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Bodies—more or less
Public Health The Journal of The Society of Community Medicine (Formerly the Society o f Medical Officers of Health)
Volume 90
Bodies--More
Number 6
September 1976
or Less
A plague upon them all! There are t, ir too many'. Fund raising incessantly. Playing upon our consciences: Competing. overlapping and.duplicating activities. Engendering committees and sub-commilTees. Sustaining, rank upon rank o f Presidents. Vice Presidents. Chairmen, Treasurers and Secretaries ,rod all churning out more and more paper. How man.x' of us have not so exclaimed when frustrated by some manifestation of folly, jealousy or bickering arising from a local or national body. Accepting an honoured invitation to lead into Otis last issue under Israel Gordon's distinguished editorship it seems timely and relexant to pursue some of the issues raised in his understandabl 3 provocative "'1856"" editorial in the May edition and to ask ourselves Mlere we st;rod in this minter o f multiplicity of organizations and journals of our o u n creation and where u e are ~oin~. Such is the breadth of our field of interest that most of us in community n~dicine are probably faced with more subscriptions (or conscience) than applies to any other branch of medicine. We trust that our dental members will bear with us on this occasion. We are now required to pay up annually to keep our name on the Medical Register in order that we may legally serve our State employers. Some of us had supposed that (barring indiscretion) we had already purchased from the G.M.C. a life entry. We are surely a fairly stgtic lot and scarcely add much to the clerical work of the scribes. Next, in terms o f basic survival, is medical protection. Here again community medicine practitioners mt~stly debarred from private practice must be one of the insurer's fSavourite low-risk groups. We trust they will keep us realistically in mh~d in the course of differential subscri ption reviews. Perhaps our third membership consideration as generic doctors is the B.M.A. We must surely admit that we have been mostly well served and welcomed at t.he centre and the periphery. Our own colleagues contribute much in the matter of central activity and negotiations so essential to.us but we have also had a very fair share o f the time ~ind eflBrt of an able, amiable and hardworked Secretariat. Elston Grey-Turner has been a particularly good friend of the Public Health Service and we wish him ~ e very best in Iris new appointment. There can be few of us who would not endorse his message in t he B.M.J. o f l 7 July 1976. 261
262
K. Vickery
These three could be the extent of c o m m i t m e n t for many a .loctor. Even so, a motion was carried at the recent A.R.M. calling for their amalgamation. Moving in our consideration from the general to the specialist, the next body to claim our attention, although very new, is the Faculty. One must here confess personally to having been slow to appreciate the significance nd potential o f events leading up to its formation. Being singularly fortunate in local job satisfaction with an opportunity to administer and develop health and social services comprehensively together, one saw Seebobm and the way Local Government re-organization was going against the County Boroughs as thoroughly retrograde and detrimental to the interests o f one's own local health and welfare authority. One felt compelled to join the fight to endeavour at least to modify the course of events. Nevertheless, the early signs o f the authoritarian days ahead of "government by Ministry circular" were already manifest. One remembers vividly participating in a Council deputation to plead for an exemption from the expensive necessity of setting up a new Social Services Department within a County Borough which could well be, and in the event was, abolished a couple o f years later. The confrontation with the stony faced and unyielding members o f the Inter-departmental Committee (Ht~me Office and Health), with the poliiicians sitting by mute and seemingly helpless, was an eye opener. Others of our fraternity (some who perceived the writing on the wall even earlier whilst enduring the tribulation o f London re-organization) were fortunately conceiving a new baby o f exclusively medical parentage---community medicine---and preparing high standards |br its nurture. A m o n g these colleagues we owe a particular debt to Wilfrid Harding for his foresight and effort in the emergence o f the Faculty and l~r much else that he has done to secure the foundations o f parity of academic esteem and professional opportunity for the consultant c o m m u n i t y physician. His vigilance continues as instanced by his very recent successful representation with the Secretary o f State in the matter o f community medicine and the standstill. He and his Board ~ill, 1 am sure. agree that there are other and corporate activities necessary for community medicine and we trust we may have their co-operation and advice in ensuring clarity of mutual objectives and functions in the course of essential reviews o f the future o f the Society and other bodies. The relevance and future o f our o~'ganizations is closely related to our numbers, functions and job satisfaction. There may be days when we have doubts of our belief in consensus management. There may be days when we wonder if we now really believe in democracy. We may reflect how singularly inappropriate is that mouthful o f a title "Medical Officer fbr Environmental Health'" when we are called upon to deal with matters so personal to health as communicable disease. We may be concerned how thin on the ground are those of us with experience o f communicable disease and of the increasing measure of good luck necessary to maintain rotas o f availability notwithstanding the confident expectations o f the departmental circulars. We may worry that even with large populations we may become rusty in some aspects o f our infectious disease expertise. We m a y wonder in the event o f a really nasty outbreak how effectively we will manage to mobilize the necessary troops in whose recruitment, training and administration we now have little or no part. In all these matters, and in our new Health Service responsibilities, we are conscious of the continuing need for professional groups where we can meet at times with those who are doing the same jobs and at other times with those o f other disciplines. The degree o f our participation in the existing organizations has been influenced by inclii, ~tion, location and the authority we worked for. Relative to a conference town, my own activity has tended to be within those bodies such as the Royal Society o f Health and the Royal Institute o f Public Health and Hygiene who have the resource and expertise to put on a good conference and bring business to my former, not unappreciative, employers.
Bodies--More or Less
263
We look to a valuable and continuing role for the Royal Society o f Health particularly as an inter-disciplinary forum but with some nostalgic regret one doubts if we can ever again see the three or four thousand annual pilgrims and camp followers to the Eastbourne Congress. May we take this opportunity of congratulating the Royal Society of Health on reaching its Centenary this year and extend our very best wishes for a most effective future. There are many other bodies such as the R.S.M. and the B.P.A. to which according to interests we may subscribe. Subscriptions bring journals, newsletters and annual reports. However hard we try, the reading of them (sometimes even the unwrapping of them) lends to gain upon us. A colleague of mine finds that with a few pharmaceutical samples as additives, they compost down very nicely even in the surgery. A clergyman of my acquaintance faced with the same problem allows them to accumulate on a certain table until it will contain no more. He declares that he then kneels, lays his hands upon them, prays in sorrow and repentance, and burns the lot. Very high in the affections of most of us was tile Society of Medical Officers of Health which affection has continued with the change o f name which accompanied the changes in our own titles, it seems ironical at the very time when our well established respected body, with its very modest subscription inclusive of one of the best of the journals, was contemplating its demise there should be emerging in light of pragmatic need new associations of community physicians, each having requirements o f administration and subscription and with objeclives so very similar to the former County Borough, County District, County, M & CW and Welfare groups of our Society. Coincident with this, the Royal Institute of Public Health and Hygiene, already having welcomed the Association of District C o m m u n i t y Physicians, is in the process of reviewing its role in this brave new post-reorganization world. By tradition, the Institute's Council has been medical and multi-disciplinary, including in its time a wide representation of eminent clinical consultants. In more recent years, whilst retaining a wholesome leavening of clinicians, the Council membership has moved more towards public health and occupational medicine with a most welcome recent recruitment of additional active members o f the Society. Apart from the potential o f its membership o f Council and an income derived mainly from the world of public hygiene and commerce, a great asset of the Institute is the ownership of its valuable and prestigious central London properties. Like the Society, a tremendous amount of work has been accomplished with a very small staff. Furthermore, and something to be valued in these days o f administrators who would do us down if given half a chance, we have an asset in the person of our Secretary, Bob Horsham, who in spite o f all the headaches we pose as the individualists we are, has a warm and abiding affection and loyalty for doctors. It is also good to note that the Institute's journal Community Health is so widely appreciated. Some of the problems, frustrations, suspicions and uncertainties o f and between the respective bodies are frankly stated in Gordon's "'1856" editorial. He wonders if the Society will become an appendage of the R.I.P.H. We trust not indeed. The Institute is not looking for appendices or aggrandizement. It has plenty to get on with including a challenge to update and revitalize the D.P.H. course for which there is a continuing and increasing demand from overseas postgraduates. The Institute is privileged to provide a holding operation for the assets and interim activities of the Society. There is time--albeit a short t i m e - - t o take stock. My exhortation is that this time be used in re-appraisal and assessment of essential overall requirements of community medicine practitioners. In the meantime may we appeal to Society members who may be hesitant, to renew their subscriptions at least once more. We must surely explore
264
K. Vickerv
the practicability of the emergence of a federating organization with one subscription, one journal, meeting the respective group professional needs of Community Physicians in their ~veral functional varieties, of other Child Specialists, of colleagues in tile Employment Medical Advisory Service and in occupational medicine, and possibly the medical membership of the Institute. A pipedream ? A pious hope? Maybe, but at a time when Sir George Godber pertinently reminds the whole profession of the baleful consequences of its fragmentation (B.M.J., 31 July 1976) should we not at least in our own field make a determined efforl to rationalize our objectives and consolidate our resources and activities ?
Kenneth Vick er)" Chairman of Council, Royal Institute of Public ltealth and Hygiene.
Public Health, Volume 91 Following negotiations with the R.I.P.H.H., Tile Society of Community Medicine has moved to new Registered Offices at 28 Portland Place, London. The Council of the Society is currently considering its future organization and role. In collaboration with Academic Press it has been agreed that the Journal, Public Health, shall continue, and the next issue will be in January 1977. Dr I. Gordon has retired from his post as editor and will be succeeded by Dr J. S. Robertson. Contributions for the next volume would be greatly appreciated. They should be sent to Dr J. S. Robertson, Trent House, Hebden Road, Scunthorpe. Contributions relating to any aspect of community medicine or dentistry may be submitted. Results of original research including epidemiological and sociological studies would be particularly welcome.
Volume 90
Bodies--More
Number 6
September 1976
or Less
A plague upon them all! There are t, ir too many'. Fund raising incessantly. Playing upon our consciences: Competing. overlapping and.duplicating activities. Engendering committees and sub-commilTees. Sustaining, rank upon rank o f Presidents. Vice Presidents. Chairmen, Treasurers and Secretaries ,rod all churning out more and more paper. How man.x' of us have not so exclaimed when frustrated by some manifestation of folly, jealousy or bickering arising from a local or national body. Accepting an honoured invitation to lead into Otis last issue under Israel Gordon's distinguished editorship it seems timely and relexant to pursue some of the issues raised in his understandabl 3 provocative "'1856"" editorial in the May edition and to ask ourselves Mlere we st;rod in this minter o f multiplicity of organizations and journals of our o u n creation and where u e are ~oin~. Such is the breadth of our field of interest that most of us in community n~dicine are probably faced with more subscriptions (or conscience) than applies to any other branch of medicine. We trust that our dental members will bear with us on this occasion. We are now required to pay up annually to keep our name on the Medical Register in order that we may legally serve our State employers. Some of us had supposed that (barring indiscretion) we had already purchased from the G.M.C. a life entry. We are surely a fairly stgtic lot and scarcely add much to the clerical work of the scribes. Next, in terms o f basic survival, is medical protection. Here again community medicine practitioners mt~stly debarred from private practice must be one of the insurer's fSavourite low-risk groups. We trust they will keep us realistically in mh~d in the course of differential subscri ption reviews. Perhaps our third membership consideration as generic doctors is the B.M.A. We must surely admit that we have been mostly well served and welcomed at t.he centre and the periphery. Our own colleagues contribute much in the matter of central activity and negotiations so essential to.us but we have also had a very fair share o f the time ~ind eflBrt of an able, amiable and hardworked Secretariat. Elston Grey-Turner has been a particularly good friend of the Public Health Service and we wish him ~ e very best in Iris new appointment. There can be few of us who would not endorse his message in t he B.M.J. o f l 7 July 1976. 261
262
K. Vickery
These three could be the extent of c o m m i t m e n t for many a .loctor. Even so, a motion was carried at the recent A.R.M. calling for their amalgamation. Moving in our consideration from the general to the specialist, the next body to claim our attention, although very new, is the Faculty. One must here confess personally to having been slow to appreciate the significance nd potential o f events leading up to its formation. Being singularly fortunate in local job satisfaction with an opportunity to administer and develop health and social services comprehensively together, one saw Seebobm and the way Local Government re-organization was going against the County Boroughs as thoroughly retrograde and detrimental to the interests o f one's own local health and welfare authority. One felt compelled to join the fight to endeavour at least to modify the course of events. Nevertheless, the early signs o f the authoritarian days ahead of "government by Ministry circular" were already manifest. One remembers vividly participating in a Council deputation to plead for an exemption from the expensive necessity of setting up a new Social Services Department within a County Borough which could well be, and in the event was, abolished a couple o f years later. The confrontation with the stony faced and unyielding members o f the Inter-departmental Committee (Ht~me Office and Health), with the poliiicians sitting by mute and seemingly helpless, was an eye opener. Others of our fraternity (some who perceived the writing on the wall even earlier whilst enduring the tribulation o f London re-organization) were fortunately conceiving a new baby o f exclusively medical parentage---community medicine---and preparing high standards |br its nurture. A m o n g these colleagues we owe a particular debt to Wilfrid Harding for his foresight and effort in the emergence o f the Faculty and l~r much else that he has done to secure the foundations o f parity of academic esteem and professional opportunity for the consultant c o m m u n i t y physician. His vigilance continues as instanced by his very recent successful representation with the Secretary o f State in the matter o f community medicine and the standstill. He and his Board ~ill, 1 am sure. agree that there are other and corporate activities necessary for community medicine and we trust we may have their co-operation and advice in ensuring clarity of mutual objectives and functions in the course of essential reviews o f the future o f the Society and other bodies. The relevance and future o f our o~'ganizations is closely related to our numbers, functions and job satisfaction. There may be days when we have doubts of our belief in consensus management. There may be days when we wonder if we now really believe in democracy. We may reflect how singularly inappropriate is that mouthful o f a title "Medical Officer fbr Environmental Health'" when we are called upon to deal with matters so personal to health as communicable disease. We may be concerned how thin on the ground are those of us with experience o f communicable disease and of the increasing measure of good luck necessary to maintain rotas o f availability notwithstanding the confident expectations o f the departmental circulars. We may worry that even with large populations we may become rusty in some aspects o f our infectious disease expertise. We m a y wonder in the event o f a really nasty outbreak how effectively we will manage to mobilize the necessary troops in whose recruitment, training and administration we now have little or no part. In all these matters, and in our new Health Service responsibilities, we are conscious of the continuing need for professional groups where we can meet at times with those who are doing the same jobs and at other times with those o f other disciplines. The degree o f our participation in the existing organizations has been influenced by inclii, ~tion, location and the authority we worked for. Relative to a conference town, my own activity has tended to be within those bodies such as the Royal Society o f Health and the Royal Institute o f Public Health and Hygiene who have the resource and expertise to put on a good conference and bring business to my former, not unappreciative, employers.
Bodies--More or Less
263
We look to a valuable and continuing role for the Royal Society o f Health particularly as an inter-disciplinary forum but with some nostalgic regret one doubts if we can ever again see the three or four thousand annual pilgrims and camp followers to the Eastbourne Congress. May we take this opportunity of congratulating the Royal Society of Health on reaching its Centenary this year and extend our very best wishes for a most effective future. There are many other bodies such as the R.S.M. and the B.P.A. to which according to interests we may subscribe. Subscriptions bring journals, newsletters and annual reports. However hard we try, the reading of them (sometimes even the unwrapping of them) lends to gain upon us. A colleague of mine finds that with a few pharmaceutical samples as additives, they compost down very nicely even in the surgery. A clergyman of my acquaintance faced with the same problem allows them to accumulate on a certain table until it will contain no more. He declares that he then kneels, lays his hands upon them, prays in sorrow and repentance, and burns the lot. Very high in the affections of most of us was tile Society of Medical Officers of Health which affection has continued with the change o f name which accompanied the changes in our own titles, it seems ironical at the very time when our well established respected body, with its very modest subscription inclusive of one of the best of the journals, was contemplating its demise there should be emerging in light of pragmatic need new associations of community physicians, each having requirements o f administration and subscription and with objeclives so very similar to the former County Borough, County District, County, M & CW and Welfare groups of our Society. Coincident with this, the Royal Institute of Public Health and Hygiene, already having welcomed the Association of District C o m m u n i t y Physicians, is in the process of reviewing its role in this brave new post-reorganization world. By tradition, the Institute's Council has been medical and multi-disciplinary, including in its time a wide representation of eminent clinical consultants. In more recent years, whilst retaining a wholesome leavening of clinicians, the Council membership has moved more towards public health and occupational medicine with a most welcome recent recruitment of additional active members o f the Society. Apart from the potential o f its membership o f Council and an income derived mainly from the world of public hygiene and commerce, a great asset of the Institute is the ownership of its valuable and prestigious central London properties. Like the Society, a tremendous amount of work has been accomplished with a very small staff. Furthermore, and something to be valued in these days o f administrators who would do us down if given half a chance, we have an asset in the person of our Secretary, Bob Horsham, who in spite o f all the headaches we pose as the individualists we are, has a warm and abiding affection and loyalty for doctors. It is also good to note that the Institute's journal Community Health is so widely appreciated. Some of the problems, frustrations, suspicions and uncertainties o f and between the respective bodies are frankly stated in Gordon's "'1856" editorial. He wonders if the Society will become an appendage of the R.I.P.H. We trust not indeed. The Institute is not looking for appendices or aggrandizement. It has plenty to get on with including a challenge to update and revitalize the D.P.H. course for which there is a continuing and increasing demand from overseas postgraduates. The Institute is privileged to provide a holding operation for the assets and interim activities of the Society. There is time--albeit a short t i m e - - t o take stock. My exhortation is that this time be used in re-appraisal and assessment of essential overall requirements of community medicine practitioners. In the meantime may we appeal to Society members who may be hesitant, to renew their subscriptions at least once more. We must surely explore
264
K. Vickerv
the practicability of the emergence of a federating organization with one subscription, one journal, meeting the respective group professional needs of Community Physicians in their ~veral functional varieties, of other Child Specialists, of colleagues in tile Employment Medical Advisory Service and in occupational medicine, and possibly the medical membership of the Institute. A pipedream ? A pious hope? Maybe, but at a time when Sir George Godber pertinently reminds the whole profession of the baleful consequences of its fragmentation (B.M.J., 31 July 1976) should we not at least in our own field make a determined efforl to rationalize our objectives and consolidate our resources and activities ?
Kenneth Vick er)" Chairman of Council, Royal Institute of Public ltealth and Hygiene.
Public Health, Volume 91 Following negotiations with the R.I.P.H.H., Tile Society of Community Medicine has moved to new Registered Offices at 28 Portland Place, London. The Council of the Society is currently considering its future organization and role. In collaboration with Academic Press it has been agreed that the Journal, Public Health, shall continue, and the next issue will be in January 1977. Dr I. Gordon has retired from his post as editor and will be succeeded by Dr J. S. Robertson. Contributions for the next volume would be greatly appreciated. They should be sent to Dr J. S. Robertson, Trent House, Hebden Road, Scunthorpe. Contributions relating to any aspect of community medicine or dentistry may be submitted. Results of original research including epidemiological and sociological studies would be particularly welcome.