In 1934 the National Executive Policy Sub-committee appointed four Sub-committees. The Medical Services sub-committee consisted of:
- Dr. H. B. Morgan (Chairman),
- Rt. Hon. Christopher Addison,M.D.,
- Dr. Somerville Hastings,
- Dr. C. W. Brook,
- Dr. H. Finer,
- Dr. R. Lyster,
- Dr. Oscar Tobin,
- Dr. Esther Rickards,
with Miss Mabel Croat, and Messrs. I. J. Hayward, C. W. Key, J. A. Newrick, E. G. Rowlinson, Lewis Silkin, and J. L. Smyth.
The Local Government and Social Services Committee also set up special Sub-Committees to deal with “A State Medical Service,” the “Welfare of the Blind,” and “Water Supply.”
Conference Debate October 1934 in Southport
The CHAIRMAN: The next item is the section on Health Services in “For Socialism and Peace,” together with the Appendix “A State Health Service” in the Executive Report.
Mrs. B. Ayrton Gould (National Executive): The position as regards the proposals for a State Health Service is, that a special sub-Committee, appointed by the National Executive, has been sitting throughout the year on the question and has issued this preliminary statement, which appears as an Appendix to the Executive’s Report. No formal decision on it has been taken by the Executive. We are simply putting it before Conference for discussion, before going into further details of policy.
A State Health Service is a very complicated question, because of the large number of interests there are. Before anything could be done, arrangements would have to be made with regard to National Health Insurance, the Approved Societies, the medical profession and the present public medical services. The two main suggestions are these: that Health Insurance should be confined to cash benefits; that the whole of the contributions under Health Insurance should go to cash benefits, which should be as much as possible along the lines of the ordinary Unemployment Insurance benefits; that all medical benefits should be provided under a public medical service, run by the County and County Borough Councils. Instead of insurance being extended to dependents, everything, apart from the cash benefits, should be given along the lines of a public medical service. We should get clinics and hospitals, and the whole thing should be carried out in this way under the local authorities —of course, completely removed from the Poor Law. The suggestion is that you should pass this preliminary report before the question is gone into in greater detail, We do not anticipate that there will be any serious objection. We think you will be willing to accept this, which is along the lines we have all been wanting for a long time, and during the coming year it will be possible to issue a report in greater detail for submission to you next year.
Mr. RaysJ. Davies, M.P. (N.U. Distributive and Allied Workers): I am very pleased indeed that the Executive has not come to a final decision on this very important question of National Health Insurance and medical benefits in general. I would, however, ask the Executive to take the first step which, in my view, is imperative and which is practicable, and it is this. The Government has brought under the Unemployment Insurance scheme all boys and girls of from 14 to 16 years of age, and for every reason you can give for bringing them under the Unemployment Insurance Scheme, I can give ten reasons in favour of including them for National Health Insurance purposes. I would, therefore, urge the Executive to include that point in their programme. I understand that every elementary school child is medically examined during school years about four or five times, but when the child leaves school at 14 years of age there is a gulf until he or she enters National Health Insurance at 16 years of age, and no medical attention whatever is given to the child between those ages.
The Executive, in the next stage, are very doubtful as to whether we should extend National Health Insurance and cover the dependents of insured persons for medical benefit purposes. There are in this country about 15 million to 16 million insured persons under the National Health Insurance Scheme. The vast majority of them are insured under the capitalist Approved Societies, and it has astonished me on many occasions that in view of the fact that practically every insured person is of the working class they are allowed to pass by their ordinary Trade Union Approved Society. I would therefore say to the Executive that they are confronted with one of the mightiest problems of all when they are faced with the fact that the influence in politics in this country, especially under this Government, is directed in the main through the large and mighty capitalist Approved Societies. If we are going to secure an adequate medical service in this country outside those who are insured under the National Health Insurance, I can see no hope whatever through the present Health Insurance scheme. You must do it by some other means and leave medical benefit within the present scheme.
The anomalies that have cropped up within the National Health Insurance Scheme are indeed extraordinary, and I would ask the Executive to pay attention to one important factor. Take the unemployed man. In spite of the promises of this Government when they passed their last amending scheme under the National Health Insurance Act, the situation of the old unemployed fellow to-day under that scheme is absolutely more tragic than ever it was. He goes out of employment ; he is a broken man physically, and just when he requires medical benefit most he is wiped out of the scheme altogether. It seems to me that the report ought to concentrate on those three points.
Dr. SOMERVILLE HASTINGS, L.C. C. (Socialist Medical Association):
I should like to congratulate the Executive for having produced this report. I want to stress the point that this is only a first step. I and my Association will not be content until there is provided for everyone who is prepared to accept it, free of charge, the best preventive and curative system that is possible. We want everything necessary for the prevention and cure of disease to be provided, without any consideration of immediate payment. We believe that this is possible, and we want every doctor, and not only just a few, to be associated with the preventive services. This scheme is only in embryo, and I do want to urge the Executive to carry on with what is admittedly a very difficult task.
We are getting hold of the local authorities. Labour majorities are developing and we, who are concerned with the administration of health committees, want to have before us a picture of the final aim we are trying to reach. In this report we have got some picture of what we are aiming at. There are two points I may very briefly emphasize.
The first is that it stresses the need for medical work to be done from health centres. There records can be kept; there doctors can consult together; there special treatment can be given and people’s minds can be divorced from the supposition that a bottle of medicine will cure all disease.
The second is that we feel that in this scheme people ought to know that the facilities which we have at present will be largely continued. Some people like to choose their own doctor, as far as possible. That, it seems to me, will be just as possible in such a scheme as is considered in this report as at present. I would suggest that we must not put too much stress on free choice of doctor, because people can have faith in an institution just as much as in an individual. People have faith in a hospital although they do not know the name of a single doctor on its staff. There is not so very much free choice of doctor in country districts at present. Under this scheme there would be considerable freedom of choice. The popular doctor under this scheme would have his list filled very quickly, and the less popular doctor would have put on his list the people who were too late. We have to remember that unless the doctors under this scheme are over-worked and inefficient, they cannot, just as at present, do more than a certain amount of work, and the less popular doctor will have people put on his list, because many people do not take the trouble to seek out a doctor until they are ill.
I feel that this is a good start and I urge the Executive to continue with the good work.