The following are excerpts from a discussion between Derek Williams and Jon Glasby in January 2012, in which Derek talks about setting up HSMC in 1972, the funding and staffing arrangements and the issues in the NHS at the time that influenced the decision to establish the Centre.
"I think the original funding arrangement was for up to 6 posts. It was going to be quite a big activity, but the main aim, was to provide in the Midlands a centre that would help run courses that would integrate the disparate elements of the NHS up to that time – the hospital element, the Local Authority element and so on.
For the first few years of the Centre’s life, funding was relatively benign. We negotiated an annual contract with DHSS – you know running into six figures – and this enabled us to keep rolling forward the short term contracts of all the staff, including myself. It was quite a long time before I got a tenured post at the University. I got the impression that one of the things that has changed quite a lot since my day, and perhaps it was changing during my day, was the way in which HSMC has become woven more closely into the mainstream of University activities.
I think the expectations of DHSS were always that it would be a training centre, and they were preoccupied in the early stages with trying to bring together all the disparate parts of the NHS in the – was it the 1974 reorganisation? I tried to make it clear in our documents that – from the outset I always saw three elements in our work – training, research and consultancy. And we did build up various research activities fairly quickly. We also tried to establish a closer relationship with the neighbouring NHS than other centres. We had something that we called rather ambiguously, ‘The Zone’, which meant that we built special relations with the West Midlands, the South West and the Oxford region and tried to provide special kinds of management development and research support for health authorities in that zone, in that element of the NHS, and that seemed to work fairly well.
I established something called the NHS Fellowship Scheme where people like John Clark came and worked for us for a year and was seconded from the service for a year. You could do a Masters degree, because that’s one of the things we established. I think we were one of the first centres to establish a Masters degree – you could go back to the service with a Masters degree, ideally take a more senior position as a result of that, and also contribute greatly as experienced, hands on administrators particularly to the teaching in the centre. That was one thing we did. That tended to have a regional element, but our courses, the integration courses that we began to run and after that the so called senior management courses were national, and people could come from anywhere. These were in the run up to the great reorganisation of 1974 and they were attended by administrators, hospital administrators, hospital nurses, local authority doctors and that sort of thing, primary care administrators. It was an attempt to bring these various elements, particularly the local authority and the hospital worlds together and to address together the issues of integration that would follow the reorganisation.
I suppose the nature of management in the service was a very difficult question to address in the early days. The service wasn’t really managed at all, it was administered by professional administrators who were willing to concede to almost wholly independent groups of clinicians, all the major decisions about how the health service should develop and inviting people to think beyond that towards a more creative and you know, a more creative form of management was one of the challenges.
I mean getting people like Mike Drummond in was very new. Mike Drummond’s thinking about cost benefit analysis, John Yates thinking about performance were wholly new concepts. The things I think we did quite well but perhaps better than some of the other centres was that we did create a community with – an open community. The National Association of Health Authorities which became the NHS Confederation, came and worked in the centre for many years against the advice of one or two of my colleagues, but it did us good to have them in the building.
John Yates who wanted to develop his own, at that time, perceived to be rather eccentric ideas about clinical performance. We were happy to give him a home and that way we kind of undermined some of the traditional assumptions about academic boundaries. I think that was a good thing and I don’t think I ever regretted that."