Annals of Royal January 1 979
College
of
the
Surgeons
of
England Volume 6i No I
FROM THE PRESIDENT Address to the Annual Meeting of Fellows and Members at Swansea on 28th September 1978 Members of Council and Faculty Boards, Fel- that message, indeed only to emphasise it at the present time. lows, and Members, It is a great pleasure and privilege for CounAt the last Annual General Meeting I also cil to have this opportunity to visit the Prin- reported that although Council had kept the cipality for our Annual General Meeting. Primary and Final FRCS examinations under As if our love for Wales had not already regular review for many years, we would be been amply demonstrated by Prince Charles's giving further attention to the Edinburgh Coltwo visits to the College this year ! On the first lege proposals of August I977. It will be reoccasion at the time of the Hunterian 2 5oth called that Edinburgh had suggested a Part I anniversary celebrations, when he so ably and examination, which would have combined the at such short notice stood in for HM the Queen basic sciences with surgery in general, to be and Prince Philip; and the second time when followed by a Part II specialist examination. the Prince of Wales was admitted to the Hon- These proposals were emphatically rejected by orary Fellowship and addressed our diplomates Council, by the Court of Examiners, and by representatives of the Primary examiners. in the Edward Lumley Hall on I2th July. they had also been rejected by wellMoreover, This year's elections to Council came some of our regional advisers and attended meetings was anof this venue the meeting time after nounced. I need hardly tell you how welcome tutors. We are therefore confident that Counare the newly elected members of Council and cil's judgment is sound and representative of a how glad we are to have Mr Hilary Wade with wide spectrum of our Fellows' views. Us. In this connection it is important to rememI also mentioned at our last Annual Meeting ber that opportunity for service to the College that one or two of the Specialist Associations and its Fellows is not only the prerogative of (notably the orthopaedic surgeons and neuroCouncil Members. For we are always acutely surgeons) had been considering the possibility conscious of the goodwill and support of our of some formal examination towards the end many active surgical tutors and advisers. I of higher training. And one or two of the other must especially commend the many years of Specialist Training Committees envisaged the industry and loyal support of Mr Arnold Aldis, possibility of interviewing Fellows towards the who was until recently our College Regional end of their training. It is my personal view Adviser in Wales. that any interview at that stage should chiefly In my last annual address I stressed the vital be directed to assessing the training programme importance of maintaining professional morale and the trainers rather than the trainees. As I and high standards in the face of so many have said before, I find it hard to look with discouraging circumstances. I especially under- favour on any scheme which would present lined the real hazard of the professions becom- mature men and women with a further examing too accustomed to that atmosphere of ination hurdle at that stage. I have a pretty bureaucratic malaise and industrial strife which shrewd idea that that sentiment is shared by has become characteristic of the NHS in far most young doctors. It is indeed sad that agetoo many places. I see no reason to modify ing professional people can sometimes become
2
From the President
obsessed with setting up further hurdles for the young that they themselves never had to contend with. Are we not in danger of becoming too preoccupied with needlessly detailed assessment of those in training? Should we not be more concerned with keeping some of the older surgeons up to date? This latter aspect of continuing assessment was recently referred to at our Board of Surgical Specialties in relation to (i) the basic sciences and (2) new surgical techniques. In regard to the basic sciences, a suggestion had been put forward by a publisher that each specialist association might draw up a corpus of updated basic science related to its own specialty which might be published in book form as part of a 'syllabus' for higher training. In discussion at the Board of Surgical Specialties it became clear that there was no great enthusiasm for this idea. It is apparent that many of us feel that it is the established surgeon who inevitably grows steadily more out of touch with the basic science he learnt in his youth, as well as tending to become ignorant of new knowledge in the basic sciences relevant to his own specialty. In regard to the second point I made, concerning new surgical techniques, some of us have been much impressed by two important postgraduate courses which have been held at the College. The earlier, highly successful, of these was in techniques of microsurgery. More recently, in June I978, there was a so-called AO/ASIF course on methods of internal fixation of bone, organised by Mr A Graham Apley in collaboration with a group of Swiss surgeons who flew over to England for the occasion. That course was attended by close on Ioo senior registrars and established consultants and was deemed a great success by all concerned. The ophthalmologists have organised similar courses at Moorfields which clearly fulfil a real need in keeping established surgeons up to date. It is because I believe that this College has such a vital function to play in relation to medical standards that I am anxious that we shall not become needlessly preoccupied with our basically sound examination system. I have often referred to the great importance of the Royal Colleges as quality controllers. This especially applies to the inspection of hospitals and the 'vetting' of both training and senior
staff posts. There is room for considerable improvement in the work we do here. With the collaboration of our surgical colleagues throughout the country I am convinced that this College could do a great deal more to persuade and, indeed, to compel hospital authorities to improve their facilities. Critical and responsible reports by our assessors in respect of inadequate operation theatres, poor libraries, bad resident accommodation, and a variety of other matters can do much to promote the speedy remedying of serious deficiencies. And though, to date, we have only infrequently resorted to actual withdrawal of recognition, on such occasions this has resulted in correction of the deficiencies. I am sure that the College must be prepared to be much tougher with some hospital authorities about the continued neglect of fundamental facilities which often lead to serious bottlenecks in the delivery of efficient surgical care. But the successful exercise of such powers requires sensitivity and sound judgment. On the occasion of this meeting I would like to refer to the very important work done by the various academic departments at Lincoln's Inn Fields. Three of these, anaesthetic research, dental science, and ophthalmology, are controlled solely by the College. The other five departments-anatomy, biochemistry, applied physiology, pathology, and pharmacologyare administered by the Institute of Basic Medical Sciences, which is a unique condominium between the College and the University of London. All of these eight departments are hives of industry both in teaching and research. The quality of the work is well shown by the distinction of those who fill the chairs, by the satisfaction of the postgraduate students who attend their courses, and by the fact that there were no less than 2I applicants for the chair of biochemistry when this was advertised last year. I mention all these points because there are still many people, even amongst our own Fellows, who picture the College as primarily an examining body. Nothing could be further from the truth. Our examinations are important, but they represent only a fraction of ouir responsibilities to the profession and the public we serve. Finally, a word or two about the Royal Commission on the NHS. Fellows will remem-
From the President
ber that this Royal College submitted written evidence to the Royal Commission in two parts. Information in Part I was collected from our Fellows on a countrywide basis through the willing help of our advisers and tutors. Earlier this year we were invited to give oral evidence and, on i2th May, we took a strong team to meet the Commission. That group included Mr Peter Bevan, Mr Walpole Lewin, Professor Kenneth Liddelow, Sir Alan Parks, Dr Cyril Scurr (who represented the Dean of the Faculty of Anaesthetists), Sir Rodney (now Lord) Smith, Mr Johnson-Gilbert, and myself. We had a spirited and good-humoured session with the Commission and I believe that we made our points succinctly and effectively. But it would be foolish to expect too much from the deliberations of a Royal Commission. All experience shows that epoch-making reforms do not often emanate from such a source. And even if the Commission published a really lively and valuable report many of its recommendations would be conveniently forgotten or ignored by politicians. In truth there is nothing this NHS needs more than lively competition from non-governmental sources. And much as all of us have deeply regretted the mischievous and misguided machinations of the political left in their determination to separate private practice from the
3
NHS, it could be that this may be turned to advantage in the end. However, it is my own firm belief that private facilities within the NHS must also be preserved in the public interest. Experience teaches us that all monopolies are bad and State monopolies the worst of all. In these circumstances we should welcome anything which offers to the public alternative and supplementary sources of medical care and to the health professions supplementary and alternative sources of income. But with the present state of political intolerance towards free enterprise and independent institutions the long-term viability of a private sector must always be in some jeopardy both in education and medicine. There is no room for complacency and the price of all this is eternal vigilance and constant effort. As Churchill once said, there is nothing to offer but 'blood, toil, sweat and tears'. You may rest assured that your Council will continue to show a lively concern for the public interest by insisting upon the highest standards of medical and dental care and by seeking to ensure the ethical and professional freedom of the individual practitioner in the service of his patients. REGINALD MURLEY
College
of
the
Surgeons
of
England Volume 6i No I
FROM THE PRESIDENT Address to the Annual Meeting of Fellows and Members at Swansea on 28th September 1978 Members of Council and Faculty Boards, Fel- that message, indeed only to emphasise it at the present time. lows, and Members, It is a great pleasure and privilege for CounAt the last Annual General Meeting I also cil to have this opportunity to visit the Prin- reported that although Council had kept the cipality for our Annual General Meeting. Primary and Final FRCS examinations under As if our love for Wales had not already regular review for many years, we would be been amply demonstrated by Prince Charles's giving further attention to the Edinburgh Coltwo visits to the College this year ! On the first lege proposals of August I977. It will be reoccasion at the time of the Hunterian 2 5oth called that Edinburgh had suggested a Part I anniversary celebrations, when he so ably and examination, which would have combined the at such short notice stood in for HM the Queen basic sciences with surgery in general, to be and Prince Philip; and the second time when followed by a Part II specialist examination. the Prince of Wales was admitted to the Hon- These proposals were emphatically rejected by orary Fellowship and addressed our diplomates Council, by the Court of Examiners, and by representatives of the Primary examiners. in the Edward Lumley Hall on I2th July. they had also been rejected by wellMoreover, This year's elections to Council came some of our regional advisers and attended meetings was anof this venue the meeting time after nounced. I need hardly tell you how welcome tutors. We are therefore confident that Counare the newly elected members of Council and cil's judgment is sound and representative of a how glad we are to have Mr Hilary Wade with wide spectrum of our Fellows' views. Us. In this connection it is important to rememI also mentioned at our last Annual Meeting ber that opportunity for service to the College that one or two of the Specialist Associations and its Fellows is not only the prerogative of (notably the orthopaedic surgeons and neuroCouncil Members. For we are always acutely surgeons) had been considering the possibility conscious of the goodwill and support of our of some formal examination towards the end many active surgical tutors and advisers. I of higher training. And one or two of the other must especially commend the many years of Specialist Training Committees envisaged the industry and loyal support of Mr Arnold Aldis, possibility of interviewing Fellows towards the who was until recently our College Regional end of their training. It is my personal view Adviser in Wales. that any interview at that stage should chiefly In my last annual address I stressed the vital be directed to assessing the training programme importance of maintaining professional morale and the trainers rather than the trainees. As I and high standards in the face of so many have said before, I find it hard to look with discouraging circumstances. I especially under- favour on any scheme which would present lined the real hazard of the professions becom- mature men and women with a further examing too accustomed to that atmosphere of ination hurdle at that stage. I have a pretty bureaucratic malaise and industrial strife which shrewd idea that that sentiment is shared by has become characteristic of the NHS in far most young doctors. It is indeed sad that agetoo many places. I see no reason to modify ing professional people can sometimes become
2
From the President
obsessed with setting up further hurdles for the young that they themselves never had to contend with. Are we not in danger of becoming too preoccupied with needlessly detailed assessment of those in training? Should we not be more concerned with keeping some of the older surgeons up to date? This latter aspect of continuing assessment was recently referred to at our Board of Surgical Specialties in relation to (i) the basic sciences and (2) new surgical techniques. In regard to the basic sciences, a suggestion had been put forward by a publisher that each specialist association might draw up a corpus of updated basic science related to its own specialty which might be published in book form as part of a 'syllabus' for higher training. In discussion at the Board of Surgical Specialties it became clear that there was no great enthusiasm for this idea. It is apparent that many of us feel that it is the established surgeon who inevitably grows steadily more out of touch with the basic science he learnt in his youth, as well as tending to become ignorant of new knowledge in the basic sciences relevant to his own specialty. In regard to the second point I made, concerning new surgical techniques, some of us have been much impressed by two important postgraduate courses which have been held at the College. The earlier, highly successful, of these was in techniques of microsurgery. More recently, in June I978, there was a so-called AO/ASIF course on methods of internal fixation of bone, organised by Mr A Graham Apley in collaboration with a group of Swiss surgeons who flew over to England for the occasion. That course was attended by close on Ioo senior registrars and established consultants and was deemed a great success by all concerned. The ophthalmologists have organised similar courses at Moorfields which clearly fulfil a real need in keeping established surgeons up to date. It is because I believe that this College has such a vital function to play in relation to medical standards that I am anxious that we shall not become needlessly preoccupied with our basically sound examination system. I have often referred to the great importance of the Royal Colleges as quality controllers. This especially applies to the inspection of hospitals and the 'vetting' of both training and senior
staff posts. There is room for considerable improvement in the work we do here. With the collaboration of our surgical colleagues throughout the country I am convinced that this College could do a great deal more to persuade and, indeed, to compel hospital authorities to improve their facilities. Critical and responsible reports by our assessors in respect of inadequate operation theatres, poor libraries, bad resident accommodation, and a variety of other matters can do much to promote the speedy remedying of serious deficiencies. And though, to date, we have only infrequently resorted to actual withdrawal of recognition, on such occasions this has resulted in correction of the deficiencies. I am sure that the College must be prepared to be much tougher with some hospital authorities about the continued neglect of fundamental facilities which often lead to serious bottlenecks in the delivery of efficient surgical care. But the successful exercise of such powers requires sensitivity and sound judgment. On the occasion of this meeting I would like to refer to the very important work done by the various academic departments at Lincoln's Inn Fields. Three of these, anaesthetic research, dental science, and ophthalmology, are controlled solely by the College. The other five departments-anatomy, biochemistry, applied physiology, pathology, and pharmacologyare administered by the Institute of Basic Medical Sciences, which is a unique condominium between the College and the University of London. All of these eight departments are hives of industry both in teaching and research. The quality of the work is well shown by the distinction of those who fill the chairs, by the satisfaction of the postgraduate students who attend their courses, and by the fact that there were no less than 2I applicants for the chair of biochemistry when this was advertised last year. I mention all these points because there are still many people, even amongst our own Fellows, who picture the College as primarily an examining body. Nothing could be further from the truth. Our examinations are important, but they represent only a fraction of ouir responsibilities to the profession and the public we serve. Finally, a word or two about the Royal Commission on the NHS. Fellows will remem-
From the President
ber that this Royal College submitted written evidence to the Royal Commission in two parts. Information in Part I was collected from our Fellows on a countrywide basis through the willing help of our advisers and tutors. Earlier this year we were invited to give oral evidence and, on i2th May, we took a strong team to meet the Commission. That group included Mr Peter Bevan, Mr Walpole Lewin, Professor Kenneth Liddelow, Sir Alan Parks, Dr Cyril Scurr (who represented the Dean of the Faculty of Anaesthetists), Sir Rodney (now Lord) Smith, Mr Johnson-Gilbert, and myself. We had a spirited and good-humoured session with the Commission and I believe that we made our points succinctly and effectively. But it would be foolish to expect too much from the deliberations of a Royal Commission. All experience shows that epoch-making reforms do not often emanate from such a source. And even if the Commission published a really lively and valuable report many of its recommendations would be conveniently forgotten or ignored by politicians. In truth there is nothing this NHS needs more than lively competition from non-governmental sources. And much as all of us have deeply regretted the mischievous and misguided machinations of the political left in their determination to separate private practice from the
3
NHS, it could be that this may be turned to advantage in the end. However, it is my own firm belief that private facilities within the NHS must also be preserved in the public interest. Experience teaches us that all monopolies are bad and State monopolies the worst of all. In these circumstances we should welcome anything which offers to the public alternative and supplementary sources of medical care and to the health professions supplementary and alternative sources of income. But with the present state of political intolerance towards free enterprise and independent institutions the long-term viability of a private sector must always be in some jeopardy both in education and medicine. There is no room for complacency and the price of all this is eternal vigilance and constant effort. As Churchill once said, there is nothing to offer but 'blood, toil, sweat and tears'. You may rest assured that your Council will continue to show a lively concern for the public interest by insisting upon the highest standards of medical and dental care and by seeking to ensure the ethical and professional freedom of the individual practitioner in the service of his patients. REGINALD MURLEY
