551
Commentary
from Westminster
Although salary remains the main reason for the continuing exodus, two other factors are believed to be increasing the outward flow. The more important is the of doctors within the E.E.C. which months began eight ago. During this time the General Medical Council has received over 1000 inquiries from doctors wanting to know how to get a certificate allowing them to work in other E.E.C. countries. The Council has actually handed out certificates to about 200 British-trained doctors. The other area of the world which is thought to be attracting senior people away from the N.H.S. is, of course, the Middle East, where the D.H.S.S. has mounted a big drive to increase British influence. But until the true facts are disclosed, much must remain speculation. free
From Our Parliamentary
Correspondent Anxieties about Medical Emigration PLAYING the numbers game has always been a risky occupation when it comes to the emigration of doctors. Yet with unfailing consistency the issue crops up in the
political arena every few years. The last time was at the height of Mrs Barbara Castle’s battle with the doctors years ago when the row ended in some confusion about what the real figures were. Today the issue is building up again, but the confusion remains. Dr Gerard Vaughan, Conservative spokesman on health, presented with growing anxiety from sections of the medical profession, has written to Mr David Ennals, Secretary of State for Social Services, urging him to say just how many doctors are leaving Britain to work abroad. He believes the whole matter is being smoked over by the Department of Health and Social Security either because it has incompetently failed to assess the situation or because it wants to conceal the true facts. He suspects that concealment is the more likely of the two
two
reasons.
Dr
Vaughan was prompted to take up the matter after meeting a deputation of anaesthetists last week. They cited an example from Birmingham where four consulvacancies which were twice advertised attracted no applicants. Two of the jobs specifically mentioned that the vacancies arose as a result of emigration. Dr Vaughan believes that a grave situation could develop in which surgeons might be unable to operate because of a shortage of anaesthetists. His main concern is to find out how many key people are leaving the National Health Service. Clearly the loss of one head of department is much more serious than the loss of several newly qualified doctors and he believes there is now a steady drift of top people to all parts of the world. The only people in a position to know the facts are the men from the Ministry. Organisations such as the British Medical Association have to rely largely on guesswork. The B.M.A.’s impression is that the annual net loss of British doctors, which has been around 300 for each of the past twelve years, is now approaching the 500 mark. One source on which they base their knowledge is the number of inquiries about emigration which the Association receives from doctors. These have risen steadily from 71 in 1973 to 534 in 1974, 1036 in 1975, 1041 last year, and a figure which is likely to be even higher this year. Inquiries about the old Commonwealth countries still top the list and the B.M.A. confirms that more inquiries are coming from senior doctant
tors.
In the absence of any detailed breakdown of the official emigration figures it is hard to assess the true picture. But my understanding is that the number of consultants now leaving the N.H.S. to work abroad is about 40 a year. All the D.H.S.S. will do is give the number of British and Irish born doctors leaving the country each year. These have risen from around the 800 mark in the early 1970s to about 1100 in 1974-75 and again in 1975-76. But in 1974-75 550 doctors returned to Britain and the following year the figure was about 750.
movement
Expenditure on the N.H.S. Pressure on the Government to begin reflating economy with an autumn Budget is growing as
the the annual conference season gets under way. Trade unions will be joined by left-wingers at the annual Labour Party conference next month in urging the Cabinet to take early action to curb unemployment and increase public expenditure. The unions have opened up a fresh campaign against cuts in health spending and, as the Labour conference agenda, published last weekend, demand from Labour Party shows, there is a constituencies for an increase in Health Service
parallel
resources.
One argument now being heard is that over the past few years Government policy of giving priority to current spending in the Health Service while cutting back on capital spending is building up tremendous problems for the future. Some weeks ago the Commons Expenditure Committee warned that although the D.H.S.S. might well have chosen the lesser of two evils in the short term, in the long term a deteriorating physical fabric would be likely to mean deteriorating services to patients and high current costs. The consequence of a policy of cutting the capital programme was to store up for the social services. Those who argue on these lines question the strategy of cutting back on new hospital building. They accept that there is no point in building new hospitals if they cannot open for lack of money, but they question the assumption that new buildings must invariably also be more expensive buildings to run. By prolonging the life of existing buildings, extra costs are being generated in maintaining them. One part of the argument which tends to support the unions and those sections of the Labour Party calling for more health resources is that the effect of current policy will be to create more pressure for a much larger building programme at the beginning of the next decade..By then there may be fewer financial constraints on public expenditure, but there may also be more competing demands on the building industry which at present is so short of orders and so badly affected by unemployment. The danger is that an enlarged building programme in the 1980s would be cut back because of bottlenecks in the construction industry, as has happened so often in the past. Those who believe there should be a reassessment of
problems
the priorities between current and capital spending because of what they regard as the present imbalance are
eagerly awaiting the
Government’s review of its consultative document on priorities in the health and personal social services published last year. This set out the Department’s priorities for expenditure until 1979-80 and has now been reviewed in the light of the comments received. The revised document, due out within the next few weeks, will show to what extent the Government has met any of the criticisms made.
Australia DRUG ABUSE AND ROYAL COMMISSIONS
During the last year, there have been many demands for a State royal commission to be set up to inquire into drug abuse in New South Wales. The present State (Labour) government has been reluctant to do so pending the report of the existing Joint Committee of Inquiry-a committee representative of the Upper and Lower Houses of the N.S.W. Parliament, and appointed in October, 1976, to replace the corresponding committee which had been holding hearings since 1975, and had been set up by the previous (Liberal) government. This replacement was received with some apprehension by anti-marihuana campaigners because, although it is the privilege of a government to appoint its own committees of inquiry, it was also known that the N.S.W. (Labour) government was opposed to the use of marihuana being a criminal offence. The law’here on marihuana is as follows: Australia is a signatory to the 1966 Geneva Convention, which included marihuana with the narcotics as a dangerous drug (a decision taken, incidentally, without reference to a pharmacologist). Accordingly, in Australia, use or possession of marihuana is, in law, a criminal offence carrying a maximum penalty of 2 years in prison. If the State Poisons Acts were to be amended so that use or possession became a misdemeanour and no longer a crime, Australia would be defaulting on her agreement with the W.H.O.-a procedure not to be embarked on lightly. However, in the face of the as yet equivocal scientific findings on the possible dangers of smoking marihuana, the knowledge that cannabis is widely used by the young and not so young, and the fact that the pro-marihuana campaigners frequently draw attention, with some justice, to the 2-9% incidence of alcoholism throughout Australia, N.S.W. magistrates have now adopted a policy of imposing fines or of dismissing users (when first offenders) with a warning. This is almost analogous to the treatment accorded unsuccessful suiciders, against whom no legal action is ever taken, although suicide remains a crime on the Statute Book. This seems to be a reasonable approach to the problem, pending confirmable studies of the long-term effects of the drug, with particular reference to its effects in conjunction with alcohol use. Marihuana grows with ease in N.S.W. and can even be growing wild. During 1974, the N.S.W. drug squad discovered 111 plantations (worth millions on the black market) in those country areas where a large proportion of the hardworking migrant population lives. Prosecutions in these cases, which were based on the charge of "being in possession", led to many convictions, but the penalties were light and, what is more, light in comparison with the sentences then (1973-74) being given to youngsters caught smoking. In consequence, many people, including Mr Don Mackay, the local Liberal candidate who lived in the country town of Griffith, became increasingly outspoken in their anti-marihuana campaign.
found
The situation
was
greatly aggravated by the incident
a
Accusations became rife of involvement in drug trafficking the Mafia, diplomats, and prominent businessmen -some such accusations even being made under parliamentary and press privilege. With each new generalised accusation, the demand for a royal commission grew. The tragic and mysterious disappearance of Mr Don Mackay in Griffith late in July added to the clamour, and on Aug. 2 the N.S.W. Premier appointed Mr Justice Woodward of the N.S.W. Supreme Court as sole commissioner to inquire into the wider aspects of N.S.W. drug trafficking, to identify the persons involved, and to report within 6 months. During the last year, one has been led to wonder if the form of addiction that produces the greatest human suffering is not the addiction some people have to malicious gossip.
by police, migrants,
Round the World
.
kilometres from Griffith); the drug squad raided farm which contained a plantation of 31.5 acres of marihuana, worth about 20 million dollars on the black market. Prosecution under Section S45A of the N.S.W. Poisons Act, which involves trial by a district court judge and jury with a maximum sentence of 10 years (summary trial without a jury has a maximum of 2), led to the disclosure of a flaw in the law, because the onus lay with the prosecution to prove that the defendants had grown the crop for sale, since under S45A it is not an offence to cultivate marihuana in N.S.W.
eambally (64
at
Col-
The demands for a royal commission were of course not based solely on the issue of marihuana use; throughout Australia there has been a dramatic increase in narcotic addiction during the last 10 years. The South Australian (Labour) government set up its own State royal commission in 1976. Because the federal (Liberal) government controls the Customs Department, and thus the purse strings, there has been a growing demand for a royal commission at federal level. This has now been promised by the Prime Minister. This proliferation of committees (all of which have had alcohol and tobacco explicitly excluded from their remits) reflects not only political involvement but the grave concern felt throughout the community about the growing number of narcotic addicts (estimated by the State Health Commission at 10 000 young persons in N.S.W. in 1977), and the failure of the rehabilitation centres despite an estimated expenditure of$10 000 per person. Methadone maintenance was introduced into N.S.W. in 1970 and continues there, but not in the federal capital, where it was tried and then abandoned as being unsatisfactory. During 1976, 48 young persons died in N.S.W. from narcotic overdoses, and the amounts of heroin, cocaine, and cannabis seized by the Federal Narcotics Bureau have jumped from 2468 g, 3.5g, and 178 654 g, respectively, in 1971, to 15 351 g, 1561 g, and 1 226 922 g in 1976. The narcotics are said to originate in the Golden Triangle, and are smuggled in by couriers among the million air and sea passengers who travel to and from Australia each year; it is impossible to search everyone. Recently, a consignment of heroin worth$500 000 was seized at
Sydney Airport.
-
The public demands that the Government do something about the situation-but what can be done to eliminate the money-hungry? As for treatment, within N.S.W. narcotic rehabilitation centres have tried all the known methods: farm and animal work, support, counselling, meditation, relaxation, psychotherapy, aversion therapy, acupuncture, and so on; the success-rate is only 3% with volunteer cases. What can one do for the young addicts? One contribution towards prevention might be made if the authorities were simply to keep on announcing the hard facts about addiction. And the well-meaning individuals (some of whom come from overseas) who urge new, "highly successful", methods for the treatment of heroin addiction should, before being allowed to promote their ideas, be required to prove their bona fides, and to state in which reputable medical or scientific journals they have published the evidence for their remarkable results, and whether their claims have been verified by their colleagues.
Commentary
from Westminster
Although salary remains the main reason for the continuing exodus, two other factors are believed to be increasing the outward flow. The more important is the of doctors within the E.E.C. which months began eight ago. During this time the General Medical Council has received over 1000 inquiries from doctors wanting to know how to get a certificate allowing them to work in other E.E.C. countries. The Council has actually handed out certificates to about 200 British-trained doctors. The other area of the world which is thought to be attracting senior people away from the N.H.S. is, of course, the Middle East, where the D.H.S.S. has mounted a big drive to increase British influence. But until the true facts are disclosed, much must remain speculation. free
From Our Parliamentary
Correspondent Anxieties about Medical Emigration PLAYING the numbers game has always been a risky occupation when it comes to the emigration of doctors. Yet with unfailing consistency the issue crops up in the
political arena every few years. The last time was at the height of Mrs Barbara Castle’s battle with the doctors years ago when the row ended in some confusion about what the real figures were. Today the issue is building up again, but the confusion remains. Dr Gerard Vaughan, Conservative spokesman on health, presented with growing anxiety from sections of the medical profession, has written to Mr David Ennals, Secretary of State for Social Services, urging him to say just how many doctors are leaving Britain to work abroad. He believes the whole matter is being smoked over by the Department of Health and Social Security either because it has incompetently failed to assess the situation or because it wants to conceal the true facts. He suspects that concealment is the more likely of the two
two
reasons.
Dr
Vaughan was prompted to take up the matter after meeting a deputation of anaesthetists last week. They cited an example from Birmingham where four consulvacancies which were twice advertised attracted no applicants. Two of the jobs specifically mentioned that the vacancies arose as a result of emigration. Dr Vaughan believes that a grave situation could develop in which surgeons might be unable to operate because of a shortage of anaesthetists. His main concern is to find out how many key people are leaving the National Health Service. Clearly the loss of one head of department is much more serious than the loss of several newly qualified doctors and he believes there is now a steady drift of top people to all parts of the world. The only people in a position to know the facts are the men from the Ministry. Organisations such as the British Medical Association have to rely largely on guesswork. The B.M.A.’s impression is that the annual net loss of British doctors, which has been around 300 for each of the past twelve years, is now approaching the 500 mark. One source on which they base their knowledge is the number of inquiries about emigration which the Association receives from doctors. These have risen steadily from 71 in 1973 to 534 in 1974, 1036 in 1975, 1041 last year, and a figure which is likely to be even higher this year. Inquiries about the old Commonwealth countries still top the list and the B.M.A. confirms that more inquiries are coming from senior doctant
tors.
In the absence of any detailed breakdown of the official emigration figures it is hard to assess the true picture. But my understanding is that the number of consultants now leaving the N.H.S. to work abroad is about 40 a year. All the D.H.S.S. will do is give the number of British and Irish born doctors leaving the country each year. These have risen from around the 800 mark in the early 1970s to about 1100 in 1974-75 and again in 1975-76. But in 1974-75 550 doctors returned to Britain and the following year the figure was about 750.
movement
Expenditure on the N.H.S. Pressure on the Government to begin reflating economy with an autumn Budget is growing as
the the annual conference season gets under way. Trade unions will be joined by left-wingers at the annual Labour Party conference next month in urging the Cabinet to take early action to curb unemployment and increase public expenditure. The unions have opened up a fresh campaign against cuts in health spending and, as the Labour conference agenda, published last weekend, demand from Labour Party shows, there is a constituencies for an increase in Health Service
parallel
resources.
One argument now being heard is that over the past few years Government policy of giving priority to current spending in the Health Service while cutting back on capital spending is building up tremendous problems for the future. Some weeks ago the Commons Expenditure Committee warned that although the D.H.S.S. might well have chosen the lesser of two evils in the short term, in the long term a deteriorating physical fabric would be likely to mean deteriorating services to patients and high current costs. The consequence of a policy of cutting the capital programme was to store up for the social services. Those who argue on these lines question the strategy of cutting back on new hospital building. They accept that there is no point in building new hospitals if they cannot open for lack of money, but they question the assumption that new buildings must invariably also be more expensive buildings to run. By prolonging the life of existing buildings, extra costs are being generated in maintaining them. One part of the argument which tends to support the unions and those sections of the Labour Party calling for more health resources is that the effect of current policy will be to create more pressure for a much larger building programme at the beginning of the next decade..By then there may be fewer financial constraints on public expenditure, but there may also be more competing demands on the building industry which at present is so short of orders and so badly affected by unemployment. The danger is that an enlarged building programme in the 1980s would be cut back because of bottlenecks in the construction industry, as has happened so often in the past. Those who believe there should be a reassessment of
problems
the priorities between current and capital spending because of what they regard as the present imbalance are
eagerly awaiting the
Government’s review of its consultative document on priorities in the health and personal social services published last year. This set out the Department’s priorities for expenditure until 1979-80 and has now been reviewed in the light of the comments received. The revised document, due out within the next few weeks, will show to what extent the Government has met any of the criticisms made.
Australia DRUG ABUSE AND ROYAL COMMISSIONS
During the last year, there have been many demands for a State royal commission to be set up to inquire into drug abuse in New South Wales. The present State (Labour) government has been reluctant to do so pending the report of the existing Joint Committee of Inquiry-a committee representative of the Upper and Lower Houses of the N.S.W. Parliament, and appointed in October, 1976, to replace the corresponding committee which had been holding hearings since 1975, and had been set up by the previous (Liberal) government. This replacement was received with some apprehension by anti-marihuana campaigners because, although it is the privilege of a government to appoint its own committees of inquiry, it was also known that the N.S.W. (Labour) government was opposed to the use of marihuana being a criminal offence. The law’here on marihuana is as follows: Australia is a signatory to the 1966 Geneva Convention, which included marihuana with the narcotics as a dangerous drug (a decision taken, incidentally, without reference to a pharmacologist). Accordingly, in Australia, use or possession of marihuana is, in law, a criminal offence carrying a maximum penalty of 2 years in prison. If the State Poisons Acts were to be amended so that use or possession became a misdemeanour and no longer a crime, Australia would be defaulting on her agreement with the W.H.O.-a procedure not to be embarked on lightly. However, in the face of the as yet equivocal scientific findings on the possible dangers of smoking marihuana, the knowledge that cannabis is widely used by the young and not so young, and the fact that the pro-marihuana campaigners frequently draw attention, with some justice, to the 2-9% incidence of alcoholism throughout Australia, N.S.W. magistrates have now adopted a policy of imposing fines or of dismissing users (when first offenders) with a warning. This is almost analogous to the treatment accorded unsuccessful suiciders, against whom no legal action is ever taken, although suicide remains a crime on the Statute Book. This seems to be a reasonable approach to the problem, pending confirmable studies of the long-term effects of the drug, with particular reference to its effects in conjunction with alcohol use. Marihuana grows with ease in N.S.W. and can even be growing wild. During 1974, the N.S.W. drug squad discovered 111 plantations (worth millions on the black market) in those country areas where a large proportion of the hardworking migrant population lives. Prosecutions in these cases, which were based on the charge of "being in possession", led to many convictions, but the penalties were light and, what is more, light in comparison with the sentences then (1973-74) being given to youngsters caught smoking. In consequence, many people, including Mr Don Mackay, the local Liberal candidate who lived in the country town of Griffith, became increasingly outspoken in their anti-marihuana campaign.
found
The situation
was
greatly aggravated by the incident
a
Accusations became rife of involvement in drug trafficking the Mafia, diplomats, and prominent businessmen -some such accusations even being made under parliamentary and press privilege. With each new generalised accusation, the demand for a royal commission grew. The tragic and mysterious disappearance of Mr Don Mackay in Griffith late in July added to the clamour, and on Aug. 2 the N.S.W. Premier appointed Mr Justice Woodward of the N.S.W. Supreme Court as sole commissioner to inquire into the wider aspects of N.S.W. drug trafficking, to identify the persons involved, and to report within 6 months. During the last year, one has been led to wonder if the form of addiction that produces the greatest human suffering is not the addiction some people have to malicious gossip.
by police, migrants,
Round the World
.
kilometres from Griffith); the drug squad raided farm which contained a plantation of 31.5 acres of marihuana, worth about 20 million dollars on the black market. Prosecution under Section S45A of the N.S.W. Poisons Act, which involves trial by a district court judge and jury with a maximum sentence of 10 years (summary trial without a jury has a maximum of 2), led to the disclosure of a flaw in the law, because the onus lay with the prosecution to prove that the defendants had grown the crop for sale, since under S45A it is not an offence to cultivate marihuana in N.S.W.
eambally (64
at
Col-
The demands for a royal commission were of course not based solely on the issue of marihuana use; throughout Australia there has been a dramatic increase in narcotic addiction during the last 10 years. The South Australian (Labour) government set up its own State royal commission in 1976. Because the federal (Liberal) government controls the Customs Department, and thus the purse strings, there has been a growing demand for a royal commission at federal level. This has now been promised by the Prime Minister. This proliferation of committees (all of which have had alcohol and tobacco explicitly excluded from their remits) reflects not only political involvement but the grave concern felt throughout the community about the growing number of narcotic addicts (estimated by the State Health Commission at 10 000 young persons in N.S.W. in 1977), and the failure of the rehabilitation centres despite an estimated expenditure of$10 000 per person. Methadone maintenance was introduced into N.S.W. in 1970 and continues there, but not in the federal capital, where it was tried and then abandoned as being unsatisfactory. During 1976, 48 young persons died in N.S.W. from narcotic overdoses, and the amounts of heroin, cocaine, and cannabis seized by the Federal Narcotics Bureau have jumped from 2468 g, 3.5g, and 178 654 g, respectively, in 1971, to 15 351 g, 1561 g, and 1 226 922 g in 1976. The narcotics are said to originate in the Golden Triangle, and are smuggled in by couriers among the million air and sea passengers who travel to and from Australia each year; it is impossible to search everyone. Recently, a consignment of heroin worth$500 000 was seized at
Sydney Airport.
-
The public demands that the Government do something about the situation-but what can be done to eliminate the money-hungry? As for treatment, within N.S.W. narcotic rehabilitation centres have tried all the known methods: farm and animal work, support, counselling, meditation, relaxation, psychotherapy, aversion therapy, acupuncture, and so on; the success-rate is only 3% with volunteer cases. What can one do for the young addicts? One contribution towards prevention might be made if the authorities were simply to keep on announcing the hard facts about addiction. And the well-meaning individuals (some of whom come from overseas) who urge new, "highly successful", methods for the treatment of heroin addiction should, before being allowed to promote their ideas, be required to prove their bona fides, and to state in which reputable medical or scientific journals they have published the evidence for their remarkable results, and whether their claims have been verified by their colleagues.
