In February, 1961, the Tory Government made an outright attack on the National Health Service. They announced increased charges for prescriptions, increased charges for dentures and spectacles and increases in the prices of welfare foods. Flat-rate contributions by National Health and Insurance stamps were also increased.
To try and make this pill more palatable the announcement had been preceded by another announcing a scheme for hospital building and renovation. But this scheme merely implements, five years afterwards, the recommendations of the Guillebaud Committee (which the Tory Government set up hoping it would recommend economies in the service).
The need to finance the hospital scheme has been made one of the excuses for raising the charges and it is clear that the Tory government is only willing to raise expenditure on this important social service if they take the increases from other than direct taxation-and this in spite of the fact that expenditure of the N.H.S. in terms of a proportion of the National income is lower than in 1950. Instead of raising the money from general taxation Mr. Enoch Powell has brought in a whole series of flat-rate contributions which will fall most heavily on the sick and the needy. He has created a new slogan for his Ministry.
“The Worse Your Health – the More You Pay”
The Socialist Medical Association calls on people of every social group to join together to reverse this Tory policy.
The National Health Service Act of 1946 placed on the Minister of Health the duty of promoting . . . “a comprehensive health service to secure the improvement of physical and mental health, and the prevention, diagnosis and treatment of illness”.
Since the inception of the National Health Service many attempts have been made in different ways to limit the idea of a comprehensive service, free to all at the time of use. These attempts have been both direct, by legislation, and more indirect, by the creation of a climate of opinion inimical to a free comprehensive service through talk of “abuses”, “extravagance”. the suggestion that “the treatment available is not as good as it was before the N.H.S. started”- and that the rise in the total cost of the service has been excessive. The Government attempts to justify its action by the Labour government’s charges on spectacles and teeth in 1951, despite the fact that they were imposed during the Korean war and were for three years duration only. Labour Party policy now clearly plans for the removal of all charges.
The Conservative Government set up the Guillebaud Committee to consider expenditure on the N.H.S. This Committee in fact called for the removal of charges on dentures and glasses and increased capital spending on the Health Service. It noted that in spite of the increased cost of the health services, they were receiving a smaller percentage of the national income than before the establishment of the N.H.S. In August, 1960, a joint meeting of the London Local Medical Committee and the London Pharmaceutical Committee expressed the view that:
“The present prescription charge is a tax which besides stimulating the wrong incentives has proved disappointing financially. The Ministry of Health should be informed that these charges are wrong and should be abolished at once”.
The concern of Conservatives about the cost of the service had not prevented them from supporting a campaign to provide Free Drugs for private patients. They were not content to use the medical facilities available but yet wanted a Government subsidy for their privileged position.
Twelve years after the start of the N.H.S. there has been a watering down of the grand humanitarian conception of the best available service free at the time of need. There is less talk of expansion to meet the needs and more clamour for economies to lift the “burden” from the State. During this period certain landmarks denote this deterioration and the flight from socialist humanitarian ideals.
1. Attacks
We have referred to charges, which have always been opposed by the medical profession and now are condemned by the Labour Party and professional bodies in the Health Service.
2. Private Beds in Hospitals
In many hospitals taken over from the Local Authorities or war-time emergency hospital, no private beds existed. Recent trends with the growth of the number of part-time specialists at the expense of the numbers of full-time specialists have resulted in private beds being provided in some of these hospitals. The Minister is under heavy pressure to provide more private beds in hospitals previously staffed entirely by full-time consultants.
3. Part-time Specialists
As noted, the full-time specialist who had no professional interest outside his work in the N.H.S. wards and out-patients, is gradually giving way to the part-timer who is permitted private practice. This policy is deliberate and results from methods of payments and taxation policy which favour the part-time specialist.
4. Growth of the Provident Associations
This is exemplified by the British United Provident Association which, starting as recently as 1947, now offers cover for private attention to over 800,000 people. The Provident Associations provide cover for specialist fees for private consultations, and operations and the main cost of a bed in a private ward. They are now proposing to cover the cost of a private family doctor service. Through group schemes industrial firms arrange cover for executive and managerial staffs.
5. Free Drugs for Private Patients
We have already referred to this demand. If it were met, it would encourage the growth in general practice of the same two standards of service which prevail unchallenged in the hospital sector.
6. Growth of Private Sector
There is increasing demand for private facilities due to some inadequacies of the N.H.S., e.g., the long waiting time both for outpatient appointments and for hospital beds. This causes further inadequacies by removing facilities from those who cannot afford them, to make them available for the better-off; there is a deliberate trend in the N.H.S. to encourage queue-jumping, rather than meeting the needs of the Service.
SHORTAGE OF NURSING AND ANCILLARY PERSONNEL
Low rates of pay and poor working conditions have led to a fall in recruitment to the nursing and allied professions. The minimum standard of education for student nurses has been lowered with consequent loss of professional standing. Teaching hospitals continue to attract sufficient applicants, but non-teaching hospitals depend very largely on Irish, Colonial and foreign personnel. On completion of training, many of these prefer to return to their country of origin to continue practice, and thus aggravate our shortage of trained personnel in all fields.
ROLE OF THE LOCAL HEALTH AUTHORITIES
Under the Act the local health authorities (the democratic organ of local government) were meant to extend their role in health work particularly preventive work. Instead, they have been discouraged both financially and politically from providing the Health Centres which were described as the king-pin of the Service. Recently the introduction by the Tories of the Block-Grant System of finance means that any proposals to expand the L.H.A. services threatens an increase in the rates. Within the L.H.A.’s share of responsibility, it encourages competition between different services provided by the authority for the available funds.
At the same time, L.H.A.’s are unlikely to feel able to press for the generous policy which alone can remedy the current shortage of trained staff such as domiciliary midwives, health visitors and district nurses.
In the special field of Mental Health, the 1959 Act has given new and important responsibilities to the L.H.A.’s. These cannot be fulfilled unless adequate Exchequer funds are provided.
SOME PROBLEMS OF ADMINISTRATION
Only three salient points out of many are quoted:
(a) The tripartite administration of the N.H.S. has been criticised not only by the S.M.A. but by other responsible bodies. Now the Minister of Health has echoed these criticisms, but offers no constructive improvements. The Government, while claiming to be anxious to revitalise local government, has made no recommendation for the closer integration of all parts of the service.
(b) Since the Tories came to power, people serving on administrative organs of the N.H.S. as nominees of working-class and mass-organisations have been steadily replaced by individuals identified with Tory and “upper-class” interest. The running of the hospital service has consequently been removed steadily further from the contact and influence of the ordinary man who is the most likely to have need of the hospital’s resources.
(c) The Local Medical Committees, representing the interests of the family doctors in the areas they cover, exercise an excessive influence on the development of Health Services in the area. Examples can be quoted in which the provision by a local health authority of a badly needed Health Centre has been sabotaged by the reactionary attitude of the Local Medical Committee. While it is important to ensure that the interests of the doctors are suitably protected, where these conflict with the interests of the community the latter must take precedence.
THE ONLY ANSWER
The N.H.S. must change to meet both the challenge and possibilities of further development in medicine and make use of the resources of our society. But the direction of change must be determined not by economic dogmas of a “free society” which would further bind both the patient and the doctor, but by humanitarian and professional considerations. Aneurin Bevan‘s contribution and challenge to our society must not be allowed to fossilize nor to be perverted. The growing points of the N.H.S. are:
Research: not only into clinical and scientific problems, but also into problems of organising and administering the health services at all levels. Emphasis must be placed on democratising the Service, and special study should be made of integrating voluntary effort with municipal and State services. The Blood Transfusion Service is a shining example of what can be achieved in this way.
Preventive Services: Industrial Health Cover – expansion limited both by want of money and lack of basic planning. Industry is not meeting its responsibility to safeguard and treat its work-people. Apart from a few large concerns vast numbers of workers have little or no cover.
Health Centres: These would offer great advance to doctors and patients, and would also give an opportunity of integrating preventive and curative services as well as releasing medical man-power.
Now, when the service is being steadily undermined by the Tory government, is the time to fight both to defend and extend the service.
THE HEALTH OF THE PEOPLE IS THE CONCERN OF THE PEOPLE
Published for the Socialist Medical Association by Today & Tomorrow Publications Ltd., and printed by DIMBLEBY & SONS, LTD. (T.U.), 14 King Street, Richmond, Surrey