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23 February, 1920.]

COLONIAL MEDICAL SERVICES COMMITTEE.

Dr. Cox, Dr. Macpherson, Dr. van Someren, and Dr. GoodlIFYE.

led to think that there was more private practice than was the case?-That is the information we have got, yea.

3573. What do you mean by "tacitly led to think "If they did not hear anything about private practice, candidates assumed there was money to be made out of it P-I cannot justify the impression the men came away with, but men have written to us and called to see us, who have told us that they did not think the whole facts of the situation were laid plainly before them when they took the job on. 3574. You mean, on this matter of private practice, they were led to understand there was a good deal to be made by private practice? They were led to think that, perhaps not by what was said, but what was not said. Some men may have been very foolish, but I have tried to pass the information on as we have got it.

3575. You have suggested that the Colonial officers should have their private practice severely restricted where there were opportunities for private practice? --Yes.

3576. You do not attach any importance to the fact that it is good for any officer to have an extensive private practice? Yes, I do.

3577. An officer, for instance, would be all the better for some general practice?-We have said here it would be a good thing.

3578. Still, you would cut it down?-If it is an aren which is sufficiently attractive to attract men of good standing as private practitioners, I think it is a pity they should suffer competition from Govern- ment men.

3579. Looking at it from a trade union point of view, you are prepared to damage the public Service in the interest of the private practitioner P-No, I am not prepared to damage it at all. I take it, a man is not put into the Government Service, the Government has no need for him at all unless they have sufficient work to keep him employed.

3680. A man in the Government Service has a comparatively small number of women and children to attend to, whereas in private practice you would get many women and children ?-I was under the impression that men in the Colonial Service got a fair amount.

3581. A certain amount. You do not think, do you, that the advantage to be gained by a Government medical officer extending his knowledge and experience by private practice, ought to be really employed against a private practitioner P-I do not want to draw any hard and fast line, because I think it is impossible. but I think the vory fact that private practitioners, if they are men of equal professional status have been attracted to the place, shows there is a sufficient margin over to keep a man of that type going, and I think it is rather unfair that he should be subjected to the competition of a who is being paid for the first call on his services by the Government.

mau

3582. Chairman: Then, in such places, would you forbid Gororument officers to have private practice? Do you think the Government should forbid them to take private practice P-You say "in such places "; it would have to be in places in which it was quite obvious that the needs-

3583. I take the places that you were mentioning? --In which it was quite obvious that the needs of the population were supplied, and even in that case the Government Officer might well be allowed to act as a specialist or consultant.

3584. But you would not allow him to take ordinary private practice ?-Not if the needs of the place are well catered for by private practitioners.

3585. Although previously Government Officers in the Bervice have always had the private practice?— As long as the situation were made perfectly clear to them when they went in, that they were not to expect much or any private practice.

3586. But you cannot do it in this case; I am taking the place where there was originally not enough private practice, the place has grown in im- portance; private practice has become more lucrative;

[Continued.

that has attracted private practitioners; there were then enough private practitioners to do all the private practice, would you then take away from Government. Officers the privilege of private practice?-I think they might well be restricted thon to consulting practice. I should object to it just as much then as to an Army or Navy man competing with me for my private practice at home.

3587. Mr. Fiddian: Are you suggesting compensa- tion? For instance, you would be prepared to deprive this man of the opportunity of making £200 or £300 a year. and give him nothing instead?—No. I did not say anything of the kind.

3588. What kind of compensation would you give him? You would not shut out any man doing this practice straightaway; you would make A new arrangement when there was a vacancy.

3589. When that particular man left the district ?-- You; I think it would be very hard indeed to deprivo a mau without notice or compensation.

3590. Chairman: It is a very difficult position. Even if there is a vacancy, the successor would expect the private practice, which you think should be taken away from him?-No, I think the successor should be told quite frankly, you are going to a place where there will be no private practice.

3591. But he is probably an officer in the Service who has been looking forward all his career to getting that position where there is that private practice?- I still think it is a wrong principle to allow whole- time Government Officers to compote where there is an ample supply of private practitioners in the ordinary way.

3592, Sir Harry Verney: Do your colleagues agree; do you take that view too?-(Dr. Goodlife): In Uganda, with the exception of two or three stations, there is absolutely no private practice at all.

3593. Taking these two or three, you would be quite prepared, if you were the officer next to get that place, to find suddenly the private practice was taken away from you?-No. we were given to understand recently that promotion does not go by seniority. therefore I should be wrong in aspiring to any place at all unless I were definitely appointed.

3594. Sir James Fowler: But lately, when it was proposed to deprive the Medical Officers of the West African Medical Staff of private practice, was that not a great cause of discontent at once?- I am not aware of the West Coast provisions, Sir. (Dr. Cos): He does not know the West African con- ditions.

3595. No, but it is to the point.

3596. Mr. Fiddian: You know there is a scale of fees for private practice in West Africa P-Yes, I believe there is quite a number of areas in which a scale of fees more or less recognised.

3597. But there is one definitely-laid down in West Africa ?--Yes,

3598. You have had complaints about that?-I cannot say we have had complaints.

3599. That is the best I know, a most elaborate scale prepared by the Advisory Committee at home; you have heard no complaints about it?-No, we have had no complaints.

3600. But, generally speaking, you think the prin- ciple unwise?-As long as it is understood that I do not wish to interfere with anything that is going on now, where the Medical Officers consider they have a right to private practice, and they have been given to understand that they have a right to privato practice. Subject to that. I do think where the popu- lation increases in wealth and size to such an extent as to be able to support private practitioners, it is not right that they should be subject to the com- petition, in ordinary practice, of men who are being paid by the Government, and on whose time the Government has a first claim.

3601. What I meant was that there was a scale of fees laid down which Government Medical Officers were not to go beyond in private practice?—Yes.

3602, I understood you,

generally speaking, objected to the existence of such a scale at all?-i know nothing about that scale. The only scale we have brought to your notice, and to which very strong

23 February, 1920.]

MINUTES OF EVIDENCE.

DR. Cox, DR. MACPHERSON, DR. VAN SOMEREN, AND DR. GOODLIFFE,

objection was taken, was an attempt made in Grenada, which apparently has not gone any further, au attempt to lay down a scale for the outside public, and it is said to have had a very bad effect indeed upon quite legitimate fees that could be got from people in the neighbourhood.

3603. I do not know much about that. I was rather surprised you did not know the scales which apply to the whole West African Bervice P-I said we had no complaints about it.

3603. But I think, on principle, you do say, in your memorandum, you object to the existence of a scale of fees, do you not ?-I am propared to agree that there may be circumstances which would justify the existence of a scale for people, but there are dangers There is the danger of standardising the fees for other people who are not poor.

3604. You think, if a medical man is alone in a district, for instance, with no competition whatever, he ought to be left to charge just what he thinks fair? No, I would not say that. I think some medi. cal men could not be trusted in these circumstances. I would not for a moment say that every medical man is to be trusted implicitly not to exploit a position of that kind.

3605. As regards the Advisory Committee, you want it extended to take the whole of the Colonies, the Medical Service in the Colonies; you know it would be difficult to work?-I really have no notion how difficult to work it would be.

3606. You say the feeling has been expressed here by several Medical Officers in the Colonies that there are cases of injustice which could be better dealt with if there had been an Advisory Committee to appeal to? There is a feeling that there should be some body like that which would act as a sort of Court of Appeal, a body composed entirely or mainly of medical

men.

3607. I think the Advisory Committee never act as n Court of Appeal in the case of injustice to any particular Officer.

3608. Sir James Fowler: No?-We suggest the Secretary of State would be well advised to instruct the Advisory Committee to take that function.

3609. Mr. Fiddian: Do you imagine that such a state of things would make the Medical Service more popular with the administration P-1 do not know. I should imagine that probably a man from whoso decision there never had been an appeal would not like it; I am quite sure of that.

3610. You see certain advantages in the absence of friction in the administration of the Medical Service? -I do, indeed.

3611. I auggest to you there has been a great deal of friction in the past for which the administration has not altogether been responsible-Very probably. 3612. The high salarios paid to Medical Officera are out of proportion to the pay of the rest of the service, and that state of things makes the Service un- popular? You do not auggest that in order---

3613. I put it to you that that is one cause of fric- tion ?--There are reasons why the scale of salaries of medical men ought to be higher than some other Services; he enters the Service older than some people, with his technical training already to his hand. The other men, many of them, get all their technical training in the Service.

3613A. Some of them have had rather an expensive education ?-A medical education is supposed to be the most expansive education at the present time. You have five to six years in which you earn abso- lutely nothing with fairly expensive education and examinationa

3614. On the other hand, education at Oxford and Cambridge is still very expensive?-A good many medical men go to Oxford and Cambridge.

But do

3615. Not many?-A good many men go. not think for one moment I am trying to belittle the men who go into the Civil Service; far from it; no one has a higher admiration for the average Civil

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[Continued.

Servant in this country or outside it than I have, but I am here to stick up for the medical side, and I say there are reasons why he should be well paid, one of the reasons being that if you do not pay him well you will not get him, because the competition at home, and from other quarters, is so great. The Services and India feel they cannot get the men they want, because there are not sufficient of them and they pay more than you do.

3616, I put it to you that it is largely due to the fact that there are not sufficient medical men to go round? Partly.

3617. Bo that no matter what we pay some will have to go without somewhere? For the moment that is true.

3618. In three or four years your difficulty would be lessoned?-It would be lessened, yes.

3619. Those who want to save the public purse will hang on for three or four years, and see? That is a matter for the Government. You will have what you pay for. If you can manage to go on for three or four years, your officers deteriorating in health, making men in the service miserable, it may pay to wait three or four years. I venture to suggest it will not.

3620. I suggest, in any case, nobody will get as many medical men as they want, because there are not enough to go round?-I want you to have your share.

3621. Did you ever consider the question who was to pay these Medical Inspectors?-I imagine the Treasury might come in somewhere.

I

3622. The Imperial Treasury P-I suppose 30. imagine some of these Colonies could not pay a con- tribution, and the Imperial Treasury might have to make it good.

3623. Your idea is that they should be paid on a contributory basis, even by the poorer Colonies, and the poorer Colonies would pay less? That is the suggestion I should like to make.

3624. You said that you thought the introduction of military titles would be an advantage to the Medical Service?-The perpetuation of the titles. that had been used during the War.

3625. Is that really put forward seriously? Are these military titles? I do not want to be misunder- stood. There are certain titles which have been used in some parts of the Colonial Service, quite apart from the military servico altogether.

3626. Military titles?-Director of Medical Ser- vices.

3627. Yes, that title was introduced before the War; it had nothing to do with the Army?—I did not understand Sir James Fowler was asking whether I wanted Army titles to be used.

3628. Sir James Fowler: Not Army titles; they are titles of administration which have been used in the Army, and had become matters of common know- ledge during the War; but they are not essentially Army titles P-I think not.

the

3629. The Director of Medical Services; Assistant Director of Medical Services?—Yes.

3630. Mr. Fiddian: They are Army titles, except that to some alight extent they have been used in the Colonies?--Of course, as say, I have had no personal experience. I imagine that the Ase of some of these titles has been found rather beneficial.

3631. You agree with the use of the military titles*~{}}r, floodliffe) We do not use the military titles at all; we use the term "Medical Director. We talk about Directors of Transport; we never looked upon them as military titles.

on

3632. A standard?-Principal Medical

Officer :

those lines, he would probably be a Director of Medical Services; but I think we ought to retain, the old titles of Principal Medical Officer and Senior Medical Officer. (Dr. Cor): Those are Army titles, S.M.O, and P.M.O., but we never looked upon them us exclusively Army titles.

title is

3633. Some of them have a different signification? --I do not mind the signification; if the found useful and handy, continue it, I say.

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