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However, a diploma anywhere in Europe will entitle thehealth professional to work anywhere.

1992 might see greater movement of these professions andothers between EEC countries. British nurses, of whomthere are likely to be too few anyway, could be in highdemand in Europe. The movement could also be

encouraged by "mixed" marriages, the wife going to work inher husband’s country. A British midwife might marry aDutchman and want to continue her profession in Holland.This has happened. Initially there were difficulties, butsince the EEC directive was clear the Dutch authorities gaveway.The reality is that countries are left with little choice but to

implement directives where they exist. If they refuse theycan be taken to the European Court of Justice, which is, ineffect, a supreme court.

Amazingly, this is only now being recognised by manyMPs and (dare one say it) ministers. Even pro-Marketministers are complaining that civil servants are telling themthey have no choice over many decisions. The newlyre-elected EEC president, Jacques Delors, has predictedthat in 10 years 80% of social and economic policy will becovered by Brussels directives. Mrs Thatcher is herselfknown to be disturbed by the trend. She has disowned theDelors prediction--only a few days after welcoming hisreappointment. Pro-Market MPs believe there is now anirreversible movement towards a federal Europe. The PrimeMinister is determined it will not happen.The tussle taking place is highly relevant to the medical

profession. Some of the potentially most controversialchanges could be in the pharmaceutical industry. TheCommission is proposing that there should be a free marketin ttie sale of drugs, cutting across the present licensingsy-lems in Britain and other member states. The question iswhether to go on with national licensing authorities or togive this to a supranational EEC body.

It does not stop there. Some of the directives beingproposed appear to strike at the monopoly position of theNHS as a drug purchaser. If the NHS says it will only have alimited number of drugs, is this restraining competition?The first step will be a directive to make clear what each

country is doing now. In all this, there is one overriding fact.Article 3 of the Treaty of Rome states that the primary aim isthe free movement of goods, services, and persons. For"goods", read "drugs". One consequence could be to giveBritain’s 190 district health authorities, or even individualhospitals, the responsibility for buying their own

pharmaceuticals from anywhere in Europe at the lowestprice. This must be a factor in Mrs Thatcher’s considerationof the future of the National Health Service.

Break-up of DHSS

ON July 25, to the surprise of many, a Cabinet reshufflewas announced. Its main feature was the splitting up of themammoth Department of Health and Social Security. Onlythis month colleagues and aides of the Prime Minister weresaying confidently that if the DHSS was to be broken up, itcould not take place until 1989. The new factor in theequation is the gradual conviction reached by the PrimeMinister as a result of her NHS review that the DHSS,spending 44% of the entire Government budget, was toomuch for any one minister to handle. She considered the

option of leaving Mr John Moore in place to finish off theNHS review but concluded it was better to do the surgerynow and leave the summer for the reorganisation and for the

new Health Secretary, Mr Kenneth Clarke, to trail thereview findings at the Conservative Party conference inOctober and produce a white paper when the House ofCommons resumes after the recess. Mrs Thatcher is usuallyreluctant to change the structure of Government but thistime she was convinced otherwise. The DHSS had 95 669

employees, of whom 87 230 were in social security and some8000 in health, and spending was C48 billion and £ 21 billion,respectively.

It is not too difficult to see why Mrs Thatcher has chosenClarke to present the new health package and why she hasbrought in Mr David Mellor to back him up. She had triedthe quiet persuasiveness of Moore to get across the healthmessage. He can come across well on television in presentinga calm, carefully argued case, but she concluded that he didnot have the sharpness which Tory backbenchers look for inthe Commons. The fates have treated Moore harshly. Hehad viral pneumonia for several months and often haddifficulty in making himself heard in the Commons, butpolitics is rarely about fairness. Both Clarke and Mellor arehighly articulate QCs and forceful advocates unlikely to beruffled in any circumstances. What is more, Clarke wasMinister of Health for three years between 1982 and 1985,before he moved to Employment and then Trade andIndustry. Besides speaking on industry matters in theCommons he was also Minister for the Inner Cities. Healthwill be the first department he has had on his own. Hisinterest in the NHS is long-standing. While a barrister inBirmingham he wrote a Bow Group pamphlet What’sWrong with General Practice? He feels passionately aboutracial discrimination and deprivation, and set up his owninner city unit in the Department of Employment longbefore the Prime Minister designated him Minister for theInner Cities. In an interview with me earlier this year hemade it clear that he was disappointed that the PrimeMinister had not given him more direct power to push innercity policy.

If there is the feeling that Clarke has not been sufficientlystretched in his previous jobs, he is likely to be so now, takingover the many and highly controversial duties carried foryears in the DHSS by Mr Tony Newton, who is rewardedwith a place in the Cabinet as Chancellor of the Duchy ofLancaster and coordinator of inner city policy. Mellorcomes from the Foreign Office where he has been in theheadlines criticising Israel for its handling of thePalestinians. He is another very able advocate, confident onany stage. Indeed the unkind joke circulating in theCommons earlier this week was that Thatcher had put thechickens with the largest mouths all into the same basket.The third member of the Health team is Mrs EdwinaCurrie.

JOHN LEWIS

International Diary1989

A conference on Urology and Gynecology for Primary CarePhysicians: San Diego, California, Jan 20-22 (Edith S. Bookstem,Conference Coordinator, PO Box 2586, La Jolla, California 92038, USA).

International symposium on Epilepsy and Behavior: Louisiana, USA,Feb 16-18 (Bonnie Becker, International Epilepsy and Behavior

Symposium, 1040 NW 22nd Avenue, Suite 400, Portland, Oregon 97210,USA).

International conference on Blood-borne Infections in the

Workplace: Stockholm, Sweden, Aug 28-30 (Ms Catharina Ostrom.Congrex AB, PO Box 5619, S-114 86 Stockholm).