{{Short description|1967 report on doctors in UK hospitals}}
The '''Cogwheel Report''' (1967) or '''Report of the Joint Working Party on the Organisation of Medical Work in Hospitals''' was the report of a committee appointed by the Ministry of Health and chaired by George Godber to investigate the organisation of doctors in hospitals in England and Wales. It recommended arranging medical work by clinical divisions.
== Context == During the 1960s, there were controversies over pay for National Health Service doctors and perceived lack of trust between doctors and hospitals.<ref name=":3" /> Community services and hospitals were seen as poorly coordinated.<ref name="Rivett" />
"A Hospital Plan for England and Wales" was published earlier in the decade and set a precedent for health planning and restructuring of services.<ref>{{cite report |url=https://assets.publishing.service.gov.uk/media/57a08d91e5274a31e000192c/The-history-and-development-of-the-UK-NHS.pdf |title=The History and Development of The UK National Health Service, 1948 - 1999 |author=Greengross |first1=Peter |last2=Grant |first2=Ken |date=July 1999 |publisher=DFID Health Systems Resource Centre |page= |docket= |quote= |last3=Collini |first3=Elizabeth |author-link= |access-date=8 January 2024}}</ref>
== Committee == The Joint Consultants' Committee and the Minister of Health created the joint working party "to consider what developments in the hospital service are desirable in order to promote improved efficiency in the organisation of medical work."<ref name=":0">{{Cite journal |date=1972 |title=Impressions of Cogwheel: Background And A Consultant Physician's View |journal=The British Medical Journal |volume=4 |issue=5831 |pages=36–38 |jstor=25420357 |pmid=5078413 |issn=0007-1447 |doi=10.1136/bmj.4.5831.36 |pmc=1786130}}</ref> John Howie Flint Brotherston was appointed to head a similar committee for the NHS in Scotland.<ref name=":0" />
Sir George Godber, the Chief Medical Officer, was appointed chair of the committee. Nine of the committee members were doctors.<ref name=":1">{{Cite journal |date=1972 |title=Steering Wheel |url=https://www.jstor.org/stable/25419468 |journal=The British Medical Journal |volume=3 |issue=5820 |pages=191–193 |jstor=25419468 |pmid=5040703 |pmc=1785690 |issn=0007-1447}}</ref> Members included Dr John Owen Fisher Davies, Howard Granville Hanley, J.A. Hauff (Assistant Secretary, Ministry of Health), Dr Thomas Roland Hill, H.H. Langston (orthopaedic surgeon), Tom L.T. Lewis, Dr Richard Mayon Mayon White, Gordon McLachlan (Secretary of the Nuffield Provincial Hospitals Trust), Geoffrey Anderson Phalp (Secretary and Principal Administrative Officer, United Birmingham Hospitals), Sir Arthur Porritt, Sir John Richardson, Dr Kenneth Robson (registrar of the Royal College of Physicians), T.B. Williamson (who retired in February 1967 due to ill health), Dr H. Yellowlees, Dr I.T. Field and Dr G.R. Ford.
== Report == The committee published its report in 1967, soon after the Salmon Report.<ref name=":3">{{Cite news |date=2002-07-11 |title=NHS History: The 1960s |url=http://news.bbc.co.uk/2/hi/programmes/the_service/2120284.stm |access-date=2024-01-08 |work=BBC News |language=en-GB}}</ref> The report became known as the "Cogwheel Report" because of its cover design.<ref>{{Cite book |last1=Bryant |first1=Robert J. S. |url=https://books.google.com/books?id=ZN2JEAAAQBAJ&dq=cogwheel+report&pg=PR16 |title=The Running of Hospitals: Selected Writings on the National Health Service, 1965-85 |last2=Bryant |first2=Mark |date=2022-09-02 |publisher=Cambridge Scholars Publishing |isbn=978-1-5275-8533-1 |language=en}}</ref>
The Report recommended that doctors be more involved in management, with specialisms having responsibility for their own resources.<ref name=":2">{{Cite book |title=The Future of Leadership and Management in the NHS: No More Heroes |publisher=The King's Fund |year=2011 |isbn=978-1-85717-620-9 |editor-last=Rowling |editor-first=Edwina}}</ref><ref name="Rivett">{{cite book |last1=Rivett |first1=Geoffrey |url=https://www.nuffieldtrust.org.uk/chapter/1958-1967-the-renaissance-of-general-practice-and-the-hospitals |title=The history of the NHS |publisher=Nuffield Trust |language=en |chapter=1968–1977: Rethinking the National Health Service |access-date=3 January 2024}}</ref> A medical executive should then be formed from representatives of each specialism.<ref name=":0" />
The Report noted that the three branches of the NHS (hospitals, general practice and local authority care) were unwieldy though efforts were being made to improve connections between them.<ref>{{Cite book |last=Weiss |first=Antonio E. |url=https://books.google.com/books?id=ZSt1DwAAQBAJ&dq=cogwheel+report&pg=PA329 |title=Management Consultancy and the British State: A Historical Analysis Since 1960 |date=2018-10-26 |publisher=Springer |isbn=978-3-319-99876-3 |language=en}}</ref>
== Impact and critiques == Following the report, the Ministry of Health encouraged hospital authorities to implement the report's recommendations. "Cogwheel divisions" were organised and consultants in a substantial number of hospitals had adjusted organisational structures.<ref name=":0" /><ref name="Rivett" />
One critique of Cogwheel was that divisional structures were not always obvious, and sometimes resulted in medical physics, diagnostic radiology and pathology being grouped into a section for administrative purposes though they were quite different specialisms.<ref>{{Cite journal |date=1972-12-09 |title=Impressions of Cogwheel. A divisional study. |journal=BMJ |language=en |volume=4 |issue=5840 |pages=602–604 |doi=10.1136/bmj.4.5840.602 |issn=0959-8138 |pmc=1786827 |pmid=4643399}}</ref> Another was that it was unclear where medical social workers fit.
In 1972, a second report was published.<ref name=":1" /> This was based on a study of 85 junior hospital doctors during which more than 840,000 observations were made of more than 77,000 actions.<ref name=":0" /> The second report noted and approved local variations but disapproved of situations where junior doctors, nurses, administrative staff, general practitioners or medical officers of health were not included.<ref name=":0" />
In 1974, the third report was published.<ref>{{Cite journal |date=1974 |title=Cogwheel Three |url=https://www.jstor.org/stable/20468608 |journal=The British Medical Journal |volume=2 |issue=5909 |pages=6 |jstor=20468608 |issn=0007-1447}}</ref>
The impact of Cogwheel was limited by the reorganisation of the NHS in 1974, under which consensus management and multi-disciplinary teams were introduced.<ref name=":2" />
== See also ==
* Seebohm Report * Salmon Report * Butterworth Report
== References == {{reflist}}
Category:1967 documents Category:1967 in the United Kingdom Category:1972 documents Category:1974 documents Category:Health care reports of the United Kingdom government Category:National Health Service Category:Hospitals in the United Kingdom