Abstract
The shape of the hospital pharmaceutical service in Great Britain in 2000 owes much to the reforms that were introduced following publication of the Noel Hall Report in 1970.¹ Yet this was not the first enquiry into the state of the service, and it is unlikely to be the last. The earliest enquiry was carried out by the Pharmaceutical Society of Great Britain on the eve of the Second World War, which put any change on hold.² Some reconfiguration of the service did occur following introduction of the NHS in 1948,³ but these were largely structural changes, and it cannot be said that any significant change in the nature of the service itself resulted at this time.

During the 1950s the service suffered from poor recruitment and retention of staff, poor pay, and low morale. To examine these issues a sub-committee of the Central Health Services Council on the hospital pharmaceutical service was established under the chairmanship of Sir Hugh Linstead. The committee presented its report in 1955.⁴ It made a total of twenty-five recommendations, most of which were concerned with the organisation of the service. Recommendation two indicated that developments should be based on three principles; 'that pharmacy is a science and art of its own, that effective advice and decisions upon pharmaceutical matters need to be in the hands of pharmacists, and that the pharmaceutical service should be progressively unified upon the basis of the group as a unit'. Yet, except at one or two innovative centres, these recommendations were never implemented. A second Linstead report followed in 1958, but this failed to be published beyond the confines of its members and the Ministry of Health.⁵

The hospital pharmaceutical service continued in a state of crisis throughout the 1960s, although one or two teaching hospitals were able to introduce developments such as ward pharmacy.⁶ It was 1968 before the government was persuaded to establish a further enquiry into the service, this time under the chairmanship of a former civil servant, Sir Noel Hall. Its membership included a majority of non-pharmacists, and its recommendations were accompanied by a 'white' health circular from the Ministry, indicating that implementation was mandatory. Structural change resulting from the reorganisation of the NHS in 1974 facilitated this process. Within a few short years the principal recommendations of the Noel Hall Report had been implemented.

Analysis of key factors which led to the success of Noel Hall but the failure of Linstead indicates that these were the membership of committees (minority of pharmacists), identification of a key supporter of the document within the Ministry of Health, the emergence of compulsory rather than advisory recommendations from the Ministry, and a favourable political and economic climate. These lessons were subsequently learnt for the Nuffield Report in 1986, which tried to do for community pharmacy what Noel Hall had done for hospital pharmacy.⁷ This identified a further factor, the willingness of the profession itself to change, as crucial to success. It is suggested that historical analyses of this kind can make an important contribution to the development of pharmacy practice policy.

References

1. Report of the Working Party on the Hospital Pharmaceutical Service, (1970), (Noel Hall Report), HMSO, London:
2. Holloway, S.W.F., (1991), Royal Pharmaceutical Society of Great Britain 1841-1991, p.345, Pharmaceutical Press, London:
3. ibid, p.346:
4. Report of the Sub-Committee on the Hospital Pharmaceutical Service, (1955), (First Linstead Report), HMSO, London:
5. Report of the Working Party on the Hospital Pharmaceutical Service, (1958), (Second Linstead Report):
6. Baker, J.A., (1967), J. Hosp. Pharmacy p.400-406:
7. Pharmacy: The Report of a Committee of Inquiry appointed by the Nuffield Foundation (1986) London.