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Mr. Richards in his closing address said it was true theCourt of Appeal had granted a decree, but it could do so oncircumstantial evidence. The court said that the inferenceto be drawn from the facts was such that when the suit wasnot defended it might be inferred that adultery took place.That did not mean that the parties could not come to thecouncil and say that although they did not defend the suitthey did not commit adultery. If the council found that theadultery alleged in the first head of the charge was not proved,they were not concerned with the second, but if they found thefirst count proved, they had to consider whether Dr. Stubbswas in professional relationship at all material times. Mr.Richards submitted that attendance on Mrs. Mitchell as amedical man was purely incidental. This was not a case of aman meeting a woman for the first time because she was apatient. All the way through they continued to meet socially.

After hearing Mr. Howard in reply and deliberating incamera, the president announced that the council had foundthe facts alleged against Dr. Stubbs in head one of the charge(the adultery in respect of which the divorce was granted)-not proved to their satisfaction.

SEXUAL PERVERSION

A practitioner appeared before the council charged withhaving been convicted of an offence arising from sexualperversion, for which he had been sentenced to twelve months’imprisonment. The case was heard in camera, and at theend the President announced in public that the council hadnot seen fit to direct the Registrar to erase the practitioner’sname from the register.

COÖPERATION BETWEEN HOSPITAL,GENERAL-PRACTITIONER, AND LOCAL-

AUTHORITY SERVICES

THE Central Health Services Council has appointeda committee to study means of promoting cooperationbetween the hospital, general-practitioner, and local-authority services. It will consider existing forms ofcooperation between (i) regional hospital boards, hospitalmanagement committees, and boards of governors; and

(ii) local authorities ; and (iii) executive councils ; and

report whether it is possible to formulate any generalprinciples on which cooperation might be promotedbetween these authorities. The members of the committeeare :

F. MESSER, c.B.E., M.P. (chairman) ; Sir HENRY COHEN,F.R.C.P. (vice-chairman) ; Sir ERNEST RocK CARLING,F.R.C.P. ; Sir ALLEN DALEY, F.R.C.P. ; F. HALL, C.B.E., M.D. ;Captain S. H. HAMPSON, M.B.E., M.c., LL.B. ; the Hon.ARTHUR HOWARD, C.V.O., M.P. ; W. V. HOWELLS, M.B. ;K. 1. JULIAN, C.B.E. ; Prof. HILDA LLOYD, P.R.C.O.G. ; R. A.MICKELWRIGHT, F.H.A. ; Sir CECIL OAKES, C.B.E. ; CouncillorWILLIAM ONIONS ; Prof. R. H. PARRY, F.R.C.P.; W. G. PAT-TERSON, M.D. ; E. W. SCORER, O.B.E. ; A. TALBOT ROGERS,M.B. ; Alderman W. E. YORKE, C.B.E.

The joint secretaries are Mr. E. J. S. Clarke andMr. J. T. NA"oodlock, of the Ministry of Health.

Reconstruction

JOINT CONSULTATION IN HOSPITALS

TOM E. DALTON

THE joint consultative committees which are now tobe set up in hospitals with the approval of the GeneralWhitley Council and of the Ministry of Health will makefurther demands on those concerned with the efficient

running of hospitals.In industry joint consultative committees have not

always achieved their purpose; and even in thosebranches where some measure of success has beenrecorded they have sometimes produced strained relationsbetween workers and management. The setting up ofsuch a committee in a hospital will not automaticallyproduce harmonious relations. Furthermore, jointconsultation is not an end in itself, but merely a meanswhereby workers can get a better grasp of the difficultiesof management, and the management a better grasp ofthe contribution that workers can make.

Hospital administrators can learn some useful lessonsfrom industry. In the past thirty years many erstwhiletheories have been discarded. Thus, economic coii-

siderations are no longer regarded as the principalactivating force ; and tradition has proved a strongerfactor than reason in influencing the way a worker doeshis job. Moreover, it has been increasingly recognisedthat workers are-very naturally-sensitive about any-thing that impinges on their self-respect. They desirean outlet for their grievances, and a chance to put forwardtheir ideas and theories and to ask the why and whereforeof processes and policies determined by their managers.Joint consultation can help to satisfy these needs, andto make workers aware that they are an important partof the concern.

In 1918 the Ministry of Labour-well in advance ofits time-published the following list of functions (" notmeant to be exhaustive ") suggested as suitable fordiscussion by works committees : (1) issue and revisionof works rules ; (2) questions of discipline and conductas between management and work-people ; (3) terms ofengagement of work-people ; (4) technical library, andlectures on the technical and social aspects of the industry ;

(5) the training of apprentices ; and (6) suggestions forimproving the methods and organisation of works, andthe testing of suggestions.With time and experience, the list of functions has

been expanded. In industry, however, the traditionaldistrust between employed and employer remains ; thereis little enough common ground. The worker still regardsthe making of profit as a form of exploitation of hisservices ; so there is conflict on policy. In hospitals,on the other hand, there is a very powerful emotionalimpulse which, if properly used, can provide commonground ; the alleviation of suffering arouses in mostminds a sympathy that can transcend all other motives.

PROPOSED ORGANISATION

The committees now to be set up will not discussrates of pay or total hours of work. Special machineryexists for dealing with such matters ; and to permitdiscussion of them would be to undermine the authorityof such bodies as the joint industrial councils and theWhitley councils.The committee’s functions are to be as follows :1. To promote the closest cooperation and provide a

recognised means of consultation between the managementcommittee or board of governors, its senior officers, and staff.

2. To give the staffs a wider interest in, and a greaterresponsibility for, the conditions under which their work isperformed ; to give the maximum assistance in promotingthe welfare of the patients and efficient administration inthe hospitals controlled by the committee or board ; to makesuggestions for the improvement of the general arrangementsfor the comfort of the staff, their recreation, entertainment,and dietary.

3. To prevent friction and misunderstanding.4. Subject to the proviso that no recommendations of the

hospital staffs committee shall conflict with, or override, anydecision of the general council or the appropriate functionalcouncil, to deal with such matters as : (a) the distribution ofworking hours ; (b) holiday arrangements ; and (c) questionsof physical welfare (cloakroom arrangements, heating,ventilation, &c.).

5. To consider any hospital rules affecting staff, apartfrom any that may be prescribed nationally or regionally.Members are to be elected from the following grades

of staff : administrative and clerical; nursing and

midwifery ; technical and professional other than nursesand midwives ; domestic, farm, and garden ; and artisan.

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In a circular to hospital authorities (R.H.B. [50] 47)the Ministry of Health declares that " it is contemplatedthat consultative committees will be set up in all hospitalsexcept where the small number of staff makes such acommittee inappropriate." Committees, it is pointed out,should be set up for individual hospitals rather thangroups, since the whole purpose of the consultativemachinery is to enable local problems to be discussed.Even in a small hospital the management committeeshould not oppose the setting up of a committee if thestaff clearly desires its establishment ; and where a

committee is not appropriate or desired, arrangementsshould be made for informal consultation betweenmanagement and staff on matters which would becovered by a committee. There is no need, adds thecircular, for the two sides of the committee to be evenlybalanced in numbers ; " and, indeed, it is perhapspreferable that the management side representativesshould be fewer in number than the representatives onthe staff side." Since the committee’s recommendationsare decided by agreement between the two sides-andnot by a vote of the whole committee-this does not Iaffect decisions. ’

THE CHAIRMAN

On the chairman will depend the ability of each ofthese committees to develop a common purpose throughsteady development of joint responsibility and attentionto sound administrative principles. He must be a Solomonin wisdom and a Job in patience. In particular, he mustbe prepared to recognise that delegates from the staffside have a better grasp of hospital problems than maybe supposed. He must be able to grasp a point beingmade by a hesitant, and perhaps incoherent, delegate,and to present it in a form understandable to all. Witha mediocre chairman such a delegate may get no

encouragement, or no chance to make his contribution ;and the committee will be thereby the poorer.

Joint consultation has nothing to do with workers’control, with which it is often confused. In any projectthere can be only one management ; if the workers arein control, then they are the management, and are facedwith the same problem as their predecessors-that ofobtaining the willing cooperation of everyone in theirorganisation. It is this willing cooperation that jointconsultation seeks to achieve.

Medicine and the Law

The Nurses’ Elections and the Returning OfficerTHE difficulty which arose lately over the election to

the General Nursing Council for England and Walesraises questions of the powers and responsibilities of areturning officer. It will be recalled that, under the1949 Act, the new constitution of the Council is to

include 14 elected members who will respectively repre-sent each of the 14 areas into which the Minister has forthis purpose divided the country ;

" and each of these nurses shall, on the date of theelection, be engaged in the area for which he’ [the Interpre-tation Act, of course, provides that " he

" includes " she "] ’is elected, in nursing or in other work for which the employ-ment of a registered nurse is requisite or for which a registerednurse is commonly employed."

So runs the statute, and presumably no rules purportingto be made under the statute could vary the words

engaged in the area " by narrowing their sense to

" exclusively engaged in the area " ; nor could a returningofficer take it upon himself as a matter of administrative

practice arbitrarily to insert an important adverb intothe text of the statute so as to alter the meaning. Certainnominations, however, for election to the General NursingCouncil were rejected by the returning officer for theostensible reason that the candidates were not exclu-sively

"

engaged in the area " concerned. The Ministryof Health was invited to give an authoritative interpreta-tion of the material phrase ; it declined on the plea thatit is for the courts and not for the Minister to give aruling of this kind. How the point should be referredto the courts, or who will pay for the privilege of clari-fying the law, the Ministry’s reply did not explain.Meanwhile it became known that in certain other casesseemingly parallel to those of the rejected candidates nodisqualification had been pronounced.Some analogy may be found in the position of returning

officers at parliamentary or local-government elections.In a Berwick-on-Tweed case in 1946 (Watson v. Ayton)the mayor, acting as returning officer at a local-govern-ment election, rejected as invalid the nomination of acandidate described as a " schoolmaster." The mayorassumed that the schoolmaster was the paid employeeof the Northumberland county council and therefore,under section 59 (2) of the Local Government Act, 1933,ineligible. The court held that the mayor had no sureevidence of the candidate’s official activities and couldnot decide the issue of disqualification from such informa-tion as appeared on the face of the nomination paper.

The Committee on Electoral Law Reform, many of whoserecommendations were carried out in the Representationof the People Act, 1948 (now largely consolidated inthe Act of 1949) expressed the view that the ruling in theBerwick-on-Tweed case should be incorporated in thestatute law. Accordingly Rule 9 (2) of the Third Scheduleto the Act of 1948, reproduced as Rule 13 (2) of the

Parliamentary Elections Rules in the Second Scheduleto the Act of 1949 and there declared to be applicableto local-government elections, states that the returningofficer is entitled to hold a nomination paper invalid

only on one of the two following grounds :" (a) that the particulars of the candidate or the persons

subscribing the paper are not as required by law, and" (b) that the paper is not subscribed as so required."

The nomination paper at a parliamentary election must,under the statute, state the full names, place of residence,and description of the candidate ; the description mustnot refer to his political activities (i.e., he must not bedescribed, for instance, as " the Labour candidate")and, if it is unduly long, the returning officer may (inconsultation, if possible, with the candidate, his agentor sponsors) shorten it or substitute another. Thematerial fact is that the returning officer is concernedonly with the nomination paper, not with the nominationas distinct from the nomination paper. He cannot enterinto the question of the candidate’s qualification. Therecent legislation appears to be reconcilable with thejudgment of Mr. Justice Wright in Harford v. Lynskeyin 1899 : " If the nomination paper is, on the face of it,a mere abuse of the right of nomination or an obviousunreality, as for instance if it purported to nominate ...a deceased sovereign, there can be no doubt that it oughtto be rejected and no petition could be maintained inrespect of its rejection."

If these principles are applicable to the General NursingCouncil elections, the recent action of the returningofficer seems questionable, though no-one will be anxiousto initiate litigation with the idea of having the electiondeclared void because a valid nomination was wronglyrejected. The returning officer acts in a sense judicially ;provided that his action is not vitiated by bad faith orpartiality (which nobody suggests) he personally is

unchallengeable. If it really is his duty to decidewhether a candidate is or is not " engaged in the area "in nursing or similar work, and if he decides differentlyin what appear to be similar cases, there may be noremedy. But it is never a satisfactory situation if thelaw is made to appear either uncertain or unequal in itsapplication-or both.