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PUBLIC RECORD OFFICE, LONDON

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COLONIAL MEDICAL SERVICES COMMITTEE.

23 February, 1920.] DR. Cox, Dr. Macpherson, DR. VAN SOMERen, and Dr. Goodliffe.

THIRTEENTH DAY.

Monday, 23rd February, 1920.

PREBENT:

SIR WALTER EGERTON, K.C.M.G, (Chairman),

LIEUTENANT-COLONEL SIR

BART, D.B.O.

HARRY VERNEY,

SUROZON REAR-ADMIRAL 8m HUMPHRY D.

ROLLESTON, K.C.B., M.D., F.R.C.P.

[Continued.

LIEUTENANT-COLONEL SIR JAMES KINGSTON FOWLER, K.Ç.V.O., C.M.G., M.D., D.Sc., F.R.C.P., R.A.M.C. (T.).

Ma. T. HOOD, C.M.G., M.R.C.S., L.R.C.P. MR. A. FIDDIAN.

Ma. J. E. W. FLOOD (Secretary).

DR. ALFRED Cox, The Medical Secretary, The British Medical Association, Dr. A. D. MacPHERSON, Assistant Medical Secretary, The British Medical Association, DR. ROBERT Van Someren, Senior Medical Officer, Uganda Protectorate, DR. JOHN HENRY GOODLIFFE, Medical Officer, Uganda Protectorate.

The British Medical Association submitted the fol- lowing memorandum of their views:-

BRITISH MEDICAL ASSOCIATION.

1. The reference to the Colonial Medical Services Committee is:-

"To consider the position of the Medical Ser- vices of the various colonies and dependencies, with a view to maintaining and increasing the supply of candidates, and to securing content- ment within the services; and to consider whether the principle of assimilating the medical services of neighbouring colonies may usefully be ex- tended, and if so, how far, and by what means,” 2. The information contained in this Memorandum is mainly based upon information obtained from the Colonial Branches of the Association. The Committee will no doubt make due allowance for the way in which the information has had to be gathered-the difficulties and delays in communication, the fact that obviously it is very difficult to submit witnesses with first-hand evidence and that it is in some cases im- possible for the Association to give the names of those who have supplied the information.

3. The British Medical Association has approxi- mately 6,500 members outside the United Kingdom, including a large proportion of the members of the Medical Services of the various Colonies and Depen- dencies who look to it to voice their grievances and protect their interests.

4. The Association proposes to place before the Committee:-

(I) some points which, according to information placed at the disposal of the Association, militate against contentment within the Bervice and make it unlikely that a proper aupply of candidates will be maintained, with suggestion as to remedies;

(II) the opinion of the Association as to assimila- tion of the Medical Services of neighbour- ing Colonies.

I. DEFECTS LEADING TO DISCONTENT IN THE SERVICE.

5. These may be grouped under the heads:-

(A) The nature of the work and the conditions

of service;

(B) Pay, allowances and pensions.

(A) NATURE OF THE WORK AND CONDITIONS OF SERVICE,

Need of Fuller and Clearer Statement of Conditions of Service.

6. The full nature of the contract made by entrants into the Service is often not understood by them. Many members of the Service are discontented because they now realise that the pensions attainable are not what they thought they would be when they entered, or because the opportunities for private prac tice are less than they expected.

7. Doubtless many of these impressions are due to want of proper care and foresight on the part of applicants, but the Association believes there is a need for a more careful statement in black and white of the exact terms, conditions and prospects of the Service, including all privileges to be enjoyed by the medical officer. In some cases there appears to be no formal written contract between the Secretary of State or local Government and the medical officer, It should be impossible for this to happen.

Insufficient Inspection of Work, and of Help by Superior Officers: Want of Intimate Touch with Colonial Office.

tered

At

8. More frequent inspection of the work of scat- officers in strongly recommended. Moru frequent visits by the superior administrative officers would be welcomed by the medical officers. present there is perhaps a tendency to judge them too much by their reports. All officers are not equally good at making the best of themselves on paper.

9. In addition to this visitation the Association strongly recommends the appointment of one or more Inspectors or Travelling Commissioners who should

23 February, 1920.]

MINUTES OF EVIDENCE.

DR. Cox, Dr. MACPHERSON, DB. VAN BOMEREN, AND DR, GOODLIFTE.

be officials of the Colonial Office, and should spend part of their time travelling and part in the Colonial Office. They should be men with large tropical ex- periance and outstanding reputation in the service. These officers would be liaison officers between the sOT- vices of the different Colonies and the Colonial Office and its Advisory Committee: they would be able to take a wide view of the needs and possibilities of tho Service and would be able to impress that view both at the centre and at the periphery.

10. The above considerations lead the Association to press for much wider publicity for the present Advisory Committee to the Colonial Office. The existence of that Committee seems to be scarcely known to officers in many parts of the Service: apparently its main dealings up to the present have been with the West African Bervice. The Association strongly recommends that the Medical Services in all the Colonies be kept in touch with the Committee and that its scope and influence be extended as widely as possible.

Need for more hospital and other buildings and equipment; also pathological facilities.

11. Before the war the Association was given to understand that in many areas the hospital and dis- pensary facilities were insufficient. That deficiency is now still more marked. The Association would urge that reports on this point be called for and given the most favourable consideration possible.

12. There is apparently need for standardisation of the supply of equipment, both drugs and appli- ances, and surgical instruments and hospital equip- ment. This matter should receive the attention of the Advisory Committee.

13. The need for increased pathological facilities and pathological staff is being more and more recog- nised in all countries. These facilities are deficient, probably in every Colony.

Opportunities for private practice.

14. The offer of opportunities for private practice has played a great part in attracting medical men to Home of the posts with the smaller salaries. But the Association has good reason to believe that this factor is losing its attraction because medical officers find that the private practice is often very small and sometimes it is limited by conditions which make it very unattractive. For example, in Grenada the Government tariff of fees for attendance on labourere" has tended to place a very low value on fees in private practice. Many who are better situated financially than the "labourer" regard the Government Tariff as a standard of medical remu- neration and demur to the payment of reasonable fees. The Government of Grenada not long ago appointed a Committee to formulate a tariff of fops for private practice. This tariff has not been officially enforced, but the Association considers that any attempt to regulate the fees for private practice is bound to lead to discontent and is a mistake, inna- much as it interferes with that elasticity as regards charges which enables the doctor to attend the deserving at lower rates by charging people who are well able to afford it a higher fee.

15. From the amount of correspondence which the Association has had on this subject, together with its experience in the kindred case of the Indian Medical Service, it believes that it is very important that no undue restriction should be put on the right of private practice. The public who are not entitled to the medical officer's services as a right welcome the opportunity of access to a well qualified man, and the fact that the official income can be increased by private practice is a stimulus to good men to enter the norvice and to endeavour to earn a reputation while in the service.

16. The Association therefore recommends (a) that where private practice is allowed it should not be whittled down by restrictions; (b) that official tariffs

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[Continued.

should not be framed for people who are able to pay for and look after themselves; and (c) that no objec- tion should be raised to medical officers increasing their fees for private practice to meet the present economic conditions.

Qualification for service.

17. The Association is concerned to learn that in the West Indies vacancies are frequently filled by the appointment of holders of American diplomas. This procedure is not calculated to strengthen British influence in the West Indies.

Statue of Medical Officer.

18. The Association believes that it is very desir- able that in order to establish and maintain the status of the Service the Director of Medical Services

of a Colony or Protectorate should be ex-officio a member of its Legislative and Executive Councils, where such bodies exist.

Restoration of pre-War personnel.

a

19. No stone should be left unturned to restore, and, in many cases, increase the pre-war personnel The difficulties of this are realised. There is a short- age in the supply of doctors which will continue for a few years, and there are plenty of posts available at home at salaries which are better than those offered for even more responsible work in the Colonial Medical Service. The consequence is shortage of entrants which is very hard on the over- worked members of the staff and consequently pre judicial to the efficiency of their work and makes them discontented. The knowledge that those in the Service are discontented quickly spreads and once a Service gets under a cloud" it takes a considerable time, even after everything has been done to remove grievances before it begins again to attract the right kind of recruit.

Opportunities for specialisation.

20. Specialisation needs to be recognised in the Colonial Medical Services to a much greater extent than it is at present. There are few areas so small as to be able to do without Surgical Specialists. Pathologista, Radiologists, Ophthalmologists

and Specialists in Venereal Disease. Officers should be encouraged to fit themselves by special study for such posts, which should carry with them extra pay.

Housing.

21. A scarcity of suitable houses is reported from many quarters. It is realised that this is inevitable in present circumstances but the Association con- siders that all the Colonial Governments should make themselves responsible for providing houses for all their Medical Officers.

Sanitary Department.

22. The evidence at the disposal of the Association lends it to believe that the Colonial Office seems to attach insufficient importance to the Sanitary Depart- ment of some of the Services. There is evidence that in East Africa for example the personnel is in- adequate, leading to the medical officers having to do work which could quite well be done by subordinates. Strong complaints have been received as to the lach of qualified British sanitary inspectors in many services. The Association believe a certain number of these inspectors to be necessary for the sake of discipline and example, and even where natives have been trained as inspectors. The British Sanitary Officers who are employed are believed to be very insufficiently paid with poor prospects as regarda pro- motion and pension, and over-worked.

The Nursing Stuff.

23. An adequate staff for this important auxiliary aorvice is unturally a matter of great concern to those? interested in the Services of the Colonic, Tho