Eleventh report from the Select Committee on Estimates : together with the minutes of evidence taken before sub-committee E and appendices, session 1950-1951: regional hospital boards and hospital management committees.
- Great Britain. Parliament. House of Commons. Select Committee on Estimates
- Date:
- [1951]
Licence: Public Domain Mark
Credit: Eleventh report from the Select Committee on Estimates : together with the minutes of evidence taken before sub-committee E and appendices, session 1950-1951: regional hospital boards and hospital management committees. Source: Wellcome Collection.
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![1 February, 1951.] [Continued, the Service is to be efficient, economical and happy, and with good morale, he must have regular joint consultative arrange- ments with the profession’s own chosen representatives as well as his own choice of advisers. 347. There is consultation going on con- stantly between the representatives of the Minister and the British Medical Associa- tion and the Royal Colleges, is there not? —Yes, there is, but one feels all the time that it is very much ad hoc, improvised, unofficial, might stop at any moment and lacks a certain amount of continuity. To give one example, the unfortunate registrar circular, which caused so much discussion and anxiety, would never have appeared had there been proper continuity of joint consultation between ourselves and _ the Minister. 348. There I think you are complaining of particular actions rather than the set-up? —It was not so much the action. I do not myself really believe this action would have _been taken, but I admit that is an opinion of my own. 349. I do not want to embark on very controversial ground?—I would say that in my opinion the joint consultation between the hospital staffs and the Ministry could be much improved, given more recognition and greater continuity. What usually happens is that when we feel worried about some- thing we have to go to the Ministry. We talk it over with them; sometimes they say “ Yes” with a certain amount of readi- ness, and at other times it is difficult to arrange a conversation. 350. You would like the policy modified so as to find a rather warmer reception? —A continuity of contact. We feel it is in the public interest and in the efficiency of the Service that there should be a con- tinuity of contact, constructive continuity, with the profession’s own representatives as well as any advisers whom the Minister, perfectly rightly, chooses for himself. Mr. J. Enoch Powell. 351. By “continuity” you mean that it should be regular and official?—Regular, official and recognised. We feel there is nothing in that which is unconstitutional, but we are quite sure the Hospital Service will never work smoothly without it. Chairman. 352. Now, Doctor Hill, I think you were warned that we would like to know some- thing more about the attitude of the British Medical Association, as representing the general practitioners, to the Hospital Ser- vice?—Yes. 353. You say very little about that in your memorandum, but on the other hand there have been many statements made in the Press of the country that the general practitioner feels that he is being squeezed out, to use a colloquialism. Is that the official view of your Association, and can you say on what ground it is based?—Yes. I do not think the view of the British Medi- cal Association is in fact very extreme on‘ this matter. I would sum it up by saying this, that they have deplored the possibility of the complete extinction of the general practitioner hospital. It is the feeling of the Council of the British Medical Asso- ciation, and I think I can say of the con- sultants as well, that a certain proportion of general practitioner staffed hospitals in appropriate areas should continue to exist as part of the Service. 354. Taking the hospitals as a whole, has the number of beds in which the general practitioners can treat their patients within their own, I think the word is, expertise increased or diminished since the Service came into operation?—I should have said it had diminished because there was a ten- dency immediately after the appointed day for many hospitals to be upgraded, and that meant putting the beds in charge of consulting physicians and surgeons. ‘There is no doubt that the number of beds in charge of general practitioners did diminish as a result of that. The British Medical Association would say this, that probably some of that diminution was quite right and proper. A hospital in a big district, serving a big population, should have con- sultant physicians and surgeons in it, and it was quite a right move to upgrade such a hospital; but the general practitioner hospitals, found perhaps in_ sparsely populated areas, the cottage hospitals, undoubtedly were reduced in number after the appointed day by this upgrading process. Mr. J. Enoch Powell. 355. Is there a financial aspect to that? I presume the upgrading, at any rate where you consider it unjustified, is an additional and unnecessary expense—is that correct?—It would be more expensive. The staff would be paid much more, and also of course it would mean an alteration in the work. That would mean more equipment and supplies, and a _ further increase in expense. 356. Is that saying that a service is being provided which is not necessary or at any rate not fully justified, or that for the same service you are paying more because of the upgrading of the hospital?——-No. The upgrading would mean a _ different stamp of work, and that was why it would cost more—not the same service. 357. Yet in a number of cases you con- sider the upgrading to be justified?—Yes, when there are adequate consultant facilities quite readily available.](https://iiif.wellcomecollection.org/image/b32182478_0075.jp2/full/800%2C/0/default.jpg)
