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Special Articles

CONSULTATION AND CONTROL

THE MINISTRY’S ASSURANCES

ON Jan. 6 the members of the Joint Consultants Com-mittee met Sir John Hawton and other officers of the

Ministry of Health.Sir RUSSELL BRAIN, chairman of the committee, said

that the profession was extremely disturbed by recentevents which seemed to point to an unwillingness on thepart of the Ministry to consult the Joint Committee oreven to keep it informed on matters in which it was

vitally interested, and on which its advice would be ofthe greatest help to the Ministry. There also appearedto be a growing belief on the part of the Ministry that thehospital and consultant services should, and could, becontrolled in detail from the centre.

Referring to the recent circular letter to boards of

governors of teaching hospitals, concerning medicalestablishments, Sir Russell reminded the Ministry thatan undertaking had been given that the results of themedical staffing survey undertaken by inspecting teamswould be discussed with the Joint Committee in generalterms before any decisions were taken. Although thematter was one which profoundly affected consultants,that undertaking had not been fulfilled. On the contrarythe communication to boards of governors had been

followed-again without the knowledge of the JointCommittee-by the recent circular to hospital boards andcommittees imposing a 5% reduction in certain categoriesof hospital staff, freezing the establishment of medicalstaff and prohibiting any expansion except with theconsent of the Minister. While medical staffs wereexcluded from the 5% reduction, an examination of therecommendations of the inspecting teams revealed thatif put into effect they would achieve almost exactly a5% reduction in the consultant establishment of teachinghospitals. If the inspecting teams’ recommendationsinvolved a similar reduction in the case of regionalboard hospitals it would mean the termination of thecontracts of some 300 part-time consultants. It wastrue that the matter had not gone beyond the stage ofrecommendations ; nevertheless it was difficult to avoidthe assumption that the recommendations indicated theMinistry’s intentions. Moreover, the Ministry’s instruc-tions on economy in staffing made no distinction betweenhospitals which were economically planned and thosewhich were not, and Sir Russell wondered what could bemore discouraging to a conscientious hospital authority.The Ministry’s attention was also drawn to the damagingeffect of the recent instructions on the problem of

absorbing the surplus of senior registrars.Sir Russell Brain pointed out that further evidence of

increased centralisation was to be found in the recentinstructions for statistical recording of the work of

pathological and radiodiagnostic departments. Themeasures suggested were open to serious criticism, andthere was a very real danger of over-standardisation.

Apart from the fact that these instructions involved anelaborate recording system which would require addi-tional clerical assistance, they implied a belief that thework of these departments could be assessed in terms ofstatistics and ignored the human element of its valueto the community.He reminded the Ministry that the Joint Committee

had repeatedly urged the need for consultation with theprofession at all levels in the service. The committee,and consultants generally, were very willing to help theMinistry, but could not do so unless they felt that theyhad the Ministry’s confidence. Unfortunately, on a

number of occasions the committee had been placed inan invidious position. It had either had to explain to

the profession that it had no prior knowledge of theMinistry’s intentions in a particular matter, or to remainsilent and appear to consent to something it felt it shouldcriticise.

In reply, Sir JOHN HAWTON said that, although hereadily admitted that there had been occasional failureson the part of the Ministry to consult the Joint Com-mittee, these were lapses in performance rather than inintention. The Ministry from the outset of the servicehad always been anxious to consult with all the bodiesconcerned with hospital policy. They had no wish todepart from this position.

Dealing with the communication to boards of governorson medical staffing, Sir John agreed that it would havebeen better if the Joint Committee had been consulted,but the failure to do so was an error, and not an inten-tional one. He wished however to correct any mistaken

impressions on the matter. The proposals that had beensent to the teaching hospitals were simply those of theinspecting teams. They were not the conclusions reachedoy ttie IV1InIstry itseit, nor was tiiere any intention onthe part of the Ministry to impose them on the boards.It was open to each hospital, and particularly to itsmedical staff committee, to look freely at them and

interpret them in the light of their local knowledge.The Ministry was only too anxious to have the views ofthe hospitals themselves.

Referring to Sir Russell Brain’s comment on a possiblereduction of medical staff arising out of the staffingsurvey, Sir John said that similarity with the 5%reduction called for in the other grades of hospital staffwas purely coincidental. There was no intention of

imposing a 5% cut on medical staffs, and the Ministryhad at the moment reached no conclusions.

Regarding other lapses in consultation, he hoped thatthe committee would appreciate that on occasion it wasnecessary for the department to announce an importantitem of Government policy without prior consultationwith the profession, but fortunately this would be arare occurrence and did not affect the general position.He added that there was no desire for increasing centrali-sation, and if centralisation had increased since theservice began it was due not to any desire for it forits own sake but to the need for an over-all controlof hospital expenditure, for which the Minister was

responsible to Parliament.Sir John Hawton stated that the Ministry was in full

agreement with the Joint Committee on the need oreffective consultation. He did not think this need couldbe formalised ; it was rather a matter of the two sides

keeping in close touch with one another. He gave anassurance that the Ministry, for its part, would do allin its power to provide effective consultation with theJoint Committee on all matters affecting consultants inthe hospital service. The Joint Committee need be inno doubt as to the Ministry’s recognition of the committeeas the body speaking for consultants and members ofhospital staffs, and of its very real desire to cooperatewith the Ministry for the good of the service.

COLLEGE OF GENERAL PRACTITIONERS

THE new college has issued a statement on some

aspects of its work, inviting suggestions and help frompractitioners.

Teaching of General Practice.-One of the objects ofthe college is to assist in the training of final-year students(and those newly qualified) in the principles and techniqueof general practice. It is already in touch with manymedical schools that have started schemes by whichyoung men and women get their first introduction togeneral practice by attending the surgeries, rounds, orlectures of general practitioners of experience ; andinformation is being collected about these methods.

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General practitioners who are interested in this type ofteaching are asked to notify the secretary of the college,as soon as possible, as to the ways in which they arewilling to help in these teaching schemes.

Postgraduate Instruction.-The college will encourageand help practitioners to accept postgraduate instruction.

This will need close cooperation with the British Post-graduate Medical Federation of the University of London,whose director has put aside a room for this purpose at hisheadquarters (2, Gordon Square, London, W.C.I). It hasbeen suggested that the college’s regional faculties shall, in asimilar way, work in close liaison with the postgraduate deansand directors of the eighteen other universities-Aberdeen,Belfast, Birmingham, Bristol, Cambridge, Cardiff, Cork,Dublin, Durham, Edinburgh, Galway, Glasgow, Leeds,Liverpool, Manchester, Oxford, St. Andrews, and Sheffield.

This postgraduate instruction can be of several kinds-attendance at hospital outpatient departments or at medicalsociety meetings, lectures, half-day courses, weekend courses,51/2-day courses (from Monday to Saturday), and courseslasting a fortnight or longer. For the last four of these courses,most National Health Service practitioners are allowed grantspaid by the Ministry of Health (fees, subsistence and travellingallowances) ; and for the last two, payment of a locum tenensmay also be approved.Practitioners are asked to notify the secretary of anysuggestions they may care to make about this post-graduate instruction-where and when they think it canmost conveniently take place in different districts, andwhat are the subjects in which they feel they mostwant help.

Research in General Practice.-The encouragement ofaccurate observation, investigation, and recording ofresults by general practitioners is to be an importantpart of the work of the college.The research committee of the college wishes to establish a

register of members and associates of the college who areinterested in the possibilities of research work in their

practices. It is hoped that this register will provide meansof introducing to one another practitioners who share commonresearch interests, to enable them to pool and exchange theirideas and information.A panel of experienced practitioners, and workers in other

fields of medicine and science, is being formed to advise andhelp not only groups of doctors but also individuals who maywish to carry out research work by themselves in their ownpractices. A number of investigations will be initiated by thecollege itself, and study groups are to be set up throughoutthe British Isles. Methods of collection of this material bypractitioners will vary, and will be designed to throw as littlestrain as possible on the routine work of each day. Cards andflimsies suitable for these investigations, and which will fitthe N.H.S. envelopes, may be printed.

In order to explore the possibilities of coordinating researchby large groups of general practitioners, it has been suggestedthat an " Investigation of the Year for General Practitioners

"

might be undertaken. Suggestions are invited about thepossible nature and scope of such an investigation.Members and associates are invited to apply to thesecretary if they would like their names to be placed onthe research register. Applicants are asked to state anyparticular research interests they may have, andwhether they would be willing to participate in group-studies.

All suggestions made to the college on these subjectsare to be carefully considered and analysed ; and a reportupon them will be published later. The deans of manymedical schools, the director of the British PostgraduateMedical Federation of the University of London, thepostgraduate deans and directors of other universities,the Medical Research Council, and many universityresearch departments have expressed their interest inthese proposals, and have agreed to advise and to helpin their possible development.Correspondence should be addressed to the Secretary, the

College of General Practitioners, 14, Black Friars Lane, QueenVictoria Street, London, E.C.4.

Points of View

DAILY PAPER PANTHEONA NEW FANTASIA OF THE UNCONSCIOUS

ALAN MCGLASHANM.C., B.A. Camb., M.R.C.S., D.P.M.

PSYCHOTHERAPIST TO THE WEST END HOSPITAL AND

ST. GEORGE’S HOSPITAL, LONDON

MILLIONS of adults read the comic strips in the dailypapers. Those who do not are amused, bamed, or

exasperated by those who do. Unhappily addicts areeither dumb (in both senses) or evasive, and they neverseem able to give valid reasons for their semi-secret vice.It is a minor sociological mystery, inviting minor research.Even a first glance shows something interesting. Comic

strips for adults, an offshoot from children’s comic papers,are not homogeneous : they fall into two main groups.One is simply a tabloid version of the ever-popularthriller. The other, distinguished always by an elementof the miraculous or magical, has an attraction subtlycompulsive, altogether different.Examples of this second kind occur everywhere ; but

strangely, by far the clearest were to be found till recentlyin a single newspaper, the Daily Mirror, where no fewerthan four of the six comic strips unmistakeably belongedto it-three of them on one page.

CONTEMPORARY MYTHS

Garth and Jane, Jimpy and Captain Reilly-Ffoull: isit possible that someone on the staff of the Daily ]}Iirrorchose these grotesques with full understanding of whathe was doing ? It is wildly unlikely. Yet beyond this,and the even less likely explanation of pure chance,there lies only one other possibility-that they werechosen by the uncannily accurate processes of uncon-scious selection, operating at the deepest level of thehuman psyche. If this were so, they would be foundto exert a curiously compulsive power, overriding rationalrepudiation, on the minds of multitudes. Which is

precisely what they do.For these figures are no casual products of the imagina-

tion. Faintly through all their exploits, vulgar andpuerile as these usually are, sounds an echo of somethingunimaginably archaic : the adventure cycles of the earlygods. Kerenyi, latest among many, has shown with highprobability that such adventure cycles are the basicthemes of human mental activity as far back as it can betraced. They recur endlessly in the likeliest and mostunlikely places, the noblest and most degenerate forms.

Consider Garth, that beefy and bewildered giant, long-suffering, virtuous, strong, faced by a never-ending seriesof heroic tasks. Is there not more than an echo here ofHercules and his labours, much-enduring far-travelledUlysses, blinded Samson, Noah, Gilgamesh ... and behindall these the timeless image of the heroic principle in man,aided magically by Heaven in reward of faith and valour ifAs for the often excruciating Jane, beautiful but

virginal, constantly wooed but never wed : above her- far, far above-does there not float, as on vaultedceilings of Venetian palaces, a company of bright figures fHainuwele the moon-maiden, irresistible Helen, Aphro-dite from the wine-dark sea, flower-gathering Persephone,and the countless images of Kore the maiden-goddess,La Belle Dame sans Merci, the unpossessable yet eter-nally nubile she, whose golden promises invest with &

brief splendour the too-credulous heart of man. Doe&not Jane in Fritzy the dachshund even possess herappropriate animal attribute, as Diana has her hound,and Cvnthia her hare ? ’?

In Captain Reilly-Ffoull the echoing image is at. oncemore immediate and more remote. His life of shamelessgusto, full of shady triumphs and richly earned humilia-