The county councils officers thought that a regional council involving over sixty local authorities was a daunting prospect, and the Clerk thought that much time would be wasted in debate. As a regional council would need supporting staff, would it not be better to have the staff without the council? Officers could outline principles and draw up a plan to guide decisions when the voluntary or municipal hospitals were seeking money. The councils officers thought that an officer group would inevitably have to work closely with the lcc, and would absorb lcc thinking. Lord Latham would have preferred a simple lcc takeover of those voluntary hospitals which were needed, but his officers pointed to the strength of the opposition to be faced. The council therefore decided to develop a london county council view of a regional scheme, and also to continue to plan a comprehensive service for the administrative county including cooperation with the larger voluntary hospitals. The ministry was told that the london county council thought that a regional council would be a waste of time.
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It was known that the nuffield Provincial Hospitals Trust was about to publish a memorandum on regionalisation, and writing in the Star on, alderman Latham said: The fifth-columnists against democracy are preparing to steal the peoples municipal hospitals., the beavers of reaction are ceaselessly gnawing. Latham feared that although three-quarters of Londons hospital beds were provided by the council, to save the voluntary hospitals all would be-taken over and handed to non-elected regional bodies, which would preserve the features of the voluntary system paper but sacrifice public accountability. Instead, he wished to see a comprehensive service administered by the local authorities into which the voluntary hospitals would have to come if they wished to play their part. He warned his readers to be on their guard - sappers against democracy would get them if they did not watch out. Public disagreements of this nature, in advance of a government statement, were unhelpful. The ministry suggested a confidential discussion with lcc officers on post-war hospital policy, and the possibility of forming a london regional council. Latham was briefed by the Clerk and Allen Daley, who had succeeded Sir Frederick menzies as medical officer of health. Daley had taken over in 1939 and was a different type of man. He was a superb administrator with demoniac energy, but he had a smoothness of manner which made him easy to work with. One administrator who knew him said that, had he not been medical officer of health, he might easily have been the clerk to the council.
He suggested two desirable developments:. The grouping of hospitals to serve not only the metropolitan area but also a large part of the home counties. He suggested wedge-shaped areas with their apex in the centre like the Emergency hospital Scheme sectors. The decentralisation of teaching work. If regional organisation was to be complete, provincial hospitals would have to be developed. The destruction of teaching hospitals by the blitz had created an opportunity for development on rational lines which would be lost if hospitals compelled to leave by bombing were allowed to return and rebuild in the centre of the city. Future plans and the london county council Whilst this preliminary work was proceeding within the ministry, and confidential discussions were taking place, the issue of the future hospital service and how it might be organised plan was raised in a most abrasive fashion by the leader.
Regional authorities could plan services which might then be funded from exchequer funds, insurance contributions and a precept on local authorities. It was recognised that a centrally directed regional organisation would be opposed by local government, and a key question would be the thesis relationship between Whitehall and local authorities. Possibly each area might have a body consisting of local authority., voluntary hospital and medical representatives, the ownership of the hospitals remaining unchanged. It was soon clear that the arrangements which might suit the rest of the country would be inappropriate in London, and that the financial framework would be of crucial importance, particularly to the teaching hospitals. The Office committee on Postwar Hospital Policy thought that it might be possible to treat the teaching hospitals separately, leaving them a much higher degree of independence. Related to this, in London, was the necessity of maintaining as many as twelve teaching hospitals. The government had been asked to assist the teaching hospitals but Sir Edward Forber, whilst recognising that this was a controversial matter, questioned the need for twelve as some resume were really too small.11 A paper prepared by john Pater for the committee drew attention.
At the same time. The lancet published a plan for British Hospitals which advocated regionalisation and centralisation, and made biting comments about the london hospitals. The author was Stephen taylor, later Lord taylor, and a lengthy and emotive correspondence followed which was summarised in the journal in a statesmanlike fashion by lord Horder. Picture post also discussed hospital planning in a special issue on Britain in the future. The authors advocated a salaried state health service which placed an emphasis on preventive rather than curative medicine.10 by 1941 several factors were making it increasingly urgent to establish a postwar hospital policy. The Emergency medical Service had created the opportunity; a long-term policy was required to decide which hospitals in an area should be preserved and developed; and new and lively bodies like the nuffield Trust were emerging in the policy-making field. From January to september 1941 a ministry committee on postwar hospital policy was at work, which had a preliminary paper laid before it containing proposals remarkably like those which ultimately formed the basis of the nhs act (1946). The committee soon accepted that some form of regionalisation was necessary, because modern health services could not be provided within small local authority areas.
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The medical schools, like the alternative hospitals, faced many problems as a result of inadequate accommodation and makeshift laboratories, but in one way or another they were overcome.7 The experience of coping with dispersed students and staff, and trying to teach under such conditions, convinced most. When, after the war, the medical schools were expanded, this conviction led to the demand for large university hospitals. Planning a future hospital service, the twists of the negotiations and the complex issues which had to be decided before the introduction of the national health Service by bevan in 1948 form a story which has been told elsewhere.8 Lord Dawsons interim report of 1920. It was followed in the thirties by proposals and reports from several organisations, including the British Medical Association.9 The nuffield Provincial Hospitals Trust was pressing ahead with the concept of regionalisation, while wilson Jameson, dean of the london School of Hygiene and Tropical Medicine, organised. Known as the gasbag Committee, it examined a number of problems including the financial plight of the teaching hospitals.
Only the state could provide the large sums necessary but how, asked the group, could the teaching hospitals preserve their much valued independence in such a situation? There were ten to twelve members of the gasbag Committee, including Wilson Jameson, until he moved to the ministry as chief medical officer: topley, allen Daley (moh lcc macaulay (moh middlesex george picketing (St Marys Ernest Rock-carling, landsborough Thomson and Harold Himsworth. There was a free exchange of views and notes were not kept as a matter of policy. An attempt was made to gain consensus on major matters of policy and the group met regularly from September 1939 until the saturday before dunkirk, august 1940. Since february 1938 the ministry had been exploring various options and in October 1939 Sir Edward Forber, who had recently retired from the board of the Inland revenue but had been a deputy secretary point at the ministry of health, was invited to enquire into wartime/postwar.
The senior officer in each sector had direct access to the permanent Secretary at the ministry of health, and through municipal medical officers at sector headquarters, to municipal hospitals. His main power was the distribution of medical staff to hospitals according to their specialties and skills. The municipal and mental hospitals to be upgraded for casualty purposes had been chosen by the ministry, largely without the advice of the sector officer. Many hoped that the cooperation which had been enforced through war could be preserved in peacetime. The outstanding merit of the Emergency medical Service said. Political and Economic Planning, is that it has begun a process which total war makes absolutely imperative - a pooling and reasonable distribution of medical resources and scientific skill.
Regrettably, the publication continued, the sectors worked too much as independent units, a situation encouraged by the appointment of distinguished teaching hospital consultants as group officers.6 The group officers, and their administrative counterparts, saw less need than. Political and Economic Planning for cross-sector coordination, as most problems could be resolved within the boundaries of their own areas. Within these sectors, links between hospitals were established which persist to this day. The effects of evacuation, fire and bombing are described in hospital histories like camerons account of guys and Clark-kennedys of The london.4 Not one of the london county councils hospitals escaped damage. The poet laureate, john Masefield, considered writing a history of Londons hospitals under fire, and he obtained a special allocation of petrol coupons to enable him to visit them. Sadly, the project was abandoned.
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Patients were discharged or evacuated from the hospitals in paper central London in preparation for a wave of air-raid casualties which did not materialise. The staff who had paper been evacuated had little. Some occupied themselves treating local patients, many of whom had never previously had the benefit of specialist attention. Meanwhile, hospital beds stood empty in central London until, at length, limited services were resumed. In spite of the casualties which followed the evacuation from Dunkirk and the london blitz of 1940—1941 the Emergency medical Service was never placed under the stress which had been predicted and for which it had been designed, serious though the damage from bombing proved. However the Emergency medical Service, more than any other single factor, can be held responsible for the form and pattern of hospital organisation which emerged in London. A certain amount of friction existed between the two parts of the system, based on traditional insularities of outlook, but not so much as to prevent a synthesis of the two groups of hospitals. Doctors and nurses for the first time moved freely between the voluntary and the municipal hospitals, seeing the problems each faced. The experiences of teaching hospital staff and students who were drafted to municipal hospitals, where standards of clinical care often left much to be desired, helped later in the acceptance of the national health Service.
Nine sectors radiated from an apex in the centre of London into the home counties, and grandma were based on one or more of the teaching hospitals; the Essex sector was based upon hospitals in Stratford, Ilford and Romford (see table 20, page 240, and Figure. At their extremities the sectors included parts of Essex, hertfordshire, buckinghamshire, kent, surrey and Berkshire which strictly belonged to other home defense regions — the regional organisational pattern established for military purposes. The, london sectors, sectors i ii, the london and Essex hospitals. Sector iii, st Bartholomews Hospital and the royal Free. Sector iv, university college hospital and Charing Cross Hospital. Sector v, the middlesex Hospital, sector vi, st Marys Hospital. Sector vii, st georges Hospital and the westminster Hospital. Sector viii, st Thomass Hospital, sector ix, kings College hospital. Sector x, guys Hospital, map of London Sectors source: The lancet 1939, i, p723, the Emergency medical Service was introduced as soon as war broke out, and gave central government a right of direction over both voluntary and municipal hospitals which it had never before.
establishment of first-aid posts and the sandbagging of the hospitals.3. The metropolitan Police district and the area within about forty miles of it was divided into ten sectors. The general aim was to establish first-aid and casualty sorting centres in the danger areas, providing enough treatment to fit casualties for a journey by ambulance to advance base hospitals. These were in presumably safer areas, with enough staff and equipment for operative treatment of the injured. Base hospitals to which patients could be moved for after-care were still further from the centre. Finally there was a group of less well equipped hospitals for convalescent and chronic cases. The sector officers began the task of surveying the strange assortment of mental asylums, public assistance institutions and other hospitals which were at their disposal. They considered plans for the evacuation of staff and students.4 Contact was established with Sir Frederick menzies and other medical officers of health, and a map was published. The lancet showing the arrangement of the sectors and the position of the advance base hospitals.5.
It was thus the threat of the luftwaffe which compelled Britain — and London — to reorganise the hospital services. Many detailed and practical problems had to be sorted out and the london Voluntary hospitals Committee became increasingly anxious that while the ministrys scheme was all right as far as it went, few staff had been allocated to the task; they had inadequate authority and. On 1 February 1939 the ministry wrote to the committee suggesting that as soon as the boundaries of the sectors supermarket had been announced, the voluntary hospitals should agree amongst themselves to nominate a doctor to work out the details of the scheme. The ministry would approve the nomination formally and pay this group officer 100 per year for his services. The committee thought that this went nowhere far enough and on 7 February wrote to the permanent Secretary pointing out that a detailed and intricate organisation would be necessary, with group officers who would have to be capable men, able to take command in time. The committee made a series of proposals which it wished to see laid before the minister and, if necessary, the cabinet. Adverse comments appeared in the press which Sir Charles Wilson disavowed. The minister took a month to reply, and rejected the suggestion of failure to take the situation seriously.
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A few years ago when a very distinguished personage, as president of a great teaching hospital, was inaugurating the first installment of a rebuilding scheme, he pressed a button and started a light revolving on the top of the tower. Taken a little aback, he turned to the dean who was standing by him and murmured: good Lord, what have i done now? We can imagine the minister of health making some database such ejaculation when he first realised the inexorable upshot of his Emergency hospital Scheme. Designed to serve the purpose of a moment it has set going wheels which will turn and turn until the whole aspect of hospital and consulting practice, as we knew them as lately as the end of last August, has changed beyond recognition. The lancet, after Sir Charles Wilsons committee had reported on how Londons hospital service might be organised to meet the threat of bombing, the london county council seconded staff to the ministry to assist the subsequent planning of medical and ambulance services. In October 1938 negotiations started with the voluntary hospitals to establish a segmental scheme but progress was slow. Sir Frederick menzies contrasted the efficiency with which the municipal hospitals could be organised with the difficulties experienced in bringing about a willing cooperation on the part of the voluntary hospitals. The minister of health, Mr Walter Elliot, was told by his officials that Sir Frederick rather exaggerated the contrast between the rectitude of the lcc and the depravity of the voluntary hospitals, although some of the hospital representatives had not been so helpful as they. The creation of the emergency medical service.