Health Service for the People
SOCIALIST MEDICAL ASSOCIATION, 59 New Oxford Street London WC1
SPEAKER’S NOTES
(This is one method of handling the subject (May 1945) which has suited a number and variety of audiences. It should be used as a guide to the main points from which a selection is made according to the type of audience and the time allowed. If every point is used 1 ¼ hours would be needed, but main headings take 20 to 25 minutes. Statistical examples can be chosen from Stephen Taylor’s book “Battle for Health”, or from Titmuss or Aleck Bourne.)
Health should be the concern of all citizens.
Without health life cannot be enjoyed and service cannot be given to the community.
Has long been the dream of socialists and one of the reasons for the establishment of the Co-op. movement (Robert Owen) .
Why Labour demands an efficient service – because well aware of the social implications of disease (studies by British Socialists and by Engels ), e. g.
(1) Economic loss to community
(2) Amount of suffering involved – average of 3 visits to a doctor every 2 years.
(3) Variation in class incidence, e.g.
(a) Tuberculosis 2 times as fatal in under £250 a year class as in over £1000 a year class.
(b) Rheumatism and poverty –
in 1875, wages 21s. 8.7 (25-30 yrs) per 100,000 died
in 1942, wages 43s. 1.3 (25-30 yrs) per 100,000 died
Morris has clearly shown relation to poverty at present day
(c) Infantile mortality – present figures 69/1000,New Zealand 30/1000, Ideal 15/1000. Quote Glasgow, or other available figures for industrial areas
(d) Measles 19 times as dangerous to children in poorest class as compared with richest (see Titmuss)
Much of this can only be solved by socialism, i.e. optimum diet, housing etc., but always there will be a need for a medical and health service.
A modern health service should have 4 main functions
(1) to cure – put first because urgent today, but later will be second function;
(2) to prevent
(3) to educate
(4) to impress its scientific knowledge on social legislation.
Now consider these today
(1) Curative. Social Security League says “it is nobody’s business to see that the best types of medical treatment are at the patient’s elbow” Why?
(a) Delay in application of new knowledge.
(b) Maldistribution and isolation of G.P.s
(c) N.H.I. serves only one third of the population;
(d) Maldistribution of specialists, contrast e.g Cornwall and Harley Street.
(e) Hospital beds are (i) too few, e.g. Hospital Survey for London says Surrey has 1/3rd of beds it needs and (ii) in small, inefficient institutions, one third of voluntary hospitals have less than 30 beds.
(2) Prevention as yet undeveloped
(3) Education in health impossible while doctors compete for disease.
(4) Medicine and social legislation (Politics) B.M.A. “Health is not mainly a question of medical services … in regard to social questions there is ample room for improvement and action by the State.”
All this gives us what the White Paper called “a complicated patchwork pattern”and it is still untrue to say that any citizen has a complete health service … it still depends too much on, where people live or work, to what (social) group they belong or what happens to be the matter with them”.
Now the new service
Experience in other countries- New Zealand, U.S.A., U.S.S.R., etc.
Principles on which it must be built
(1) complete – no single item missing for a single citizen.
(2) For 100%, i.e. a single standard, the highest;
(3) Duty of State to ensure service actually exists;
(4) Free at time of use;
(5) Based on team-work: team of all health workers (doctors 50,000, others 450,000): Health Centres as place at and through which the team works.
(6) One hospital system, 10 beds for 1000; 800 to 1000 beds per hospital.
(7) Prevention; preservation and promotion of health education in health.
White Paper did accept some of these (not hospitals) without providing necessary machinery
What is the opposition?
(1) General political neo-fascist or individualist
(2) Local Authorities, afraid of losing present functions.
(3) B.M.A. – but not doctors. Quote Questionary figures, eg.68% in favour of Health Centres (83% of forces)
B.M.A. and Willink as an example of the new Toryism.
Socialists have no objection to negotiations on terms and conditions of doctors, but doctors
(1) cannot claim privilege not granted to other health workers;
(2) should not discuss and appear to settle matters with which Parliament should deal
B.M.A./Willink document would
(1) set up a medical bureaucracy which would delay progress
(2) Perpetuate worst features of N.H.I.
(3) prevent rapid development of Health Centres and deny local initiative in their establishment;
(4) perpetuate the buying and selling of practices (a purely British system)
Public opinion must be roused and the only hope is a Labour Government. and Labour’s own policy.