The Director-General
The Royal Commission on Health 1925 recorded a number of comments and conclusions pertinent to the current discussions on a proposed Medical Council and the complex problems of the relation of such a Council to the N.H. & M.R.C.
- Available material on the subject of morbidity now not used might be made available. Members of the medical profession are in possession of a great deal of information as to the incidence and causation of disease not at present to statisticians or Commonwealth authorities.
Exact and complete knowledge in regard to morbidity is of fundamental importance in any enquiry or in any administration in regard to public health and we are of opinion that the information indicated should be obtained.
We are of the opinion that the state has been reached in national development when the Commonwealth should exercise to the full its powers with regard to statistics and should arrange for the collection and classification of the statistics of morbidity.
- Medical Practitioners are among the first to come into relation with those who are affected with illness.
A large proportion of medical practitioners also recognise obligations other than those imposed by the law in this connection and fulfil them voluntarily and gratuitously for the interests of their patients and the community.
The Federal Committee of the British Medical Association state ‘in no State is the service of the practitioner officially utilised for the prevention of disease to any degree consistent with his knowledge and opportunity’ and ‘any scheme to rectify existing conditions must have as its immediate ideal the link up of the general practitioner into active participation in the general scheme’.
The medical practitioner should be the unit of the medical side of administration.
We are of the opinion that much can be done under existing circumstances by mutual agreement to bring the medical practitioner into greater participation in health administration.
- To provide for greater satisfactory liaison and co-operation between State and State and Commonwealth and State, and to promote uniformity in legislation and administration, the Commonwealth recommended that formation of a Federal Health Council, to consist of 3 representatives of the Commonwealth Department of Health (including the Director-General) and the Chief Medical Officer of each State.
Such a Council was in fact, formed and met on the 25th January 1927. In its initial meeting the Acting Minister for Health (Sir Earle Page) said – “I would remind you of the functions of your Council as specified in the Order in Council; to advise your respective Governments on health questions generally and as to measures to ensure co-operation and to promote uniformity of legislation and administration in matters concerning the health of the people. I suggest that you do not regard these matters of health too exclusively from the position which we have inherited as a result of the evolution of public health administration in England or too exclusively from that aspect which is indicated in our public health laws. I would urge that you take most seriously into consideration that great body of highly qualified men who are engaged in the daily practice of medicine throughout the Commonwealth and examine particularly the possibility of enlisting their services in some definite function in the great purpose for which you have been constituted – the prevention of disease and death. I feel strongly that the active co-operation of the medical profession generally is essential to a full realisation of our common purpose”.
- The Royal Commission also recommended the establishment of a Health research council, a small body consisting of the Director General of Health, one representative from each of the Australian Medical Schools, three representatives of the medical profession nominated by the B.M.A. and a scientist nominated by the National Research Council.
The Commission stated it considered special encouragement should be given to research that may be carried out independently of well equipped laboratories.
The research body was not formed until 1937 when a number of persons falling into the categories recommended by the Commission for the constitution of the Research Council were included upon the remodelled Federal Health Council, now to be called the National Health and Medical Research Council.
- The National Health and Medical Research Council, in the words of the Rt. Hon. W.M. Hughes, in opening the proceedings are:
“To promote the health of the people of Australia, to protect them from disease; and to devise, co-ordinate and to direct research into the cause and cure of those diseases, which levy so heavy a toll upon the community and which have hitherto baffled medical science”.
In his inaugural address, the Chairman, Dr. J.H.L. Cumpston, emphasised the necessity of extending health administration and medical research to the general practitioner level.
High hopes were expressed that the formation of the Council would mark a new epoch in health and medical administration in the Commonwealth.
I think it is the consensus of opinion amongst most of us acquainted with the N.H. & M.R.C. that it has failed to live up to the expectations of its founders or to serve the purpose intended for it. Even the research field in which the Council has done most, if not all, of its work of value has been confined to “pure research”. The statistical and clinical work of general practice has been neglected and most hospital opportunities wasted. I have, moreover, frequently commented as a member of the Council and since, that it is regrettable that neither Council nor its research Committee initiate research. Rather it is the practice to sit as a custodian of limited funds to apportion those funds to some of all of applicants nominating their own fields of research.
I suggest that the reasons that the N.H. & R.M.C. has proved disappointing may be summarised as follows:
- In the health field it lacks inspiration. Health representatives are ex officio the heads of State Health Departments. It is to be assumed that if they felt any substantial or revolutionary improvement were necessary in existing health administration they would initiate these in their own States and come to Council imbued with the purpose of having other States follow their example. For a variety of reasons Health Departments in the States of Australia are complacent and this complacency is reflected on Council in an almost complete absence of suggestions for its agenda.
- The Council is out of contact with the medical practitioner. Prior to the formation of both bodies the political and departmental intention was that the medical practitioner should be given an opportunity to assist in health administration, the improvement of medical practice and in field research. Neither body has afforded him this opportunity.
- The specialist members of Council come to its meetings uninspired because the organisations and individuals they represent play no part in implementing the decisions of the Council and are largely unaffected by its recommendations. These representatives, therefore, are subject to no pressure or inspiration from the body of opinion they are intended to sponsor. On the contrary, they sit on the Council as specialists prepared to give an expert technical opinion if such be sought. Between meetings apparently, membership of the Council means precisely nothing to them.
I suggest that these three factors may be corrected by providing on Council inspiration
(a) from the Commonwealth Department of Health; and
(b) from the practising medical profession.
The little that the Council has achieved so far outside the functions of the Research Committee has practically all been promoted by this Department. Now that this Department and the practicing profession must contemplate an era of very close co-operation, there is a golden opportunity to repair one of the deficiencies which have impaired the value of the Council hitherto.
Since the Commonwealth is in need of some small body which will serve it as a liaison organisation with the general practitioner and the practising specialist the opportunity might well be taken to use its members to provide that contact with practice which has hitherto been deficient on the Council.
Furthermore, if the opportunity is to taken to assure that the members of the new body are responsible spokesmen for and representatives of the practising profession and at the same time fall into professional categories required by membership of the existing Council, inspiration of the N.H.& M.R.C. may be expected to reach that body from the profession at large.
There is another consideration, somewhat abstract perhaps, but which I feel may be of the utmost importance to the welfare of the medical profession, the general public and the future relationships of this Department with both. The medical profession through the years has developed a strong and deep sentiment of public service and high ethical standards. Monetary reward has been a matter of secondary importance, in fact, for the better type of practitioner and ostensibly for the less unscrupulous. The present emphasis upon fee for service inseparable from the contentious discussions proceeding profession in the development of a National Service are likely to invert the old standards of values so that in the public relations of the profession material considerations will become the transcendent issue. To avert this dangerous development, it is necessary once more to lay emphasis upon the honourable obligations of public service and this may well be effected by placing the representatives of the profession in a situation where they can objectively view the problems and obligations of health and medical service, the needs of the patient and the aspirations of the Government in free and open discussion with all parties involved in medical and health administration.
It only remains so to organise professional representation whether specialist or general practitioner as to ensure that each representative is the spokesman of and for his category. It is not for us, I submit but for the B.M.A. to concern itself with the complex problem of how election to his office may best be achieved.
Dr Downes expresses the fear that animosity stirred in the members of the new medical Council by political disputes with the Government of the day may seriously mar the smooth discharge of the research position of the Council. I think this fear is groundless – even under the present organisation political dissension confront the Health representation may be achieved on the NH&MRC without affecting revolutionary change and without embarrassing research, by reference to the following device. If, however, you feel Dr Downes is justified, I suggest the objective of responsible representation may be achieved on the NH&MRC without affecting revolutionary change and without embarrassing research, by recourse to the following device.
The Government by Executive Council Minute could constitute three bodies –
- A Federal Health Council – analogous to that already functioning as the Public Health Committee of the NH&MRC;
- A Medical Research Council – with the identity and functions of the Medical Advisory Committee of the NH&MRC; After all, this body at present has only 4 members of the Council of its total of 13.
- Medical Council – selected as recommended and to serve as a liaison body between the Minister and the profession.
These 3 bodies could discharge their respective routine functions as autonomous bodies but would meet as the NH&MRC to discuss and resolve upon mutual problems and the co-ordination and integration of their respective activities in the National Health administration.
C.E. Cook
8.1952