Correspondence between Mr. Hastings and Mr. Bevan

PARLIAMENTARY LABOUR PARTY

Points for the consideration by the Health Group on the National Health Services Bill

1. Doctors will Work from Health Centres only if they wish and not if the Executive Council or Local Authority, providing the Health Centres, so desire.
2. Doctors who use the Health Centres will be in contact with the Local Authorities that provide them only via the Executive Councils.
3. Patients on a doctor’s list can be seen privately for fees by his partner provided the doctors are not working from a Health Centre.
4. But this is not permitted to the doctors of a Health Centre who enter into partnership as “encouraged” by the Minister. Will not this discourage Health Centre Practice?
5. Charges to doctors for use of Health Centre are to be determined by Executive Council who can make them prohibitive and so discourage Health Centre Practice.
6. There is apparently no limit to the number on any doctor’s list.
7. No provision is apparently made for the general practitioner who desires to become a full time officer.
8. The choice by patient of either private or Health Centre pharmacist must lead to duplication and waste.
9.  Health centre doctors are to be paid in part by capitation if they so desire and to engage in private practice.
10. A “specialist’ is not defined.
11. Boards of governors of teaching hospitals will apparently appoint their own staff and largely control their own finances.
12.  “Pay beds” may be provided even in Municipal Hospitals that  have never had them and fees charged for treatment in them.

25.3.46

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Ministry of Health, Whitehall, S.W.1.

27th March, 1946,

Dear Somerville Hastings,

Many thanks for your letter about the Health Group meeting tomorrow, and its enclosure.

First you mention point 3 of the enclosure. I think this is wrong.  I have not, of course, got down to detailed terms of service yet, but I think we shall have to secure that no one can charge fees to any patient who is (a) on his own list,  (b) on the list of any­one else in the same Health Centre,  (c) on the list of any of his partners in a partnership outside the Health Centre.

Next, as to doctors in the interim period. We have based our aggregate compensation figure on what the profession agree to be the full capital values involved. Therefore there should be full compen­sation available for all. The profession will advise me how they want this fairly distributed. A young man buying a practice in the interim period, therefore, will obtain the right to whatever part of the full compensation attaches to that practice – and what that is will have to be settled by the profession itself. He should be alright for his money, therefore, unless he pays materially more than the compensation which that practice will earn – and no doubt the future contracts will develop a clause providing for that. Alternatively the young doctor can go as an assistant. When the scheme starts he will then go on as an assistant where he was, if he wished, or seek public practice as a principal through the new Medical Practices Committee in any area where doctors were wanted. There will be plenty of room for him!

But, generally, I certainly think that I must try to arrange quite soon (probably after Second Reading) for some public announce­ment or guidance to be given, by myself or through professional organisations or both.  I will think more about this.

On your enclosure, I have mentioned the point covered by 3 and 4. On 5 the answer is that I shall in fact settle the charges to be made by the Councils, as part of the terms of service regu­lations. On 6, there will certainly be limits to the doctor’s lists, and these will also be dealt with by regulations – which will have to permit higher limits when assistants are employed, and so on. On 7, any general practitioner can come into the service wholly, and do nothing else, if he wishes; in Health Centres I hope this will become the increasing tendency. On 8, my object is the convenience of the patient, who may well want to get a prescription made up on the spot at the Health Centre, but repeated a few days later at a chemist’s nearer home.

As to 10, all specialists appointed in the hospital and specia­list service will have to be passed” by an advisory appointments committee professionally capable of judging qualifications and experi­ence. This is quite a new safeguard and is to be covered by regula­tions under Clause 14.

As to 11, I want both the Boards of Governors and the Regional Boards to be as free and flexible in administration as possible. But both will be working within a planned service settled for the Region by me and will and will be always subject – as may be needed – to my directions. As to 12, I certainly am not concerned with whether a hospital was municipal or voluntary before, so far as pay-beds are affected; my objects in providing pay-beds will be (a) to prevent encouraging a rival “nursing-home” service and (b) to attract into the scheme at the outset, and attach to my hospital, all the leaders of the profession; the whole thing is to be subject always to the primary needs of the public service, of course.

As to 1, 2 and 9, I have no special comment, and I think these correctly represent the proposals.

I hope these very hasty notes may be of help.

Yours sincerely,

(signed) Aneurin

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Socialist Medical Association 35 Long Acre, London.  W.C.2

5th April,1946.

My dear Bevan,

The Socialist Medical Association has a Committee sitting for the careful study of the Health Services Bill. It is our sole desire to be helpful and do all we can not only to get the bill through Parliament but to ensure its efficient working throughout the country. But in our studies certain difficulties of interpre­tation arise which we would be very grateful if we might have cleared up.  If I may, I will put them in the form of a series of questions.

1. There is no definition of a specialist. Will a list be prepared of those who may.be called specialists or in what other way will the bogus specialist be distinguished from the genuine?
2. Who will pay the specialist?
3. How will the specialist be paid? In the case of the whole time doctor this should be clear, but will the part time, individual be paid by salary or items of service? The latter in our opinion has
   considerable danger.
4. Can full time specialists working in connection with the hospital service see private patients and, if so, will it be only in his off-duty time or will this have to dove-tail into his ordinary work?
5. Will every individual in the country have a doctor allocated to him even if he makes no application or expresses no desire for this?
6. We believe that, like ourselves, you are anxious that as many doctors as possible should transfer their practices to Health Centres when these are provided.  In what way can they be pressed to do this?

It has occurred to us that a doctor who has any private practice at all must have a consulting and waiting room and that, as these can be used for public patients as well as private, he will be averse to pay extra for the privilege of seeing his public patients in the Health Centre.

7.  When the time comes for the Local Authorities to build or in some cases to extend the existing Health Centres what advice will your department give them? In other words, have you schemes prepared for model Health Centres in different types of area?
8.  To what extent would a repeal of the National Health Insurance Act be required?
9.  Clause 18 of the bill states that supplies of human blood and preparations not easily obtainable will be available to doctors on payment of charges as the Minister thinks fit, but presuming these things are necessary – and they should not be supplied otherwise – will it not be the right of every patient using the service to take advantage of the whole or any part of it as he may desire and con­sequently ought not these things to be supplied free?

I am sorry to be so much trouble to you,

Yours very sincerely,

Somerville Hastings

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