One Voice: Federal Council
Despite its achievements so far it was clear that, for a number of reasons, there were severe limitations on the Federal Committee’s capacity to exert BMA influence on the process in which, following World War I, national government inexorably increased its power over health policy.
The powers that the Federal Committee had been given meant that it was not much more than a kind of way station on the way to an effective national structure. No branch had actually agreed to cede to the new body any of its powers. The Committee was unable to initiate any matters, only to coordinate those sent to it by the branches, coordinate them and then send them back to the branches for action. Its constitution ensured that it was but a medium for negotiations involving the branches. As Dr Ross-Smith noted in his history, it was an “advisory body to the branches in medical or political matters of a national character”. As the MJA recorded at the time, “the chief handicap of the Federal Committee was that it had no power to initiate new movements or to institute reforms; it dealt only with matters brought to it by the branches”. The new Federal Council, it went on to say, would deal with “large questions affecting the whole of Australia”.
The new body was finally incorporated in May 1933. It had taken more than four years to get the branches to agree on the form of the constitution of the Council. Three prime objectives were agreed: “to promote in Australia the medical and allied sciences, to maintain the honour of the medical profession, and to promote and maintain the interests of the profession.” Its constitution provided that it “may consider any matter affecting the medical profession in Australia, and may act in connection therewith on behalf of the branches collectively”. But, when the constitution was examined closely, it was found not to show any attempt at specifying the powers of the Council. It could “consider” but how could it “act”? Some limitations on its powers were defined, on the other hand: it could not enforce decisions on the branches, for example, and the branches (or a majority of branches) reserved the right to approve matters.
Nonetheless, expectations of the new Council were high. Dr Mervyn Archdall, the new editor of the MJA, greeted it as “a corporate body with power to initiate and to carry into effect measures advantageous to the Branches. The days of tedious reference to the Branches on matters of all kinds, the days of slow machinery are, or should be, done”. It would not be long before cold water would be thrown on that idea.
Actually setting up the Council was not all smooth either. It had very little in the way of financial support. Its funds, which came from a quite small annual increase in members’ subscriptions, was reported barely to cover the costs of its two meetings a month. The funding problem was alleviated to an extent by supplementary grants from the branches, and even a subvention of £1,000 a year over three years from the BMA Parent Council in England. The problem was still grave enough that it was decided to limit membership of the Council to 12 members. (Later, after the debate over the powers of the Council vis-à-vis the branches had reached a critical juncture and, when mollification of the branches was badly needed, membership was increased to 15: four from New South Wales, three from Victoria and two each from the other four States. It then represented more accurately the numerical strength of the branches.) Dr John Hunter, though continuing as Medical Secretary of the NSW branch, had been acting also as Secretary of the Council. Dr Hunter’s brother Hugh was appointed his assistant three years later as the workload built up. Though it was appreciated that impending Commonwealth legislation meant even more work, there were no funds for a full-time Council secretariat, the Federal Secretary having to share office and staff with the NSW branch.
The Council quickly exerted influence on developing health policy, however, despite these difficulties. It drew up proposals for a policy of integrating hospitals in a national system for the 1934 Congress, following up on the ideas being promulgated in Australia by Professor Errol Meyers of Queensland and in the UK by the BMA proselytising pamphlet A General Medical Service for the Nation in 1930. In 1935, the Federal Council suggested (and put to Commonwealth and State governments) proposals for a national health insurance system. It was in consultation with the Commonwealth Government on an independent national medical research organisation, as the Federal Committee had proposed in 1912, which led to the creation of the National Health and Medical Research Council. Although the new structure was “in some ways cumbersome and slow,” as Dr Ross-Smith says in his account, it “stood the test of time. Negotiations with the Commonwealth Government Health Department formed a major part of the Council’s activity . . . owing to the rapid growth of the National Health Service in Australia. Negotiating on behalf of the profession with other Commonwealth Government departments, such as those of repatriation and social services, was also a major function of the Federal Council”.
There was much to be negotiated. “Matters of a national character” had grown spectacularly in numbers and scope since Federation. So had their impact on the medical profession. Immediate matters included the status of doctors in the Government’s plans – shortly to be revealed – for a national health insurance scheme.