THE DIRECTOR-GENERAL:
The control and prevention of disease other than quarantinable disease and the provision of hospital and ancillary services for the people have traditionally been the responsibility of State Departments. As at present constituted these are largely the unplanned growth of bodies originally formed to control morbidity and mortality during the last century following recognition of the fact that filth and squalor were important agents in the transmission of disease and when epidemiology was but imperfectly understood. They have done much to reduce the incidence and toll of infectious diseases but from their origin, their traditions, the training of their staff and the legislation under which they operate they have developed a preoccupation with the narrower field of sanitation and infectious disease control. With the disappearance of the diseases which led to their formation they have not responded to any inspiration from contact with medical practice and advances in medical knowledge, towards undertaking research into and the control of the killing diseases which have now assumed greater prominence.
The functions of a Department of Public Health should include –
- The study of the incidence of disease and the causes of morbidity and mortality in the community
- Identification of the factors which are preventable and sustained action towards the removal of these
- Research into improved diagnosis and into methods of treatment calculated to shorten the period of illness or to avert a fatal outcome, and activity in extending the knowledge of and facilities for the universal application of these.
The Commonwealth recently through the extension of pharmaceutical benefits and medical benefits has become increasingly interested both in the practice of medicine in the community whether in hospital or out, and in the prevention and effectual treatment of disease. Apart from consideration of the welfare of the patient the Commonwealth is financially interested in his speedy return to health and in avoidance of extravagance and waste in the course of his treatment.
For the effectual prevention of the major killing diseases today a considerable amount of clinical research is necessary. This involves not only organised technical and special research in hospitals but the collection of a mass of information at the general practitioner level. The work of Pickles has shown that information of inestimable value not readily accessible in the ordinary field of research may be obtained from the study of disease in private general practice.
The Commonwealth in conducting its medical benefits scheme will require the active and ungrudging co-operation of the general practitioner and for certain of its researches will require returns from him which he may be reluctant to furnish unless he appreciates that he is playing a part in an important medical research.
At the same time the Commonwealth will require some control over practitioners of medicine –
- To protect itself from extravagant, wasteful or improper us of expensive equipment or drugs
- To ensure ethical conduct and the minimising of public scandal
- To regulate the relations between the Department of Health and the practising profession
All such measures of direction or restraint will be repugnant to the profession unless they are assumed voluntarily in the public interest and a close liaison between the Department and practitioners generally becomes essential.
To achieve a similar purpose in Western Australia a State Health Council was formed consisting of medical men elected by the convocation groups of the British Medical Association as representatives of and spokesmen for their respective groups. Each of these, on the one hand, made available freely and fully to the Department his special knowledge and experience and on the other, assumed the responsibility of obtaining the full co-operation of members of his group in all activities undertaken by the Department after full discussion round the Council table. It is suggested that a similar Medical Council at Commonwealth level should include representatives of the following –
It would be an advantage to have on the Council a medical officer of experience in State public health administration. Such might be nominated from one of the States or if available, from the Commonwealth Department of Health. From time to time meetings of the Council should be attended by officers specialising in public health administration, nursing, radiology, tuberculosis, pathology, anaesthetics. With the exception of the anaesthetist, these are already available on the staff of the Department.
The Council should be able to delegate to special committees certain matters of medical research or administrative problems. Such committees might include the following – Pathology; radiology; anaesthetics; nursing; pharmacy and therapeutics; tropical medicine; public health in its relation to the practitioners; epidemiology; tuberculosis; maternal and infant health; school health.
The functions of the Council would be –
- To provide the Department with informed opinion regarding the incidence, control and treatment of disease in the community
- To constitute a liaison body between the Commonwealth Minister for Health and the practising profession
- To direct research into and to make recommendations regarding factors or morbidity and mortality
- To organise medical practice both in its preventive and therapeutic phases, in general practice and in hospital
- To initiate or to report upon such public health, medical and hospital legislation as may be necessary from time to time to establish the health and medical organisation on a secure basis
- To give the medical profession an effectual voice in health and medical organisation
- To serve as a directing and disciplinary body organising the medical profession in public health and medical practice
The Council should be chaired by the Director-General of Health.
It is important that the professional persons appointed to the Council shall be –
- Spokesmen in their professional categories
- Themselves specialists of the highest qualification
To achieve the first purpose it is desirable that they shall not be selected by the Minister but shall be elected representatives of their groups.
Broadly, the constitution of the N.H. & M.R.C. may be considered to cover some of these functions since it was created to advise the Commonwealth and State Governments on any matters concerning health and medical care.
The constitution of such a Council, apart from the N.H. & M.R.C., might lead to some confusion and duplication of function.
In point of fact, were a paediatrician and a country medical practitioner added to the N.H. & M.R.C., all the members for the proposed new body could be drawn from the National Health Council. It is necessary, however, to quality this generalisation by stating that members of the present Council are nominated by the B.M.A. and to meet the intention of the new body it would be necessary for the B.M.A. to nominate persons elected by the respective convocation groups. There should then be no difficulty in expanding the N.H. & M.R.C. to include the additional appointees mentioned and to create the new body as a committee of the N.H. & M.R.C. analogous to the Public Health Committee already existing. The advantages would be that although the working committee would be convenient size, at meetings of the N.H. & M.R.C. not greatly increased in number all other interested parties would have an opportunity of discussing matters raised and recommendations made by the Committee. In addition, there already exist as committees of the N.H. & M.R.C. a majority of the special committees which the new body would require for its purposes.
Alternatively, to avoid any suggestion of submergence of the new body in the larger Council it might be constituted as an independent body of full authority to deal with those special aspects relating to the co-operation of the practising profession with the Commonwealth Department of Health and the constitution of the N.H. & M.R.C. could be altered to have members of the new body sit ex officio as or in lieu of the B.M.A.’s representatives on the Council where in association with the Council’s other members they could discuss and advise upon the broader aspects of health and medical administration and medical research.
(Signed) C.E. COOK
14/8/52