October 1981. Luke Zander addresses an important change within the academic structure of the Royal Society of Medicine.

I believe it is most important that we should clearly identify what the aims for the Society should be, and amongst the principle ones I would list the following :

1. That it should establish a distinctive role for itself, which would not be in competition with but complementary to that of other medical associations and institutes. This means that we need to consider carefully the activities that are undertaken in the Society and put particular emphasis on those which have a distinctive difference from those undertaken elsewhere.

2. That it should realise its unique potential to promote advances in many areas of medicine and medical science by providing a setting in which individuals with different disciplines and perspectives can be brought together to exchange ideas on problems of mutual concern.

The overall pattern of Sectional activities (with upwards of 3OO meetings at each session) is fragmentary, and does not provide the Society with a clear identity other than that of a medical club, which in many respects is failing in the face of increasing competition. Most clinicians have available to them, within comparatively easy reach of their places of work, sufficient meetings which follow the traditional pattern, focusing on topics that relate closely to their particular fields of interest and at which they will find colleagues from the same sphere of activity. The fact that very special benefits can be derived from meetings in which individuals from different specialties come together is well recognised, and Sections have frequently been encouraged to arrange them, but in spite of these exhortations and a general belief in their value they are not often held. The RSM with its multidisciplinary structure is ideally, even uniquely suited to organise such types of meetings.

3. It should aim to serve as a stimulus for innovation by providing a setting which facilitates and encourages the exploration of new and as yet unproven ideas of both scientific and social importance, unrestrained by the official protocol that all too frequently operates within the DHSS, the BMA and the Royal Colleges. One of the most serious restrictions to the development of innovative thinking is that of finding a neutral ground on which to explore new ideas, particularly if they run counter to contemporary orthodox views. An important characteristic of the RSM is its independence from any sectarian vested interests; accordingly it potentially provides a most important setting for just such a function.

4. That it should function in a way that will have a wide attraction to members of the professions, medical and paramedical, young and established, those involved in the provision of health care and members of the laiety.

5. The RSM should provide a social ambience which facilitates its role as a natural meeting place, not just in relationship to formal meetings but as a place to which individual members of the profession would naturally consider coming when meeting colleagues.

The function of the RSM as a unifying force in an age of rapidly increasing specialisation is one of extreme importance and significance. If such meetings are to be characteristic of the Society rather than isolated events dependent on individual members' imagination and energy, a new structure must be found which will not only facilitate but actively encourage the development of this type of approach. It is suggested that the Society should establish a certain number of Forums which are related to specific topics, in contrast to the Sections which relate to a particular discipline.

These Forums would necessarily be multidisciplinary; therefore this important aspect of their function would be built into their structure and thus be quite independent of the individuals concerned. In the Spring of this year we held a multidisciplinary three day conference on "Pregnancy care for the 1980's" jointly with the Section of Obstetrics and Gynaecology. Participants were drawn not just from general practice, obstetrics, paediatrics and midwifery but also included health visitors, psychologists, educationists, sociologists and those representing the interests of the mothers who receive the care. The conference, with its unusual if not unique range of disciplines, represented not only on the platform but also amongst those attending, was generally considered to have been an unqualified success. However, it is relevant to mention that although the meeting was widely publicised and oversubscribed, the number of attending obstetricians was very small. This was a cause for both disappointment and concern. Disappointment stemmed from the fact that those who have taken on themselves the task and responsibility of providing pregnancy care should feel an unusual meeting of this nature to be of little interest. The concern was more fundamental and of wider significance, in that it raises the question of how we are to ensure that those taking the decisions concerning the delivery of care have the appropriate depth and breadth of knowledge and experience. This is a question that is in no way restricted to the issue of obstetrics, but rather is of critical importance to the delivery of medical care as a whole. It is important that we in the profession realise that we must make decisions about the service in which we are engaged that are free of bias and self-interest, if we are to satisfy the needs and demands of those whose interests we claim to have at heart. It is essential that we exhibit a willingness not only to listen to but also to hear the views of others. By establishing a Forum on pregnancy and neonatal care, the issue gets removed from the umbrella of one or the other discipline and becomes the focus of analysis by a wide range of different disciplines through non-hierarchical interdisciplinary discussion.

What should the activities of such a Forum be? These could take many forms; it could arrange meetings or conferences in the normal way, or organise seminars aimed at providing a teaching role directed at undergraduate or postgraduate levels. It could serve the function of an information centre, both for the collection and distribution of information, while at times it could assume an advisory role publishing reports and monographs through the Society. One of the important characteristics of the RSM in this regard is that it has its own channel for publications.

At a different level it would be possible to imagine a situation whereby a Forum of this nature could act as an important means by which major policy documents of either the profession or even government could be reviewed from a multidisciplinary perspective, a possibility which does not exist at present. If these functions are to be realised it is essential that such a grouping meets on neutral ground, and it is difficult to imagine a more ideal setting for this than the RSM. A memorandum summarising some of these ideas has already been submitted to the President of the Society, Sir John Stallworthy, who has been most supportive. It has also been considered by the Council, who gave it unanimous approval.

Preliminary steps have now been taken toward the establishment of the first of these Forums, concerned with pregnancy and newborn care, and the initial meeting of a steering committee has already taken place. This brought together two obstetricians, a paediatrician, two midwives, a clinical psychologist, two general practitioners, an epidemiologist, a sociologist and the president of the National Childbirth Trust. The group has begun to consider such issues as the activities to be undertaken, how to ensure the multidisciplinary structure, how the Forum would relate to the existing structure of the Sections and the question of finance.

Other topics which would seem most suitable for consideration in the same way are child care and the management of mental health etc.. One existing Section which might well be considered as a Forum is the Section of Medical Education. One could imagine that if this brought together not only medical professionals active in this field, but also those from the paramedical professions together with educationists, psychologists and individuals with expertise from a range of teaching methods, it would confer great benefit.

There is a special case. The establishment of the Open Section has marked a major step forward for the RSM, bringing together individuals from both the profession and from the population at large to consider issues of general concern. In this sense it does have a multidisciplinary structure. The difference between this and the Forum lies in the fact that it is not a working group, where specific topics provide a continuing focus for consideration. But it is to be hoped that members from outside the professions will take part and provide valuable input into the deliberations of the Forums.

Over the years the idea of an academy of medicine has been raised frequently, as it was in the recommendations of the Wolstenholme Report. In 1973 a leading letter signed by the presidents of the Royal Colleges was published in the BMJ, together with a long editorial suggesting the establishment of such an institution, and in 1979 similar correspondence took place. In both instances the idea was based on the representatives of the various medical institutions and colleges coming together in such an academy, which would then serve the function of improving communication. However there is little in this suggestion to give one confidence that it will be a means of breaking down the barriers that already exist. The difference in the idea of the Forum is that it will bring together people who together are striving to find ways of approaching a common problem; in that lies its strength. Ours is indeed the Royal Society of Medicine not a Royal Society of the medical profession.

No organisation similar to such Forums exists as far as I know anywhere, either in Europe or in North America, and if its potential is realised, it will give a very special purpose to the RSM, which would not only ensure its own development but will give it a very significant role to play on the medical stage. But no scheme will work unless a sufficient number of people care enough about the Society to accept the challenge that this opportunity provides and to give the project their time, energy and imagination.

One of the characteristics of the contemporary medical scene is that due to the increasing fragmentation of care meaningful communication between those engaged in different aspects of its delivery is becoming more difficult. This fragmentation has been carried forward into the academic institutions with the establishment of many new colleges and sub-specialty groups, all of which has served to limit interdisciplinary exchange. The developing isolation in which many within the profession are now working inhibits the input of ideas and also removes the checks and balances which are necessary if one is to ensure that decisions taken from a certain perspective do not have damaging or unforeseen effects on other components of the healthcare system.

In 1983 a multidisciplinary Forum on Maternity and the Newborn was established at the Royal Society of Medicine. Its purpose was to bring together individuals from differing backgrounds to consider topics of mutual interest and concern. Its members are drawn from Obstetrics, Midwifery, General Practice, Neonatal Paediatrics, Community Medicine, Behavioural Sciences, and include also representatives of the receivers of care. The establishment of such an interdisciplinary group has been a major innovation at the RSM and its success can, in part, be measured by the fact that eight other similar topic related Forums have subsequently been established.

Because the orientation and objectives of the Forum are so close to those of the Journal of the RSM it was felt appropriate to publish regular reports of its meetings. The first of these, "Having a Baby in Europe", is of a meeting in which the delivery of pregnancy care in this country was considered in an international context. A study of the perinatal services of 32 countries had been undertaken by a working party of the World Health Organisation (Europe) under the Chairmanship of Dr Marsden Wagner. Although a report was published in 1985 it received very little attention in this country, and this Forum meeting is the first time that it has been publicly discussed.