PUBLIC HEALTH NOVEMBER

T H E A P P O I N T M E N T OF M E D I C A L OFFICERS OF H E A L T H

The following memorandum was prepared in 1936 /or the Council of the So'ciety of Medical Officers of Health. It was referred to the Branches and Groups for comment. On May 21st, 1937, the Council, hav- ing considered the comments, decided to forward the memorandum to the Association of Municipal Corpora- tions and the County Councils Association with a request for their favourable consideration of it. The memorandum was not printed in the jo~trnal at that time, but it may now be regarded as of more general interest and worthy of wider' circulation in view of the re-awakened interest in medical planning.

INTRODUCTORY In March, 1932, a resolution of the Northern

Branch in the following terms:- That the Ministry of Health be approached by

the Society of Medical Officers of Health with a view to the establishment of a special Com- mittee which shall be available to advise Local Authorities in the selection of candidates for appointment in the Public Health Service

was considered by the Council of the Society and circulated to the Branches and Groups, Much inter- est in the proposal was subsequently taken by Fellows of the Society, and in November, 1933, the Council approved a recommendation of the General Purposes Committee that we should prepare a memorandum on the method of making appointments in the public health service for the consideration of the Council. Our delay in presenting the report has been partly due to difficulties in obtaining some of the information which we thought might be useful to the Council.

GENERAL We propose to limit the subject of this memorandum

to the method of selecting medical officers of health for appointment. We have arrived at this decision for the following reasons. The efficiency, atmosphere and outlook of a local government department depend largely upon the qualifications, character, ability and experience of the officer in charge of it. We believe that' most local authorities look to their medical officers of health for guidance as to the appointment of other officers in health departments, and, as a general rule, attach due weight to their advice. Where this policy is followed, the desirable principle that local governing bodies should make their own appointments, but that they should receive and pay regard to expert advice, is satisfied, and it does not seem to us necessary to introduce any other intermediary between the appoint- ing body and the department; but, if there is a senior medical officer in charge of a section to which an appointment is about to be made, his or her advice should also be available to the council through the medical officer of health. If a medical officer of health should introduce any improper or unfair methods into this process of selection, as has been suggested in some recent instances, the Society has means of drawing attention to such exceptional in- stances and of endeavouring to prevent their recur-

rence. Complaints of this kind are too infrequent to justify any suggestion that the method of appointment requires reform. Some of the difficulties which have recently arisen might be removed by an extension of the Minister's power to make regulations as to the qualifications of medical and other technical officers in health departments, including the school medical ser- vice (see L.G.A., 1929, sect, 59). On the other hand there is clearly widespread discontent with the way in which appointments of medical officers of health are sometimes made, which may react upon the quality of entrants to the service if no better means can be found.

THE PRESENT SYSTEM

The view which is widely held, especially among the younger men who have reached an age and acquired experience fitting them for responsible posts, is that the present system of making appointments leaves too much to chance, and sometimes even results in a de- cision being made on other grounds than merit. They feel compelled to apply for every possible appointment, whether they are confident that they are well fitted for it or not, because of this element of chance which they cannot afford to ignore. Consequently, a local author- ity who have a vacancy are inundated with large num- bers of applications from professional men which they have neither the time nor the specialised knowledge to examine thoroughly. In the preliminary process of elimination they naturally and rightly take into con- sideration the importance of the post which a candidate holds, the size and importance of the area which he serves, his previous appointments, any higher qualifica- tions which he holds and the manner in which his application is set out. In our experience, few mem- bers of appointing committees find time to read through all the testimonials submitted by all the applicants. I t is a rough and ready system which gives a premium to candidates who can find other means of bringing their names to the notice of mem- bers of councils or committees, and often penalises those who treat seriously the announcement commonly appearing in advertisements that canvassing directly or indirectly will be a disqualification. The position of deputies or senior assistants is peculiarly anomalous; if they are already in the service of the appointing authority they are certain of consideration but, if they are not, they may stand a poor chance of being in- cluded in a short list along with men already holding responsible posts, however distinguished their records and however large and important the area they serve may be.

The position of those whose names appear on a short list is often difficult. They are, at least, assured of having an opportunity of appearing before the appointing body, but they are frequently surprised at the motives and interests revealed at such interviews as actuating the minds of the members, or at the per- functoriness of their enquiries. They may have re- frained from canvassing and yet find that others have done it without penalty; or they may learn that steps they have taken to use influence have discredited them while other candidates who have been more fortunate or discreet in using similar means have benefited by

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1941 PUBLIC HEALTH

them. The widespread conviction that, even when merit has brought a candidate to the short list, it is not the governing factor in determining the final appointment is bad for those engaged in the service and leads them to adopt an attitude of cynicism in advising able young practitioners who think of enter- ing it. Public health officials freely refer to appoint- menta which have been made in recent years as illustrating the unfortunate results of the system.

While members of local authorities take a keen interest in appointments--indeed they are usually the occasion for exceptionally well attended meetings of the committees concerned--they cannot be regarded as well equipped for selecting senior officials, especially when the position calls for high professional standing as well as administrative experience and competence. Not infrequently councillors, in private conversation, admit the difficulties which they encounter in this con- nection and express regret that there is at present no practical alternative. It is not surprising that there is a growing predilection for internal promotion, a practice which has some advantages but is not always conducive to efficiency and may be unfair to other officers in the service.

As far as we can gather most experienced officers, as well as members of councils, hold the view that no system would be workable in this country which took the responsibility of making appointments of chief officials out of the hands of local authorities, and we are entirely in accord with this opinion. The problem is to find good and acceptable means of helping auth- orities without introducing new opportunities for abuse. DEPARTMENTAL COMMITTEE ON QUALIFICATIONS, ETC.,

OF LOCAL GOVERNMENT OFFICERS This Committee, which reported in 1934, devoted

some attention to the subject under discussion, but their deliberations were not exhaustive as might have been expected in view of their wide reference. Certain of their general observations are, however, pertinent to the question. The method of selection of local govern- ment officers, they say, should be carefully calculated to secure the ablest of the candidates who present themseIves and (this being a consideration specially applicable to a public service) the method of selection must be strictly impartial (p. 20). They recommend that all local authorities should provide by standing order that canvassing for any appointment will dis- qualify the candidate; and should see that the order is observed (p. 21). The Departmental Committee's more practical suggestions include the setting up by every local authority of an establishment committee entrusted with all questions of recruitment, promotions, etc., and directly concerned, among other things, with the appointment of senior officers, which would best be dealt with by a small joint group composed of mem- bers of the employing and establishment committees (pp. 46-7). The final recommendation of the Depart- mental Committee, on which they lay special stress, is the establishment by local authorities of a central advisory committee, representative of themselves, the Ministry of Health and perhaps of local government officers and educational bodies, which would advise them on all questions of recruitment, etc., and which might also be used as their agent (pp. 48-50). It will

be seen that the Committee's recommendations on the specific point at issue were not very far-reaching, ex- cept in relation to the possible functions of a central advisory committee to which we shall return later. In 1934 the Minister of Health set up a Standing Advisory Committee representing local authorities to advise him on any question of policy or administra- tion affecting the public health services which may be referred to them by the Minister, and, while this com- mittee does not appear to have been constituted for the particular, object with which we are concerned, the question Is one which might be referred to them if the Minister thought proper.

FOREIaN PaACTICE. We have obtained some information from the Health

Organisation of the League of Nations as to the prac- tice in European countries. The systems of local government, however, and the relations between central and local administration are so different from ours that we have not thought it worth while quoting from the information. Appointments and promotion by ex- amination or selection by the Minister, as, for instance, in Italy and Poland, would not, we feel sure, find fav- our with most of the members of the Society, and would certainly not be acceptable to local authorities. In America, where the most striking feature of local government is its variability from place to place, it is too often assumed in this country that the prevailing autocratic power of state governors and mayors during their period of office leads to bad appointments. Some- times the governor or mayor, faced with the appoint- ment of a health commissioner or health officer, refers the matter to a small committee of experts convened for the purpose and abides by their selection. For instance, in Washington, the constitution of whose government is peculiar, a recent selection was made in this way with satisfaction both to the authority and those engaged in the public health service. Gener- ally it is correct to say that in the United States of America use of expert guidance as to senior appoint- ments is rather more common than in this country.

IRISH LOCAL APPOINTMENTS COMMISSION The method which has been adopted in the Irish

Free State to improve the selection of local govern- ment officers deserves more attention than it has re- ceived in this country. We are indebted to the Local Appointments Commissioners for very full informa- tion on the subject, and the following is a brief epitome of it. The Commission was established by the Local Authorities (Officers and Employees) Act, 1926. The Act applies to appointments of chief executive officers, professional or technical officers other than teachers and any other officers or employees to whose appointment the appropriate Minister, with the con- currence of the Commissioners, may declare the Act to apply. By Orders made from time to time the following additional types of appointment have been brought within the Act, viz., superintendent assistance officers, agricultural instructors of various kinds, accountants of county councils, chief clerks and store- keepers o f mental hospitals, as well as a number of offices under specified local authorities. The net of the Commission is, therefore, spread wide. The Corn-

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PUBLIC HEALTH NOVEMBER

missioners, three in number, are appointed by the Executive Council and may be salaried, and they are provided with staff. Appointments of the above type may be filled with the Minister's consent and without reference to the Commissioners only if the new in- cumbent holds or has held a similar pensionable post under a local authority and is appointed within three months of the vacancy. In all other cases the auth- ority must request the Commissioners to recommend a person for appointment, and in the authority's de- fault the matter is referred to the Commissioners by the Minister. The Commissioners may, under the Act, recommend either one person for appointment, or more than one for the authority's final selection~ Qualifications for posts are prescribed by the Commis- sioners with the consent of the Minister and in cer- tain circumstances qualifications for offices comprised within any particular description, class or grade may be prescribed. Generally selection for appointment may be made by competitive examination, but the Com- missioners with the consent of the Minister may dis- pense with (and in fact in almost all cases have dispensed with) competitive examinations in favour of selection following interview.

The Commission, then, comes into operation at the request of the local authority--a request which is obligatory under certain conditions and seems to be the usual procedure for appointing medical officers of health. The Commission advertises the vacancy and invites applications. A board of selection, with a lay chairman and consisting of technical experts, accord- ing to the nature of the appointment, is constituted. The experts are chosen from panels supplied by the various professional or technical bodies and give their services gratuitously. The personnel of Boards varies for each appointment. The danger of candidates be- coming known to Boards or vice versa is thus elim- inated. The function of a Board is to arrange the candidates in order of merit and to advise the Com- missioners. The Commissioners recommend the best qualified and most suitable candidate in accordance with such advice subject to satisfactory evidence of age, health and character and any preference for a knowledge of Irish. In practice only one candidate is recommended to the authority, since the Commis- sioners regard it as their duty to select and recommend the best person available, and consider that any other system would involve the publication of the Board's assessment of the relative merits of candidates, which would be unfair both to the candidates and the Board, and would not relieve the authority of the embarrass- ment of canvassing.

This scheme, which has been in operation in the Irish Free State for almost ten years, appears, on t h e whole, to have worked smoothly and to have proved acceptable to the authorities, their officers and the public. In the opinion of Irish practitioners it has greatly raised the standard of public medical services in their country.

PROFESSORIAL APPOINTMENTS The method followed by some universities for select-

ing independent heads of departments is of interest in this connection. The governing body always re- tains the right to appoint members of its staff (except to Regius Chairs) but usually delegates the selection

of one or more persons for their consideration to a committee which often has authority to seek assist- ance from outside. The committee may have an ex- ternal assessor attached to it, or it may indeed, as in the University of Wales, consist of equal numbers of internal and external members, with the head of the college where the vacancy has occurred as its chairman~ the external members and one of the in- ternal being experts in the teaching of the subject in question.

SUGGESTIONS. It seems to us that it is possible to arrive at certain

conclusions from a consideration of the foregoing systems together with the circumstances of local gov- ernment in Great Britain.. We do not think that proposals to ensure the enforcement of prohibitions of canvassing are practicable under present conditions. This practice at least affords the members of authori- ties some means of forming their own opinion of candidates whose applications convey little to them. We desire to reiterate the view we have already ex- pressed that the spirit and tradition of local goVern- ment in this country would not lend themselves to any scheme which detracted from the autonomy of local authorities; while appointments are often unsat- isfactory, they are not usually so bad as to justify any revolutionary change. Some system is desirable which would prove its own value and might be adopted voluntarily by an increasing number of authorities.

What appears to be required is to place professional guidance at the disposal of local authorities when they are making an appointment of a medical officer of health. The retiring officer may be available for this purpose, but sometimes the authority may hesitate to consult him or he may be in a difficult and invidious position if one of his own staff is a candidate. The local medical profession, outside the ranks of the pub- lic health services, are not usually in a position to give authoritative advice. Local authorities have been known to consult the medical department of the Min- istry, and certainly their officers hav~ opportunities of assessing the competency of men who have held responsible appointments elsewhere. The practice, however, does not seem to have found much favour. It would be preferable for local authorities to estab- lish their own machine through the associations which represent them.

I t is here that such a central advisory committee on recruitment, etc., as that suggested by the De- partmental Committee might be utilised. The forma- tion of a committee of this kind would afford to local authorities an opportunity to establish, through their own agency, a panel of experts, any one or more of whom would be available at the request of local auth- orities to advise them in the preparation o f a short list, or, if it were desired, to assist an appointing com- mittee in interviewing candidates and assessing their merits. It is not unlikely that councils would be will- ing to take advantage of such a facility if it were pro- vided and recommended by their own central body. A panel of the kind suggested would preferably con- sist mainly of medical officers of health who either had retired or had reached such an age and standing that they would not themselves seek promotion or transfer.

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1941 PUBLIC HEALTH

If there is no prospect of the establishment of such a committee by local authorities, it is possible that the Minister, if representations were made to him, might regard the subject as appropriate for reference to the Standing Advisory Committee which he has already set up.

If a satisfactory method of selection can be devised, we do not think that it should be laid down as an axiom that every vacancy should be advertised. When a deputy or senior assistant in the department con- cerned is well fitted for the post and finds favour with the authority, it is unfair to other members of the service to induce them to apply by insisting on a formal and unreal throwing open of the appointment. But we believe members of the service and many councillors would feel more confidence in internal promotions if external advice were obtained, through some such organisation as we have suggested, before an officer were promoted to a post for which there might be even more suitable candidates in the service of other authorities.

February, 1936.

OBITUARY JAMES KERR, M.A., M.D., D.P.H.

Dr. James Kerr, a pioneer worker in the school medical service and originator of the school medical service in Bradford, died at his home in Edinburgh on October 5th.

James Kerr was born in Glasgow and educated at Manchester Grammar School. He entered St. John's College, Cambridge, with a science scholarship, and gained first-class honours in the Natural Sciences Tripos in 1883. He received his medical education at St. Bartholomew's Hospital, where he held the senior science scholarship. He took'the M.B., B.Ch. and D.P.H. of Cambridge in 1887, and proceeded to the M.D. in 1891.

Dr. Kerr joined the honorary medical staff of the Bradford Royal Infirmary and the Bradford Eye and Ear Hospital, but later he turned from clinical to administrative work and became medical superintend- ent under the Bradford School Board. It was at this time that he organised the school medical service of the city. He became first medical officer to the old London School Board, and when this was taken over by the L.C.C. became Medical Officer (Education), a post which he held with distinction from 1902 to 1911. Dr. Kerr's public duties were wide and varied. He was secretary of the second International Congress of School Hygiene, and served on the International Commission on Standards of Illumination and on the examination board for the English Board of Educa- tion. He gave the Ingleby Lecture before the University of Birmingham, and was awarded the Howard Medal by the Royal Statistical Society. During the war 1914-18 he served in the R.A.~VI.C. with the temporary rank of major, and he was hon- oured by the rank of Officier de l'Instruction Publique de France. His published works include several books: The Air We Breathe; School Vision and the Myopic Scholar; The Fundamentals o'[ School Health. In the last publication Dr. Kerr collected the informa- tion gained in his many energetic years of service with

the schools. I t was the first exposition of present-day developments in health culture among children and adolescents and is an exhaustive study of the subject, containing 850 pages and many references to original literature.

Dr. Kerr took an active interest in politics and was for many years a member of the Fabian Society, serving for a time on its executive. He was a member of the Labour Party's Advisory Committees on Public Health and on Education. When he retired twelve years ago he went to Edinburgh, where he became chairman of Donaldson's Hospital and took an active interest in the work of the hospital on behalf of the deaf and dumb. He is survived by his wife and by his son, Dr. Douglas Kerr, principal police surgeon under the Corporation of Edinburgh.

H. S. BUaNELL-JONES, D.P.rI. We regret to record the death at Worle, Somerset,

after a long illness, of Dr, H. S. Burnell-Jones, recently acting tuberculosis officer for Worcester.

Harold Stanley Burnell-Jones received his medical education at Cardiff, Leeds, Bristol, London Hospital, and University College. He took the L.S.A., London, in 1907, the D.P.H., Oxon, in 1911, and the L.M.S.S.A., London, in 1917. He had practised in Birmingham, North London, and at West Wickham, Kent. He was at one time clinical assistant at the Central London Throat, Nose, and Ear Hospital, and he also ran the throat department of the Croydon Gen- eral Hospital for some months after the death of Mr. Juler. He worked for a time in the skin department of the Royal Northern Hospital. Among his other appointments were Assistant School Medical Officer for Somerset, resident medical officer to the M.A.B. Fever Hospitals, and assistant in the Bacteriology and Chemistry Department of the Middlesex Hospital. His publications include Further notes on Tuberculin (1937) and Further notes on tuberculin in treatment of cataneous tuberculosis (1937).

Dr. Burnell-Jones was an accomplished organist. He was always neat in appearance and of a genial disposition. He leaves a widow and six children, four of whom are in the Services. One daughter is a Bart's nurse now serving in the Army, and of his three sons two are in Canada.

ALEXANDER ROBERTSON, M.B., CH.B., D.P.H. We regret to record the death at the age of 62

of Dr. Alexander Robertson, medical officer of health for the Burghs of Elgin, Lossiemouth, and Rothes.

Alexander Robertson went to Aberdeen University, and passed M.B., Ch.B., in 1902, taking the D.P.H. in 1905. For seven years he was in Kenya as Govern- ment medical officer. He next worked for four years as assistant medical officer at the Bermondsey Infirm- ary in South London. In 1914 he entered private practice in Elgin, where he also undertook public health administration. At the time of his death he was senior surgeon to Dr. Gray's Hospital.

Dr. Robertson was an elder of St. Giles's Church, Elgin. He was also a football enthusiast, and was vice-president and honorary medical adviser of the local football club.

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