First Showdown with Lords may come on the Health Bill

Charles Wortham Brook

“NEW LEADER,” MARCH 30th, 1946

The National Health Service is a great step forward because first and foremost it creates a unified and co-ordinated National Health Service, free and open to all.

It ends the patronage of the Voluntary Hospital system, which has outlived any usefulness that it may have had in the past, and at the same time solves the problem created by the Chamberlain Local Government Act of 1929, when a dual hospital system came into existence. This Act incidentally created a disparity of efficiency of Public Authority hospitals, for in politically-backward areas they still have the Poor Law taint.

It may be a bitter pill for the Labour L.C.C. that under the proposed legislation their hospitals will have to be surrendered, but it is going to be an immense advantage for the people of Kent, Berkshire, Dorset, Devon and Cornwall, where the public services are generally of a poor standard.

The new Bill goes far to take the vested interest out of Medicine, an evil which really started in 1858 when the first Medical Act was passed and has rapidly increased since the National Insurance Act of 1911.

The leaders of the British Medical Association (which started as a very small concern in 1832), have declared their intention of fighting the Bill to the last ditch. Nobody should underestimate the power of the B.M.A., although its membership is split from top to bottom on this issue.

The leaders of the B.M.A. have four cards up their sleeves. They can play on the feelings of the general public by horrific forecasts of regimentation of both doctor and patient; they can take advantage of the fact that there are not enough doctors in the country to man the proposed Service adequately; they can sabotage the scheme in certain areas— incidentally the politically backward ones— by subsidising doctors to prevent them entering the Service; and, if they lose the battle in the Commons, which they will, they can continue to fight it in the Lords, where they have effective spokesmen in Lord Moran (Winston Churchill’s medical adviser and President of the Royal College of Physicians) and Lord Horder. Both these men are not only leaders of their profession, but are able debaters, and the Labour Party will be hard pressed to keep up with them.

‘In fact, it is my opinion, that this Bill may be used by the Lords as the first excuse for a show-down with the Government, and if the B.M.A. succeeds in inflaming public opinion against the Bill, it may cause a first-class political crisis.

My own criticism is that on certain features Bevan has already compromised too much. He has made the large Teaching Hospitals a law unto themselves. He has permitted the continuation of “pay beds” in the Hospitals. His proposals for Health Centres are far too vague, and I regret that the responsible authorities for providing these Health Centres are to be the County Councils and County Borough Councils. This may work well where Labour is in control and is determined to do the job properly, but in politically backward areas, and it is in these areas that the B.M.A. “last ditchers” hold sway, everything will be done to discourage the establishment of these Health Centres in the same way that the proper development of County Council Hospitals has been retarded. Although the Minister will have power to intervene, the reactionary County Councils will have plenty of excuses ready for embarking on a “go slow” policy, in view of the fact that housing has first priority and will continue to do so for some time.

I regret that those Parliamentary abominations— “Permissive Clauses”— have been inserted in the text of the Bill, especially in the section dealing with “Home Helps.”

The proposal for a salary plus capitation plus private practice for general practitioners is perhaps the most regrettable feature of the whole scheme. It really pleases nobody. Members of the Socialist Medical Association don’t, like it as they want a full-time salaried Service, while it is already evident that the B.M.A. won’t accept it.

Personally, if I had been in Aneurin Bevan’s place, and had been forced to accept a compromise in view of the shortage of doctors, 1 should have said to the medical profession: “If the best of you would like to join the Service on a full-time salaried basis, then I will pay you well, provide you with first-class Health Centres, and when the time comes for you to retire, you will receive adequate pensions. As for the rest of you, carry on as the B.M.A. suggest, have your capitation fees, and buy and sell your practices. Of course, you will have to improve your surgeries and make a better job of your work than many of you are doing under the National Health Insurance Act.

“At the same time I intend to recruit as medical students young men and women of ability, educate them, feed them, clothe them and give their parents or dependents adequate allowances for the loss of their potential support. My only condition is that when they have qualified they will enter the Service on a full-time salaried basis.

“I venture to suggest that in ten years’ time I shall have built up such a fine service that those of you who chose to stay outside, and those of you whom I intend to keep outside, will have to find another means of livelihood.”