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Surgeon Lieutenant Commanders Smith and Mathews (November 2001 JRSM, pp. 590-591) should be congratulated for their highlighting of the mutual benefits of the secondment of military specialist registrars to non-MDHU NHS hospitals. Of course this has been happening for at least forty years but the need to re-emphasize the standing of military specialists in comparison with their civilian contemporaries is poignant at this time of global uncertainty.
On 7 November 2001, the History of Medicine Section hosted an outstanding meeting at which a string of junior medical officers from the era of National Service recounted their experiences of conscripted service in the Armed Forces. Some were serious, some hilarious but all relevant to today's scenario.
The closure of the Military Hospitals in the mid-1990s, to which the authors allude, resulted in a major exodus of talented specialists, a very large proportion of whom were appointed to good NHS consultant posts; moreover, many have been selected subsequently as clinical and medical directors by virtue of the administrative skills and discipline learned in the military. It is my strong conviction that bodies of people, whether they be businesses, battalions or hospitals, succeed or fail because of the drive and charisma of the senior personnel in post at a particular time.
Field Marshall Lord Bramall stated in an asterisked debate on 5 March 1997 in the House of Lords that ‘... the Defence Costs Study, where, by largely destroying the military ethos of medicine among the Armed Forces Medical Services and knocking the stuffing out of them, [it] has brought about the very exodus and shortages of specialists which Ministers have been complaining are the causes of the present state of affairs...’. This is indeed what happened.
However, the very drive and enthusiasm of Smith and Mathews along with their specialist registrar contemporaries in the surgical disciplines, many of whom I have met, cause me to revert from a position of despondency to one of real hope for the future of the Defence Medical Services. My only real concern is that the General Staffs will not listen to them for at least ten more years. Being so militarily junior they wield insufficient ‘clout’. They should be heard.