We devoted a section of our report to the problems of medical education in London with its twelve medical schools, and their associated teaching hospitals, for the most part located within a small area of dwindling population. Our proposals involved reducing the number of schools to six by a process of twinning, and the association of each of the new schools with a multifaculty institution. These proposals were violently opposed by the medical traditionalists, and by the then Principal of the University of London, and were therefore in effect rejected, although, with the passage of time, some parts of our ideas have been put into effect (e.g. in the case of St Bartholomew's Hospital, the London Hospital and Queen Mary College) and I have no doubt that in time more mergers will occur. I found it difficult not to be amused when, in 1979-80, the situation in London had become so manifestly unsatisfactory (as I knew it would if our proposals were ignored) that a new committee under Lord Flowers was set up by the University of London to examine it afresh. The solution proposed by Lord Flowers and his colleagues differed little in general principle from ours, save that they laid no stress on association with multifaculty institutions; like us, they proposed the pairing and amalgamation of the London medical schools, but they also recommended the closure of one of them (the Westminster), a recommendation bound to cause a storm.
My own belief is that the Todd Report, had it been acted upon promptly, would have given a better long-term solution, but, however that may be, the Flowers Report has been attacked by the medical traditionalists just as ours was, even after the lapse of ten years during which conditions had further deteriorated. The failure to follow the recommendations of Todd or Flowers, or a distillate of both, will merely postpone and render even more difficult the inevitable reorganisation of medical education in London. It is amazing how ostrich-like our medical colleagues can be!
It was not to be expected that the report of a Commission such as ours would be 'accepted' by government, for much of it dealt with matters over which government could have no control. Government did, however, accept our recommendation that new clinical schools should be instituted in the Universities of Cambridge, Southampton and Leicester, all of which are now in being, giving us the capacity more nearly to meet the growth of demand for doctors in the future. Despite suggestions to the contrary in recent public statements, I still believe that our estimates of demand will be in due course vindicated. Recent changes in the organisation of the National Health Service are also moving in the direction we suggested. In other areas, too, I am not dissatisfied with the progress made since our Report was published; there have been substantial reforms in undergraduate teaching courses, and postgraduate training has undergone much development. It is true that our views on the career structure in medicine have not yet found favour, but it is my own view that they will be adopted in due time; professions as long established and as conservative as medicine are invariably slow to move.
Broadly speaking, the so-called Todd Report was well received, and had a considerable impact in the United Kingdom. Perhaps more surprisingly, it aroused considerable interest not only in Commonwealth countries in which medical education is mainly along British lines, but also in the United States where the pattern is different. The degree to which any of our ideas have been adopted there (if at all) is unknown to me, but I recall the great interest shown by professors and deans from many of the American medical schools when I presented our findings to them at a large meeting of their Association in Houston in November 1968. I found that there was much more on which we could agree than I had expected. But perhaps I should not have been surprised; medical education and medical practice are under the same pressures everywhere. Every new discovery in medicine creates a demand for medical care which did not exist before. This is a situation where invention becomes the mother of necessity, and the demand for more and more health care is insatiable. Under these circumstances all countries will inevitably be driven along the same paths in their efforts to deal with it, and the patterns of medical education will become more and more uniform as a result.
During the 1960s I did a great deal of overseas travel, visiting and lecturing in many different countries. It was during this period that I first visited Africa. In 1965 I was invited to visit Accra where my former pupil, J. A. Quartey, had become Professor of Chemistry in the University of Ghana. I was guest of the recently formed Ghana Academy of Science, and my visit was timed to coincide with that of Queen Elizabeth and the Duke of Edinburgh, so that I saw Accra very much en fete, living, as I did, downtown in the Ambassador Hotel. Admittedly, the festive spirit was not very evident among the rather silent and gloomy Russian technicians who seemed to make up most of the company there, but we had flags, fireworks, etc. Kwame Nkrumah was still in power, and I met him once or twice; I was not over-impressed for, although he seemed to me to be an astute politician and something of a demagogue, he had a rather low intellectual ceiling. As a result, he was a ready prey to the rather shady bunch of sycophantic advisers who were around him. He certainly had some foolish ideas. On one evening while I was there, a great banquet was arranged (for men only as I recall it) at which the Duke of Edinburgh was to be formally invited to be Patron of the Ghana Academy of Science, and I was to be admitted as an Honorary Member. On the morning of the day appointed for the ceremony I was breakfasting on the terrace at the Ambassador, when Joe Quartey arrived, accompanied by Professor Ernest Boateng who was, I think, Secretary of the Academy at the time, and who appeared very upset. He told me he had just come from Nkrumah, who had told him that he had decided that the Academy should become a much grander body, and that he should lead the way; accordingly he, Nkrumah, would announce at the banquet the creation of the Pan-African Academy of Science with himself as President, and ask the Duke to be Patron. Boateng, like me, thought that to do such a thing without prior international consultation would infuriate the other African countries, and that the Duke would certainly have to decline the invitation to everyone's embarrassment. We decided we had to take some action, but found that Nkrumah had already set off with the Queen to open the new Volta Dam; the matter had therefore to wait until the evening. Fortunately, between Nkrumah's return to Accra and the banquet, we got him to change his mind and the banquet went ahead as planned; no Pan-African Academy was mentioned, but it was a near thing!
I greatly enjoyed that first visit to Ghana, despite the undertone of discontent with the regime that I found among the academics and other educated people. The people seemed gay and friendly, and the enormous market-mammies in the Accra market had to be seen to be believed. Apparently, the local inhabitants admire the physical proportions of these ladies as much as their business abilities, and find European women rather feeble looking. At the time I speak of, my friend Joe Quartey had a houseboy (actually a middle-aged man) who looked after Joe and his wife Patience in their house on the edge of the university campus at Legon, which is, I suppose, three or four miles from Accra. The houseboy, who had never been as far as Accra in his life, decided he would like to see the Queen, and so he set off early in the morning and walked to Accra to see the Queen perform some ceremony. He duly returned in the evening and resumed his duties without making any comment on his day's outing. The following morning Joe asked him if he had indeed seen the Queen. 'Yes,' came the monosyllabic answer.' But is that all you have to say about it?' said Joe. 'Huh! She no be big strong woman - no be proper queen!' Parts of Ghana are beautiful - I remember the great rollers coming in on the glittering white sands at Winneba, and the dense forests on the road up to Kumasi. While I was there, Nkrumah was busily building up the newly created Technical University at Kumasi, incorporating in it what had been a first-class technical and agricultural school (which I felt would have been more useful than the grandiose institution being developed in its place). At the time of my visit there was a bit of a row going on between the university administration and a student residence on the outer rim of the campus; in accordance with current happenings elsewhere, I was not surprised to hear that the residence was locally called Katanga and its warden Tshombe! Kumasi was an interesting place - quite different from Accra. Tribal feeling seemed strong, and the Asantahene was held in great respect as effective king of the Ashanti people.