History of HCSA

The Fifties | The Sixties | The Seventies | The Eighties | The Nineties

The Forties

The dusty old red minute books have yielded a very clear picture of the turmoil of the period just before the outbreak of the NHS.

In 1944 at 2pm on September 28th in the Cowdray Hall of the Royal College of Nursing, 44 Consultants from all over the country met because of the "growing dissatisfaction with the method of election of the representatives of the non-teaching hospitals on the Beveridge Committee."

The organizer of this meeting was Mr. H.J. McCurrich, a surgeon from the Royal Sussex County Hospital, Brighton. The 'Association of Honorary Staffs of the Major (non-Teaching) Voluntary Hospitals' was born and Mr. McCurrich's election as President was carried with acclaim.

From 1944 onwards the number of voluntary hospital staffs that joined grew until, at the AGM in 1946, 127 were listed as members. Meanwhile the battle of the founding of the NHS went on unabated.

In January 1948 Dr. J.P.N. Joules succeeded Mr. McCurrich as President and in April discussions began with the BMA about representation of Regional Consultants. It was reported that "several members expressed the fear, however, that the Council of the BMA whose members were predominantly general practitioners, might find themselves in conflict with the Consultants and Specialists Committee."

With the formation of the NHS under way and temporary contracts about to be offered to Consultants and Specialists, fears grew for the representation of regional Consultants and of their interests being properly represented within the negotiating framework being established. Talks began in earnest with the Association of Municipal Specialists about forming a separate organization of Regional Hospital Consultants and Specialists.

By October 1948 the main topic of concern was the Spens Committee Report on the remuneration of Consultants and Specialists. Times had changed and, with the establishment of the NHS, the Voluntary Hospital Staffs Organization, as originally founded, also had to change.

Title - The name of the Association shall be 'The Regional Hospitals' Consultants and Specialists Association'.

Object - To consider and act on all matters affecting Consultants and Specialists who are in relation to the Regional Hospital Boards and to safeguard and promote the legitimate interests of such Consultants and Specialists.

Membership - There shall be individual membership and all Consultants - Specialists employed whole or part-time by the Regional Boards - shall be eligible as well as those who, in the opinion of the Council, are suitable members.

At the inaugural meeting of the RHCSA - Mr. H.J. McCurrich was elected Chairman. During this highly charged period, Consultants and Specialists were working with temporary contracts whilst negotiations were taking place between the BMA and Department.

By the middle of 1949 the RHCSA expressed its concern to the Spens Committee that "it does not contain more than one member of the medical staff of a hospital under a Regional Hospital Board".

The RHCSA asked that a greater proportion of members of such (Regional) Staffs be appointed to the Committee. This was turned down by the Minister 'who was reluctant to increase the size of the Committee'.

(Permanent contracts for Consultants and Specialists were agreed and Consultants advised to accept them late Summer 1949). The arguments about representation of Regional Consultants and Specialists with the BMA's Joint Committee sound strangely familiar. The RHCSA went before this Joint Committee, chaired by Sir Lionel Whitby to argue the case for additional Regional Consultant representation. The argument used being - "that it was not democratically elected and was out of touch with the periphery, particularly as there were so few representatives of Regional Board Hospitals on the Joint Committee". The RHCSA passed the following resolution on December 1st, 1949 - 'that this Association does not accept the Joint Committee as a properly constituted body to represent, on a democratic basis, the Consultants and Specialists employed in the NHS in regard to Whitley Council, partly because there is inadequate representation of non-Teaching interests'.

The Fifties

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From 1950 onwards the Association settled into a role of promoting the Regional Consultants' view to both the Central Consultants Committee of the BMA and directly to the Department.

Looking back through the minutes of that period it is surprising - or is it?- that so many items have a familiar ring; professional secrecy: domiciliary visits; reduction in amenity beds; shortage of junior medical staff; mileage allowances; Appointments Committees; even litigation by patients appeared in May 1953. The President, Mr. Jowett, said that "fear of complaints and litigation by patients was affecting the efficiency of the hospital service".

The minutes touch upon pay; merit awards; superannuation; pensions and private beds under threat from a Labour Party conference. The Bradbeer report on Internal Administration of Hospitals; the Strachan Report on Hospital Medical Staffing; the Guillebaud Report on the cost of the NHS and the Willink Report on medical manpower.

Where did all these report go? Was there a special graveyard for NHS reports? Or could it just be that is why the DHSS headquarters found their way to the Elephant and Castle?

The 1957 Royal Commission on Remuneration of Doctors and Dentists started work and the RHCSA gave Evidence to this Committee.

There was also the forerunner of one of the trade marks that distinguishes the RHCSA/HCSA - the use of direct referenda and ballots. This one was on "Junior Staffing and other facilities in non-teaching Hospitals".

The Royal Commission reported - and was accepted. The Review Body was born.

The Sixties

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Meetings were held with the BMA during this period to discuss Representation on the JCC - nothing changed. There was another report in 1962 of Sir Robert Platt's Committee on Medical Staffing Structure in the Hospital Service.

RHCSA began a major campaign to improve Consultants' pensions, whilst there was also a reference to "the extremely bad publicity Consultants have in the press often aggravated by the mistakes of other doctors". Nothing has changed. And again, in 1967, "members of the Association should mount a campaign of letters to the press, both lay and medical, drawing attention to the deteriorating conditions in peripheral hospitals".

In 1968 Mr. Donald Young became President - major dissatisfaction at the Review Body Report that tilted the balance between Hospital Doctors in favour of General Practitioners; the Report of the Royal Commission on Medical Education was received and in 1969 Dr. John Winter presented a proposal that a Consultants' working week should be based on 10 instead of 11 sessions.

Then came the catalyst. On October 2nd, 1969 the Department of Health issued a Report: The Responsibilities of the Consultant Grade: (The Tomato Document). The main recommendation of the Report read "Medical work in hospitals could be so arranged that the nature of the service contribution of junior doctors is appropriate to the requirements of their training. Consultants would be supported by an increasing number of GP's and others working part-time in hospital, and by juniors but only to the extent dictated primarily by training programmes which would lead these juniors in due course to Consultant status or general practice. Each individual Consultant, following an increase in the number of Consultants, would be enabled to carry out more items of care himself for any individual patient than is at present possible".

The RHCSA responded - "The Council resolved unanimously that this Report was totally unacceptable to the RHCSA and the President was asked to express this opinion to Sir George Godber, the Central Committee for Hospital Medical Services [CCHMS] of the BMA and in letters to the BMJ and Lancet".

Then in October 1969 at the Royal Society of Medicine, 110 Regional Consultants met from all over the country. They were all deeply concerned over the effects of this Report - Responsibilities of the Consultant Grade.

That meeting decided that, in order to combat the threat to Consultant practice, the Regional Consultants should be approached via the RHCSA. A letter and questionnaire were circulated to all Regional Consultants.

The Seventies

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The die was cast. The rate of expansion of the RHCSA was very rapid indeed as the threat, particularly to Regional Consultants and their standards, was intense and even in 1970 the question was put to members - "In the event of a disagreement with the Department of Health, would you be prepared to support action involving some form of sanctions, if it were the wish of the majority of the membership?"

In 1970, as the staffing row was boiling away, the Review Body findings were referred to the Prices and Industry Board. Council was incensed - " This Association states that unilateral abrogation of the independent negotiating machinery by the Government will have such immediate and long term implications that it must be a resignation issue, unless the RB is properly reconstructed in the terms defined by the Royal Commission."

Mr. Brownlow Martin was appointed Executive Officer of the Association and the office moved to the Old Court House, Ascot on January 1st, 1971.

The membership continued to increase at a steady rate. The new Industrial Relations Act meant that there had to be a ballot of members to seek approval to register the RHCSA as a Trades Union under the Act.

Members did vote overwhelmingly to become a Registered Trades Union. However the BMA also registered and claimed sole bargaining rights for all doctors. This led to a prolonged period of discussion between the two organizations to resolve their differences.

In 1973 the Association of District Consultants in Scotland disbanded with a recommendation that members should consider joining the RHCSA.

Over 100 did so and the Scottish Region of the RHCSA was formed with Mr. Jack Ritchie joining the Council.

Dr. John Winter became President and, as the membership continued its steady increase, so did the demand that Teaching Hospital Consultants should be allowed to join.

Membership was thrown open to all in 1974 and, from April 1st, the Association dropped the 'R' and became the Hospital Consultants and Specialists Association.

These were hectic times both internally and externally. Mrs. Barbara Castle appeared as one of the most combative post-war Secretaries of State.

HCSA produced its Hospital Medical Staffing Report which advocated the introduction of a non-Consultant service grade - a hospital specialist. It took a further 14 years for this concept to be accepted and emerge as the Staff Grade in "Achieving a Balance" albeit at a lower level than envisaged in the HCSA report.

The next two years were dramatic. There was the industrial action by COHSE and NUPE aimed at putting the squeeze on private practice in NHS hospitals. The Owen Working Party was studying Consultants' contracts and for once the BMA and HCSA worked together. These negotiations were brought to an abrupt end by Mrs. Castle who presented her "Total Commitment Allowance" contract, on a take it or leave it basis. The profession didn't take it and the sanction of 'working to contract' was imposed by both the HCSA and BMA.

These combined sanctions ended in division, when, after a series of secret late night meetings between Mrs. Castle and the BMA, a shopping list was tacked onto the existing contract. The BMA deemed this to be satisfactory, the HCSA did not. The Review Body award of 18% had been withheld whilst action was taking place and was released soon afterwards. At the time it was considered that pressure from GP's had had a great deal to do with the BMA's action.

Also at this time Mrs. Castle chose to announce to the House of Commons her plans to phase out pay-beds from NHS hospitals. These were indeed exciting times!

It was during this period that the professions united as never before to fight a highly skilled and successful rearguard action against Mrs. Castle's proposals to phase out pay-beds. In the end a much watered down set of proposals was accepted. The effect of this battle was to give a sharp stimulus to the establishment of a flourishing private sector outside the NHS.

The other major happening in this period was the establishment of a Royal Commission on the NHS. The HCSA collected evidence, Part I 'What was wrong' and Part II 'The way forward'.

The HCSA joined a European grouping called the F'd'ration Europ'enne des M'decins Collectivit's (afterwards to become the FEMS - the 'S' being Salari's). This grouping consisted of over 100,000 salaried hospital doctors in the EEC. Mr. Georges Jantet became the HCSA representative and the FEMS Deputy President.

HCSA concentrated its energies on improving the pay and conditions of service of Consultants; Consultants' contracts; ACAS negotiations concerning representation and recognition, and hospital staffing.

This was the period when the contracts were being renegotiated. The HCSA were deeply concerned that the professions were being asked to accept a package of proposals before they had been priced by the Review Body. In the event, the BMA were saved from an embarrassing situation by a change of Government, which introduced a revised version of the old contract HC(90)16 with 10% private practice earnings limit allowable to whole-time Consultants. In 1979 HCSA considered affiliation to the TUC. After a prolonged period of inter-union antagonism it was considered that affiliation of a professional group might bring a different perspective to the debates of the TUC's Health Services Committee. Affiliation was not easy for a small Independent Union and was considered by some members to be inappropriate. However in a ballot HCSA members voted overwhelmingly to affiliate and this took place on October 1st. HCSA has since played its full part in the Health Services Committee work, proposed and seconded motions at Congress and been part of many delegations to see various Secretaries of State and Ministers for Health.

The Eighties

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The tenor for this decade was set with a report to Council about possible Consultant redundancies. Serious discussions took place between the CCHMS of the BMA and HCSA about formal representation and recognition. It culminated in an offer of three seats on the CCHMS, as it was then called, at a cost of £55,000 per annum. This offer was declined. In 1980 the Review Body warned with ominous accuracy "It would be wrong for doctors and dentists to occupy a fixed position in the general pay hierarchy or for their remuneration to be determined by an automatic formula". Also in 1980 the Health Services Act removed Area Health Authorities and repealed the 1976/7 pay-bed legislation. The proposals contained in the Short Report, a reduction in the number of Registrars and an increased number of Consultants, were rumbling on and met with steadfast HCSA opposition. HCSA members overwhelmingly voted for a scheme of Seniority Payments to replace Merit Awards, a policy that was endorsed again in the late eighties. In 1983 HCSA members overwhelmingly voted for the introduction of a Specialist Grade to ease the manpower situation.

In the same year work intensified on HCSA's Contract proposals for a 10 Session Contract to be Work Sensitive, which would do away with the artificial barrier between whole time and maximum part-time contracts. This work culminated in the late eighties with the policy, still extant, for a Work Sensitive Contract.

Griffiths appeared, firstly as a Chairman on an inquiry and then with the introduction of its recommendations. Administration was out and Management was in. Cuts and cash shortages in the NHS were continuous throughout the decade.

HCSA continued to battle the concept of the Short Report that wanted to turn the Hospital Service into a Consultant-Based Service - one in which the Consultants did the majority of work - from Consultant-Led Service.

HCSA was playing its full part in European affairs through its membership of FEMS and with Council member, Mr. Georges Jantet, one of its leading lights. In 1986 came the publication of Achieving a Balance aimed at getting rid of the bottle-necks being encountered by Senior Registrars in their search for Consultant appointments and also as a pump-priming exercise by creating and funding more Consultant posts. The Staff Grade Doctor, albeit not the HCSA's Specialist Grade but similar, was introduced.

HCSA had success in its Pay Claim/Evidence to the review Body in 1986 when it was demonstrated that the fringe benefits enjoyed by comparator groups should be taken into account. This secured a 1.6% additional award. HCSA also approved the introduction of a unified non-Consultant Hospital Career Grade. If that proposal had been taken up on 1987 there would not now be the necessity for Trusts to create any number of different grades of "Trust Doctor".

HCSA continued to meet various Secretaries of State for Social Services and Ministers for Health.

Inadequate NHS funding now became critical. Crown Indemnity was introduced in response to the rapidly increasing obligatory Medical Defence Organization subscriptions.

On June 30th, 1988 HCSA Chief Executive Brownlow Martin retired and was replaced by Stephen Charkham who had been on the HCSA staff since 1974. Bill Bilson became Head of Administration.

In 1989 the catalyst for the NHS Reforms was triggered. Three Royal College Presidents called upon Mrs. Thatcher, the then PM, to detail the disastrous state of funding in the NHS. They were effectively handbagged because Mrs. Thatcher set up a secret Working Group to discuss and formulate a total reform of the NHS. "Working for Patients" was born and, with it, the NHS Reforms.

The Nineties

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This decade has been dominated by the NHS Reforms introduced in "Patients First". They divided the NHS into Providers and Purchasers - a feature that will probably not be changed by any incoming Government. Also created was the Trust Hospital System with some 450 separate Trusts. The Government was keen, and still is, to bring in local pay bargaining and contracts. This has been strenuously opposed by a united profession. Local Negotiating Committees were established in nearly all Trust Hospitals and, as a result, HCSA members, who were elected by their Medical Staff Committees, have been able to take a full part in negotiations. Contrary to many predictions, the HCSA and BMA have worked harmoniously at local level. The BMA challenged the Reforms head-on whilst the HCSA tried a diplomatic approach with meetings with the Secretary of State for Health, Kenneth Clarke and his successors, William Waldegrave, Virginia Bottomley and Stephen Dorrell. We are all now feeling the full effects of the Reforms. Cash crises are back with us and competition has proved to be a curse on the delivery of Hospital Services. There has been a massive increase in the number and variety of managers and also the amount of time spent by Consultants on 'pure' management work. Morale has reached a new low with an HCSA survey revealing that 700 members were genuinely planning to retire before the age of 65. Manpower planning has proved to be little short of a disaster.

A deal was struck between Junior Doctors, BMA's CCSC, DoH and Royal Colleges to reduce Junior Doctors' hours. The basis of the agreement was underpinned by the need to replace lost clinical time by increasing the number of Consultants. There was a proviso - not worth the paper it was written on - that Junior Doctors' work would not be uploaded onto Consultants. There were not sufficient Doctors in Training to make up the numbers - as the HCSA predicted - and Trust Hospitals started to pressure Consultants to carry out this work. Finally, the United Kingdom was compelled to obey EC regulations about training and the Calman Committee introduced a system of more formalized training resulting in a Certificate of Completion of Specialist Training [CCST] without which no Specialist Registrar [SpR] could apply for a Consultant post. Again this sweeping reform required a far greater number of Consultants to do the work. The manpower crisis deepened.

Job Plans and Work Programmes have featured prominently since being introduced in 1980. HCSA's CONSULTANT ADVISORY SERVICE really came into its own and has advised many hundreds of members. What the vast majority of Work Programmes show is how much work is carried out by Consultants over and above their contractual obligations, mostly without any reward.

The Audit Commission has also been making its presence felt. "The Doctors' Tale" and "The Doctors' Tale Continued" seek to impress on managers the need to control more closely the activities of Consultants.

The next significant event will be the General Election - the result of which will determine the future shape of the NHS.

On the domestic from HCSA's Head of Administration, Mr. Bill Bilson retired in 1990 and sadly died in 1992. Mr. Graham Poynton joined the HCSA staff in 1990 as Head of Administration.