The Contribution of Professor Teddy Chester

Administration, Management and Training in the National Health Service: The Contribution of Professor Teddy Chester

Edited by Philip Begley and Stephanie Snow

Department of Public Health and Policy University of Liverpool

Centre for the History of Science, Technology and Medicine University of Manchester

All rights reserved. This material is made available for personal and research only. We give permission for this file to be downloaded for such personal use. For reproduction or further distribution of all or part of this file permission must be sought from the copyright holder.

Published by: Department of Public Health and Policy, University of Liverpool, 2020.

ISBN: 978-1-9999209-5-1.

Administration, Management and Training in the National Health Service: The Contribution of Professor Teddy Chester

The Transcript of a Witness Seminar held at the University of Manchester on 14 March 2019

Acknowledgements: The convenors would like to thank John Pantall and Michael Lambert for supplying helpful background information, and all the witnesses for their generous involvement.

Contents

Instructions for Citation……………………………………………………………...………p.5

Introduction……………………………………………………………………………...…..p.6

Contributors…………………………………………………………………………...……..p.8

Areas for Discussion……………………………………….……………………………….p.10

Witness Seminar Transcript…………………………………………………….…………..p.12

Appendix………………………………………………………………………….………..p.68

Instructions for Citation

References to the Witness Seminar should follow the format below:

[Witness name], in Administration, Management and Training in the National Health Service: The Contribution of Professor Teddy Chester, held 14 March 2019 at the University of Manchester, published by the Department of Public Health and Policy, University of Liverpool, 2020, web details [page number of reference].

Introduction

Theodore Edward Chester was born in Austria in June 1908. He worked in law and administration before serving in the British Royal Army Service Corps and the Intelligence Corps during the Second World War. Whilst working in adult education at the University of Oxford he met Sir George Schuster, and in 1948 he joined the Acton Society Trust, an offshoot of the Joseph Rowntree Reform Trust which Schuster had helped to establish, that sought to ‘analyse the implications of the welfare state for liberty and the individual’. He became a Senior Researcher and then Director.1 Here Chester honed his interest in administration in the public and private sectors and published a series of studies of hospital organisation.2

Under the influence of Sir John Stopford, Vice Chancellor but also Chairman of Manchester Regional Hospital Board, Chester was appointed as the first Professor of Social Administration at the University of Manchester in 1955. He helped to establish and then took a leading role in the running of the first National Training Scheme for Hospital Administrators, based in Manchester and at the King’s Fund in London. The first intake arrived in 1956. The scheme’s successor continues today. Many senior NHS figures undertook the training scheme, which provided them with a valuable mix of practical and theoretical experience, and were influenced by Chester’s work. He has been remembered as an influential tutor and mentor who was greatly interested in his students, before and after they joined the health service.

Chester was also a member of the National Selection Committee for the Recruitment of Senior Hospital Administrative Staff (1956-66), the Advisory Committee on Management Efficiency in the Health Service (1959-65), and served on the Lycett Green Committee of Inquiry into the recruitment, training and promotion of clerical and administrative staff (1962-63).3 He became Dean of the Faculty of Economic and Social Studies in 1962 and in the wake of the Robbins Report helped to found Manchester Business School in 1965, one of the first of its kind in the UK.4

Chester was appointed a CBE in 1967 and remained at Manchester until his nominal retirement in 1975. He continued to be actively engaged as an Emeritus Professor and from 1979 directed an influential management programme for NHS clinicians. Throughout his career Chester held visiting Professorships in Europe, the United States, Canada and Australia, and published extensively on management, training, education, health systems and organisations.5 He died in August 1991. An annual lecture at Alliance Manchester Business School is named in his honour.

1 https://www.rowntreesociety.org.uk/history/rowntree-a-z/joseph-rowntree-reform-trust/. 2 Acton Society Trust, Hospitals and the State: Hospital Organisation and Administration under the National Health Service, 6 Vols. (London, 1955-59). 3 Report of the Committee of Inquiry into the Recruitment, Training and Promotion of Administrative and Clerical Staff in the Hospital Service (London, HMSO, 1963). 4 Higher Education: Report of the Committee Appointed by the Prime Minister under the Chairmanship of Lord Robbins 1961–63, Cmnd. 2154 (London, HMSO, 1963). 5 See Appendix.

The aim of this witness seminar was to bring together those who worked with, were taught by or had other connections to Chester in order to share their memories and insights, and begin to assess his career and legacy.

Contributors

Chair

Dr Stephanie Snow: Senior Research Fellow, Director, NHS at 70: The Story of Lives Project, University of Manchester.

Witnesses

Mr David Allen: Degree in Economics. RAND Corporation – work on military problems and for the New York City Housing and Fire Departments. PhD at University of Manchester – supervised by Gordon Forsyth and Teddy Chester. Published as Hospital Planning: The Development of the 1962 Hospital Plan, 1979. Director of Studies, Health Services Management Unit, Manchester Business School, 1977-90 – including running (with David Grimes) the management course for Senior Registrars.

Dr Peter Barnes: Junior Medical Training posts, Manchester, 1966-74. Consultant, Hope Hospital (now Salford Royal), 1974-2006. Posts as Postgraduate Tutor, Chairman of the Medical Staff Committee and Executive Medical Director, 1994-2006.

Dr David Grimes: House Officer, Senior House Officer, Resident Medical Officer, Manchester Royal Infirmary, 1966-70. Medical Registrar, St George’s Hospital, 1970-72. Senior Medical Registrar, Manchester Royal Infirmary and Withington Hospital, 1972-77. Consultant Physician/Gastroenterologist, Blackburn Hospitals, East Lancashire Hospitals Trust, 1977-2013. Posts as Undergraduate Tutor, Postgraduate Tutor, Chairman of Medical Division, Medical Director, Chairman of the North West Regional Medical Committee. Senior Examiner, Member of the Manpower Committee, Royal College of Physicians and running (with David Allen) the management course for Senior Registrars.

Councillor John Pantall: Graduated from Nottingham University. Industrial Administration course, Manchester College of Technology, 1955. Member of the Department of Industrial Administration, 1956-61. Tutor on the National Administrative Training Scheme, Department of Social Administration, 1961-67. Work on applied research to the NHS, Manchester Business School, 1967-70 full time, 1970-76 part time. Projects with the Department of Health and Tutor on the National Administrative Training Scheme, 1970-76. Freelance consultant – including work with Health and Social Services in Northern Ireland, 1976-82. Member of Health Services Management Unit – including running NHS management courses, work with Argyll and Clyde Health Board, Patient’s Charter, Benchmarking, Outpatient Demonstration Sites, European Exchange Programme, and review of acute services in Fermanagh and West Tyrone, 1982- 2002. Member of Stockport Council since 1979 – including posts as Chair of Social Services, 1987-93, Board Member of Stockport Health Authority and Manchester Airport. Chair of Stockport Wellbeing Board, 2013-16. Member, UK Central Probation Council.

Mr David Robson: Trainee, National Administrative Training Scheme, University of Manchester, 1958-61. Graduate Assistant, West Cumberland Hospital, 1961-66. Team Leader, Operational Activities Unit, Liverpool Regional Hospital Board, 1966-69. Leader of Development and Research Team, Assistant Clerk of Management Services, St Thomas’ Hospital, 1969-74. District Administrator, Hereford and Worcester Area Health Authority,

1974-82. District Administrator and Secretary, 1982-84, Secretary and Director of Quality, Worcester, District Health Authority. Self-employed Health Service Planner – including Trainer with Health Service Management Centre, University of Birmingham. Secretary to the Trust Board, City Hospital, Birmingham, 1987-96.

Mr Robin Stewart: Degrees in Classics from the Universities of Edinburgh and Cambridge, 1952-58. Trainee, National Administrative Training Scheme, University of Manchester, 1958- 61. Diploma in Social Administration, University of Manchester. Diploma of the Institute of Hospital Administrators (now Institute of Healthcare Management). Senior Administrative Assistant, 1961-63, Deputy Secretary and Treasurer, 1963-70, Board of Management for Glasgow Royal Infirmary and Associated Hospitals. Secretary, Northern Regional Hospital Board, Inverness, 1970-74. Secretary, 1974-85, General Manager (now Chief Executive), 1985-94, Highland Health Board - including posts as Secretary, Treasurer and Chairman of the Scottish Division of the IHA, Chairman of the Scottish Health Board General Managers, and Member and Leader of the UK Delegation to the Hospital Committee of the EEC.

In Attendance

Dr Philip Begley: Lecturer in the History of Medicine, University of Liverpool.

Dr Michael Lambert: Research Associate, University of Liverpool.

Professor Sally Sheard: Andrew Geddes and John Rankin Professor of Modern History, University of Liverpool.

Professor Kieran Walshe: Professor of Health Policy and Management, University of Manchester.

Ms Naomi Weaver: Researcher and Digital Editor, NHS at 70 Project, University of Manchester.

Areas for Discussion

Early Career

• What led Chester to join the Acton Society Trust? • What were the hallmarks of his approach to administration and the NHS during this period?

National Administrative Training Scheme

• What brought Chester to Manchester? • How significant was his appointment as Professor of Social Administration? • How did the National Administrative Training Scheme develop? • What was distinctive about the Manchester scheme and what was the relationship with the King’s Fund? • What was the relationship between Chester and his trainees and how did it evolve once they were working in the NHS? • What role did women have in the scheme? • How were Manchester trainees viewed by other NHS administrators? • How did the scheme change over time? • What wider initiatives was Chester involved in during this period?

University of Manchester

• What led Chester to establish the Extra-Mural Department and evening management seminars for managers from industry? • How was the Manchester School of Management and Administration created? • What part did Chester play in the setting up of the Business School? • To what extent did this reflect the success of the National Administrative Training Scheme?

1974 NHS Reorganisation

• What was Chester’s involvement with the 1974 NHS Reorganisation? • To what extent did consensus management reflect his teaching? • What influence did Chester have on the evolution of administration in the NHS?

Management Programme for Clinicians

• How did management training for clinicians emerge? • Was it related to the introduction of General Management? • What impact did it have on those clinicians who attended?

Relationships and Networks

• What was the nature of Chester’s relationships with other academics, senior NHS figures, medical professionals, civil servants and politicians? • What networks did he develop and how did these play into his work?

Legacy

• How far did Chester’s influence stretch over the course of former trainees and students’ careers? • What lessons might we learn from Chester’s career? • What has been his lasting legacy for health policy in the UK and the NHS?

Witness Seminar Transcript

Administration, Management and Training in the National Health Service: The Contribution of Professor Teddy Chester

Stephanie Snow

I'm delighted to welcome you all here this afternoon. It's a small group but actually I think we have excellent representation across so many of the areas of Teddy Chester's life and work, that will enable us to begin to capture his legacy and impact in the fields of health and public policy.

The real inspiration for getting the seminar together was the fact that we've recently been given Chester's personal papers and archives through Kieran [Walshe’s] links with the family. So we're hoping to use this as an event which will then lead us to get some resources, so that we can digitise those archives, possibly add other archives to them, but actually create an online collection that would be really helpful for current researchers and practitioners. And this seminar will provide the beginnings of the context for that task.

Chester, from what I've heard, and certainly from the initial discussions we've had today, was an absolute virtuoso when it came to networks and relationship-building. And I'm happy to say that this event has come together because of the close relationship Manchester and Liverpool Universities enjoy around the intersections of health, history and policy, and also our close collaborations with Alliance Manchester Business School. As well as running a three-year national programme of work to capture the 70-year history of the NHS, I also have a Wellcome Trust award which is for a project looking at the idea of how quality came into healthcare from the 1960s onwards, and Chester's work is a really key part of that because it intersects with so many of those dimensions.

We had an initial seminar, including Robin Stewart and David Robson, a few years back, when we were working with the late John Pickstone and Steve Harrison, and that really gave me an interest in the history of administration, but particularly in the context of the NHS.1 So it's very exciting to feel that we can now move forward to that.

I'd now like to introduce Sally Sheard, Professor of Modern History, Director of the Centre of Humanities and Social Sciences of Health, Medicine and Technology at the University of Liverpool, to explain her interest in Chester.

Sally Sheard

Thank you very much, Stephanie. And thank you for hosting. It's wonderful to be here. The Governance of Health project, which I lead, is also funded by the Wellcome Trust. In this case,

1 The Recent History of Guy’s and St Thomas’, 1970s to 2000s, held 16 June 2011 at Guy’s and St Thomas Foundation Trust, published by the Centre for the History of Science, Technology and Medicine, University of Manchester, 2011. John Pickstone and Stephen Harrison were influential historians of medicine and health based at the University of Manchester for many years.

it's a five-year project through a Senior Investigator Award. I'm looking at the shifting authority in the NHS, from 1948 through to the present day, away from the dominance of the medical profession, and where we see the rise of a professional hospital administration, NHS management, the use of external management consultants, but also the rise of health economics as a key policy driver. I've had a fantastic team of researchers working with me, and two of them are here today – Dr Phil Begley and Dr Michael Lambert. Phil is leading the project strand on managerialism, so he is the one that is, I think, probably most interested in Teddy Chester within the project. Michael is leading the strand of the project that is looking at Merseyside health governance and a little bit broader, North West health governance, and interested in some of those relationships that Chester was building across the region, out of the university here, into the NHS and within the universities more generally.

I first came across Teddy Chester's work in a previous project, when I was writing the biography of Brian Abel-Smith, who was a key government advisor on the NHS – he was on the Guillebaud Report in '53 to '56.2 He then joined Richard Titmuss' team at the London School of Economics as a lecturer in social administration, and was very influential right the way through up until close to when he died in 1996.3 And I know that Brian Abel-Smith did collaborate with Teddy Chester on a number of different projects. So that's another of my interests in Teddy Chester's work. I've been working as well on issues such as hospital length of stay and waiting time management. And again, these are areas in which Teddy Chester and some of his researchers, such as Beatrice Hunter, had very strong interests.4 I'm delighted to be able to be here and hear the conversation. Thank you.

Stephanie Snow

Thank you, Sally. I'd now like to introduce Kieran Walshe, Professor of Health Policy and Management, and also Head of the Health Management Group at Alliance Manchester Business School. Would you like to say a little bit about your interest?

Kieran Walshe

I'll say a little bit about it, certainly, yes. And again, I'd echo what Sally said in saying thank you for hosting this, Stephanie. I think this is going to be a really interesting afternoon, for me certainly. It's not often I come to a meeting where I feel where I'm one of the youngest there as well these days, so I like that too.

I'm Head of the Health Management Group at the Business School, which is the successor to the Health Service Management Unit, which Chester founded in 1956. And in 2006, we celebrated the 50th anniversary of the unit being set up and we organised a number of activities around that. Some of the past people came along, so Gordon Forsyth and Mike Schofield, and

2 Brian Abel Smith (1926-1996) was Professor of Social Administration at the London School of Economics from 1965 to 1991, and one of the first special advisers to the Secretary of State for Health and Social Services from 1968 to 1970 and 1974 to 1978. The 1956 Guillebaud Report was the result of a Committee of Enquiry into the financial viability of the early NHS: Report of the Committee of Enquiry into the Cost of the National Health Service (London, HMSO, 1956). 3 Richard Titmuss (1907-1973) was Professor of Social Administration at the LSE from 1950 to 1973. 4 Beatrice Hunter was a Research Associate in the Department of Social Administration at the University of Manchester.

others, came. But we also organised, for the first time, an annual lecture which we named after Chester, the Teddy Chester Lecture, which has been given by Jennifer Dixon, Chris Ham, Stephen Dorrell, a variety of people, and it happens every year in November. And I set that lecture up because I felt there was no sense of the history of the institution about the place, inevitably. You know, people had changed, people had moved on, and I wanted…I'll come back to the history of the institution in a moment and you'll see why…

Robert Chester, I think his name is, who's Teddy's son, came to that first lecture and that was the first time I met him. He used to work at one time at UMIST.5 And so we talked there and then stayed in touch, and it was really through that, that last year I think it was, Stephanie, Robert emailed me to say that his mother had died and he was clearing her house out, and he had a garage full of Teddy Chester's papers, and would I like them. And I said, ‘Oh, yes, I'm sure we'd like them’. I'm not completely sure I realised how much a garage full was. So, I drove down to him and filled my Land Cruiser to the brim with boxes of slightly mouldy paperwork and brought them all back, and approached Stephanie. And that's how we got the archive and that's the work that's now ongoing.

The group that I lead – in fact, I've handed over the lead to a colleague recently – but the group I've led for ten years is about 25 academic staff in the Business School. It continues to run the education component of the Management Training Scheme.6 It also runs, with the University of Birmingham, the very large programme for the Leadership Academy, which is the big programme for in-service management leadership development.7 And it also contributes to the board level programmes. So, I think the work the group does represents very much the kind of things that Chester spent his life and career doing.

Final point: I joined the NHS in 1985, after graduating from the University of Manchester on the management training scheme. Having thought about a career in the civil service or the NHS, or – this was probably a good call – I got offered a place on the GLC's management training scheme as well…didn't take that.8 So I joined the management training scheme in 1985 and did my educational component of the scheme here. Interestingly, I never met Chester, which is a great regret. Gordon Forsyth was a slightly inscrutable and somewhat imposing presence who occasionally floated through, but it was people like Rod Sheaff and Jim Hughes, and others, who were the tutors on the scheme and who ran the content.9 And I think like all trainees we were arrogant and troublesome, and somewhat above ourselves. And it was the era of the introduction of general management and we all went out into the service. I'm still in touch with my cohort, we meet up every year or couple of years. And we were the thirtieth cohort of national management trainees, and it is now over 30 years, isn't it, it's about 33 years since we joined the NHS.

So it's lovely to see everybody here and I look forward to learning a lot more about Chester, who I never met.

5 The University of Manchester Institute of Science and Technology. Merged into the new University of Manchester in 2004. 6 NHS Graduate Management Training Scheme: http://www.nhsgraduates.co.uk/. 7 NHS Leadership Academy: https://www.leadershipacademy.nhs.uk/. 8 The Greater London Council – the main local administrative body in London from 1965 to 1986. 9 Gordon Forsyth was Lecturer in Social Administration at the University of Manchester from 1961 and Head of Department from 1975 to 1981. Rod Sheaff was a Research Fellow at the University of Manchester and is now Professor of Health Services Research at the University of Plymouth.

Stephanie Snow

Thank you, Kieran.

Just a brief recap of what the idea of a Witness Seminar is, in case you're not familiar with the approach. The aim is very much to bring people together who have memories and reflections on a particular area or topic, or shared interest. And this afternoon, our interest, of course, is in Teddy Chester. The aim is very much a spontaneous discussion rather than prepared statements.

The goal is to make the value of Chester's work and the legacy of his archives into a resource that is going to be able to be used by researchers and practitioners across health policy and social sciences. I feel we're in a really crucial time period to capture this, before we lose a generation that actually had that real experience. One of the things that Sally and I are particularly concerned about is the lack of institutional memory in the NHS and health policymaking organisations. These sorts of events give us material which we can then share and bring to the attention of people who are currently facing the challenges of the NHS today.

John Pantall, can we ask you to begin by talking about Chester's early career before he came to Manchester?

John Pantall

I talked to him over the years and he was a jurist in Vienna. He did what I think lawyers do – he gave opinions and earned fees, but he also did teaching. And the day the Nazis took over, half his class appeared with Nazi armbands. But Teddy then, and I can't remember since, never really got involved in narrow party politics. Because the first people the Nazis arrested were politicians…Jews as well…but Teddy wasn't a politician and I think that meant he was able to come to Britain with his brother, who was a dentist. Interestingly, his brother kept his original name, because presumably in dentistry in London, you could charge bigger fees if you sounded…whereas Teddy anglicised…

David Allen

What was his original name?

John Pantall

I don't know. I know he told me that his brother had kept his original name. Teddy then served in the British Forces, starting off in the Royal Army Service Corp as a Private. He got promotion, he told me, to Acting Unpaid Lance Corporal when he devised a system for the officer in charge of the vehicle depot where he was to know how many vehicles he'd got. Can you imagine Teddy as a Private? Towards the end of the war, he was in army intelligence, obviously because of languages and the aftermath in Germany, and became a Sergeant. The only other military bit in his career – when he used to visit the US Air Force Army health facilities in Bavaria, they had to give him an honorary rank and they classified him as a Brigadier. And he used to be quite chuffed by that…achieved being a Sergeant in the British Army but he was treated by the Americans as the equivalent to a Brigadier.

He had difficulty then getting into what he wanted to get into, adult education, after the war. And then it was suggested to him that George Wigg – I think who was an MP by then – but George Wigg had been involved in mysterious ways in intelligence, and to see George Wigg who would somehow put a word in.10 And Teddy ended up with a job at the Oxford University Delegacy for…well I think extra-mural, but adult studies…the equivalent of the extra-mural department.

He obviously came into contact with the Chair of the Oxford Regional Hospital Board, Sir George Schuster, who set up a think tank – the Acton Society Trust.11 I don't know the actual dates but Teddy was in the Acton Society Trust and one of the other people there was Reg Revans.12 And it was about focusing on the management of newly nationalised industry etc. Reg Revans had worked for the Coal Board and so on, and brought that bit in. Teddy, I think through his contacts with Sir George, was more interested in health. The Acton Society pamphlets are the ones that I remember, because they were still being used and didn't really date.13

Difficult to say exactly the sequence of events, but the Vice-Chancellor of Manchester University, John Stopford, was chair of the Manchester Regional Hospital Board.14 So Teddy was appointed in 1955 as the first Chair of Social Admin., and Reg Revans was appointed the same year in the Faculty of Technology at Manchester College of Technology as the Chair of Industrial Admin. So, it's quite interesting the two people who worked together at the Acton Society came to Manchester. It was the time around 1953 when the Guillebaud committee, was looking at the costs of the NHS, and clearly the civil servants would be well aware of the thinking of Guillebaud, but Teddy claims that the setting up of the National Training Scheme wasn't connected with Guillebaud.15 I'm not quite sure of that, because what Guillebaud did when it reported – it put an emphasis on management. It called it administrative education. Administrative education for clinicians, use of information, and actually PIs [Performance Indicators] developed soon after. Teddy said it was not anything to do with Guillebaud, but I must re-read the book by John Pater from the Department [of Health and Social Services] on the history, which was published in 1981.16

So, a year later – the first year of the National Training Scheme. Two centres – the King's Fund and here. We took in the Northern regions, the Midlands, Northern Ireland and Scotland. It was later on in 1961 when we actually acquired Wales, who didn't like the King's Fund too much...

10 George Wigg (Baron Wigg) (1900-1983) was Labour MP for Dudley from 1945 to 1967. 11 Sir George Schuster (1881-1982) was Chair of Oxford Regional Hospital Board from 1951 to 1963. The Acton Society Trust, an offshoot of the Joseph Rowntree Reform Trust, was established after the Second World War and sought to ‘analyse the implications of the welfare state for liberty and the individual’: https://www.rowntreesociety.org.uk/history/rowntree-a-z/joseph-rowntree-reform-trust/. 12 Reginald Revans (1907-2003) was Director of Education at the National Coal Board from 1945 to 1950. After the Acton Society Trust he was Professor of Industrial Administration at the University of Manchester from 1955 to 1965. 13 Acton Society Trust, Hospitals and the State: Hospital Organisation and Administration under the National Health Service, 6 Vols. (London, 1955-59). 14 John Stopford (Baron Stopford of Fallowfield) (1888-1961) was Vice Chancellor of the University of Manchester from 1934 to 1956 and Chair of Manchester Regional Hospital Board from 1947 to 1953. 15 The National Administrative Training Scheme established at the King’s Fund and the University of Manchester in 1956. 16 J. Pater, The Making of the National Health Service (London, 1981). John Pater (1911-1989) was a civil servant in the Ministry of Health and the Department of Health and Social Services from 1947 to 1973.

Stephanie Snow

Can I just stop you there for a moment John, before we move on to the National Training Scheme? Does anybody else have any reflections of Chester talking about his work when he was at Acton? Because that seems to be quite a formative period which really influenced a lot of his later work, particularly working on the pamphlets.

David Allen

I can remember his reaction to Reg Revans, if that's relevant. No…he just had lots of contacts, and those were critical. He could find you someone to answer all sorts of questions, which I'm sure date from that period, but I can't think of any time he mentioned his work there particularly.

Stephanie Snow

OK, that's great. So yes, let's go on with the National Training Scheme for hospital administrators. John [Pantall] has given us the context for that being set up. Perhaps we could now turn to David Robson and Robin Stewart, who are our earliest trainees from that scheme.

David Robson

Just one thing, I don't know whether it's apocryphal or whether it's accurate…Teddy also used to say that it was because, although the hospital service did have a lot of administrative people, it never got around to training them. The King's Fund did have a training system going way back immediately post-war. They were called King's Fund Bursars or something like that. When that ceased to exist, there wasn't anything. So presumably, people like John Pater, as well as Teddy, were saying ‘Here is something that needed to be sorted’, because otherwise who is going to be that support part of the hospital service at that time.

And Teddy always maintained to us that he reckoned it was John Pater was his most powerful ally in the Ministry of Health and who made this possible. But just to divert a bit…he always used to say to us, all these people I'm going to introduce you to are people who know about things, they influence the service, they've been around a long time, you must push them. And, therefore, your behaviour in their company doesn't have to be reverential, it should be incisive, it should be strong, you should make them possibly feel uncomfortable, he didn't think it wrong to challenge. The one person I remember that he was always reverential towards was John Pater.

Stephanie Snow

Michael, did you want to come in?

Michael Lambert

I would love to, because I have some documentary evidence to confirm exactly that. I've been through the University of Manchester archives, mainly for my doctoral research but also as part of this. If I may, I'd just like to read a letter from John Pater to John Stopford, dated the 19th of February 1955, which reads:

'Perhaps I ought to begin by making it clear that I am writing in a wholly personal capacity, and not in any sort of official way, and also that I'm writing to you as Vice-Chancellor, and not as a participant in the hospital service. The point I'm interested in is the possibility of developing somewhere in the North of England, under the wing of the University, some arrangements for the training of hospital administrators of the kind that have been going on at the Hospital Administrative Staff College in Notting Hill, run by the King Edward’s Hospital Fund. My reason for approaching you is, first, that Stephen Taylor suggested it to me. And the second is that I am emboldened by the news in the paper that you are appointing Chester as Professor of Social Administration from next May. I'm not at all sure what Social Administration is, but it seems to me that it may have something to do with a subject I'm interested in, and I know that Chester has taken some interest in this subject himself in the past'.17

Stephanie Snow

Excellent.

Kieran Walshe

And I have on my computer a history of the scheme written in 2006 by Graham Saunders.18 I'd forgotten I even had it until you started talking about this. But that has a page or so on the beginning, post-1948. And that says, that in 1947-48, the Institute of Hospital Administrators was arguing for a training programme and the staff side of the Whitley Council, the clerical bit, was also doing so.19 And it says, in the early 1950s, the Hospital Administrative Staff College of the King Edward's Hospital for London, which became the King's Fund College, had been established and was running programmes for the new NHS. And it has council minutes about that.

Stephanie Snow

Excellent, thank you.

17 University of Manchester Archives, VCA/7/406/1, Pater to Stopford, 19 February 1955. 18 G. Saunders, The NHS National Management Training Scheme in England: A Chronology (Warwick, NHS Institute, 2006). 19 Named after the Liberal MP John Whitley who helped to establish the precedent, Whitley Councils were formal bodies, common across much of the public sector during the twentieth century, where representatives of management and staff could negotiate pay, terms and conditions and other issues.

David Grimes

Could I ask briefly…I'm aware of Sir John Stopford but I don't know who John Pater was.

David Robson

He was a civil servant at the Ministry of Health.

David Grimes

I assumed that was the case. OK.

John Pantall

He wrote a book in 1981 about the history of the NHS, which is interesting to look at.

I also think that many of the younger administrators had come up the inky-fingers way. They'd got a school certificate, they started young, pre-war, they'd taken the exams of the Institute of Hospital Administrators etc. With the Butler Education Act in 1944, suddenly the world was changing. So, people came back from the war, they were in senior positions in the new service. I don't know the numbers, but there was a suggestion, I think Teddy did say, that there was a sort of replacement cohort coming in.20 And I think what was interesting…the way the training scheme was set up did allow people who'd not got degrees but had done the Institute of Hospital Administrators exams, or later on the finance one, to come in. Vic Driscoll was a good case in point.21 He left school at 14.

Robin Stewart

Can I say something, perhaps? We had one in our 1958 intake to the training scheme here, Peter Holbrook.22 He was a non-graduate working in hospital offices, who had taken the job.

I just wanted to say two things about the pre-history. Am I right in thinking that he [Chester] attributed his time in the army to his interest in organisation and management? Because when he reflected on how the Army ran itself, he came to certain conclusions and developed his theories of management and organisation. And secondly, as to the beginning of the National Training Scheme, my understanding was that in 1948 suddenly a whole lot of hospital authorities were created, needing secretaries, treasurers etc., and they came from all corners, there was no natural source of people. There were people who had been in the war and had

20 According to a 1958 paper by Chester, there were 500 applicants for the first year (1956) of the National Administrative Training Scheme at the University of Manchester, and 300 in the second year (1957), for only 16 vacancies, drawn from a shortlist of 100: UMA, VCA/7/406/1, ‘Postgraduate Management Training at a University’, February 1958. 21 After completing the National Administrative Training Scheme, Victor Driscoll worked at St Thomas’ Hospital, London before becoming Administrator at the Royal Perth Hospital, Australia in 1968. 22 Peter Holbrook worked as a civil servant at Inland Revenue, before taking a hospital clerical post and then being accepted onto the National Administrative Training Scheme.

never done any job because they'd gone straight into the Army when they left school, or lawyers or council people, or whatever. And my understanding was that the training scheme was set up to create a body of people dedicated and trained to be in the National Health Service, so that there was a source of recruitment when the senior positions became vacant later.

Stephanie Snow

And what attracted you to join the scheme?

Robin Stewart

Well, when I was at the university, the kind of overall idea…I was doing Classics. I wasn't going to be an academic. I wasn't going to go into that field. The civil service was generally the kind of idea I had, and I was entered for the civil service exams. But at the Cambridge University Appointments Board, I was told about alternatives which were similar. One was the National Coal Board I remember, one was the BBC and one was the Hospital Training Scheme, which I'd never heard of before. So, I applied for it and got appointed to it, before the civil service exams took place. And I said, ‘Can I wait until I hear about the civil service exams?’ And I was told ‘No, you say yes or no’. And so, I said ‘Yes’. And it seemed to be a similar kind of career as the one I had had in mind before.

Can I say now about the actual time on the training scheme and Teddy Chester? I think it's very well put in this briefing paper – 'An influential tutor and mentor, who was greatly interested in his students before and after they joined the health service'. The word I had in my mind similar to ‘influential’ was ‘inspirational’ – in two ways. One, he was an example – a person who'd come, left his native country and made his career in a different country, who had kind of had to stutter to start with, because of the Army service and not able to get on, at an age when people would be trying to consolidate their career and move on to more senior posts. And yet he’d done it. So, he was a very good example of someone where it can be done. And at the same time, inspirational in the sense of selling, not exactly in the words of one syllable, but just by the general approach and the general atmosphere – ‘You can do the same’. ‘You're entering a worthwhile career. You can make a success of it, and you will be upholding a job which is of good public service interest to the community’. And so, in fact, he, as I say, inspired us to make the best of our careers.

And perhaps – as far as someone who's greatly interested in students before and after they joined the health service – sometime after he retired, I got a phone call from him [Chester] in my office in Inverness…‘My wife and I are coming on a coach tour of Scotland and we're staying at a hotel in Strathpeffer, close to Inverness. Why don't you and your wife come out and have dinner with us in the hotel?’ So, I did. At the dinner party entertainment was provided by a Scottish fiddle band and Scottish country dancers, and he said to me ‘Come on, this is not for us. Folk music is the same in every country’. I can remember that precisely. And we went on to a far corner and he said ‘We'll have a chat’. So, we had a chat, of course about what I was doing in the Highland Health Board and so on, and the health service generally. And at the end of the evening he said ‘Now tomorrow the party's being taken by the coach into Inverness to spend the day in Inverness sightseeing, shopping, and so on. It's not for me. I'm coming to your office. I'll be there at half past 10’. No question whether I had any appointments, board meetings or anything at all. And so, he did, he turned up. And I think it makes me say…he

never relaxed. He was retired, supposedly, but he was still…his mind was active, and he was by nature a researcher and an inquirer, and so he took the opportunity to have a further discussion with me about the workings of the health service.

Stephanie Snow

So, was it Teddy Chester that made the Manchester scheme distinctive, or was there something about Manchester and the scheme itself? What were the dynamics around that?

Robin Stewart

Hard to say.

David Robson

Well, there was the University's insistence that if they were going to host the training scheme, there must be an academic element to it, and, therefore, there had to be a proper academic year doing the Diploma, which just didn't exist in London. And, therefore, we did this sandwich course with practical assignments…academic, practical. Whereas London had to…well, I think, as far as I know, they just squeezed in bits of academic courses over a matter of perhaps a month or two months, in between the various assignments which people were allocated to.

David Allen

Can I just ask you– what was the content of these courses, what were you taught?

David Robson

I don't know how different it was from a standard Manchester University diploma in social administration. There was the history of social services from the nineteenth century to the creation of the NHS, there was statistics, industrial relations, industrial sociology…

Robin Stewart

Accounting.

David Robson

Accounting, yes.

Robin Stewart

Law.

David Robson

Law. But the unique element from Teddy's input was the weekly sessions we had with him where he either did something himself or brought in all sorts of people to talk about aspects of the health service.

David Allen

And it's that bit which I think is uniquely Teddy. I mean, the rest of it…I did a commerce degree around the same time and we did those subjects. That's Teddy's unique thing – bringing people in from outside.

John Pantall

Teddy was very clear that the aim was to produce managers, and although it was a diploma for advanced studies (social admin.), it was really a management preparation. And he was very clear about that.

Interestingly enough, I remember one occasion him being asked about evaluation and he said ‘No, we don't use questionnaires. People will know in ten years' time whether it's made a difference’ having people trained. But I think it was a feature compared with the King's Fund, as you point out, that was important. There was always this wish of people during their academic year to keep in touch with the practical world. And we had a number of part-time or visiting tutors who were ex-trainees who worked in United Manchester Hospitals, for example. So, he actually used them to do a kind of ‘keep in touch’ seminar. I don't know whether early on he did that, but certainly in the 1960s when I was tutor, that was just one way of keeping in touch.

David Robson

Did that happen after he'd been stopped holding the annual get-togethers?

This question arises because it was import to build up a cohort of people who had come into the hospital service, in the same way, who would understand each other because of the background they had. He [Chester] said it was very important that these people over the different cohorts should meet each other. So, he held an annual weekend event, initially held in the YMCA place over on…

John Pantall

Montgomery House.

David Robson

Thank you. But the Ministry of Health said ‘No, no, no. You're creating a specialist elite. You're not allowed to do things like that, we're all equal here’, or something. And so, he stopped that. So, whether instead when he had people here doing the diploma course, he actually brought people in so that they could meet their prospective colleagues.

John Pantall

No, I don't think the two are connected. What happened was that he couldn't use his own budget for paying for those events. And certainly, one of the latter ones I remember, which we held at another halls of residence, Hulme Hall, we geared it to the subsistence rate, so that people came and they claimed their subsistence from their own authorities, and that paid for the rent. Because it wasn't costed because it was, as I say, bringing people together, rather than having lots of external people. And then after he [Chester] retired, they tended to cease. And then one of my successors threw away the files.

Stephanie Snow

David Allen, you wanted to come in.

David Allen

Just on John's point about ‘We will know the benefit in ten years' time’, and your [Stephanie Snow] point about Teddy and quality. I had a lot of dealings with Teddy on my courses, and I believe in quality – I was the Regional Quality Manager at one time, so I believe in quality. We handed out these happiness questionnaires, so-called, and there were some complaints about Teddy going on about something. I timorously offered them to Teddy. Teddy grabbed them and threw them in the wastepaper basket – ‘Oh I don’t believe in those things’. And that was his attitude to those things.

John Pantall

I was able, towards the end of the 1960s when I…I'm trying to think which course I was involved in…but to use John Burgoyne from the Business school to design a before beginning the course and post-course evaluation. And that was OK. Teddy often would say ‘Yes, get on with it’, but he wouldn't do it himself.

David Allen

Yes. Did you take any notice of him?

John Pantall

As I say, not with the trainees, but with another course. John Burgoyne later became a Professor at Lancaster.23

Stephanie Snow

I'm interested to hear your reflections on Chester's use of the term ‘management’ during this period, because the introduction of general management with the Griffiths Report in 1983, in histories of the NHS, is seen as the definitive point for management. But it's quite clear from the way in which you're talking about it and the way in which Chester writes about it, that he saw management as different to administration, and I wonder if you could reflect on that.

John Pantall

He really saw managers using information and evidence, and post-Guillebaud, when he was on the Advisory Council for Management Efficiency in the NHS – which was chaired by a main board director from a large company then called ICI, that people may remember – one of the things that had come out of Guillebaud was a need for using information. The terminology changes, so it probably was ‘information’ that was the term. But PIs actually came into the NHS in the early 1960s – costs and returns, and so on. And so, Teddy would, I think, see the importance of using that kind of performance information, although he could be quite sceptical of some of it…later on, the Regional Hospital Board in Manchester moved to Gateway House… he was saying ‘It's full of information untouched by human brains’.

Robin Stewart

When we were on the training scheme, I don't remember the word management being used at all. It was the National Administrative Training Scheme. We were going to be hospital administrators. It was the Institute of Hospital Administrators that we joined. Management just didn't…wasn't mentioned.

David Robson

I'd have said it was there, even if unmentioned. I think we were expected, as John's indicated, to use the information to make the service run better, more smoothly, more efficiently. So, we may have been called administrators, because that was the custom and practice, but I think we were expected to be different perhaps from just filling in forms or following set procedures. We were expected to use whatever information there was around. Certainly, I was glad because the first substantive job I had, which was up in the Newcastle region, they were using punch- card cost accounting information. We coded as much expenditure as possible directly to wards and departments. This included the payroll as well as goods either directly purchased or distributed from the stores. In return we did have monthly cost information coming out to the Hospital Management Committee. We were expected to look at it, interpret and comment on

23 John Burgoyne is Emeritus Professor in the Management School at the University of Lancaster.

it. I can recall the time spent trying to put the coding right. That was our administrative task, but working with nursing and other professional staff to create something they would find helpful was also there.

David Grimes

Could I make a contribution at this point? My perspective of the health service is that of a clinical doctor, mainly on a sort of one to one with individual patients etc. Now, when I hear the word administration, I always think of the big steam engine in Barnoldswick, not far from where I live, which goes around and it's run effectively by a man with an oilcan. And I always think of that man as Teddy. He wants everything to work smoothly. OK, improvements in efficiency etc., but everything working smoothly.

My first contact with Teddy was on a pre-1974 course. And this was a course he put on for doctors, for consultants and general practitioners, and occasionally for public health doctors as well, and mainly bringing together consultants and general practitioners. And he was not one to run a course for consultants and a course for general practice separately. The most important part of the course was them being together for a week and talking to each other and sharing experiences. And that was very, very much his style. I sort of gate-crashed on that course. I was a senior registrar, and the consultant professor I worked for at MRI [Manchester Royal Infirmary] put me on the course. And Teddy didn't quite know what to do with me, he'd never heard of senior registrars, I don't think, but he went on from strength to strength. He picked up on that and said these are the consultants-in-waiting as it were. And so, Peter [Barnes] and I were in the same year at university and we shared this with Teddy, these senior registrar courses which went on for many years, and David [Allen] was the organiser of these. This was very much Teddy's style, bringing people together.

I heard a few minutes ago the word ‘governance’. Well, Teddy would never have used the word governance, I'm sure. It frightens me to this day. It implies more of a top-down approach, rather than a bottom-up approach to the smooth running of a hospital. And I often think that governance has a lot to answer for, quite honestly, although I can understand its purpose. But Teddy was very much ‘Make sure everything's working at the ground level, that people talk to each other, they know what each other's jobs are, that the consultants know what the GPs are doing, that the consultants know what the treasurer is all about, and also what the general manager's responsibilities are’. If people understand each other, they get on well together, and if they get on well together, then things will work smoothly. And then suddenly, you get an aberration like Nigel Farage and everything becomes disjointed, but he [Chester] would have kept out someone like that, I'm sure. Smooth working from people sharing relationships.

Stephanie Snow

Was that part of your training when you were on the scheme, Robin and David Robson?

David Robson

Yes…well, in one very small way. Our first attachments, straight off within the first month, was to an individual general hospital. Wherever possible, people like John Pantall and his

predecessors, they arranged for us to live in the junior medical staff accommodation. Because he [Chester] said ‘Look, you're both more or less the same age, more or less the same level of your careers and therefore you can talk to each other, you can begin to understand each other’, which I think is exactly the same point that you're making.

David Grimes

Yes, it is.

Robin Stewart

We got to know the place from the bottom. I was attached to Dumfries Infirmary, and lived in a flat with a registrar. It was for a married registrar, he wasn't married, so I got to share the flat with him, and the junior medical staff residence dining room, much to the annoyance of at least one of my colleagues there, and worked from the bottom. For example, the Secretary of the Hospital Board there who looked after what I was doing said ‘You're going to join the ambulance service first and you'll see the area that we use, you'll see how people come to the hospital. And then you're going to the outpatients department and the registry, and see the register and people signing in’, and so on and so forth. And then all the other different departments, including sitting in the operating theatre and in a labour ward, much to the annoyance of the matron of the maternity hospital – she was frustrated because I had to sit in on at least one birth. So, we started at the bottom and got to know the work of every single department. When I was home in Edinburgh at Hogmanay I was able to regale my friends with the fact that the previous day I'd been at a post-mortem.

John Pantall

There was quite a lot of hostility in many hospitals toward administrators on the part of clinicians. They were ‘9 to 5’ people, they didn't share the nights, the weekends, all the problems. And I think the approach in that sort of first period was to get into clinical and care services, but also getting over to clinicians that actually you're interested what happened at nights and weekends, and so on.

Robin Stewart

Yes.

John Pantall

And that I think was quite an important thing.

Teddy, incidentally, I'm not sure what year, did get into teaching the final year medical students about…let's call them admin. type things. But it was interesting – it was a Friday afternoon at 3.30.

Robin Stewart

Yes, you're quite right on all these things. Staying in the hospital at night – so we got to see the work of the hospital. I was sharing a flat with a registrar in surgery – he was on-call. In the evening when he was called, I went in with him to see what he had to do and be in the theatre while he was doing something. I also got to know the nurses in the paediatric department who had a line of cots of babies to be fed, and I actually fed some babies, which would have been to the horror of the mothers who sent their sick children to hospital for expert care.

Stephanie Snow

David Allen and then Peter Barnes, you wanted to come in.

David Allen

I was just wondering whether John [Pantall] might know – were you called ‘Teddy Boys’ in your day?

Robin Stewart

Yes.

David Robson

That's why I'm wearing this tie.

David Allen

Oh, there you go.

David Grimes

Oh, very good, excellent.

Stephanie Snow

Could we have the story about the tie at this point?

David Robson

Oh, alright. After…I suppose it was probably after there'd been about three or four intakes, and…as has just been said…we were thought of as Teddy's children, if not boys entirely. So,

we thought ‘Well, we should have something to mark our presence’. And so somebody who was from the first intake, a guy called Ken Bales got volunteered to go and find out how we could get some material made up into ties, and…well, ‘Can I avoid making a loss?’, I think was his main worry.24 And so he turned up at one of these weekend gatherings with a whole boxful, probably a gross or something of these ties, and because there weren't anything like 144 graduate trainees, or even people in training in Manchester by that time, those of us who were there were encouraged to buy two, so that Ken wouldn't be out of pocket.

Sally Sheard

And what did they give to the women?

David Robson

I can't remember the answer to that, I'm afraid. I have a vague recollection that some of the material may have been made up into neck or even head squares. The material was purpose designed and woven, as I recall: certainly, it was supplied by Moss Bros.

Peter Barnes

Were there women on the course?

Robin Stewart

Not on our intake, the third intake at Manchester, but there were in the first two, and then others after us. It just so happened in our year that there were none.

David Robson

We were all male, I'm afraid.

Stephanie Snow

Peter Barnes.

Peter Barnes

I want to pick up on what David [Grimes] was saying. My recollection, which may be faulty, but I think in this it isn't, is that I first met Teddy Chester as a registrar in 1971. And he was running courses then for junior doctors. There weren't any consultants on those courses. At that

24 Kenneth Bales (1931-2011) went on to be Regional Managing Director of West Midlands Regional Health Authority from 1984 to 1992.

time, I was the junior representative on the medical staff committee at Manchester Royal Infirmary, where I was never asked to say anything, and if I said anything, it was totally ignored. And the general attitude amongst the senior staff against towards the administrators, as they were called, was that they were people with a job to do, but they are the staff and we're the owners.

Later, when I was a consultant and chairing a medical staff committee, one of our obstetricians, who had been a gunner in the air force, said ‘The only way to negotiate with an administrator is with your foot on his throat’. What I'm getting at is that I wonder if Teddy understood the sensitivity and whether or not management was a theme that he was pursuing, without sensibly naming it at the time.

Many of you will remember the kind of hostility after the Griffiths Report.25 And clinicians, by and large, the senior ones especially, were opposed to the whole idea. I used to be allowed to go to these things when I was a junior doctor and my consultant said ‘Oh, you're going off to be brainwashed again’. I think there's an attitudinal difference that perhaps Teddy Chester understood and would have avoided the use of management even though that was what he was pursuing. And I think the idea that he was running courses for juniors at the same time as running courses for senior juniors and consultants, demonstrates the wisdom of knowing that there's an upstream that needs to be dealt with.

Stephanie Snow

Thank you. Michael Lambert, did you want to come in?

Michael Lambert

Just a very brief comment from material from the archives again, that in terms of the correspondence that Teddy Chester had with the Vice-Chancellor [John Stopford] and John Pater and those in the Department of Health – it's always referred to in official language as the ‘administrative scheme’, but whenever he's published about it or running curricular material, it's always referred to as training in ‘general management’, even from 1958 to 1959 onwards.26

Sally Sheard

That's interesting.

Stephanie Snow

Yes, it is.

25 The ‘Griffiths Report’ was the outcome of the 1983 NHS Management Inquiry led by Sir Roy Griffiths which argued for the introduction of ‘general management’: http://nhshistory.net/griffiths.html. 26 UMA, VCA/7/406/1, ‘Postgraduate Management Training at a University’, February 1958; Chester to Stopford, 28 November 1956.

Kieran Walshe

It only became the ‘management training scheme’ in 1984, around the time of Griffiths, that's when it got renamed.

David Allen

They changed the name of the…equivalent of the Royal College for administrators. Duncan Nichol was running it at the time.27 Duncan changed it overnight to ‘general managers’.

Kieran Walshe

Yes, the Institute of Hospital Administrators had become the Institute of Health Services Management. It's now, I'm afraid, something of a figment of it’s past. It doesn’t really exist anymore.

David Allen

Yes – the point being that Duncan [Nichol] grasped the aspect that his cohort, instead of being administrators, was going to be the general managers – so, cutting out the nurses and other people.

David Grimes

But we're in the era then of the pressures upon the health service building up. It was technology driven, and once open-heart surgery got going, dialysis got going…other things…there were pressures on the service and there wasn't adequate funding, and so choices had to be made. And this is the issue, isn't it really. Administration is fine when there are no choices to be made. When choices are to be made, that's when you need management, which means something rather different. It's changing the sense of direction.

I remember very well in some of our courses, when the financial pressures were upon us, that the senior registrars and consultants, young consultants, like myself at the time, would get very angry that there wasn't enough money and say ‘We must get more funding’, and it became a political venture. As Teddy would put it, ‘Making the rules is politics, running within the rules is management. This is what we do. We're not being politicians, we're being managers’. And he went on a little bit further – ‘I can understand your frustrations, but don't forget, frustration is the difference between expectation and reality. We can't change reality, so let's see what we can do about expectations’.

27 Duncan Nichol was Regional General Manager of Mersey Regional Health Authority from 1984 to 1989 and President of the Institute of Health Service Management from 1984 to 1985, then Chief Executive of the NHS Management Executive from 1989 to 1994.

Stephanie Snow

Thank you.

Before we break, I'd like to touch briefly now on the other Manchester activities that Chester was involved in, for example, setting up the extra-mural department. And perhaps, David Allen, you could start us off by talking about your experience of doing a PhD at Manchester.

David Allen

Yes. I came to Manchester in 1970 with the specific aim of getting a PhD. I was as a visiting lecturer in management science in the Business School, and I was pointed towards Teddy Chester as a suitable, effective supervisor. I'd come from the Rand Corporation in Santa Monica, and spent my time on cost effectiveness, cost benefit analysis, programme budgeting systems, and all that sort of stuff. So, it was an opportunity to apply those rational models to the medical services. But I found that it was very difficult because, as the two doctors here know better than me, the patients come in with different conditions, get treated in different ways, come out in different ways, and it's very difficult…you can work out and give an estimate of the cost, but what are the benefits? And it took ten years before a better brain than mine came up with QALYs.28

So, I found I couldn't do it. I still needed a PhD and Teddy pointed me towards the Enoch Powell 1962 Hospital Plan.29 If decisions are so difficult to be made with rational models, how do you make them? And so, I studied the 1962 plan for four years or so, came out with a PhD, which was published, and all the rest of it. And I'm very grateful. Teddy delegated the actual supervision to his deputy, but Teddy made major inputs in terms of ideas, in terms of context. He set me up with Enoch Powell and with the senior people, like Sir George Godber, who were involved in the 1962 plan.30 It was very interesting, to actually discover descriptive decision- making in academic terms. So yes, that's my PhD.

Stephanie Snow

John Pantall.

John Pantall

Certainly, Teddy, soon after he was appointed, got involved with the extra-mural department in developing management courses. I know in the archive there's some correspondence from 1958 with adult education, so it already was twin tracking in a way. He’d got the National Training Scheme and the health interest, but he was also pursuing the broader management

28 Quality Adjusted Life Years. A cost-effectiveness measurement used widely, including in Britain, to assess the viability of different health interventions: E. Mackillop and S. Sheard, ‘Quantifying Life: Understanding the History of Quality Adjusted Life Years (QALYs), Social Science and Medicine, Vol. 211, 2018. 29 Enoch Powell (1912-1998) was Conservative MP for Wolverhampton South West from 1950 to 1974, Ulster Unionist MP for South Down from 1974 to 1987, and Minister for Health from 1960 to 1963. In 1962 Powell announced the development of a new generation of District General Hospitals. 30 Sir George Godber (1908-2009) was Chief Medical Officer for England from 1960 to 1973.

interest, and those continued. And before the announcement by the Wilson government on the ‘white heat’ of technology – setting up business schools, Teddy had already developed a further course which was really a transition course for people who were specialist managers but were moving into general management, which was an interesting area – you're good at your specialty and then you get promoted and you're crap.31 So he certainly had a long history with the extra- mural adult education etc. I'm never quite sure where, later on, the divide was and at what point some of them actually got brought within the Business School, but he did cultivate people. So, in relation to the industrial attachments that was an elective for trainees, Teddy looked to big companies, I know ICI [Imperial Chemical Industries] was one, and he actually had good connections with senior managers in ICI. So, he was twin-tracking in a way. And, of course, when it came to the Business School being set up, he’d got quite a lot of general support, and even though he didn't want to get into the Business School himself, he wanted to make sure his bit of the action was, I think, protected.

David Allen

Yes, you've mentioned his role in setting up the Business School – that is his major achievement. And probably you know, Kieran, more about the history of it than I do. I came in in 1970 – the Business School was set up in 1968?

Kieran Walshe

1965.

David Allen

1965. Well, I don't think we actually moved…it didn't move into the places…

David Grimes

It was in Piccadilly originally.

David Allen

It was in Piccadilly, yes.

John Pantall

I worked down there from 1967 to 1970.

31 Speech by then Leader of the Opposition Harold Wilson (Baron Wilson of Rievaulx) (1916-1995) to the Labour Party conference in 1963 which argued for technological change.

David Allen

Did you? A converted showroom. Then we got this fancy place across the road which has been changed now, of course. But he [Chester] was a major mover in that, and along with a number of other people, including Reg Revans, who had his way. But McClelland was appointed – outsider, Oxford, a tutor in management I think, at Balliol. Is that right, Kieran, do you know the details?

Kieran Walshe

Grigor McClelland is this? I don't know anything about his background, but yes.32

John Pantall

He ran a retail chain.

David Robson

Laws Stores in Newcastle.

David Allen

Teddy continued to be a member of the board, and very active in that. Douglas Hague, who was Mrs Thatcher's economic advisor, was on it.33 And he [Chester] put his oar in quite a bit.

Stephanie Snow

So, to what extent was the success of establishing the Business School reflecting the success of the administrative training scheme?

John Pantall

I don't think there was any initial connection, because Teddy kept ownership of his health activities. When I worked at the Business School from 1967 to 1970, the Professor of Management Development, a guy called John Morris – I persuaded him that it would be good to have a briefing seminar for NHS people about what the Business School did.34 Teddy took objection to that and then got the Vice-Chancellor to explain to Grigor McClelland that

32 Grigor McClelland (1922-2013) was Managing Director of Laws Stores from 1949 to 1965 and from 1978 to 1985, and Director of Manchester Business School from 1965 to 1977 and Professor of Business Administration from 1967 to 1977. 33 Sir Douglas Hague (1926-2015) was Professor of Managerial Economics at Manchester Business School from 1965 to 1981 and a member of the Prime Minister’s Policy Unit from 1979 to 1983. 34 John Morris (1923-2005) was Professor of Management Development at Manchester Business School.

anything to do with management in the health field was Teddy Chester's. Doing research was okay, but…

David Allen

Not his stuff.

John Pantall

And so the first person who actually did an MBA [Master of Business Administration] from the health field was a guy called John Cooper, or Ted Cooper, depending which epoch you knew him in, who worked for Sheffield Regional Hospital Board…the Deputy Secretary to the board was a guy called Maurice Naylor, who was really influential, and both Revans and Chester had a lot of connections with…I don't know if you've found anything, but that was quite important.35 It wasn't until 1972 that somebody came from the NHS to do an MBA. I think he [Naylor] is still alive aged 98. He was behind management education. But Teddy held back the Business School from getting into the health field and I guess the public sector more generally.

David Allen

Teddy had the credibility of running these programmes, so he could use that credibility to be on the board. There was the Robbins Report in 1963 and competition between all the different places, and I think Teddy was involved in that.36

Kieran Walshe

Harold Wilson…the Robbins Report…the ‘white heat of technology’, it was that era. The Robbins Report recommended setting up Business Schools on the American model, and London Business School and Manchester Business School were founded with a big chunk of money.

David Allen

It was the politicking Teddy got into, I think.

35 John Cooper undertook the National Administrative Training Scheme in 1965 and completed an MBA at Manchester Business School in 1971, going on to be Chief Executive of Hammersmith Hospitals NHS Trust from 1994 to 2001. William (Maurice) Naylor was Secretary of Sheffield Regional Hospital Board from 1963 to 1973. 36 Higher Education: Report of the Committee Appointed by the Prime Minister under the Chairmanship of Lord Robbins 1961–63, Cmnd. 2154 (London, HMSO, 1963).

Kieran Walshe

Yes. But the Unit [Health Service Management Unit] remained separate from the Business School right up until the 1990s. It was one of a number of units the university had which were described as ‘extra faculty units’, kind of little floating bits of the university, and the organisation eventually rationalised that and moved the unit into the Business School in the late 1990s.

David Grimes

The importance of the Business School as a structure to Teddy was very profound, because of its residential accommodation. I mentioned these courses for general practitioners, consultants etc. and Teddy bringing them together – he didn't want people to sit together in a lecture theatre or a seminar room. You were to eat together and to drink together. Sleeping together might have been a bit…

David Allen

Extracurricular…

David Grimes

…beyond what he was expecting, but nevertheless…The Business School allowed the social dimension brilliantly. That was very important to Teddy.

David Robson

Can I just add in that one of the things which the Business School did in the 1970s was running three-month management courses…

David Allen

Twelve weeks, yes. I taught on them.

David Robson

…and the NHS made use of that. I was working at the time at St Thomas' Hospital and the governors there said to Bryan McSwiney, ‘Right, you may send one person each year to a Business School of the appropriate person's choices’.37 And so at least two of us came to Manchester on different courses, and would have said that the mixing of the disciplines and careers of all the people…I can't remember how many we were…about 30...was very very

37 Bryan McSwiney (1920-2011) was Clerk of the Governors of St Thomas’ Hospital, London from 1962 to 1974.

Teddy-like. I think Teddy actually was a visiting contributor to the one I went to. So, he didn't totally ignore what the Business School was doing.

David Allen

When I took over the management training for doctors for the region, Peter [Barnes] became one of the members of what succeeded that – your course was considerably shorter, I think…two weeks, three weeks, or something like that…but we continued to send people to the Business School on pure management courses.

Stephanie Snow

Yes, and we'll talk about that in more depth after the break. Any final reflections on the things we've covered so far, before we stop?

John Pantall

I made the point earlier that I think what's important is his [Chester’s] style of influencing etc. He cultivated and built relationships. But he was very selective. When we got overseas visitors or people on sabbaticals, he said ‘Yes, we'll happily have you for a month’. Teddy would decide whether they were going to be valuable or not to him, and if they weren't, after ten minutes he'd say ‘John will look after you’. And very occasionally, he actually misjudged the importance of someone. I remember we had strong connections with the Catholic University at Leuven, because Jan Blanpain the Professor of Public Health and Teddy were instrumental in setting up the first European association…now it's called the European Health Management Association.38 So Professor Blanpain said ‘Oh, I've got so-and-so’, and Teddy didn't realise that the guy had been the Rector of the university in…I don't know whether it was Leopoldville or Stanleyville in the Congo…and when the Belgians came out of the Congo, there were lots of people came over, and this guy was high up. But Teddy didn't understand really where he fitted in his scenario.

One of the other things he did – when he went to conferences or was a speaker, anybody he thought would be a useful future contact, he would write them a little letter afterwards – and I'm sure you've found in the archive some of these – and send them a copy of one of his articles, normally from ‘Bank Review’. He had that technique of cultivating the people he wanted to, but he was quite ruthless in some ways of discarding people.

The other thing he did was…he went for shadow politicians. I never knew whether he had contact with Enoch Powell, but Enoch Powell was Minister of Health when Teddy was appointed to the Lycett Green inquiry.39 Enoch Powell signed off the names, but I never knew and I never thought at the time of asking Teddy, although Teddy was very interested in the capital programme. He then got the shadow Labour minister, Kenneth Robinson – he said

38 Jan Blanpain (d. 2019) was Professor at the Medical School and School of Public Health, Leuven University, Belgium. 39 Report of the Committee of Inquiry into the Recruitment, Training and Promotion of Administrative and Clerical Staff in the Hospital Service (London, HMSO, 1963).

‘John, you can invite Kenneth Robinson to so-and-so to trainees’.40 He pursued that policy. He invited Sir Keith Joseph when Sir Keith was a shadow, to talk to a very selected group of people, and it meant when these people became Ministers or Secretaries of State then it was going to be much easier to get them to Manchester.41

Teddy also linked that to the private office. So, Teddy would get to know the Private Secretary, and one of the ones, particularly in 1974, was Norman Warner, now Lord Warner.42 And in that way, it meant he'd got two strands – if he'd invited the Minister before he became a Minister, and if he’d got the private office. Just after Teddy retired, there was some legislation with joint planning and he got David Ennals, who was Secretary of State in 1976, to come and kind of launch the new strategy at the Manchester Business School.43 He was quite clever, but he was very selective. If he didn't rate you…

David Allen

He was a great networker. Everybody does it, but Teddy was an expert at it. By the way, he did know Enoch Powell – that's how I got to interview Enoch Powell. He wrote to him and said ‘Mr Allen wants to do this’…down in Sloane Square there in his little study…‘Sit down Mr Allen’.

Kieran Walshe

That strategy lives on. I heard Julia Cumberlege describe that strategy as ‘Stay ‘in’ with the ‘outs’’, which I think was a nice way of putting it.44

Stephanie Snow

That sounds a very good note on which to take a pause.

[Adjournment]

40 Sir Kenneth Robinson (1911-1996) was Labour MP for St. Pancras North from 1949 to 1970 and Minister of Health from 1964 to 1968. 41 Sir Keith Joseph (Baron Joseph) (1918-1994) was Conservative MP for Leeds North East from 1956 to 1987 and Secretary of State for Social Services from 1970 to 1974. 42 Norman Warner (Baron Warner) was Principal Private Secretary to the Secretary of State for Social Services from 1974 to 1976. 43 David Ennals (Baron Ennals) (1922-1995) was Labour MP for Dover from 1964 to 1970, for Norwich North from 1974 to 1983, and Secretary of State for Health and Social Services from 1976 to 1979. 44 Julia Cumberlege (Baroness Cumberlege) was Parliamentary Under-Secretary of State for Health from 1992 to 1997.

Stephanie Snow

OK. Could we start by picking up with the 1974 NHS reorganisation? It would be really interesting to tease out what involvement Chester had with that.

John Pantall

I think what was interesting was how long it took to come to fruition. It was during the time that Robinson was Secretary of State that the first Green Paper came out in 1968, and it wasn't until 1972 when…I never know whether it's greenish-white, whitish-green…the White Paper came out, which then provided the basis for the legislation the following year.45 But four years is quite a long time…change of government, secretaries of state…after Robinson it was Crossman, then it was Sir Keith Joseph.46 And of course we also had the Redcliffe-Maud Report on local government, which fitted with what was being proposed.47

Teddy was asked then to start the training for chief officers from the existing authorities of the tripartite structure in 1972. By the time we got to 1974 we had to have some refresher courses for some people. I think Teddy took a personal interest. When we started off with four-week courses, he was there all the time. Another colleague and myself were the kind of full-time tutors, but working directly with Teddy in that way was quite interesting.

Stephanie Snow

And to what extent do you think the ‘consensus management’ model that came in with the 1974 reorganisation reflected Chester’s style of training and direction on the national administrative training scheme?

David Grimes

I thought that was just perfect. That's what Teddy was trying to achieve – consensus. Now consensus doesn't come very well to consultants. A colleague of mine was chairman of the directorate of surgery in the hospital and I said ‘It must be wonderful for you having a directorate of eight consultants’. ‘No’, he said. ‘It’s not like that. I've got eight directorates, each of one consultant’. So, the individualism was there.

But clearly consensus was the big thing, and that's what Teddy was so good at – making people realise that you can't get by without consensus management. It was the first time that, professionally, GPs and consultants had got together. They might have got together on the golf course, but even then, they might have been members of different golf clubs for all I know…they probably were. But bringing them together onto one management team…it was

45 The Administrative Structure of the Medical and Related Services in England and Wales (London, HMSO, 1968); National Health Service Reorganisation: England (London, HMSO, 1972). 46 Richard Crossman (1907-1974) was Labour MP for Coventry East from 1945 to 1974 and Secretary of State for Social Services from 1968 to 1970. 47 Royal Commission on Local Government in England, Cmnd. 4040 (London, HMSO, 1969).

the ‘Grey Book’, wasn't it, I remember at that time…This was the big thing that Teddy was so good at – trying to sell consensus in a very informal way.48

Sally Sheard

Phil, do you want to add in anything at this point? We did a Witness Seminar on the 1974 reorganisation last year and Phil's been doing some work on the role of management experts and how they contributed.49

Philip Begley

From our Witness Seminar and the other research we've done, our thinking has very much been that the 1974 reorganisation…the Grey Book, consensus management…was a compromise that it was natural to reach between all the different interest groups working in the health service. As you say, in some areas consensus management did not work very well because of the particular individuals, the particular traditions of how things worked in those areas, but in others, it did work quite well where you had people on the ground – senior doctors, hospital administrators – who perhaps thinking like Chester, had worked in that kind of collegiate way before. So, I don't think there's really a universal picture in how those reforms worked on the ground. We've spoken to some former NHS administrators who trained with Chester and took on board his style of thinking – working collegiately, as you say – and I think they tend to see the 1974 reorganisation as less disruptive and less dysfunctional than others who came from a different tradition.

David Robson

I would say the opposite of dysfunctional. As far as I was concerned, that period in my working life was the most a) enjoyable, and b) I think, effective, because, and maybe we were lucky – we were a group of people who worked very closely together, very happily together, and the GP and consultant input was fairly consistent for quite a long time, for probably a period of up to four years – but even so, the sort of nominated appointing group of professional people on the GPs’ and consultants’ side managed to find somebody who was happy to fit in with the permanent people who were there on an appointed basis. Certainly, as far as I personally was concerned, I think general management was a disaster in which I didn't seek a GM appointment, even though in Worcester the consensus style District Management Team continued.

David Grimes

That's why it was a disaster.

48 Management Arrangements for the Reorganised National Health Service (London, HMSO, 1972). 49 P. Begley, S. Sheard and E. Mackillop (eds.), The 1974 NHS Reorganisation (University of Liverpool, 2017).

David Robson

No, it wasn't…

John Pantall

I think what's interesting of course is two years after this major reorganisation a Royal Commission was set up.50 You've got to ask what led to it being set up so quickly. I think back to…the Grey Book was mentioned…each of the four parts of the United Kingdom had their separate…I think it was the ‘Red Book’ in Wales and there was probably a ‘Black Book’ in Northern Ireland, and so on…but there was quite a lot of consultancy expertise. So, in England, the Department of Health had McKinsey advising them.51 John Banham used to come regularly. Teddy liked John Banham.52 He became CBI Director later on…

Kieran Walshe

The other key figure was Robert Maxwell.53 He was McKinsey’s lead officer on it and became Chief Exec. of the King's Fund in the 1980s.

John Pantall

My experience afterwards…I did some very slight work looking at the meetings of the new health authorities, and obviously talked to people involved. One thing I found was variability. One trick of consensus management was if the representative of the consultants was wanting to disagree with what was going to be discussed, he probably absented himself from the meeting. There was one particular London teaching hospital where this was happening. So, in theory they had a consensus team, but if it came to a current issue…can you actually get a representative consultant, can you get a representative GP? If places did, fine. If they didn't, which I don't know the extent, but certainly I saw one very good example on doing some more in-depth work with them, of the consultant rep. in particular actually playing the game.

Kieran Walshe

Have you found much in Chester's papers about the 1974 reorganisation and his engagement in it – letters or other materials?

50 Report of the Royal Commission on the National Health Service, Cmnd. 7615 (London: HMSO, 1979). 51 See P. Begley and S. Sheard, ‘McKinsey and the Tripartite Monster: The Role of Management Consultants in the 1974 NHS Reorganisation’, Medical History, Vol. 63, No.4, 2019. 52 Sir John Banham was a consultant with McKinsey and Co. from 1969 to 1983 and Director General of the Confederation of British Industry from 1987 to 1992. 53 Dr Robert Maxwell was a consultant with McKinsey and Co. from 1966 to 1975 and Secretary and Chief Executive of the King’s Fund from 1980 to 1997.

Stephanie Snow

Nothing at the moment, but I've only skimmed it, I've not done anything in-depth. So, there could well be stuff there. Michael, did anything come in the archives in relation to 1974 that you picked up on?

Michael Lambert

Nothing meaningful, but that's because it's mainly material that relates to the faculty, the department and the Vice-Chancellor that survives.54

Robin Stewart

One question of relationships that did come up with us in 1974, when we became a health board instead of a hospital authority – the man who had been Medical Officer of Health for the county was not pleased not to be appointed Chief Medical Officer of the health board. He was not accustomed to working under any other chief.

John Pantall

You still of course Robin, in Scotland, had for a long time, after they'd been liquidated in England, Medical Superintendents. I remember when Willie Farquhar was doing his final job – Willie was a trainee at Aberdeen Royal Infirmary.55 The boss guy he was working to was a Medical Superintendent, and that was very different, because I can't think of, outside of psychiatric and the mentally handicap field here in England, there were many acute hospitals with the equivalent of a Medical Superintendent. Of course, in 1968 we had the Cogwheel Report on medical organisation, and I did a little evaluation at Manchester Royal Infirmary on it for them.56

Robin Stewart

Certainly, when I was in Glasgow – Glasgow Royal Infirmary, 1963 to 1970 – there was a Medical Superintendent. I never thought of him as being manager of the consultants. I just thought he was a person who helped to smooth the way in the office, rather than being a director of the rest of the medical staff.

54 A letter from DHSS to Chester about the NHS Reorganisation courses and seminars he ran for existing administrators, but with little about their substance, is retained in the University of Manchester Archives: VCA/7/937, Williamson to Chester, 23 August 1974. 55 In the course of his career Willie Farquhar was also a staff officer at Tayside Health Board, and a member of the Management Executive for the National Health Service in Scotland and the Clinical Resource and Audit Group. 56 First Report of the Joint Working Party on the Organisation of Medical Work in Hospitals (London, HMSO, 1967).

Peter Barnes

I was a Senior House Officer at Baguley Hospital, which has now been assimilated into Wythenshawe. It was a standalone TB [Tuberculosis] hospital, and because it dealt with chest diseases – it's one of the places where cardiac surgery was being developed, alongside Manchester Royal Infirmary – I was there in 1968 and there was a Medical Superintendent there. He was Scottish, funnily enough.

Stephanie Snow

And that's a very good entry into thinking more about the management programme that Chester set up for clinicians. So perhaps, Peter Barnes, you'd like to continue, because you referred earlier to your first meeting with Chester through attending one of those sessions.

Peter Barnes

I must admit, from the first meeting with Teddy I was enthralled. Maybe it's because I was a young guy, but he was talking a language that I'd never heard before. It was inclusive. Did I read somewhere he that might have had early work dealing with divorces or counselling?

David Allen

Yes.

Peter Barnes

I thought that shone through in the way we'd go to these meetings and we'd sit round, not in a circle, but in an oval, because that was the shape of the room, and he would introduce a topic and then invite us to talk. And he would masquerade as a facilitator – I say masquerade because I'm sure he was driving the conversation subtly in the direction he wanted it to go. But I was impressed a) with his style – the notion that even as juniors, we had opinions that might be worth listening to and nurturing, and b) his comprehensive knowledge. Did somebody quote…‘He's got a good memory but nothing's original?’ Whatever came up, he could produce… I never knew whether it was right or not…but he would answer it factually – ‘We spent this much this year, and that much last year’, and I was just incredibly impressed.

Then there's one little anecdote…I honestly can't remember what I was talking about, but he let me go on and on and on and on, and what I said was greeted with stunned silence. And afterwards, he said ‘What was all that nonsense you were talking?’ And I said ‘Well, why didn't you stop me?’ And he said ‘I just wanted to see if I gave you enough rope whether you would hang yourself’.

Stephanie Snow

Do you remember any of the topics that he would bring discussion together around?

Peter Barnes

Finance was one that impressed me, largely because of what seemed to be his comprehensive knowledge of what was spent in other countries, what was spent in our country, what was spent in this part of the world, how that spending was changing. Then there were issues about the organisation and the hierarchies, and how we might get on better together. But I was a junior doctor and I wasn't taking notes. I was just left with the impression that here was a much better way of doing things than had been my limited experience as a junior representative at Manchester Royal Infirmary. I thought he was very impressive.

Stephanie Snow

And how did that come through the rest of your career? What influence did that have?

Peter Barnes

I think I was left with a permanent feeling that there was a role for doctors in management – part of the consensus thing. I was appointed as a consultant in 1974. Chairman of the Medical Division was done on ‘Buggins’ turn’ and it soon became my turn. So, at a relative early stage – 1976 or 1977 – I was chairman of the division, and it seemed to me that it was a useful role to play and that I could interpret the clinicians' views to the managers, and the managers' views to the clinicians. I don't think I invented anything, but I felt it was an incredibly useful role, being able to get the two sides to talk to each other, and I'm sure that's something that had come down from Teddy's view.

John Pantall

I think it's interesting the sort of research Teddy had got going – I'm not thinking of PhD students but the actual research. Two examples – one, he had what was probably an almoner, a hospital social worker, to actually analyse, in probably three hospitals, length of stay for common conditions, surgical conditions, and then try and identify what contributed to the difference. The mythology had always been that it was because of clinicians, that they really decide. But what he found from the research was lots of organisational factors, like if you admit someone on the house officer's half-day, that initial bit is not going to be done until the next day. And that was quite interesting for Teddy, actually looking at getting work done and that detail.

The other one was, he studied what happened to a number of Department of Health circulars – what were called pink circulars – where there was a requirement of taking certain actions, and actually finding out…outpatient waiting times, I think might have been one subject…then trying to understand what actions were being taken, whether it led to any effective change or not. That I found quite interesting for Teddy, because that was a way Reg Revans would have been interested in – looking what happened at the coalface and so on. I saw a certain similarity, which I never said to Teddy. So, he was quite interested in what might be of importance to us as end customers – getting reduced outpatient waiting times or getting reduced length of stay, avoidable length of stay, and I can't think at the moment of other things he got research on, but those were two I remember.

David Allen

David might be able to add to Peter's experience.

David Grimes

Just thinking about what John was saying there, Teddy had these established very powerful links with doctors locally within the region, particularly in Manchester and Salford, and it wasn't really carried on, apart from David Allen and the courses that we would run. The research basis didn't seem to continue at all, and I was disappointed that Manchester University did not establish a unit of health economics, because we could see in York and Bristol, for example, health economics being a big thing and we had the foundations for it here in Manchester. It never happened. I always regretted that.

Kieran Walshe

Well, there is one now.

David Grimes

OK. Yes.

Sally Sheard

I think one possible explanation for that might be because of the very powerful lobbying of the Department of Health and Social Security by Alan Williams and Alan Peacock at York. They were doing that through Gordon McLachlan at the Nuffield Trust, and I wondered whether Manchester had a similar advocate within the King's Fund.57 Was there any…

Kieran Walshe

Why within the King's Fund?

Sally Sheard

Well, because there was rivalry in terms of the training schemes, but there was also collaboration between Chester and the King's Fund. I wondered whether there was any sense in which Chester used the King's Fund as his advocate with the Department of Health at the time?

57 See E. Mackillop, S. Sheard and M. Lambert (eds.), The Development of Health Economics and the Role of the University of York (University of Liverpool, 2018).

John Pantall

Just on this general subject of collaboration – we did have a meeting at the beginning of the 1960s of the various interests in the University, with a view to forming an institute. And in the end, Teddy probably got the idea sunk, because I think he saw a loss of control, and so on. I was the bag-carrier…junior person…’John, take the minutes’. It looked promising and then it came to nought, but there were a tremendous number of people doing work and research and development in the health field. We tended to use a lot of them on our courses for trainees, so there was no barrier to that. There was one tutor and one secretary from the training scheme, so we weren't in this position that Reg Revans once said – ‘If you didn't do it this way, you'd have a lot of redundant lecturers’ – because we used people etc.

Health economics, David, I'm just trying to think. Later on, we got onto that, much later, with Bob Steele and so on, who was a disciple of Gavin Mooney.58 But we lost an opportunity in the early 1960s.

David Allen

Just to go back to what you were talking about with Peter [Barnes] and the SRs [Senior Registrars] – David [Grimes] was also an early member of the SRs and you participated, David, in the management of it eventually, didn't you, and taking over the organisation of that with Teddy, before I arrived?

David Grimes

We were just talking over coffee – Peter and I were saying we've been together now for fifty- eight years, haven't we? 1961 until 2019. We started together and we're still together. Yes, and we both follow very, very similar lines, very, very much under the stimulation of Teddy Chester, quite honestly. I sometimes think that I was a pretty useless Medical Director. I think I was a pretty useless everything really, but particularly Medical Director, because I was very much in…as you said about the superintendents smoothing the waters. I saw that as my role, to smooth the waters, rather than to sort of drive the organisation forward. Smoothing the waters – that was the style I got from Teddy I'm afraid, whether it was good or not, I don't know.

Kieran Walshe

Picking up on Sally's point earlier – I do think that the national versus regional dimension is interesting to think about because, certainly when I came to Manchester, Regional Health Authorities were very strongly present in shaping what happened in their regions. So, the regional chairs and the regional administrators were really big figures, and the regions had very different traditions. So, for example, the West Midlands tradition was really very different from the North West tradition. Similarly, the four London regions were different. So, I wonder…I'd be interested in people's views…whether Chester was actually more regionally focused than

58 Gavin Mooney (1943-2012) helped to established the Health Economics Research Unit at the University of Aberdeen in 1977, and later became Professor of Health Economics.

he was nationally focused. And it's still true that national politicians go to the King's Fund and the Nuffield Trust in London, and the Health Foundation these days, because they're just around the corner, and they're much less likely to come to groups like us unless we make an effort to manage that relationship.

What has changed is that those regional structures over the last twenty years have been substantially atrophied. There's a bit of a resurgence now, but Regional Health Authorities were abolished and reorganised, and so on, and so that sense of regional dynamic, which was present into the 2000s…when I arrived, Joan Higgins, who was a successor to Chester, was Professor of Health Policy Management and was also chairing the North West Regional Health Authority.59 That sort of thing was much more important in those days.

Going back to your point about the relationship with the Department [of Health] – I don't think it would have been mediated by the King's Fund, but it was always a more distant relationship.

Going back to the training scheme – that was true in the training scheme as well. So, I well remember that, in my year, us Manchester trainees being so dynamic, we organised, because there hadn't been one for a long time, a national trainees’ conference. All the trainees came, apart from the King's Fund ones.

David Grimes

The gentlemen.

Kieran Walshe

Yes. And the King's Fund used to have…have you come across the October Club?

David Robson

Yes.

Kieran Walshe

Do you want to say what the October Club was?

David Robson

The October Club was open to all former national trainees, and possibly others crept in as well, but it was very much a London and Home Counties or Southern England based organisation.60

59 Dame Joan Higgins was Professor of Health Policy at the University of Manchester from 1992 to 2004 and Chair of Manchester Health Authority from 1996 to 1999. 60 Established in July 1964, the October Club sought to preserve the association between past members of the National Administrative Training Scheme and promote and encourage study into aspects of hospital administration.

Geographically, it met in London (apart from weekend events) and I first came across it when I worked in London. I did continue when I moved out to Worcester, but did in the end find I would go to weekend events, but not ones that happened on a weekday night. It was very involved with the NHS reorganisation in leading up to 1974. It wrote papers after papers on the Green Paper and the subsequent White Paper, and very much, I suppose, promoting a role for the administrative presence in the district management team, because I think the feeling was that the Department of Health was playing that down. It was very much in favour of the consensus model, where everybody who was present was an equal partner.

Kieran Walshe

It was quite London-centric…we weren't invited to join. It was King's Fund trainees primarily who joined…

David Robson

Except for us Manchester ones that went astray – East Cumbria’s Group Secretary was a regular attender.

Kieran Walshe

There was a very strong sense of King's Fund London-centric thinking in that relationship with the Department, which I think persists and has always been there.

Michael Lambert

I'd just like to exemplify that…prior to the 1974 reorganisation, there were a number of circulars which changed the management trainee system within England. So, in 1962 a Nuffield Centre opened in Leeds, and in 1967 they then reorganised the regions and increased the intakes to 15 per unit. So, Manchester by this point was allocated, Manchester, Liverpool, South Western, Wales and Birmingham Regional Hospital Boards. Leeds had Leeds, Sheffield, Newcastle, Oxford and East Anglia. And the King's Fund had North West, North East, South East and South West Metropolitan and newly opened Wessex. So, there was a reinforcement I think of this south, Home Counties dynamic versus those not in…

Kieran Walshe

Then in 1974 they expanded it to include Birmingham as a centre. So, for a long time, it was Birmingham, Manchester, Leeds and the King's Fund in London.

John Pantall

One thing that I found interesting was that after 1974 Teddy took quite a lot more interest in the membership of the new health authorities. Pre-1974 with Hospital Management

Committees, he made, I remember, one or two derogatory remarks, but generally he didn't have much interest with them. But immediately after 1974, he worked very hard, particularly with the Area Health Authorities, teaching the members, and there were some quite impressive events where he really got people thinking about their roles. The old Hospital Management Committees, he didn't really have much interest in. I don't know where he ever got invited to be a member at all, but it wouldn't have been his thing anyway.

Stephanie Snow

So, in terms of the introduction of general management, how did that play out in the interactions between clinicians on the Chester seminars and things? Because by the 1980s, David Allen, you were running those, were you?

David Allen

When Teddy retired, Gordon Forsyth took over as Director of the Health Services Management Unit.61 That was a big responsibility, so he asked me to become Director of Studies of the Unit and run the Unit, and in fact become Director of the Unit when he was on sabbatical. So, I looked after a whole range of programmes, including the National Training Scheme, and some courses for nurses. But I was responsible, with David Grimes' help, for the senior registrar… SpR [Specialist Registrar], it became…based upon Teddy's approach. There was a five-day course aimed at senior registrars just about to become consultants, to introduce them to the management, in order that when they took their interview, they could answer the questions in the interview on management, and also, once they became a consultant, they had some idea how the organisation went…who to talk to, what to say…some idea of why they couldn't get all the money they wanted. Again, there were twenty sessions asking the chief executive, the chief nurse, each one of the members of the consensus team, to talk…we got people from the Department [of Health] nationally, trade unionists, all, again, talking. I chaired the session, introduced them, they would say their bit, the SRs asked questions and it was very effective. David spent a good deal of time chairing various sessions.

David Grimes

Interesting times around the 1974 reorganisation when we were doing this. It was a time of bringing things together. The NHS in 1948 brought things together in a way, but that bringing together was consolidated in 1974 – bringing together the various management groups of the hospital, bringing together general practice, community medicine, public health, hospital consultants, and also, before that, we'd had more or less a bringing together, as mentioned, with the Cogwheel system of bringing the consultants into, supposedly, working together within the hospitals. I think it was very successful, but perhaps it was bringing too much together all at once, and then it fragmented. I think that general management was the start of the fragmentation, because suddenly we had an unequal member as it were, someone with more authority than the others. I can see the reason for this, that if a decision had to be made, often with a consensus group it won't be made, unless someone says ‘Look, we've got to make a

61 Gordon Forsyth was a Research Fellow, Lecturer and then Professor in the Department of Social Administration at the University of Manchester.

decision’…and that became the general manager. But since then, we've had a drifting apart and general practitioners and consultants don't see each other now, that's gone, they've gone their different ways. The hospitals have broken up into Trusts, we separate them off from community service etc. One thing that I always regretted was the mental health services – about that time there were a lot of scandals as to what was going on with long term mental institutions. I think the press and the government were a bit too heavy on them, quite honestly, but anyway it led to their closures. The mental health units came into the hospitals and were managed within the hospitals, and I found that a huge advantage. That's gone as well. Now the mental health units have been taken out of the hospitals, into their own service somewhere else out there. So, it's a time of coming together which I think, again, was very much Teddy's style, and I think what Peter [Barnes] and I really appreciated. I'm not quite so sure about what's been going on in more recent years, trying to create this competition. I don't think it was altogether a good thing.

Stephanie Snow

David Allen.

David Allen

I also ran a session, modelled on Teddy’s, for GPs. David [Grimes] spoke on the GP one as a consultant explaining the problems, and we got a general practitioner, David…

David Grimes

McKinlay.

David Allen

…McKinlay to talk about general practice.62 Those two sessions caused the most controversy on the courses. It was the GPs getting at the consultants, and the senior registrars getting at …David [Grimes] and I produced a book based upon the sessions, in which you can read David McKinlay's contribution.63 It was dedicated to Teddy though, that was the other point.

John Pantall

1974 didn't lead really to an integrated service, because actually what it was about was moving from the tripartite structure into one of having all the elements that…but organisationally – as happened also in Northern Ireland, where, in October 1973, a few months before the English one, they actually set up unified health and social service boards – that didn’t lead to integration. That was the problem – having the GPs paying rations through the new health authorities, didn't mean that these small businessmen were…their role was sort of altering in terms, and we're still struggling with that.

62 Dr W.J. David McKinlay was a GP in Clitheroe, Lancashire and later Director of Postgraduate General Practice Education at the University of Manchester. 63 D. Allen and D. Grimes (eds.), Management for Clinicians (London, 1982).

Then in 1976 we got legislation for joint planning, and older colleagues will remember that we then had what were called ‘joint healthcare planning teams’, which attempted to bring together. Then it became, later on, ‘joint care planning teams’. But 1974 in itself provided a different structure, but for the GPs it didn't alter their status as small business people.

David Allen

Can I just finalise the point about Teddy's clinical management courses? Teddy called them ‘management’ courses. No Business School would recognise them as management courses. They'd have sessions, like you mentioned David [Grimes], in terms of leadership teams, delegation etc. Teddy, as far as I know, didn't study that ever or have any particular support for that type of philosophy. Unfortunately, the strength of Teddy's model was such that the region never put on…well, maybe there were a few, but rarely…management-type courses that a Business School now provides. So, it's ironic that his success voided your training in terms of what we would call management theory.

Peter Barnes

I suppose I’d reflect on Teddy's courses for clinicians as understanding management…

David Allen

Yes, that’s right.

Peter Barnes

…rather than learning how to do it. I wonder – it's a bit of a digression – but I wonder how things have changed when, with the introduction of general management, there are all kinds of stories of people being brought in to run hospitals from outside and clinicians greeting with joy the fact that yet another one had bitten the dust after a year or two – reinforcing the clinicians' view that they're a different breed. I wonder now, because I retired as Medical Director in 2006 and I've not kept up with it, what the current cadre of Medical Directors is like and whether they have the view that David and I had inherited from Teddy's – enabling the two sides to speak to each other – or whether, in fact, it's been a total takeover by NHS managers and medical directors just see that as a possible step up for…I mean, I don't know.

Then there's a separate point – I was, not strictly but in effect, one of the founding members of the British Association of Medical Managers, which seemed to be doing a good job for clinician managers up and down the country for a number of years.64 But the funding was withdrawn, and I'm not quite sure whether it was seen to be useless or whether it was an attitudinal change in the department that ‘We know where the clinicians are now’.

64 The British Association of Medical Managers operated between 1991 and 2010.

Kieran Walshe

I can answer the latter point. That's really evolved due the Faculty of Medical Leadership and Management.

Peter Barnes

Right.

Kieran Walshe

That's now much more established. The Academy of Medical Royal Colleges incorporates the Faculty of Leadership and Management.65 So in a way, a bit more like, say, Australia or Canada, medical leadership is now recognised as an area of specialisation.

Peter Barnes

Oh, well – good.

David Allen

We continued Teddy's evening sessions for consultants in the Business School, where we invited along…you [Peter Barnes] chaired some of those sessions. So that still went on. I was then transferred into the Regional Health Authority, and Stephen Horsley, the Regional Medical Officer, who had done his MBA at the Business School, immediately cut those sessions, saying they were a drinking club.66 Which they were…

David Grimes

Afterwards.

David Allen

Quid pro quo after all.

Kieran Walshe

When I came, they used to be known as Teddy Chester's tea parties.

65 The Faculty of Leadership and Management was established in 2011. 66 Stephen Horsley was Regional Medical Officer for North Western Regional Health Authority from 1986 to 1994.

David Allen

Yes, absolutely. Well, tea was…

John Pantall

For Teddy, bringing people together was the point…in the evening and having a dinner. In hospitals, with drug companies, you offered lunches…and he continued with central funding from the Department [of Health] until he died. Because certainly, in the archive, I saw correspondence from Teddy to the Department about three months before he died about next year's budget, and there's quite a lot of material there…so he had that central funding.

He also did some specific things, for instance, with the dental hospital. I don't know the details but it was quite a lot of work he did. Now, how far that was tailored to what they wanted...but I think his mainstream evening activities were what they were – they were bringing people together, giving people a dinner. The session which I attended which attracted the biggest audience was the Chair of the body that did the consultants merit awards, distinction awards. That was the one that really attracted people. There were quite interesting sessions, but it wasn't training and development in the sense that it might be used otherwise, and people appreciated them.

David Allen

Yes.

Kieran Walshe

Can I ask then how much people think Chester was actually an academic? Because a lot of what you've said about him is – he's a facilitator, he's a trainer, he's an interpreter, a synthesist. But you've not said he did a lot of research, and you've also not really pointed to any corpus of ideas that people would identify as Chester’s, in the way that for some other academics you would. For Robert Maxwell, you could say his work on quality of care. For Chris Ham, who perhaps is a more recent name, you'd probably point to…although he is also perhaps more in the Chester frame…you might point to his work around integrated care. For Gordon Forsyth…

David Allen

Yes. There was substance there…

Kieran Walshe

He was more of an academic, wasn't he?

David Allen

He was an academic, but he had very little to do with this level.

Kieran Walshe

I know. So, I'm just interested in people's views about whether Teddy was really…

David Allen

He’s a different generation though, isn't he? Teddy was fifteen or twenty years older than Gordon.

Kieran Walshe

But is that a question of…

David Allen

It's a different approach. It depends what you mean by ‘academic’. You're using the current definition of academic – publishing bloody papers – but that wasn't Teddy's idea. Teddy didn't publish academically reviewed papers.

Kieran Walshe

No, I looked and I could find one paper in Milbank Quarterly – which I think, David [Grimes], you may have co-authored?67

David Grimes

I was co-author on that, yes.

David Allen

Was that reviewed?

David Grimes

I doubt it, quite honestly.

67 R. Schulz, D.S. Grimes and T.E. Chester, ‘Physician Participation in Health Service Management: Expectations in United States and Experiences in England’, Milbank Quarterly, Vol. 54, No. 1, 1976.

John Pantall

I never came across any peer reviewed articles by Teddy, because publications were either the Bank Reviews, or, alternatively, he added his name to Gordon Forsyth's…

Kieran Walshe

That's a great academic tradition.

David Allen

The other thing, of course – it didn’t matter in those days. He could hold his chair without academically reviewed papers.

Stephanie Snow

How would he have described himself?

David Allen

Genius? No. He was quite self-confident. The Business School had a European meeting, the big management thing, down in the Whitworth…early 1970s. Everybody there…big thing in the summer…and the Vice-Chancellor was invited to give a welcoming address. Unfortunately, no one had mentioned this to the Vice-Chancellor, and they phoned him up and he said ‘Oh, I'm watching television’. So, they stuck the mic in Teddy Chester's hand and Teddy addressed them, and everybody assumed that was the Vice-Chancellor. He had that sort of personality.

Kieran Walshe

He had gravitas, is what you're saying.

David Allen

Gravitas, absolutely.

Kieran Walshe

But I wasn't just asking about whether he did research…it's also, do you associate any particular ideas with Chester …any specialisms, in his work?

David Allen

I think it was process rather than...

Kieran Walshe

You think it was facilitation, it was engagement, it was networking – which has come up a lot. But it wasn't that he came up…in the way that you would associate some of those names from York with things like QALYs...

David Allen

There’s no body of knowledge associated with him...

David Robson

We have mentioned his use of numeracy in terms to illustrate what he was saying, and one thing which one of our colleagues mentioned to me when he said he couldn't come, was a thing that Teddy taught him how to do was how to round up or round down numbers so that they all sounded good, and he said ‘I have done that for the rest of my life’. So, there you are, that's his numeracy for you – make it sound real or true.

David Grimes

And, of course, Teddy's background was not academic at all, was it?

Kieran Walshe

No, it was a legal background.

David Grimes

He had a Law degree and become a lawyer, and so he came on. It's interesting to speculate why he became a Professor of this university without an academic training, as it were.

Sally Sheard

And amazingly, Richard Titmuss was the same. He'd been an actuary. He'd not got a degree and he became Professor of Social Administration at the LSE.

David Allen

Alan Walters, who was my Economics teacher, didn't have a PhD, and when I went to the United States he said ‘Don't bother with a PhD, you don't need that’.68 He also was a Private in the Army. He had too much intelligence to actually go out there and do anything about it.

Stephanie Snow

Michael.

Michael Lambert

I've just got a Department of Health and Social Security comment on this from a file that I found in the National Archives, where they're discussing Chester's approval for a research grant. I'm just going to read the top line of this. So, it's 6 July 1971 – 'I have, as you know, had reservations about Professor Chester's direction of research in the past, but I do not entirely share your misgivings about his current project, which will be developed under the general supervision of Dr Jean Heywood in Professor Chester's department'.69 So, the condition of the research fund being awarded was that Chester was not involved in doing it. I think that’s confirmation that the research separation is very much understood by the Department of Health.70

Kieran Walshe

Stephen Davies, who has done his PhD on the research division of the Department of Health, came up with some really interesting correspondence about early grants for research on computerisation in hospitals, which Chester got, which apparently, he screwed up.71 There was stuff saying ‘We're not going to give him a grant again’, which absolutely fits what you've just described.

John Pantall

Could I just say, when, after my six years working as Tutor, I wanted to continue working on my organisation development project, the Department of Health were very keen on my doing that at the Business School, as they felt I'd get research-type support there. There was that sort of underlying criticism I think of Teddy and research. If you also looked…apart from David Allen…at some of his PhD students – there were two Americans I remember – the important criterion was that they should live near him in Timperley or Altrincham, and bring him in. One was Manny English who'd been a captain in the US Air Force, and the other, John Babson, I

68 Sir Alan Walters (1926-2009) was Professor of Economics at Johns Hopkins University from 1976 to 1991 and Chief Economic Adviser to the Prime Minister from 1981 to 1984. 69 Dr Jean Heywood was a Lecturer from 1953 to 1970 and Reader from 1970 to 1976 in Social Administration and Director of Postgraduate Training in Social Work from 1968 to 1976 at the University of Manchester. 70 The National Archives, MH 166/968, Hayes to Cornish, 6 July 1971. 71 S. Davies, ‘Organisation and Policy for Research and Development: The Health Department of England and Wales, 1961 to 1986’ (Unpublished PhD Thesis, LSHTM, 2017).

think was a stronger person…I'm not sure whether he did it before or after he'd done his PhD at Manchester, but did the fast track medical training at McGill, and then went to Wyoming or Dakota.72 But Teddy didn't have a strong pattern of PhD students and they wouldn't have got supervised, I think.

David Allen

That's why he passed me on to Gordon Forsyth.

Stephanie Snow

So that leaves us with an interesting question, doesn't it – what would we sum up as being Chester's legacy?

David Allen

Well, I have very strong views about this. It is his personality, his networking – that he knew everybody that mattered, that he was a very shrewd man. He didn't believe in consensus management when it came to him…

[Laughter]

Kieran Walshe

That's a really nice way of putting it.

David Allen

He was quite forceful in many ways but he was a very, very intelligent man, who knew a lot and was very positive, providing he agreed with what you were doing. So, I think this idea of getting people together to exchange views, to talk about it, just trying to bring reconciliation, is profound.

David Grimes

Peace and tranquillity, you might say.

72 Dr John H. Babson graduated from the University of Ottawa in 1978 and is now practising in Cheyenne, Wyoming.

John Pantall

I think the way he operated, people did get influenced. One of the people…which, again, is in the archive material from the 1970s…I came across a letter from David Alliance who was a member of one his management courses.73 This is the same David Alliance who, almost forty years later, gave £15m…

Kieran Walshe

Yes.

John Pantall

…to help the Business School. When I asked people, they didn't know that Teddy had actually had this contact, and some of his contacts were very long term. So, he took the view on the training scheme – ten years…he did influence, but in a very different way. If you were comparing what more academic centres achieve and do, and how far they influence, I wouldn't go overboard on saying a lot of academic centres actually get improved quality quickly, and so on.

I think the other thing, which we've not really talked about is, Teddy had great interest in international comparisons. He went to the United States every year, to the Cornell summer programme etc., but he had a whole network of relationships. One of the things he did in his later years, probably out of one of his Department of Health budgets, was invite consuls for lunch. Very curious…he entertained people at the Business School for lunch, but they were consuls, and I think he kept up that interest in international things. Going back – and I've not been to the National Archive, but I'm sure you'll have been to the National Archive – when you look at the Advisory Council on Management Efficiency in the NHS, one of the things they looked at was the US system. I just wonder – and you'll probably pick this up when you go to Kew – whether Teddy had fed that in…the minutes will probably indicate whether he did…what can we learn from other systems? He was a great advocate of the NHS, but he did actually use his knowledge of other systems, and there are some papers occasionally in the archives of handouts, speeches, and so on.

People thought he liked travelling. I don't think he particularly liked travelling, but he actually liked that international comparison. Even in 1974-75 when I was covering for the National Training Scheme tutor who'd departed to an Area personnel field job, Teddy said ‘Well, what do they want to know?’ He didn't want to do a formal lecture. I said ‘Well, I think, Teddy, they'll be interested in international comparison’. ‘OK’. So, I said ‘Ask him about Japan’, and yes, he could talk about the Japanese system and so on. I don't know how far that influenced things here, but certainly he was sharing ideas across systems, and I think that was quite important.

73 David Alliance (Baron Alliance) was Chairman of N. Brown Group from 1968 to 2012. Manchester Business School was renamed Alliance Manchester Business School in 2015.

Kieran Walshe

There's a paper that rather nicely expresses that from 1972 in The Annals of the American Academy of Political and Social Science, one of the few papers I managed to find that he wrote, called ‘United States Hospital Costs in International Perspective’, which looks at the US, the UK, Sweden, Germany, and I think one other country.74 But it's not research, it's a kind of discursive review.

Robin Stewart

Is not part of the legacy the success and the later careers of the students that he had, both at the National Training Scheme and in the medical courses, and so on, that they took part in? It counts for something.

Sally Sheard

One thing we've not talked about, and I think it would be worth just hearing your views on this, is his [Chester’s] attitude to the increasing inclusion of women in the training scheme. Would anybody like to offer any comments on that? Because obviously, there were women in the years immediately preceding yours. There weren't any women in your year. Was there a conscious policy, do you think, to restrict the number of women accepted?

John Pantall

He [Chester] certainly told me that he had an agreement with the King's Fund to take one…this was for England…one woman in alternate years. I'm just surprised…I'd not really realised that, because in 1962 the trainee scheme then developed two strands, method B and method A, and method B acquired a lot of women. So, it never quite occurred to me, because there were women trainees around but on the other scheme. Later on, we discovered that the careers people at Oxford University were advising men to go for industrial and commercial training schemes, the big companies, but the NHS training scheme was suitable for women – the reversed attitude later. But Teddy definitely was discriminatory, and I didn’t really pick that up for a long time, because other women appeared on the other method of the trainee scheme.

Kieran Walshe

The figures for this are in the Lycett Green Report in the early 1960s, and it was 11-1 male- female, 11-1, 12-1, 8-1, 13-2, 39-3, 31-4, right through to the late 1960s when it started to even out.75

74 T.E. Chester, ‘United States Hospital Costs in International Perspective’, The Annals of the American Academy of Political and Social Science, Vol. 399, 1972. 75 Report of the Committee of Inquiry into the Recruitment, Training and Promotion of Administrative and Clerical Staff in the Hospital Service (London, HMSO, 1963).

David Allen

I did a commerce degree in 1960-63 and there were thirty of us. There were only four females on it.

Kieran Walshe

So, it might be reflective of the context.

Sally Sheard

Yes.

John Pantall

I think the other sort of legacy aspect was, thinking of the early years, where did trainees go to work? When we did the calculation at one time in the 1960s, I think 40 per cent had gone into teaching hospitals – which in a way were not the places where perhaps the greatest needs were. None had gone into Regional Hospital Boards, and the first person who went to work in a mental hospital, psychiatric hospital, was Peter Foster and that was through planned movement.76 So in terms of putting people into the system, did they go where the needs were greatest? Now, Teddy always had a view about Regional Hospital Boards – I think all but one of the original hospital board secretaries had never worked in the hospital service, so he'd always regarded it as separate and not somewhere where trainees would go. Later on, we got the spread of people working around the system, but in the early years it would have been interesting if people had actually gone to where the needs were greatest.

David Allen

A RAWP distribution, in fact.77

Stephanie Snow

Was that something to do with the elite nature that Chester promoted for the National Administrative Training Scheme?

David Robson

I don't know whether it was directly related to that. I think certainly trainees went to places where they thought things were happening. Having been given a training which was full of

76 Peter Foster went on to be District Administrator of the Manchester Central District Hospital Group and District General Manager of Salford Health Authority. 77 The Resource Allocation Working Party established by the Department of Health and Social Security in 1975 which designed a new NHS funding formula to take greater account of need.

seeing what was felt to be the best the hospital service could offer, people said ‘Well, why should we go for something which is less attractive’. The thing I can remember is that Leeds teaching hospitals attracted a huge cohort of trainees because they happened to be redeveloping the site or planning to redevelop the site, and so they got a whole planning department full of ex-national trainees. Those of us who went into more ordinary hospitals, again, did it because they had a specific area of interest. As far as I was concerned, I was attracted to West Cumberland, which people might say ‘That’s a bit out in the sticks’, because it was getting, as I think we it regarded anyway, the first complete DGH [District General Hospital] to be designed and built since the War.

John Pantall

In England.

David Robson

In England. Thank you, yes. So, we did go for something which we thought was attractive in healthcare or hospital terms.

Robin Stewart

My final year, so-called practical year of the training, was attached to Glasgow Royal Infirmary. As I was approaching the end of the year and was going to think about another job or whether I could get a job, funnily enough a post of Senior Administrative Assistant, a new post, was created at Glasgow Royal Infirmary.

Kieran Walshe

I wanted to say – the scheme itself was acute oriented. So, everyone did acute placements. Far fewer people did primary care placements or long-stay institution placements. And there's a sort of self-fulfilling effect there in that you do those placements there, those organisations quite often then talent spotted and recruited people and said ‘We'll find a job for you and bring you in’, and then those organisations were full of trainees who thought it was a good idea to recruit more trainees. It was really only in the 1990s when Primary Care Trusts were created that you started to see a lot of trainees going and working in primary care. Before that, FHSAs [Family Health Service Authorities] and FPCs [Family Practitioner Committees] were regarded – my apologies to everyone here who worked in them – as sort of career suicide to go and work there.

David Robson

When I applied to go to Liverpool Regional Hospital Board to do a research project there, the people in the acute hospital field said ‘Oh, that's career suicide’. I found it both a learning and a management challenge as well as an invitation to use those skills at St. Thomas’ at the end of the project.

David Allen

Surely it's a very similar model to the medical one – the doctors are attracted to attractive specialties, they go to places that they think they will enjoy. It's human nature, isn’t it.

Robin Stewart

We did include a psychiatric hospital in the so-called ‘Cook’s tour’ in the first year, for a month. My memory of that is that there was a cricket match between staff and patients, and when I turned up they said ‘Are you staff or patients?’

[Laughter]

David Grimes

And did you know?

David Allen

Many staff would have wanted to be a patient on occasion.

John Pantall

I think Wales was the only part of the country where, through planned movement, they started getting people into the parts that other regions didn't get people. St Thomas' Hospital, London had a big cohort of people…fine...and yet Regional Hospital Boards were responsible for implementing the ten-year capital programme, apart from in the teaching hospitals, but people say ‘Oh, teaching hospitals, great’, Regional Hospital Boards who really needed the skills didn’t acquire them. It was very nice to have people who were visiting teaching hospitals, but it wasn't perhaps where you were going to get transferable practice to spread around. I remember somebody coming to Blackburn in the late 1960s from Wales, and there was some movement, but it could have happened and had more influence I think on the service as a whole, earlier.

Sally Sheard

We did an interview, three years ago now, with John Wyn Owen about his experiences, and it was very interesting talking to him about that idea of sharing expertise and the circulation of trainees.78

78 John Wyn Owen (1942-2020) was District Administrator of St Thomas’ Health District from 1974 to 1979 and Secretary of the Nuffield Trust from 1997 to 2005.

David Robson

John was appointed by the board of governors to look at the research that was being done in St Thomas' Hospital and how that could be disseminated into hospital practice. So, he was a deliberate administrative link between the Department of Social Medicine, Walter Holland's department at St Thomas', and the clinical side of the hospital.79

Sally Sheard

Yes.

John Pantall

Walter Holland is another of Teddy's links. I don't know whether you've found anything from Walter Holland, but he was a Czech Jew who came in. He was another link with Teddy, quite a strong link.

Kieran Walshe

Was he? I didn't know that.

David Allen

It's a commentary really on the organisational structure of the health service that we've had this devolved structure – region, district. Whereas if you had ICI, Marks and Spencer or Tesco, they'd have central planning and they would reallocate the trainees as they saw fit. So, it's a concomitant of the nature of the design.

Kieran Walshe

Yes, it's off the point, but that implies you think the NHS is an organisation, which it isn't, and never has been. It's always been an industry, a collection of organisations, not a single organisation.

David Allen

Why shouldn't it be? I mean…

79 Walter Holland (1929-2018) was Professor of Clinical Epidemiology and Director of the Social Medicine and Health Services Research Unit at St Thomas’ Hospital from 1968 to 1994.

Kieran Walshe

Why shouldn't it be is another matter to discuss, but it never has been.

Stephanie Snow

Before we draw to a close, is there anything else that you think we should have touched on that we haven't?

David Robson

It's not what we haven't touched on…but somebody who couldn't be here today did write his personal thoughts, and that was Raymond Pitt who was the 1958 Northern Ireland trainee. I'd just like to share what he said because it is very much a personal feeling from Raymond: 'I have fond memories of Teddy. He was a first class academic, having a sharp analytical mind and wonderful way with words. He could turn seemingly complex concepts into something amazingly simple and instantly comprehensible. Teaching with passion, colour and humour, there was never a dull moment in his lecturers. More importantly to me, however, was his warmth of personality. As a young trainee in health service management and still rather wet between the ears, I appreciated so much the fact that he took a deep personal interest in each one of his students. He wasn't just our teacher, he was our father figure, mentor and friend. His boundless energy and enthusiasm were motivational to us as aspiring health service managers of the future. Teddy Chester was a man of integrity and sincerity, a visionary, and yet always down to earth. It was a privilege to have known him and to have been under his tutelage at such a critical time in our lives'.

David Allen

I’ll say ‘Amen’ to that.

John Pantall

Of course, Teddy knew the Permanent Secretary in the Northern Ireland department, and our second tutor here, Ron Brown, had worked there.80 So Teddy had a link at that level, although I don't ever remember him visiting Northern Ireland. He did visit the Republic, and very early on with the Institute of Public Admin. in Dublin, take part in courses at Killarney, they were held, and that was probably by the beginning of the 1960s he went there. But he did have the link, as you'd sometimes find with Teddy, with the Permanent Secretary.

Robin Stewart

I have a story which you might, again, think completely irrelevant, but it illustrates the type of person that Teddy Chester was and his relationship with people like me who had been his

80 Dr R.G.S. Brown (1929-1978) was Director of the Institute of Health Studies at the University of Hull.

students. That time that he came to Inverness and invited himself to my office, I met him downstairs, took him upstairs into my room, and I opened the door for him and he burst out laughing, because his picture of a person in the Highlands was of a person in wide open spaces with snow-clad hills and so on in the distance. Our office was next door to Inverness Prison. The wall of the prison was at least as high as the two-storey building in which my office was, so my window looked just across a lane directly, and you could only see anything other than a wall if you went to the window and peered up. That seemed to me that he was human, he was friendly and a delightful person.

Stephanie Snow

Thank you. Anyone else? Michael.

Michael Lambert

Just a personal experience really – my main approach through the research I’ve done has been through the archive, and whilst you probably won't find Teddy Chester mentioned explicitly in policy documents, once you start to get into the correspondence, the discussion, the thinking, the influencing behind the scenes, underneath the skin of the NHS, it's clear that he had a very strong influence within that. So, I think approaching it from that angle reveals these kinds of hidden legacies which aren't going to be celebrated in the way that big politicians are, but clearly had an impact on how the NHS has been organised and run.

David Allen

Yes. Different people have different impacts on the NHS. Some people could come up with significant intellectual advances, other people and personalities affect the continuation of the work of the NHS. And he [Chester] is one.

Kieran Walshe

I've really enjoyed today's witness seminar, and I enjoyed the other one I went to, which was on research and the development of the NHS R&D strategy.81 Sally alluded to the one on the 1974 NHS reorganisation, and it makes a general point that if you talk to people in the NHS today about any of the stuff we've talked about today, the level of understanding of the history is incredibly, woefully poor. I don't think it's just a sort of nostalgic point that people ought to remember figures like Walter Holland or Teddy Chester or Brendan Devlin or people like that, but it's that there is stuff to be learnt from these people and their ways of working, and so on.82 It feels like we have a very poor long term memory institutionally, and so thinking of ways to improve that long term memory…not to say, you people who are joining the training scheme in September, you really ought to know about Teddy Chester…but to see some greater communication of the learning from some of this would be great, and I hope that's some of

81 P. Atkinson and S. Sheard (eds.), The Origins of the National Institute for Health Research (University of Liverpool, 2018). 82 Brendan Devlin (1932-1998) was a Consultant Surgeon and Chairman of the Social Epidemiology and Audit Unit of the Royal College of Surgeons.

what comes out. I found, for example, the report on health economics that Sally and colleagues have done just really great, because it's not just about the development of health economics at York, but it's actually about the way in which academic ideas and academic interests collaborate with policymakers to make real change.83 If you want to understand the development of thinking about the financing of the NHS, and similarly, in this discussion, if you want to understand clinical leadership in the NHS, you need to understand this history of work by people like Chester and trying to get doctors and managers, and doctors and nurses, and doctors and others, to sit down and learn each other's language, live in each other's worlds, eat together and drink together, and all those sort of things.

David Allen

Have you done a similar approach on statistics in the NHS? A lot of the statistics really need to be more focused…that’s my impression as a manager in the health service…more focused on delivering effective changes. The statisticians need to be more relevant, is the point.

Kieran Walshe

I don't know. I'll look to Sally and Stephanie…I don't think we've done anything on the history of the OR [Operational Research] function, which has got a very interesting evolution.

David Allen

Yes, similar.

Stephanie Snow

I don't think there's been much done.

David Allen

It might be worth looking into. There's a lot of money spent.

Stephanie Snow

Well, perhaps that's a topic for down the road.

83 Mackillop and Sheard, ‘Quantifying Life’.

Kieran Walshe

There's a really good book by Clive Smee – Speaking Truth to Power.84 Clive Smee was the Chief Economist for the Department of Health for a long time, and led the EOR [Economic and Operational Research] bit of the department for twenty years or so. He wrote a really good book when he retired.

John Pantall

One problem we had…we were centrally funded until 1983, so our client was the Department of Health, and before that the Ministry. It was only after 1983 that we had to start earning our keep, and still a lot of it was coming from traditional activities, management courses etc. That might well have held us back. It would have been interesting to see if we'd… the only academic consultancy I remember Teddy getting involved with was in Turkey, with our social statistician from the Dover Street faculty, Wallis Taylor.85 That was advising on birth control, which I found a very mysterious one for Teddy, but that's a thing where we perhaps could have been more influential, but because our funding mechanism was, in a way, a disadvantage.

Kieran Walshe

Well, you had no incentive to go and earn money elsewhere.

David Allen

But we used our money very well....

Stephanie Snow

Well, thank you all for your contributions. I'm hoping this will be the start of the work on Chester, not an endpoint. Thank you very much again.

[Ends]

84 C. Smee, Speaking Truth to Power: Two Decades of Analysis in the Department of Health (Oxford, 2005). 85 Dr Wallis Taylor was Lecturer in Social Statistics at the University of Manchester.

Appendix

T.E. Chester – Select Publications

Training and Promotion in Nationalised Industry (London, 1951).

Patterns of Organisation (London, 1952).

Management under Nationalisation (London, 1953).

The Future of Nationalisation, (Oxford, 1953).

Hospitals and the State: Hospital Organisation and Administration under the National Health Service, Vols. 1-5 (London, 1955-58).

Wage Policy and the Health Service (Oxford, 1957).

A Study of Post-War Growth in Management Organisations (Paris, 1961).

Graduate Education for Hospital Administration in the United States: Trends (Chicago, 1969).

Organisation for Change: Preparation for Reorganisation of the National Health Service (Manchester, 1974).

Organisation for Change: The British National Health Service (Paris, 1975).

‘Public Health Systems in a Democratic Society: A Case Study of the British National Health Service’ in G. Neubauer (ed.) Alternativen der Steuerung des Gesundheitswesens im Rahmen einer Sozialen Marktwirtschaft (Gerlingen, 1984)