647

Reconstruction

HOSPITAL MANAGEMENT COMMITTEES

FROM A CORRESPONDENT

THE National Health Service Act provides that :" Every regional hospital board shall, within such period

as the Minister may by direction specify, submit to theMinister a scheme ’for the appointment by them of com-mittees, to be called hospital management committees,for the purpose of exercising functions with respect to themanagement and control of individual hospitals or groupsof hospitals, other than teaching hospitals, providing hos-pital and specialist services in the area of the board." .

" It shall be the duty of the hospital management com-mittee of any hospital or group of hospitals, subject to andin accordance with regulations and such directions as maybe given by the Minister or the regional hospital board,to control and manage that hospital or group of hospitalson behalf of the board, and for that purpose to exercise onbehalf of the board such of the functions of the board relatingto that hospital or group of hospitals as may be prescribed."When the Act was before Parliament vigorous repre-

sentations were made for amendments which wouldsecure real independence for the hospital managementcommittees. The fear then was that the idea of regionalcontrol might be pressed too far, with the result that themanagement committees would be little more than

agents of the board, deprived of any real responsibilityfor the control of their hospitals. The emphasis has nowshifted, and there seems to be a danger of the hospitalmanagement committee becoming, in practice, a minorregional board, itself controlling a wl*ole group of hos-pitals. Thus the following are examples of large groupsplaced under single committees by the South-EastMetropolitan regional board :Bromley and Farnborough.-Bromley and District Hospital;

Farnborough County Hospital; Beckenham Hospital, S.E. ;Hospital for Children (Norwood); West Kent Isolation Hos-pital and West Kent Smallpox Hospital; Beckenham and

Penge Maternity Hospital; Children’s Heart Home (WestWickham); Sydenham Invalid Babies’ Nursery ; Tuber-culosis Dispensaries at Bromley, Beckenham, and Penge..Dartford.-Dartford County Hospital; Livingstone Hos-

pital ; Joyce Green Hospital; Bow Arrow Hospital; LongReach Hospital; Southern Hospital (Dartford) ; MaternityHospital (Horton Kirby); Tuberculosis Dispensary.The danger lies in creating yet another tier of officialdomwith which those who really run the hospital will have tobattle.The experience of the voluntary hospitals has long

shown that the life and vigour of a hospital dependson the interest taken in its affairs by its own committee.With groups as large as those arranged by the South-East Metropolitan regional board it is unlikely that thehospital will look upon the hospital management com-mittee as its own committee, and powers of independentaction will have to be delegated to the house-committeeof each hospital. Yet the aim should be to make the

hospitals " group minded " ; otherwise the advantagesexpected to accrue from grouping will be unlikely tomaterialise.

In this connexion the relation between the manage-ment committee and its key hospital may need to bewatched with care. If the management committeemeets at, and controls, its key unit, will the others gettheir due share of attention ? But if, on the other hand,the management committee is separated from the keyunit, meets on neutral territory, and has its own sectionalorganisation, may not its personnel rapidly get out oftouch with the real everyday problems of a hospital andbecome blue-print planners, with the result that thehospitals will find that they have lost badly in the

exchange ? °? The balance of advantage certainly seemsto lie with the close identification of the managementcommittee with the key unit, which should stand in

the position of an elder brother to its associated units,which would largely be left to run their own affairs.

’MEMBERSHIP OF THE COMMITTEE

The Act says that the hospital management com-mittee shall be appointed by the regional hospital boardand that its members shall include :

(a) Persons appointed after consultation with any local’health authority whose area comprises the area or any partof the area served by the hospital or group.

(b) Persons appointed after consultation with any executivecouncil whose area comprises the area or any part of the areaserved by the hospital or group.

(c) Persons appointed after consultation with the seniormedical and dental staff employed at the hospital or thehospitals of the group.

(d) Persons appointed after consultation with such otherorganisations as appear to the board to be concerned.In the case of a committee appointed before the appointedday for a voluntary hospital or for a group comprising anyvoluntary hospital, the original members of the committeeshall also include persons appointed after consultation withthe governing body of any voluntary hospital concerned.The members of the hospital management committees

are now being selected by the regional boards, and it isimportant that this listing of the bodies to be represented’should not obscure the need to keep these variousinterests in their proper place. The primary require-ment for a management committee is the same as fora lay board-that is, men and women who can workhappily together and who can develop a strong corporatesense-and the whole object would be largely defeatedif this core of lay personnel was swamped by personsappointed to be representative of this and that interest.

This requirement has somehow to be reconciled withthe necessity of having the full benefit of expert adviceand inspiration from the medical and other professionalstaff, and the question arises whether the board shouldselect a number of doctors as permanent members ofthe hospital management committee. As free agents,such doctors would be in a position to identify them-selves with the board as a whole, but they would be ina somewhat anomalous position if at the same time theywere expected to serve as experts and to speak on behalfof their professional colleagues. Experience suggeststhat it is essential for the views of the medical staffof a hospital to be brought forward through a medicalcommittee, and in practice it would be a convenienceif the chairman and secretary of that committee weregiven seats on the hospital management committee.Rather than rely on the opinions of members who

happen to be doctors, the committee should have theconsidered view of the medical staff of the hospital.This procedure has the advantage (a) of ensuring thatthe lay, board is not troubled with the internal andunresolved differences between members of the medicalstaff, and (b) of ensuring participation of all the membersof the senior medical staff in discussions of policy.Let us hope that the boards will so choose the new

management committees as to carry on a tradition thathas proved its worth in the voluntary hospitals. Letthem make sure of a strong lay hospital managementcommittee and a strong medical advisory committeewith its appropriate means of liaison between the two.Let there be also a nursing advisory committee and othercommittees if need be : but let us hope that they willnot confuse the issue and create on the hospital manage-ment committee a mixed bag of "

representativepersons no more capable of running a hospital than ofmanaging an ordinary commercial concern.

This country has led the world in evolving a traditionalrelationship between the various interests which is wellunderstood in many a hospital up and down the landtoday. Fortunately there is nothing in the Act or in itsschedules that is inconsistent with it, provided they areinterpreted aright.