The Bradbeer report on internal administration of hospitals

'The National Health Service is not static'

In 1950, the Central Health Services Council appointed a committee, chaired by Alderman Bradbeer, on:

• the internal administration of hospitals to consider and report on the existing methods of administration in individual hospitals
• the extent to which clinicians should be involved in administration
• recommended changes to the organisation of hospitals.

It became clear that the terms of reference also needed to include the way in which hospitals had been grouped together.

The report, published in 1954, outlined the high degrees of variation in both size and scope of different hospital types, but also the difference in culture between hospitals that had been previously owned by local authorities, versus the voluntary hospitals:

'The National Health Service is not static. The development of the hospital service is or should be an organic development, rooted in the historic past but nevertheless still in its initial stages. The great step forward of grouping hospitals for administrative purposes was necessarily taken at one time, but further changes in organisation, more particularly as they affect individual hospitals each with its own traditions, customs and methods should be made only after the most careful consideration of all the factors in each instance.' 

Recommendations

The committee made a number of recommendations, including the following:

• Hospital administration should be regarded as tripartite, covering medical, nursing and lay considerations, but none of the three parts could work without each other. 
• The committee attempted to standardise the management of local authority hospitals, which had been hierarchical, based on a medical superintendent.
• The report endorsed the developing trend of multidisciplinary organisation in voluntary hospitals, which were commonly managed by a triumvirate of medical superintendent / administrator, matron and hospital secretary.
• At group level there should be one chief administrative officer.
• Medical committees should be strengthened, with every hospital having a medical committee constituted by the medical staff themselves. In larger hospitals there would be advantages in appointing a medical administrator at consultant level, to work closely with the nursing and lay administration processes.
• The matron should be regarded, in her capacity as head of the nursing services, as directly responsible to the governing body of the group, and should have direct access. Group nursing committees should be established in every group to give the governing body the collective advice of the senior nursing staff.
• All principal specialist officers at group level should be responsible to the governing body, through the chief administrative officer. The unit hospital administrator should generally be regarded as the senior lay officer of their hospital and responsible for its lay administration. 

The report had significant influence on administrative processes in NHS hospitals going forward. Following the report, domestic tasks which had been the responsibility of nursing staff, passed increasingly to lay administrators.