Annals of the Royal




January 1978

FROM THE PRESIDENT Having been elected on Bastille Day at the beginning of the summer holiday period I was astonished by the amount of paper work which daily accumulated on the President's desk. This does not include more than six hundred letters and telegrams of congratulation and good wishes which overhelmed me but which, I hope, have all been duly acknowledged. My surprise and pleasure on election was so profound that my sleep rhythm was much disturbed for several days. On the first night, after sleeping for two or three hours, I soothed myself by listening to recordings of Beethoven piano sonatas for the rest of the night. The following night I listened to the Brandenburg Concertos and took a long walk before sunrise. After that I had more or less recovered, helped partly by the diversions of the Court and Council cricket match against the College staff club at Downe and also by the golf match between the Council and the Dental and Anaesthetic Faculties at Highgate Golf Course. Election to the Presidency at the end of the last Council meeting of the academic year results in instant exposure to the responsibilities of office. In addition to acknowledging the many goodwill messages I found myself each day signing batches of applications for animal experimental licences, a task which I nevertheless regard as a personal duty and never to be replaced by a rubber stamp. In a different category are the diploma certificates, for which a well-chosen pen and permanent black ink rather than a ball-point are essential. But the signing of licence applications and certificates is but a minor part of a busy office routine. There is also a surprising amount of important correspondence and invitations to be dealt with. There are visits from a variety of folk with problems to dis-


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cuss. There is also the unending deluge of

Government documents; with these I had already become familiar from my service on the Joint Consultants Committee and, at an earlier date, on the BMA Council. All of this office work is greatly facilitated by the ever cheerful and highly efficient President's

Secretary, Mrs Margaret Harding. All newly elected Presidents must be deeply aware of how much they owe to the foundations laid by their predecessors. With eight Past Presidents still very much alive I am in the happy position of being able to avail myself of advice based upon their experience and sagacity during the last quarter-century. Even more does a President appreciate how much he owes to the industry and allegiance of his Council members, embracing as thev do such a wide and outstanding spectrum of surgical and administrative experience. As should be well known to my colleagues, I have for many years been concerned about the grave threats to personal and professional freedom and the growing danger of State monopoly in medicine. Indeed, I was one of a number of surgeons who, at special meetings of Fellows of this Royal College in I947 and 1948, sought to warn the then President and Council of what we regarded as the serious threat of State monopoly as well as the domination of medicine by bureaucrats and the viler winds of party politics. Needless to say, it gives Cassandras no pleasure ultimately to be proved right! It has recently become fashionable for journalists and others to talk of the imminent 'collapse' of the NHS, but this is a misleading concept in a service which is still surprisingly effectively propped up by professional goodwill. Indeed, dramatic collapse such as might be promoted by wholesale resignation of doctors


From the President

and dentists from the service could well result in the application of urgent and effective remedial measures. But what is happening is, in some ways, far more serious: steady deterioration of professional morale, inadequate and inappropriate investment of predominantly tax-derived funds, and excessive political preoccupation with the supposed virtues of 'free-at-the-time' service are causing less dramatic but more profound damage. In these circumstances it is all too easy for formerly hardworking and highly responsible doctors and dentists gradually to lose both their capacity and their determination to remedy the defects of a manifestly substandard service. Moreover, new entrants to the profession can all too easily accept poor conditions when they have no yardstick with which to compare them. Alternatively, if and when such conditions are recognised the only options open to young doctors may be emigration or 'industrial' action. Are these the sort of conditions which should be inflicted on a long-suffering and medicopolitically innocent public? To those who regard the provision of brand-new hospital buildings as the hallmark of success in a health service one can only sound a warning note and point to the awful lessons of Sweden, a country abundantly provided with new hospitals and well-equipped special departments. I would recommend all Fellows to read a recent article by Gunnar Biorck, a distinguished professor of medicine in Stockholm and a Fellow of the Royal College of Physicians of London'. That account of increasing bureaucratisation and politicisation of the Swedish Health Service closely matches many of our recent experiences in the NHS, though the Swedes have gone farther along the road. The serious effect on medical morale and patient care has also been

described in another article by Professor Philip Sandblom, formerly of Stockholm, who is now working in Zurich2. Both these papers are essential reading for the British doctor who has the welfare of his own country at heart. If I have struck a somewhat sombre note in this, my first Presidential message, it is only because I feel so strongly about the damage done by a swollen and too often incompetent bureaucracy, by needless political confrontation, and by increasing trade union militancy in many of our hospitals. Fellows may rest assured that their Council is fully apprised of all these problems and that we shall do everything in our power, subject to the limitations imposed by our Royal Charter, to help remedy this situation. Whilst many are hopeful that the Royal Commission report may in due course promote some necessary refonrms, I believe that it might be foolish to place too much reliance on their efforts, however enlightened their report may prove to be. I would conclude by emphasising that we shall need eternal vigilance within the State service to protect the public and the professions whilst doing everything possible to ensure the development of a strong independent sectoir. Without great determination, as well as an effective yardstick against which to measure the quality of personal medical care, it will become increasingly difficult to promote high medical standards and to preserve centres of medical excellence in Britain. REGINALD S MURLEY

References I Bi6rck, G (1977) Annals of Internal Medicine, 86, 8I3. 2 Sandblom, P (1976) American College of Surgeons Bulletin No 13.

From the President.

Annals of the Royal College of Surgeons January 1978 FROM THE PRESIDENT Having been elected on Bastille Day at the beginning of the summer holida...
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