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PUBLIC RECORD OFFICE

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PUBLIC RECORD OFFICE, LONDON:

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Circular.

SIR,

COLONIAL MEDICAL SERVICES COMMITTEE.

√.

Downing Street,

30th August, 1921.

I have the honour to inform you that I have had under my careful consideration the replies received from the Governments of the Colonies and Protectorates to the Circular of the 20th of September last, transmitting for observations the report of the Departmental Committee appointed to enquire into the Colonial Medical Services.

2. I observe, in the first place, that the Committee's view (as set out in paragraphs 4 and 5 of the Report) that the unification of the Colonial Medical Services into a single service, however desirable, is impracticable and not likely to become less so in the near future, is generally accepted. On the other hand, the Committee desired (paragraphs 18 to 25) that special consideration should be given to the possibility of unifying the services of neighbouring Colonies. They recommended in particular that the medical staff of the East African Administrations should be amalgamated on the same lines as the West African Medical Staff. This unification has already been accomplished in everything but name, and the question of the formal establishment of an East African Medical Staff is now under consideration. Similarly, the question of amalgamating the medical services of the Straits Settlements and the Federated and Unfederated Malay States is also receiving attention; though the question of establishing a single roster for promotion presents some difficulty.

3. A question of more immediate importance is the Committee's recommendation that an officer of standing in the medical profession should be appointed a member of the Colonial Office Staff, with the title of Director General of the Colonial Medical Service. The Committee attached considerable weight to this proposal, which has been urged on the Department from other quarters, and I have therefore given it prolonged consideration.

4. The recommendation seems to some extent to be based on the analogy of the Army and Indian Medical Services, but this analogy seems to me unsound. Both these services are single homogeneous services, responsible to one Government and acting under the direct orders of that Government wherever individuals are stationed; whereas the medical services of the Colonies serve more than thirty Governments, and are paid from as many distinct purses, Again, so far as the Army is concerned, the Director General is situated in the same place as the central administration of the Army, that is, the War Office; the Director of the Naval Medical Service is also stationed at headquarters. In the case of India too, the Director General is located in the same place as the Government of India. In the Colonies, however, the adminis tration is conducted locally by the Government of each Colony; and a Director General occupying a room in the Colonial Office would be at a considerable distance-in many cases, one of thousands of miles from the administration.

5. I do not observe anywhere in the replies of the Colonial Governments any great enthusiasm for this appointment, and some of the most important Governments are definitely opposed to the proposal. It is not probable that the Imperial Treasury would consent at the present time to find the money necessary for the creation of such an appointment at the expense of Imperial funds, whilst any arrangement by which the Colonies jointly bore the expense would be open to very serious objection, even if it were found practicable. The difficulty of choice, moreover, would be very considerable.

6. In my opinion, these arguments constitute very serious objections to the proposal; though I am not prepared to say that they are finally conclusive, and I should be willing to give further consideration to the matter if and when the financial position permitted of its being done. For the present it must stand over.

7.

As regards the observations of the Committee on the personnel of the service (paragraphs 10 to 13), I understand that preference has usually been given in the past, in selecting candidates for medical appointments, to those possessing hospital experience, other things being equal; but in present circumstances this is a counsel of perfection. It will, however, always be my aim to ensure that candidates selected for medical appointments shall have had an opportunity of holding such posts. Where, in any given case, a candidate has recently qualified, and has an opportunity of holding a hospital appointment, he should be encouraged to do so by having the Colonial appointment kept open for him, if possible; but this must depend on the circumstances of the case.

Candidates selected for medical appointments are in general required to take a course of instruction of about three months at a school of tropical medicine; and if, in addition, they undergo periods of resident service in hospital, the result may be that the Colony concerned will be deprived of their services for some seven or eight months, or even longer. It is, of course, the general experience that candidates for medical appointments are often required urgently. It is not, in my opinion, possible to select a candidate definitely and then second him for a period of hospital service, nor would it be justifiable for a Colonial Government to pay a candidate for what it is, in fact, desired to make a necessary qualification of appointment. All that is possible, in my judgment, is to inform candidates that if they obtain hospital experience their applications will be considered at the end of such service.

8. The Committee recommend (paragraph 15) the introduction of a system of competitive examination for admission to the Colonial Medical Service, but it is obvious that it is not possible to consider the proposal until the number of candidates is considerably greater than at present.

9.

COLONIAL MEDICAL SERVICES COMMITTEE,

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I see no objection to candidates for medical appointments offering themselves for service. in groups of Colonies (paragraphia 16-17 of Report), but the proposal that such groups should be based on the geographical organisation of the Colonial Office does not seem to me well founded. That organisation is based upon arrangements made for the efficient conduct of the business of the Department and does not involve any grouping of the actual Colonial Administrations, Thus the West African Medical Staff forms a single service; but the affairs of the West African Colonies are dealt with by two separate Departments. The Colonies dealt with by the Ceylon and Mauritius Department, again, differ very widely among themselves, and there is no form of unity between them, except for the fact that their administration is supervised through the same Department of this Office.

10.

I fully appreciate the desirability of visits to the Colonies by experts for special pur- poses, but I feel that the regular visits by travelling officials which the Committee propose (paragraph 26) are unnecessary and would be not unlikely to interfere with the functions of the local heads of Departments.

11. Paragraph. 28.-1n the greater number of the Colonies the initial emoluments of medical officers now amount to £600 or more; in West Africa the initial rate of salary is £660. Annual increments are not inconsiderable, and the range of salary may be considered ample. In Malaya the sterling equivalent of the salary scale begins at £616, together with a temporary allowance of 20 per cent, of salary in the case of single officers and 30 per cent, in the case of married officers. Junior medical officers in Fiji begin on £510 with quarters, or a house allowance of £50 in lieu, and private practice, or an allowance of £50 in lieu. In certain Colonies, it is true, financial stringency makes it impossible to offer so high a rate of initial salary; but in some at least of these the junior officers have the opportunity of supplementing their salaries by private practice.

12, Paragraph 29.-In Tropical Africa, and in many Colonies elsewhere, new scales of salary have now been fixed, under which the new pensionable salary exceeds pre-war salary plus war bonus. In this respect the Services of these Colonies differ from various other Services where the amount of bonus is decreasing, or tends to decrease, and does not count in full for pension purposes. It is also necessary to bear in mind the extent to which medical officers enjoy a privilege not shared by any other class of officer in the Colonies, namely, that they enjoy opportunities of private practice without forfeiting their pension rights. I do not think it possible to treat medical officers more favourably in the matter of pensions than other classes of Government officers.

13. Paragraph 30.-The system of gratuity on voluntary retirement after a certain number of years' service, which is in force in the West African Medical Staff, has been extended to medical officers in East Africa, but I see no prospect of its being extended generally to other Colonies.

14. As regards the Committee's recommendations (paragraph 32) in the matter of improved leave and passage terms, it is the case that in the larger Colonies assistance is at present given to medical officers, like other officers of the Government, to come on leave. The East and West African Administrations provide passages for officers themselves, und grants towards passages of their wives. In Malaya, Ceylon and Hong Kong, under a temporary arrangement passages are provided for officers and their families. In Jamaica, British Honduras, Mauritius and Fiji, the Colonial Government makes a grant towards the passages of officers coming on leave, pro- vided that they have served for a certain period in the Colony.

15. As regards the case of officers transferred from one Colony to the other, it is usual to provide passages for the officer and his family, provided that the initial salary of his appointment does not exceed £800 a year, indeed, some Colonies grant this concession irrespective of the amount of salary, and in the case of an officer transferred to West Africa his passage is paid without any condition as to salary, while passages are also provided for his family from the Colony in which he has been serving to this country, provided that his new salary does not exceed 4800 a year. In my opinion, it is not practicable in existing circumstances to go beyond these arrangements. The Colonial Administrations cannot give privileges to medical officers in these matters without at the same time extending them to other officers, and financial considera- tions exercise a restraining influence on the desire of the Administrations to meet their officers in this matter.

16. As regards the question of pensions for widows and orphans (paragraph 33) the Com- mittee recoguise the value of special schemes for this purpose, and I ain glud that it has been found possible to introduce such a scheme in East Africa. The extremely liberal rate of interest (8 per cent.) adopted in West Africa has also been applied to East Africa. Such funds exist in many other Colonies, and the extension of this arrangeinent is under consideration wherever local circumstances admit.

17. I fully sympathise with the view (paragraph 34 of Report) that medical officers should be offered facilities for keeping up to date in their professional knowledge while on leave. The question of the grant of special study leave for this purpose, however, must depend upon the condition of each Colony. At present, inedical officers in West and East Africa are required to take a course of post-graduate study before they can go beyond a certain point in the incremental scale. It is not uncommon, and in my opinion is wholly desirable, that assistance should be given by Colonial Governments to an officer to enable him to take such a course of special study as is likely to be of advantage to him and to the Government. The possibility of extending this arrangement to Colonies outside Tropical Africa is under consideration, but it will be realised that there are obvious difficulties in instituting a system of study leave in Colonies where the medical service is recruited from practitioners domiciled in the Colony.