds, lavatories, and so on. " But bhat, of course, is not education at all. What is really ’ education is the quality of the teachers and what they teach. Equally in this field it is a fine thing if we can have a perfect appointments system for outpatients ; that we can have a canteen, and so on ; but we must not flatter ourselves that by such means we have a satisfactory consultant service. What really matters is that the consultation should not be a ten-minute piece of advice followed by a cup of tea but that it should be an unhurried consultation between the consultant or specialist and the person who has come to be relieved of his trouble. If we can see beyond the details to what really matters we may not only be enabled to have a happier service but a truer appreciation amongst the patients of this country of what is being done for them." It was very important indeed to have as comfortable conditions as possible for those who come for advice, and it was very important that patients should come with their minds at ease. But it was also important to recognise that there were more vital matters than the mere facade so often under discussion in Parliament. Among politicians one school of thought held that the future of consultants and specialists (and the future of general practitioners as well) lay in a whole-time salaried service. Mr. Macleod thought that would be disastrous. Though he knew that this opinion was held sincerely, the utterances of some of its exponents seemed to suggest, unworthily, that all whole-time consultants were unselfish, righteous, holy people (and, of course, Socialists) while the part-time con- sultants were wicked, money-grabbing charlatans (and, of course, Tories). The truth was that consultants and specialists were not primarily whole-time or primarily part-time ; they were primarily doctors ; and they had the same standard of ethics and conduct towards their patients whether those patients were in private rooms or in wards, whether the consultant worked whole-time or part-time, and indeed whether he was in the N.H.S. or not. It was criticism that made the news : we read in the papers about things that had gone wrong but not about things that had gone right. He had been interested to hear from a London teaching hospital that though it was quite true that, whereas, before the N.H.S. came into operation, they had one letter of criticism a month, and now they had one a week, it was also true that they got thirty letters of appreciation for one such letter that they had before. The real answer, said the Minister, was that we were still in the early stages of a great experiment. There were bound to be differences, and it was right that we should speak our minds frankly and openly to each other. But if we were prepared to work together we should be able to make a tremendous success of our National Health Service.
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Transcript of THE CONSULTANT IN THE N.H.S
360
THE CONSULTANT IN THE N.H.S.THE MINISTER ON THE FUTURE
ON Feb. 3 the Central Consultants and SpecialistsCommittee held a dinner at B.M.A. House to celebrateits first five years’ work. As chairman of the committee,Dr. T. ROWLAND HILL presided.
-
Mr. D. W. C. NoRTHFIELD, in proposing The Guests, spoke ofthe presence of the presidents of the three Royal Collegesand of the British Medical Association, and praised Sir RussellBrain’s chairmanship of the Joint Consultants Committee.
Sir RUSSELL BRAIN, p.R.c.r., said it might be thought thatthe Joint Consultants Committee was rather an illogical body,but in practice it worked extremely well. As with thenervous system, so here, there were overlapping fields. TheJoint Committee and the staff side of Whitley Council hadvery great responsibilities, and their difficulties were notdiminished by the fact that from time to time, for reasonsoutside their control, they were not able to say exactly whatwas going forward. The Minister of Health would agreewith him that neither politics nor administration was an endin itself: the purpose of administration, and even of WhitleyCouncils, was to create conditions in which the best possiblework could be done. The National Health Service had
accomplished much during the few years of its existence,with its contribution to the rising standard of medicinethroughout the country. But those who reached decisions
today were legislating for the future. What happened tothemselves did not matter so much as what happened totheir successors-the conditions they would be called uponto work under, the sort of freedom they would enjoy.
COMMITTEE AND MINISTRY
Dr. J. D. S. CAMERON, who proposed the health of TheCentral Consultants and Specialists Committee, said that inthe Joint Consultants Committee complete harmony existedbetween the representatives of the colleges and corporationsand the representatives of the Central Committee. Theymight speak with varied accents but they had one voice.They had full discussions, and they had seen to it that therewas no possibility of " mistaking the echo of the Londoncoffee house for the voice of the kingdom." The motto ofthem all might be "with one aim," and the primary aimwas to secure a smooth-running health service.
Dr. ROWLAND HILL, responding, said it would be surprisingif after five years some of the machinery did not need atten-tion, and a subcommittee was working under Mr. H. H.Langston with a view to strengthening its efficiency. Duringthese five years an enormous amount of hard constructivework had been done by both bodies, and greater under-standing between the profession and the Ministry of Healthhad been achieved. But he felt at times that not enoughattention had been given to the technique of joint consultation,and he pleaded for more systematic study of the art of thinkingtogether. Too often, perhaps, consultation took place after,and not before, one or both sides had already made up itsmind to a certain course of action or inaction. Another taskof the representative consultant organisations was the hum-drum but very necessary work on terms and conditions ofservice and their modification from time to time. Manytook the view that the Whitley machinery today was
not working satisfactorily in the N.H.S. ; and it did seemto stir up the instinct of combativeness. He hoped thatthe necessary preoccupation with these material issues wouldnot impair the growing intimacy of those concerned, andthat as time went on something warmer and better than thecash nexus would unite the profession with the publicadministration of hospitals.
Mr. T. HoLMES SELLORS, in proposing The Ministry ofHealth, referred to the pre-N.H.S. days as the bachelorhood ofthe profession, when it went along in a fairly happy-go-luckyway and managed its own affairs. Since its shotgun marriage,most of its housekeeping had been done for it. This hadbeen enjoyable to some extent, but there had been argumentand difference of opinion. Perhaps this was like the angrycolloquy in Kim-" in my country we call that the beginningof love talk "-and greater harmony was in prospect.Certainly both sides realised that nagging and too muchattention to detail was the easiest way to destroy unity.He expressed appreciation of the sympathetic attitude shownby the Minister and by the Permanent Secretary, Sir JohnHawton, and other officials of the Ministry.
THE MINISTER REPLIES
Mr. IAIN MACLEOD said that the five years had seen anincrease in consultants and specialists of something like 25%-i.e., an annual increase of about 6% compared with an increaseof 11/2% in the number of beds brought into use-and theconsultant service had been brought to all parts of the country.It was a reproach to us all that not a single new hospitalhad been built here since 1939 ; but within the limits of whatwas possible there had been a substantial increase in the ;.number of ancillary and specialist departments. Resources ihad been largely concentrated on the provision of new
operating-theatres, radiology departments, pathologicallaboratories, outpatient departments, and so on. It was
greatly to the credit of the consultants and specialists that,often working in old and outmoded surroundings, they hadachieved an important, almost a spectacular, increase of
turnover, and that standards had been fully maintained.It was true that complaints and litigation had increased.
One reason was that the hospitals had become, because they
Iwere State hospitals, less personal to the patients. It wasone thing to bring a case against Dr. Brown or Smith, whomyou had known all your life, and quite -another thing to sue I
the Minister of Health in Whitehall. Mr. Macleod did not 1doubt that this change in the attitude of the people was to Isome extent the root of the difficulty. But he had beeninterested to read that in America, where there was neither aNational Health Service nor a free legal aid system, they toowere worried about increased litigation. Therefore we mustlook a little more deeply into this problem ; and his own .
solution-not a complete one-was that perhaps ’.’ todaywe are all too absorbed by detail to be conscious of thedifference between the wood and the trees." In the House of ;Jommons, when there was a debate on education, Membersiiscussed huts, playgrounds, lavatories, and so on. " Butbhat, of course, is not education at all. What is really
’
education is the quality of the teachers and what they teach.Equally in this field it is a fine thing if we can have a perfectappointments system for outpatients ; that we can have acanteen, and so on ; but we must not flatter ourselves that
by such means we have a satisfactory consultant service.What really matters is that the consultation should not be aten-minute piece of advice followed by a cup of tea but thatit should be an unhurried consultation between the consultantor specialist and the person who has come to be relieved of histrouble. If we can see beyond the details to what reallymatters we may not only be enabled to have a happier servicebut a truer appreciation amongst the patients of this countryof what is being done for them." It was very important indeedto have as comfortable conditions as possible for those whocome for advice, and it was very important that patientsshould come with their minds at ease. But it was also
important to recognise that there were more vital mattersthan the mere facade so often under discussion in Parliament.Among politicians one school of thought held that the future
of consultants and specialists (and the future of generalpractitioners as well) lay in a whole-time salaried service.Mr. Macleod thought that would be disastrous. Though heknew that this opinion was held sincerely, the utterancesof some of its exponents seemed to suggest, unworthily,that all whole-time consultants were unselfish, righteous, holypeople (and, of course, Socialists) while the part-time con-sultants were wicked, money-grabbing charlatans (and, ofcourse, Tories). The truth was that consultants and specialistswere not primarily whole-time or primarily part-time ; theywere primarily doctors ; and they had the same standard ofethics and conduct towards their patients whether thosepatients were in private rooms or in wards, whether theconsultant worked whole-time or part-time, and indeedwhether he was in the N.H.S. or not.
It was criticism that made the news : we read in the
papers about things that had gone wrong but not aboutthings that had gone right. He had been interested to hearfrom a London teaching hospital that though it was quitetrue that, whereas, before the N.H.S. came into operation,they had one letter of criticism a month, and now they hadone a week, it was also true that they got thirty letters ofappreciation for one such letter that they had before.The real answer, said the Minister, was that we were still in
the early stages of a great experiment. There were bound tobe differences, and it was right that we should speak our mindsfrankly and openly to each other. But if we were preparedto work together we should be able to make a tremendoussuccess of our National Health Service.
