For some years in the late 19th century, support for the idea of a more coordinated national structure had been growing among BMA members. Federation and the debate preceding gave it strength. This was not just because the process that led to the birth of the Commonwealth of Australia let loose a broad and proud national sentiment. The Constitution, which defined which level of government was responsible for which areas of responsibility in the new Australia, made it clear that the medical profession would now have a national level of government with which to deal on health and medical issues.
Quarantine was one such issue. Doctors in the pre-Federation colonies had long been agitating for a national quarantine system that could deal with the epidemics of smallpox and cholera that had come ashore from foreign ships from time to time, as in the Perth smallpox epidemic of the 1890s. In the mid-1880s, the NSW branch of the BMA had formally resolved to press for uniform, nationwide legislation that would enforce health inspection of all ships calling into Australia, especially in the north and west of the country. They would have been encouraged by the decision of the first Federal Council of Australia in 1883 (forerunner of the Federation Conventions of the 1890s) to discuss quarantine as one of the fields for action by the proposed national government.
Responsibility for quarantine was one of the powers given to the Commonwealth Government in S.51 of the Constitution. So were powers covering pharmaceutical, sickness and hospital benefits and invalid pensions. Significantly for the BMA and future medical organisation, the Constitution gave power to the Commonwealth to legislate for medical and dental services “(but not so as to authorise any form of civil conscription)”.
Thus the profession was drawn into national health policies and activities. And, as the new era began, it seemed urgent and inevitable that the disorganised and even ramshackle structures and institutions at state level overseeing health and medical practice also needed to be rationalised: for example, hospitals, professional registration, medical education, public health and occupational health. Commonwealth governments were now contemplating a national health service. From its very limited role in quarantine, and (especially after World War I) having responsibility for the new pension and repatriation schemes, the Commonwealth was becoming ever more active in providing, administering and paying for health and medical services. A Commonwealth Health Department would soon replace the Department of Customs and Excise (which had covered the issue of quarantine) as the department to administer national health policy. Dr John Cumpston, a prominent official in the Victorian branch of the BMA (and, later, Commonwealth Director of Quarantine before becoming founding Director-General of Health between 1921 and 1945), later noted that the framers of the Constitution “could hardly have visualised that Federation, in practice, would inevitably involve the penetration of Commonwealth authority into the intimate daily life and social relationships of every individual person in the nation”.
Within the medical profession, however, debate had long been going on about the ways in which it should and could respond to all this. Not everybody agreed with what was happening. Members were reported to be discouraged about the ideas about amalgamation or other forms of national integration by the turbulence in Victoria when the MSV and BMA were getting together – though the two organisations would be fairly amicably amalgamated shortly. Colleagues in both South Australia and New South Wales were reported in 1902 to be opposed to any moves towards national organisation, not just because of failure “to distinguish between federation and an Australian Medical Association”, but also because of “the parochial spirit which views with distrust any suggestion of change coming from an outside source”. Members in various States were said to prefer reorganisation into a discrete Australian or Australasian Medical Association rather than federation with the BMA.
Still, the pressure for “one voice” was growing and spreading, the need increasingly recognised among the branches “to have a body which could speak with one voice on matters of a national medical character,” to quote Dr Charles Ross-Smith (Secretary General of the AMA from 1963 to 1966) in his seminal article in 1962 in The Medical Journal of Australia, “The Evolution of a National Medical Association in Australia”.
In 1901, the MSV had kicked off the process by approving the recommendation by a committee that:
“the time is opportune for formation of an Australasian Medical Association with the following objects:
- the control and management of congresses;
- the establishment of an Australian Medical Journal;
- the direction of medical polity;
- medical defence.
The ‘ardent juniors’ in South Australia had been for some time energetically promoting the concept of an inter-colonial congress as a means of encouraging cross-border collegiality and exchange of information about progress in medical science. Such congresses would in practice add to the attractiveness of an organisation that would be more effective than a group of separate bodies with not much more than accidental and desultory contact. Twenty years previously, the maladministration problem at Head Office in London had stimulated the idea of an independent Australian association among members in New South Wales and Victoria. Among the activities that led finally to the formation of a branch in Western Australia was work on proposals for a federated BMA. Several of the medical journals that had been published over the preceding decades had advocated federation or national organisation. Their campaigns were reported to be well received by members frustrated because the British Medical Journal, which they received as part of their membership, for all its great value in keeping doctors up to date with the galloping medical advances of the day, was no great help in their understanding and dealing with exclusively Australian conditions. National organisations had already evolved in other English-speaking Dominions such as Canada and South Africa.
Shortly before the Inter-Colonial Congress in 1911, Dr Hayward convinced the SA branch, as the first in Australia, to agree to take the lead in moves towards union of all the BMA branches in the country. The branch proposed that a permanent federal committee be created to draw up a process which would make sure that the profession was prepared any time any government in Australia proposed any legislation that affected it. The Australian branches agreed. In 1912, very shortly after the final Australian branch of the BMA had been formed in Tasmania, a Federal Committee of the BMA was established, comprising two representatives of each branch, chosen annually.
All this agreement came with conditions that could have limited – and, later, certainly did limit – the work of the Committee. None of the branches had ceded actual powers to it. It could not initiate matters. The original concept was that it should be an Australasian committee, and New Zealand representatives attended the first couple of meetings of the committee. Later, however, the New Zealand branch opted out because “while the New Zealand branch is fully alive to the advantages of such a federation as applicable to Australia; owing to our geographical position and the different interests and conditions and also the difficulties in the way of obtaining direct and satisfactory representation on the Committee, this branch cannot see its way to join the Federation”.
The constitution of the committee was drawn up by Dr Robert Todd, a lawyer as well as a doctor and secretary of the NSW branch. It stipulated that the Committee would act as a medium for negotiating on behalf of the branches in Australia on “matters common to such branches”, and to represent Australian members of the BMA in dealings with Commonwealth and State governments on “any matter affecting the relations between the government and the medical profession”. Dr Ross-Smith described the committee as “an advisory body to the branches in medical or political matters of a national character”.
Finally, both the Committee and its constitution had to be approved by the parent organisation in Britain, a slow process (first) because the BMA constitution had to be amended to accommodate them, and (second) because they needed to be approved by the BMA branches before they could be considered by the BMA Parent Council. Luckily, the Australian application was formally approved during the BMA Annual Representative Meeting in July 1912. (Luckily, because the application managed to squeak through in the last few minutes of the last session of the last day of a conference otherwise distracted by uproar throughout because of the Lloyd George Government’s proposal to legislate for national health insurance in the UK.)
Despite all these potential hurdles, the Committee quickly got down to work. Its first meeting was held in Melbourne in May. It was chaired by Dr Hayward in an atmosphere of agitated discussion in the profession concerning its fears that the Commonwealth Government intended to introduce a national health insurance scheme and to nationalise hospitals. It passed a resolution that sought to enable the Australian branches to deal with these Australian challenges, proposing that the constitution of the British parent body be altered to provide that an Australian Council be established, its members to be elected by Australian members of the BMA, which would administer the affairs of the BMA in Australia, though not in such a way as to affect the BMA outside Australia. The Australian Council was not established until 1933. Much work had needed to be done on such delicate matters as getting the state branches to agree to its constitution and remit among the Australian branches and getting the BMA Parent Council to accept the autonomy that the Committee had in mind.
In 1916, Dr Hayward and Dr Donald Cameron from Queensland travelled to the UK to press the issue on the parent organisation. Their mission was followed six years later by another by Dr Todd. The urgency of the issue had been enforced by the great influenza epidemic of 1917-18, when federal officials had no one doctors’ organisation to consult on quarantine activities and so had been forced to consult the six state branches separately.
It was following these “eminently successful efforts”, as Dr Ross-Smith has described them, that the BMA Parent Council formally got around to agreeing to the Australian proposition in 1923. There was now a charter from the BMA by which the Federal Committee could be converted into a Federal Council and, from then on, authority by which the branches could form the Council, define its powers, functions and responsibilities and cede their own executive powers to a Council.
Discussion continued, but not much action. The Victorian branch did resolve in 1927 that the time was right for a Federal Council with executive powers. But it was not until 1930 that draft proposals for a Council were published in the MJA, which reported that “the Federal Council which takes the place of the Federal Committee will have wider powers”. When it came to defining and agreeing to those wider powers, however, there was much devil to be exorcised in the detail. The Federal Committee had been a significant step in the evolution of a national structure for the association. As a national health policy was being created, it had wrung from Prime Minister Cook his important concession on consultation. It had helped solve the longstanding problem of doctors servicing the friendly societies.