The IHM has a long history, which spans over 100 years from 1902 to the present day and has seen many changes and challenges to the healthcare system.
It is perhaps worth reflecting for a moment on life at the beginning of the Edwardian age. In 1902 motoring and the domestic use of electricity were in their infancy. You could, however, get bottled drinks for a penny in slot machines and Coca-Cola had been around for 16 years. First year infant mortality was 125 per 1,000 births. Infectious diseases were endemic: in 1901 diphtheria claimed over 800 lives and there were 1,743 cases of smallpox resulting in 257 deaths. This figure, of course, excludes the 12% of cases that were initially misdiagnosed. Students of hospital administration will not be surprised to learn that the Local Government Board had just issued a new circular in a series on vaccination, administration and the prevention of smallpox.
X-rays had just been discovered, the electrocardiograph was soon to be invented and Landsteiner was just beginning to investigate blood grouping. One of the more unusual treatments available was the use of static electricity: “When the machine is set in motion the patient becomes positively electrified, his hair stands up and a light surrounds him if the room is darkened…the general effect is refreshing”. Donations to the Northampton Infirmary The Hospital Week Fund included one to the value of £1,000. A Mr Hartley gave an initial donation of £7,500 and a subsequent donation of £10,000 to the Liverpool Hospital for Consumptives, to be built in the Delamere Forest. The London Hospital cost £87,000 per annum to run, it achieved an 86% occupancy of its 790 beds and treated 12,723 people as inpatients.
There were at this time two bodies associated with the administration of hospitals. The Hospitals Association (later which became the British Hospitals Association), might loosely be described as the forerunner of the NHS Confederation, and was founded by Sir Henry Burdett in 1884. Its journal The Hospital, first appeared in 1886. Hospital administrators in London had their own exclusive body called the Hospital Officers Club, which was founded in 1885. Membership was limited to the chief Administrative Officers only and its activities were primarily social.
The Hospital Officers Association
During 1902 a number of senior hospital officers clearly felt that there was a need for a more broadly based institution, so the Hospital Officers Association was founded in March of that year. Quoting Thomas Ryan, the Association’s President in 1907, the Association was founded to “promote the social and professional wellbeing of hospital officers … membership of the association conferred the direct advantage of an educational character by enabling each worker to associate with his fellows in the consideration of hospital questions”.
The first Presidential address given by Adrian Hope in November 1902 was reported at length in The Hospital.
By the end of 1903 the association had 93 members and was meeting on a regular basis each month. It established a journal, The Hospital Gazette in 1904, which has been in continuous publication under various names since then. Early topics included the counting of out-patient attendances; the abuse of the out-patient department by those who could afford to pay but contrived not to; and a universal pension scheme for hospital officers. The Association was initially centred in London, but it began to draw members from the Home Counties and further afield. In October 1906 Mr W. G. Carnt, a member and Secretary of the Derby Royal Infirmary, was appointed Secretary of the Manchester Royal Infirmary. The Manchester group of the Association was then founded in January 1907.
An important part of the Association throughout this period were the Saturday afternoon visits (most people worked on Saturday morning) to hospitals such as the new building at St Bartholomew’s Hospital, described as “a palace of healing”. Mr Conrad Theis, a past President and Secretary of the Royal Free Hospital, made a visit to hospitals in Paris and in 1910 he visited hospitals in both the USA and Canada. The Association was honoured in 1909 to be invited to assist the King’s Fund in the revision of the Index of Classification.
The next major step in the life of the Association came with its incorporation as a Company Limited by guarantee on 26th January 1910. 1912 saw Richard Kershaw, the President at the time, put forward a proposal to establish a Benevolent Fund. This was established in July 1913 and continues to support members in “necessitous circumstances” to this day.
December 1913 saw the first proposals to establish a system of examinations which would lead to a “Certificate of Administrative Knowledge and Ability”. The initial course, which launched in October 1914, was well received but progress was later disrupted by World War I. The January 1914 issue of the journal was devoted exclusively to the new King’s College Hospital development at Camberwell, and a subsequent edition was devoted to the Birmingham Hospitals in connection with a visit there by London members.
Activity declined during World War I and a number of members sadly lost their lives. The first annual church service was held at The National Hospital, Queens Square in October 1915. In the following year the company of Lionel H Lemon was appointed Auditor, a role it continued to hold until 1996. The Midlands Branch was formed later that year. A special dinner was given at the Trocadero Restaurant in November for Clive Bridgeman MP who had successfully campaigned for a change to the Finance Act of 1996 which enabled hospitals to reclaim a rebate of alcohol duty used for medicinal purposes. The rebate was expected to be in the order of £10,000 per annum.
Many temporary hospitals had been built during the War. Members paid a visit to one such hospital, the No. 16 Canadian General (Ontario) Hospital at Orpington in May 1919. It was reported that “The pavilions are built of uralite panelling on wood studding which seem admirable for temporary structures but does not resist the onrush of a trolley very effectively”. Later that year Mr J. H. Shaw, a founder member of the Manchester Branch and Secretary of the Southport Infirmary, was elected President. The first non-London member to achieve this distinction, Mr Shaw was the representative of the Manchester Branch on the Council of the Parent Association for a number of years.
1920 to 1940
Special interest groups within the Association are not new: the Pharmacy Unit has been active since the early 1920s. Miss Sproule, Pharmacist at the Samaritan Free Hospital, became the first lady to join the Council in July 1920. Later that year, the journal reported on the outcome of the Welsh Consultative Council and the future of the hospital system, where it was noted that there were some 178,000 beds in 2,600 hospitals. The Jessop Hospital for Women reported a deficit of £5,248 despite an increase in annual subscriptions. The Association itself had made a loss of £42 7s 4d and the balance sheet total was £722 9s 6d. At this time, it had acquired 28 Bedford Square, London, WC1 as its headquarters and had almost 500 members.
Sir Henry Burdett died on 29th April 1920. Whilst not an Association member, Sir Henry was one of the leading figures in hospital administration of the late Victorian and Edwardian periods. He wrote Hospitals of the World,published in four volumes from 1891 to 1893, and published the well-known year book Burdett’s Hospitals and Charities. In 1907 he founded The Nursing Mirror journal. His work “for hospitals was of the most trenchant character”.
It was “with great thrill of pleasure” that the journal reported the award of a knighthood to James Michelli CMG in the New Year’s Honours of 1921. Sir James became Secretary of the Seamen’s Hospital Society in 1887 and oversaw its expansion. It initially consisted of the Dreadnought Hospital at Greenwich and a dispensary in the London Docks. By 1921 the Albert Dock Hospital, the Hospital for Tropical Diseases, the Angas Convalescent Home and the London School of Hygiene and Tropical Medicine and another dispensary had been added to it. Sir James was obviously a great trainer: more than 14 members of his staff went on to obtain Hospital Secretary appointments. He was also a tireless campaigner for a pension scheme for hospital officers which was eventually achieved in 1928. Sir James became President of the Association for a second time in 1921 and served for many years on the Council.
By this time, the journal was thriving with eight pages of advertising and 20 pages of editorial content. An article in September 1921 extolled the virtues of a recent technological development: carbon paper. There was also a summary of the Dangerous Drugs Act and a lengthy article on mutual assistance. Later that year Sir James Michelli referred in his Presidential speech to expenditure on nursing: “a sister of £70 to £100 a year and everything found is not badly off, and yet there are indications that that figure is to be pushed up, and one great spending hospital of the day has already put it up.” Later in his speech he refers to the time “when the cost of the Secretary’s department was very critically observed by the various distributing funds. Now we are urged to expand in every direction…” In an address in the following spring he reflected on his early years at the Dreadnought Hospital where Sir Henry Burdett was then Secretary. “It was a dear, sleepy old place in those days – we did not begin too early and there was little work after luncheon, so there was ample time for tennis and afternoon dancing which was the rage.”
The journal was occupied with much correspondence on the topic of the junior officer and the Association in 1922. The culmination of this was the formation, at the end of the year, of a junior section of the Association with its own Executive Committee. The report of the committee on training of hospital executives in North America was the subject of a long report in the journal reflecting the continued interest of members in hospital administration, internationally as well as nationally. Guy’s Hospital had a deficit of £23,000 and space was found for a few schoolboy howlers including the fact that “Volcanoes are due to the infernal heat of the earth”. A more practical article in 1923 described the use of the slide rule for statistical tables. The membership subscription at the time was 10s 6d.
The accession to power of the first ever Labour government gave rise to a poignant editorial in March 1924: “The Labour party have a policy with regard to the hospitals, but it is a policy which would require such a large amount of money to put it into operation that we cannot think it is likely to come into the range of practical politics for very many years to come.” The Association held its first Annual Conference in May 1924 in conjunction with the Hospital Nursing and Midwifery Exhibition at Central Hall, Westminster. The conference was regarded as an unqualified success and has continued annually almost ever since.
The Diploma in Hospital Administraion
925 saw the launch of the Diploma in Hospital Administration which consisted of a primary and final examination and the writing of a thesis. Four of the nine candidates who sat the final examination passed and three of the nine that sat the primary examination passed. One of the questions was: Discuss the advantages and disadvantages of a hospital laundry as compared with outside contractors. The scheme was amended in 1926 and those who successfully completed the final examination were admitted as Associates and allowed to put the letters AHOA after their names. Associates and members could then submit a thesis to gain advancement to the Fellowship (FHOA).
Towards the end of that year a Hospital Information Bureau was established by the Association. By the summer of 1926 it had handled over 150 enquiries from 51 hospitals. Information was supplied on subjects as varied as tax, national health insurance, appointment of medical staff and theatre lighting.
The Association celebrated its 25th Anniversary in 1927 at its Annual Congress. Running alongside the Congress was the first Hospitals and Institutions Exhibition which was opened by Her Royal Highness Princess Arthur of Connaught. His Royal Highness The Prince Henry was guest of honour at a special dinner at the Hotel Cecil, who told members that he was impressed with the comprehensive nature of the present activities of the Association and its great possibilities for future service. Membership of the Association had now exceeded 600. Later that year the Association was represented by its Secretary at the preliminary conference in Paris to discuss the question of establishing an International Hospital Congress. This determined that a Congress would be held in America in 1929 with Captain Stone, the Association’s Secretary, being a member of the organising committee.
1928 opened with both good news and bad. The much-debated and hoped-for Pension Scheme for Hospital Officers and Nurses was launched with the support of the King’s Fund. Set against this was the implementation of the new Rating Act: the implications for Brighton’s seven hospitals were serious to say the least with the rates increasing from £221 to £2,764 to be met from voluntary contributions by which the hospitals were still funded. The journal gave much space to the Woolwich War Memorial Hospital, the first large voluntary hospital to be built in England since the Great War. It featured amongst other things internal courtyards and was situated on the top of Shooters Hill in south-east London. Hospital administrators had in the meantime been addressing the issue of road accidents by charging the victims on the basis that they could recover these charges from the motorist’s insurer. In one notable instance a judge disallowed such a charge on the basis that “this sort of claim is getting far too general”.
In October Mr Richard Kershaw retired after 50 years’ service as Secretary of the Central London Throat, Nose and Ear Hospital. Richard Kershaw was one of the earliest members of the Association, a past President and a Vice President. He was an advocate of the Diploma and an examiner. One of the founders of the Benevolent Fund, he remained a Trustee until his death in 1932. Another individual to whom the Institute, as it is now, owes a great debt. The proposed name change which caused much disquiet among members was dropped, despite a period of closer co-operation with the British Hospitals Association.
Captain J. E. Stone resigned as Honorary Secretary in April as a consequence of taking up the position of Secretary to the Birmingham Hospitals Centre. Appointed as Secretary in 1922, he had steered the successful implementation of the Central Bureau of Hospital Information and the Educational Scheme during his term in office. He also organised the Hospitals and Institutions Exhibition. Whilst Chief Accountant at St Thomas Hospital he wrote two seminal volumes: Hospital Accounts and Financial Control and Hospital Organisation and Management, includingPlanning and Construction. June saw the first joint conference with the British Hospitals Association, held at what is now Imperial College. One of the major speakers at this event was the Rt Hon J. H. Whitley whose name subsequently became synonymous with pay and conditions of service in the public services.
The Hospital, Incorporating the Hospital Gazette
“The Hospital, incorporating the Hospital Gazette, a monthly journal devoted to hospital and institutional work throughout the world” was the new title of the Gazette at the beginning of 1930. In the early 1920s The Hospital became a monthly publication, with the title of the Hospital and Health Review, which ceased publication in 1924. This cleared the way for the Association, working now with the British Hospitals Association, to adopt the name. The Association moved its offices to those of the British Red Cross Society at 12 Grosvenor Crescent. The Hospital Information Bureau of the Association was combined with that of the Red Cross and was later fused with a similar bureau run by the British Hospital Association. The joint conference moved for the first time outside London to Newcastle-on-Tyne. In June 1930 the Association announced, with much pleasure, that HRH The Duke of York had consented to become its Patron. He was, on his accession to the throne in 1936, succeeded by HRH Prince Arthur of Connaught. From then on, a link was formed with the Royal family that has continued with a couple of breaks to this day.
After serving the Hospital for Sick Children, Great Ormond Street for 37 years, the last ten as Secretary, James McKay retired in 1932. Mr McKay was, with Stephen Neil, one of the founders of the Association. He also founded the Hospital Gazette.
In the late 1930s the country and those responsible for managing public services and hospitals became more pre-occupied with preparations for war. Despite this the Association began to look at the possibility of establishing an Institute of Hospital Administrators-although this did not reach fruition until 1942. The major step taken in 1936 was the appointment of Mr S. R. Speller as Director of Education. Mr Speller carried forward major changes to the educational scheme, and found himself appointed Editor ofT he Hospital as well as Secretary of the Association. All evidence indicates that he coped well with these extensions to his role. Indeed, in 1939 he commenced a series of major articles on the law as it affected hospitals which led eventually to the publication of the Law Relating to Hospitals and Kindred Institutionsin 1947. A volume, no doubt, studied in some detail by longer serving members of the Institute when preparing for their examinations.
1940 to 1960
By now the Association had 1,077 members spread across nine regional branches (Headquarters, Manchester, Midlands, Yorkshire, East Midlands, Liverpool, South Wales & Monmouth, Eastern Counties, Southern). Specialist members included Almoners (50) and Pharmacists (30) and some 40 other members representing 14 other health service professions.
Not only did the Association continue its activities throughout the war years, it also took a major step forward in 1942, when it was proposed that there might be a fusion between the Association and the Incorporated Association of Clerks and Stewards of Mental Hospitals. The Hospital made reference to the tremendous number of circulars received from the Ministry of Health and even King Edward’s Hospital Fund. This led to the publication of a monthly index inThe Hospital, a practice that continued long after the war was over. Amongst the more personal notes was a request to send books to members who were prisoners of war and a request to award the George Medal to Mr S Cecil Hill FHOA, House Governor and Secretary of St Thomas’s Hospital for his courage and devotion to duty in an air raid.
The Association of Clerks and Stewards of Mental Hospitals
This Association was inaugurated in 1904, when it was known as the Association of Clerks, Stewards and Storekeepers, to cater for the administrative staff of the many mental hospitals now established throughout the country. Its main instigator was Mr W Morgans of West Ham Borough Asylum who was elected its first Honorary Secretary and Treasurer, an office which he held until 1913. The first president Mr R. T. Redman of Prestwich Asylum, was elected in 1904 and held office until 1913. On stepping down he was elected Treasurer, a post he held until his death in 1925.
One of the first issues the Executive Committee was asked to address was “to take any steps they may consider necessary to further the pension question”. The Asylum Officers Superannuation Act was passed in 1909, before similar arrangements were established for the IHOA members. The pension question did not entirely disappear even then. Another major issue was the standardisation of hospital accounts, which was later resolved in 1933 through the offices of the Local Government Board.
Due to the distribution of the memberships, two general meetings were held each year: One in the winter in London and one in the summer in the country. It began publication of a journal in 1913 which continued until it was merged with The Hospital in 1942. In 1919 it had a membership of 150, which peaked at 841 in 1939. In 1915, its objects were:
- To promote intercourse between the above-mentioned officials whereby they may become more personally known to each other, and be able to meet and discuss to their mutual advantage any matters relating to the lunacy or other laws, in which they are officially interested, or administrative work, so far as it affects their interest, duties and responsibilities.
- To endeavour to secure to all such officers certainty of adequate superannuation and otherwise advance their welfare by promoting such schemes for their benefit and information as may from time to time be thought necessary
- To afford to its members such assistance and protection as special circumstances may warrant.
The latter objective was met in part at least by the establishment of a Benevolent Fund which merged with the IHOA in 1943. It began to set a system of examinations in 1924, which was incorporated in 1932.
The Institute of Hospital Administrators
The Institute was formed in 1942, until 1944 it was known as the Incorporated Association of Hospital Administrators. Some of the honorary officers of the Hospital Officers Association and the Clerks and Stewards Association took up similar positions in the new Institute, events that were to be paralleled in 1999. Three sectional councils were established beneath the main governing body for: voluntary hospital administrators; mental hospital administrators; and public authority hospital administrators. The Association representing the latter had been affiliated to the new Institute at its inauguration.
1942 was a year of great importance to the future of the health service, with the publication of the Beveridge Report which proposed the development of a comprehensive hospital service in the post-war period. That summer a conference on the training and qualification of hospital administrators was held and it resolved that “hospital administration is of such importance as to call for special training leading to a recognised qualification”. A Committee with representatives of the profession, the Government and Local Authorities was formed to establish a standard qualifying examination. The Committee reported in 1944 and its recommendations formed the basis of the Institute’s new scheme of examinations, which began after the war. Two essential points emerged from the report: firstly, that representation on the Education Committee of the Institute would be broadly based and include nominees from Government departments, Local Authorities and other interested parties including the National and Local Government Officers Association (NALGO) with a minority of representatives from the Institute; and secondly the practice of issuing a separate certificate should continue so that completion of the final examination was separate from membership of the Institute. They also identified the need to recognise in the examinations that the law and practice in Scotland was different from that in England and Wales.
In the immediate post-war period the Institute, with NALGO and the National Association of Administrators of Local Government Establishments (NAALGE), made representations to the Minister of Health on the duties, responsibilities and qualifications of a hospital administrator and the role of the non-medical administrator under the National Health Service Bill of 1946.
Throughout the 1940s the journal was restricted in size due to the rationing of paper supplies. Despite this, it stilled provided some fascinating insights into the recesses of hospital administration.
The Institute held its first summer school in 1948 at High Leigh, Hoddesdon, Hertfordshire. These summer schools continued until 1976 and made a valuable contribution to the education of many aspiring administrators. The 5th July 1948 saw a momentous change, it being the ‘appointed day’ for the inauguration of the National Health Services Acts, the National Insurance (Industrial Injuries) Act and the National Assistance Act. With this arrived the Regional Hospital Boards (RHB), the Hospital Management Committees (HMC) that reported to them and the Boards of Governors of Teaching Hospitals (BG) which reported directly to the Ministry of Health.
1948 was also the year in which the Institute decided to publish a yearbook. At the same time the British Hospitals Association was being voluntarily wound up and the Institute was able to purchase the copyright and goodwill of theHospitals Yearbook:whose lineage could be traced directly back toBurdett’s Hospitals & Charities Annual,first published in 1889. The first edition of the Institute’s yearbook was published in 1950 and it continues to be published.
The King’s Fund, with whom the Institute had enjoyed a working relationship over many years, proposed in 1950 that it should establish a Staff College for hospital administrators. This was welcomed and the Institute was represented on its managing body. Some readers will undoubtedly have happy memories of the college at Palace Court. The role of hospital administrators in this period was surprisingly wide, demonstrated in a major article on “A mental hospital farm: the principles of administration” , published inThe Hospital. In the meantime, the Institute whose offices had been split between two premises during the war moved to 75 Portland Place-where it stayed until 1993.
In more recent years the job security of hospital managers has sometimes been likened to that of football managers. It was, therefore, interesting to discover that a major cause of celebration in 1951 was the removal of Mr John Griffith from his position as Chief Administrative Officer at the St Helier Group HMC. Briefly the terms of office of the Chairman and Vice-Chairman of the HMC were not renewed and the Vice-Chairman of the RHB was temporarily appointed Chairman. Mr Griffith was then told after a private meeting of the HMC that he could either resign or be dismissed. He was, however, assured that his “efficiency was not in question” and that “there was no imputation whatever” on his “personal or professional character”. Contemporary reports suggest that the grounds for dismissal were very flimsy and probably related to a lack of confidence in Mr Griffith by senior medical and nursing staff. Despite the best efforts of the Institute and NUPE, Mr Griffith was not reinstated nor was any satisfactory appeal heard. Representations to the Minister of Health were equally poorly responded to. In an adjournment debate on the matter the Parliamentary Secretary responding on behalf of the Minister said that “there was no evidence to suggest there was any reason why the Minister himself should intervene” and went on to suggest on the wider question of procedure that “he was as disappointed as anybody that the Whitley Council, although they had been considering this for a very long time, had not come to a decision”. This case, as with some in more recent times, did not show the health service and some of its senior managers in a good light. Mr Griffith went on to obtain an honours degree in Modern Greats at Balliol College, Oxford. He then had responsibility for the National Training Scheme for hospital administrative staff in Manchester. Subsequently, he was made Director of the Pilot Scheme for Hospital Administration in Leeds (now part of the Nuffield Centre) and finally Professor of Health Administration at the University of New South Wales, Australia.
50th Anniversary – 1952
1952, the Institute’s 50th anniversary year, began with an all-day event on the work of Hospital Authorities led by Mr S. G. Hill, who later that year was awarded Fellowship of the Institute. The conference took place at Caxton Hall and a special dinner was held at the Dorchester Hotel. Guests included the Minister of Health, Mr D. Heathcoat-Amory, the Under Secretary for Scotland, Mr J. Henderson-Stewart, the Presidents of the Royal Colleges and various other senior civil servants and health service personnel.
Mr A. E. Rippington undertook a survey of administration and the hospital service-results were published in 1954. It is interesting to note that some 80% of senior posts were then held by Institute members. Mr Rippington subsequently undertook further research into this area, published inThe Hospital. Total membership of the Institute reached almost 2,700 around this time.
The Hospital also celebrated its silver jubilee this year, reporting a wide and varied readership both in the UK and abroad. A look at the history of the journal can be found in the January 1955 issue.
The fifties and early sixties were to be a period of consolidation for the Institute, as they were for the health service. Stanley Hill, Secretary of the Northamptonshire and District HMC, was President in 1956 having previously been Chair of the Council. Stanley Hill was one of the leading figures of the Institute for the whole of this period, speaking at national and regional conferences and often writing forThe Hospital. In 1957 he penned “The Compleat Administrator” in which he suggested that the qualities of a good administrator should include: impartiality, good judgement, courage and kindness coupled preferably with a sense of humour. He stepped down from the Council in 1979 after more than 30 years service and remained actively interested in the work of the Institute until his death in 1998.
It should be said that this continuous active interest applies equally to the majority of the past Presidents who have met annually since 1972 and quizzed the honorary officers of the day on their stewardship of the Institute.
HRH The Princess Royal became patron in 1960 and served until 1965. The Institute regions (based on the English NHS regions) and the divisions (only Scotland and Wales then) played, and continue to play, an important role in the personal development of their members. Each had its own Council which organised a regular programme of evening meetings and an Annual Conference. Each region and division had a member on the National Council and there were also a number of directly elected members in it as well. Other developmental initiatives included the awarding of study grants.
In 1962 there was a robust exchange of correspondence between Mr Speller and Mr Marre of the Ministry of Health over the question of terms of redundancy payments and related matters which arose from the publication of the Hospital Plan. The Ministry of Health had refused to accept that an earlier, more favourable, scheme should remain in force and issued a circular putting its own proposals into effect. In answering a question in Parliament, the then Minister of Health assured MPs that “the arrangements had been thoroughly discussed with representatives of the staff and he was not aware that there was any, and certainly no substantial disagreement”. This rumbled on with further parliamentary, questions but was not satisfactorily resolved.
In November 1966 the Institute made a number of changes to its membership regulations. The main consequence was to admit as Licentiates those who had completed the examinations but did not have the necessary length of service or seniority to enable them to qualify for admission as an Associate. The proposal to admit unqualified affiliates was rejected.
The Institute, in conjunction with the King’s Fund, established a working party to look at “The Shape of Hospital Management in 1980?”. This recommended in 1967 that “smaller committees of management be introduced to replace the existing HMCs and these to be renamed district hospital boards” and “the district hospital boards to remain under the control of a regional or area agency and a central authority”. The “district hospitals Chief Executive to be a general manager, who will be a member of the district hospital board”. Appointment of Directors of Services was also proposed. Almost a year later, the Institute held a major conference attended by over 600 individuals from all parts of the health service (including General Practitioners, Executive Councils, Local Authority health officials and hospital administrators) to discuss the Government’s Green Paper on the health service. This paper suggested abolishing existing health service authorities and replacing them with area boards which would report to the regions. District authorities would manage hospital and community health services. There was, as Nigel Weaver reported “tacit acceptance of the fact that the tripartite division of the NHS administration should be ended”. There were, however, some reservations about the size and composition of the area health boards. Nigel Weaver was amongst that small band of administrators whose commitment to training his successors included working as a part-time lecturer in addition to his full-time post.
Modern Hospital Management was launched by the Institute in 1969. Edited by Messrs Milne and Chaplin it quickly became required reading for students. The events outlined in the preceding paragraph undoubtedly caused the Institute to look at itself and its role.
In late 1970 members agreed to a name change to the Institute of Health Service Administrators, with an extension of its aims to cover the whole field of health service administration and management. The membership of the council was also widened to include two student representatives for the first time – two changes which were overwhelmingly approved by the membership.
Another significant Institute publication was a report on Organisation and Management of a Unified Health Service: Organisation of Area Health Services by William Naylor (1971) which was an important contribution to the discussions on the reorganisation of the NHS. William Naylor went on to be President of the Institute in 1975–76.
The Hospitalre-launched itself as theHospital and Health Services Reviewon 1st January 1972. HRH The Duke of Edinburgh accepted an invitation to be Patron. The Institute submitted a paper to the Department of Health (DoH) on the NHS Reorganisation, stressing the need for clarity in the future organisational structure and management.The Grey Book: Management Arrangements for the Reorganised National Health Servicewas published by the DoH in the autumn. Impossible to summarise here, it had 174 pages, 15 diagrams and went into considerable detail. A major conference on industrial relations in the NHS was organised in the spring, arising from the major changes of the Industrial Relations Act 1971. The country and the health service was about to enter an unprecedented period of industrial strife which taxed those managing the health service through the organisational changes that took effect on 1st April 1974 to the limit.
A further change was made to the Articles of Association in 1973 to allow additional co-opted members onto the National Council for a limited period. This was agreed and it permitted additional council members to be drawn from Executive Councils and Local Health Authorities to widen the basis of the Institute membership. The Association of Health Administrative Officers was eventually to merge with the Institute in October of that year. In addition to his role at the Institute, Fraser Milne was by now Chairman of the A&C Staff Side and had the responsibility of leading the negotiations on senior staff pay and conditions. He was not helped by the Secretary of State for Health setting aside the usual machinery and publishing the new pay scales. A meeting with the Prime Minister was threatened but does not seem to have occurred and the pay rates were finally resolved through the Whitley machinery.
The Institute changed its regional boundaries to reflect those of the new NHS Regions, a practice which it has continued to date. The President (Mr R. M. Bompas) and Fraser Milne met the Department of Health and Social Security under-secretaries at the beginning of the year to discuss the very low state of morale in the NHS following the mishandling of various aspects of the reorganisation of the NHS. The very real unrest and the need to resolve a number of outstanding issues regarding compensation regulations, appeals machinery, etc had been stressed. Industrial relations problems continued into 1975 with the prospect of industrial action by NHS administrative and clerical staff who were NALGO members in pursuit of a long-standing claim to reduce their working hours. The Institute “shared the frustrations of the Staff Side” but felt that “as a professional body representing the senior administrative staff” it could not justify recommending action by its members. The Institute now felt the need to examine its own future and that of the Whitley system. Working parties were commissioned to examine each of these issues. Mr W. M. Naylor became President in 1975 and was later to be made an Honorary Fellow in the light of his contributions to the Institute. The year end saw the formation of an Institute branch in Northern Ireland, even though the number of members was not substantial.
The likelihood of the need for the Institute to register as a trade union to preserve its role in the Whitley system was to be the major challenge faced by the organisation over the next few years. This gave rise to a serious debate at that year’s Annual General Meeting, where widely differing opinions emerged which gave the Council further food for thought. The year closed with the publication of Lord McCarthy’s report on Whitleyism. McCarthy recommended change, but not root and branch reform.
75th Anniversary – 1977
The Institute celebrated the anniversary at its Conference held at the Royal Institute of British Architects in London, just across the street from its headquarters. Guests included Royland Moyle the Minister of State for Health, Lord McCarthy, various senior departmental officials and other senior personnel from the health service. An excellent history written by Norman Chaplin was published in the June 1977 issue ofThe Hospital and Health Services Review. This is highly recommended to anyone interested in the history of the Institute. Discussion at the AGM centred around the report of the Working Party on the Future of the Institute. It was noted that non-council members predominated its membership and that younger members were well represented too.
Maurice Cuming was appointed Education Officer. He had previously been a Senior Tutor at the King’s Fund College and was also the author of Hospital Staff Management and Personnel Management in the NHS.The Institute expressed its concern to Chairmen of Health Authorities in England and Wales regarding the continued or proposed changes to local management and their effect on staff morale. The changes referred to it usually being multi-district areas becoming a single district. The Institute, felt that such changes were inappropriate following the trauma of the previous major reorganisation and the fact that the Royal Commission was currently looking at the future organisation of the service.
The Council decided in 1978 to ballot the members regarding future participation in Whitley. There was an overall preference on the part of those voting for either participating in an arrangement with NALGO or through the NALGO’s Joint Consultative Committee for the Health Service. Fewer members voted in favour of continued direct participation in Whitley if it was decided not to enter into an arrangement with NALGO and only a quarter saw registration as a trade union being the way forward. The Institute then entered into an arrangement with NALGO which still continues. There was, however, some concern about the interpretation of the result amongst the membership. Looking back it appears that perhaps some of the voters failed to read the question properly before voting.
The year ended with the President expressing his consternation in a letter to The Times over a statement from the Prime Minister, Mr J Callaghan that there would be “a complete reorganisation of the NHS” while Mr David Ennals, Secretary of State for Health and Social Services was expressing the view that if any further changes were necessary these would be achieved by evolutionary process rather than by wholesale reorganisation.
1979 saw the retirement of Fraser Milne after some 40 years’ service broken only by military service during the war when he was awarded an MC. He was also awarded an OBE for his Whitley work. Mr L. B. Akid was appointed as his successor, and the Institute also made the brave decision to take on what is now the Health Service Journal by launching its own weekly supplement the Hospital and Health Service News & Appointments Reviewon 7 November.
In 1980 the journal celebrated having reached 75 years of publication. One feature of it not mentioned so far was the regular publication of information on suppliers of goods and services. By 1967 this had developed to the extent where a separate journal Hospital & Health Services Purchasing was published giving the Institute’s members three journals to peruse, two monthly and one weekly. The Conference this year was held in conjunction with the British Hospitals and Medical Exhibition of which the Institute was the sponsor. It was opened by the late HRH Princess Margaret.
Unfortunately the financial burden of publishing three journals was to prove too great for the Institute so in March 1981 Newton Mann Ltd, jointly with T. G. Scott, took over the publication of Hospital and Health Service News & Appointments Reviewand Hospital & Health Services Purchasing. Regrettably, both journals closed at the end of the contract in 1985.
Norman Chaplin again dipped his pen into the inkwell and produced a booklet, Getting it Right? The 1982 reorganisation of the NHS. The Institute at that time had a number of titles in publication including a Management Series, one of these being Problem Solving Matters: Case Studies in British Hospital Administration. The yearbook, as ever, remained a valuable publication in both a literal and useful sense. The Scottish Division conference was held in Peebles, a venue popular to this day. The Association’s President from 1931 to 1933, Mr A. H. Leaney, celebrated his hundredth birthday. He was described by a former colleague as “a brilliant after dinner speaker and proved one of the most popular Presidents the Association has ever had.”
Plans were now in action for a revised scheme of membership and examinations. Plans for Affiliate membership were not welcomed by the membership and were subsequently withdrawn. Nevertheless, the introduction of the Certificate in Health Services Management went ahead and a Certificate in Health Service Administrative Practice was introduced as well.
Longmans took over publication of the Hospital and Health Services Review at the beginning of 1983 and it became a bimonthly publication. The Annual Conference was addressed by Dr Robert Maxwell, Secretary of the King’s Fund. He reminded his audience that the health services in the UK consumed 4% of the GNP in 1960, this having risen to 5% by 1975. He felt that “the 1982 reorganisation was worth the price of dislocation, anxiety and (for some people) disappointment to reduce the number of management tiers by one”. He quoted Brian Edwards (later a President of the Institute), that there is always a temptation to play “organisational lego” with public services. Women in the NHS was the subject of an Institute report by Ian Beach who was greatly helped by two future Presidents: Miss M. E. Goose and Miss B. S. Young (now Baroness Young). This group subsequently produced a booklet for those leaving the service for a time. Ethical matters were discussed and the informal system of giving private advice when sought was endorsed. The need to explore the question of professional standards further was agreed, but it was felt that there was no case for elaborate disciplinary machinery. In July the Institute also submitted evidence to the NHS Management Inquiry (Griffiths Report).
Early 1984 saw the Institute responding in a generally positive way to the Griffiths Management Enquiry. It felt in particular that because of their training and experience, professional administrators would play a full part in the development of general management in the health service. Subsequent events showed that this was not the case everywhere, with managers from a wide variety of backgrounds being appointed to the most senior management posts. A major change to the Memorandum and Articles of Association was approved at the AGM which enabled the Institute to set up subsidiary companies if it so wished. At an extraordinary General Meeting held in October, the Institute changed its title to the Institute of Health Services Management.
It was with great pleasure that the Institute announced the appointment, from 1st April 1986, of Dr Maureen Dixon as its Director. Dr Dixon was well known to health service managers having been a lecturer at the King’s Fund College and before that on the staff at Brunel University. An author, teacher, researcher, manager and consultant, Maureen Dixon was to make further significant contributions to the Institute and health services management before her premature death in May 1997.
Barbara Young, who as Vice-Chair of the Council had led much of the work on the development of a “Policy Plan for the Institute – Priorities and Objectives”, was appointed President in 1987: the first woman to achieve this honour. Ken Jarrold, and probably many of those present, were somewhat bemused to hear Barbara Young couple his name with those of Aristotle, Julius Caesar and Francis Bacon. The audience were assured that the “answer isn’t that they were all megalomaniacs but, although separated by several centuries, each endorsed the view that things should generally be divided into three parts” adding “who am I to buck that bunch”. She went on to refer to the role of the Institute in promoting excellence in health services management and its significant contribution to the debate on health services policy.
This year also saw discussion of a Health Services Management Trust that was founded as a charity in 1988 and launched at that year’s AGM, where Clive Moth and David Clegg were thanked for their efforts in its formation. The Trust’s purpose was to support research and study in developing and improving healthcare services. Tony Mapplebeck, Chairman and long-term member of the Education Committee, introduced and subsequently saw through a number of changes in the Constitution of the Committee and continued to make an important contribution to its work and the Institute in general into the mid-nineties.
In June 1988, the journal’s title was changed toHealth Services Management. This year also saw the publication of the booklet on “The Myth of the NHS Bureaucrat” to counter some of the ill-informed criticism of NHS managers and administrators. The Institute was successful in its joint tender with the Open University for the NHS Training Authority’s Management Education Syllabus for Open Learning (MESOL) which saw the start of a successful and long association with the OU.
The yearbook, one of the Institute’s most important publications, celebrated its centenary in 1989. It is perhaps appropriate at this point to pay a tribute to Norman Chaplin, the Editor of the yearbook and the journal for many years, he retired in 1991 after over 30 years service to the Institute. This marked the passing of the last permanent staff link with the Speller and Milner era. It is perhaps characteristic of Norman’s self-effacing personality that he did not write a valedictory editorial but chose instead the IHSM’s Day Conference on Mental Health Services as the subject of his last editorial. He was a thoughtful writer and a good administrator, and his service to the Institute was recognised with the award of an Honorary Fellowship.
The White Paper, Working for Patients, was greeted with an Institute press release headline of “Managers Show Amber Light to Government Health Review” with David Bowden, then President stating that: “We welcome much of the thinking behind the report which echoes much of our own work produced last year. Health service managers are in favour of creating a freer, less bureaucratic environment but this must not be at the expense of patient care”. One of the observations made in the Institute’s detailed comments on the White Paper was an expression of disappointment that there were no specific proposals to initiate some form of accreditation for both public and private providers.
Hewlett-Packard kindly hosted a two-day Council workshop which enabled members to debate in detail some of the challenges facing the Institute, such as its role in policy formation. These workshops, with the continued support of HP, were to continue for a number of years. The Institute’s mission statement now read:
- To promote excellence in health services management and the development of good managers;
- To affect health services policy and its implementation;
- And to create and sustain a professional community of health service managers.
IHSM Consultants Ltd
A major development was suggested in 1989 which led to the formation of IHSM Consultants Ltd, a subsidiary company of the Institute in September 1990. The consultancy was led by Maureen Dixon and its primary purpose was to provide high quality management consultancy services to health organisations. Amongst the early Board members were a past President, David Bowden (first Board Chairman), Brian Aird and Peter Stansbie (both later to be Presidents of the Institute), Ian Mills (final Board Chairman) and Professor Cyril Chantler. David Hands later joined the company as a consultant.
The consultancy thrived under Maureen Dixon’s hand, having some 100 different clients from over 10 different countries. Its most important work included that on Creative Career Paths in the NHS (commissioned by the NHS Women’s Unit), corporate governance, Future Healthcare Options and the NHS Management Training Scheme. The company gave a number of health services managers their first experience of consultancy work. In the autumn of 1995 Ian Mills, acting on behalf of the Board and the Institute, entered into negotiations with Healthcare Risk Solutions Ltd and on 31st December 1995, HRS bought the assets of the company.
Pamela Charlwood was appointed Director in succession to Maureen Dixon, and it was under her leadership that the decision to move to a new headquarters was made. The search began in 1991 and ended with a move to Chalton Street, near Kings Cross Station in 1993-by which time Ray Rowden was the Director, Pamela Charlwood having stepped down in 1992. She was later to be appointed President of the Association of Managers in General Practice
Ray Rowden’s appointment saw the internal management structure at Headquarters overhauled. The development section headed by Dr Alison Baker had responsibility for management development and the policy unit. The delivery side, under Nick Briggs, looked after publications, membership, finance, facilities and the registry side of education. Ray Rowden undoubtedly raised public awareness of the Institute within a very short time with increased contact with the media and speeches at courses and conferences. In the field of education, the Institute still ran its Diploma in Health Services Management together with the Certificate in Health Management Studies (CertHMS) and the Certificate in Managing Health Services (Cert MHS) in conjunction with the Open University.
1994 saw the launch of a new fortnightly publication, The IHSM Network, aimed at members as well as a wider audience. A Statement of Primary Values was launched at the Annual Conference and the second annual practice managers conference was held in Birmingham. The Managing your Careerre source book was published and another new venture wasManagement Development Quarterly News.
The Certificate in Managing Health Services was by this time being delivered through a UK-wide network of over 40 Institute accredited centres with some 450 students completing the examinations. With managers still facing uncertainty about their future, a new publicationRedundancy: Career Crisis or Opportunity? was launched and a Resource for Managers in General Practice on terms and conditions of employment was produced as well. There was a special series of four one-day conferences on the Role of the Accountable Officer, aimed at Chief Executives, which attracted over 400 delegates. Changes were made in the Council’s Constitution to reduce representation to two members per region, which were also changed to match the new NHS Regions. Regrettably staffing levels at Headquarters had to be reduced as well because of the financial situation.
Karen Caines took up the post of Director in June 1996, just in time for the Institute’s Conference. Consultation that summer revealed that members wanted the IHSM to provide:
- An independent voice for managers;
- A focus for influencing policy, operations and culture in healthcare organisations;
- Local networking and mentoring;
- Professional standard setting;
- And professional development.
Health Management was launched as was the Institute’s first website. Building on work initiated by Roger Stokoe, a former President, Brian Aird, the current President, launched the Code of Professional Practice at the Annual Conference and referred to the work being done on Continuing Professional Development as well. With careful management, the Director and her staff with the support of the Council had moved the previous year’s substantial deficit to a surplus much to the relief of all concerned, though considerable financial challenges remained to be faced.
In 1997 the Institute sold its Chalton Street premises and moved back to London’s medical heartland, taking up residence in Chandos Street just round the corner from the King’s Fund. The general election saw politicians from both leading parties denigrate NHS managers whilst the Institute sought to influence the health policy of both parties. Devolution was now high on the agenda; fortunately the Institute’s regional structure with Northern Ireland, Scotland and Wales each having its own Council made it easier to respond. The year ended with the signing of a formal co-operation agreement with the Association of Managers in General Practice (AMGP) with cross-representation on each governing body.
The 50th Anniversary of the NHS was celebrated at a major event at Earls Court in 1998. This was addressed by the Prime Minister, Tony Blair, and the Secretary of State for Social Services, Alan Milburn. Successful as the conference was, it nevertheless left the Institute with a one-off financial problem since it did not meet its financial targets. The Institute also began consultation with the AMGP with a view to establishing a new body to which the members of both organisations would be transferred.
Karen Caines left the Institute in the Spring of 1999 and its new Chief Executive Stuart Marples took up his post in August, the interregnum being most ably managed by Deputy Director, Suzanne Tyler. The Institute was exceptionally well served by its last President, John Brunt, and its last Chair, Mike Lager, who took much of the responsibility for the negotiations with the supplier in addition to leading the ‘Shadow Executive’ with their AMGP counterparts.
The New Millennium
Following the formation of the Institute of Healthcare Management (IHM) in 1998, the IHM continued to provide Continuing Professional Development (CPD) opportunities for its diverse members: specifically, developing a Vocational Training Scheme for Practice Managers, (which has been particularly successful in Scotland) plus updating the valuable Managing in Health and Social Care modules, which have enabled many managers in the health and care sectors to consolidate their knowledge and improve their skills and knowledge in the field of management.
Members from the armed forces joined the IHM in the early 2000’s and many senior officers followed a bespoke Fellowship programme, with successful candidates gaining Fellowship recognition. This sector of the membership has developed a separate Military Division in recent years.
Some of the membership experienced an exchange with our “sister” organisation, the CCHL in Canada, and valuable discussions and exchanges were experienced by the membership in both countries.
In 2006, the Accredited Manager programme was developed and piloted to offer managers an equivalent recognition for managers in Health and Care to that of Clinicians. This needs renewal every three years, and enables members to stay current in terms of knowledge skills and behaviours required for today’s manager. The IHM continues to lobby government and offers feedback on the Health and Social Care Act as well as other pressing issues for managers, including feedback on the now current reforms.
The Executive Board has always been mindful to ensure that the IHM has a relevance for managers and can reflect the culture of the health and care sectors as they develop and change, so in 2012 a decision was made to look for a partner that would gain mutual advantage in the joint venture, and would also increase the benefits for the membership. In October 2012, the IHM became a subsidiary organisation within The Royal Society for Public Health. This relationship has already realised many benefits for the organisation, including access to more events, access to a membership room in central London and the opportunity to strengthen the membership offer and involvement that will give managers the opportunities for CPD as well as a voice in the new and complex health and care sector.
Membership remains steady throughout these challenging times as management within the sector requires different as well as more complex skills. The IHM is unique in that its membership comes from within the health and care sectors, a sector with unique challenges.