Royal Newcastle Hospital: the passing of an icon

From the 1930s to the 1960s, Royal Newcastle Hospital was the centre for innovation in Australian health care. Many of the innovations were driven by a visionary medical superintendent, Chris McCaffrey, and the staff he appointed. Among the reforms he introduced were: an overarching emphasis on efficiency; the appointment of salaried specialist staff, now widespread; the unit record system for medical records, now universal; a domiciliary care service, now established in most of Australia; and an emphasis on audit and quality studies, now largely abandoned in the form pioneered in Newcastle. These innovations were vigorously opposed by organised medicine and barely tolerated by the health bureaucracy. They are unlikely to be replicated in the current environment where hospitals are run by managers in a culture dominated by budgetary considerations.