British Medical Standards Likely To Decline

Bay of Plenty Beacon, Volume 15, Issue 93, 8 September 1950, Page 6

British Medical Standards Likely To Decline

(From J. P*. Kennedy, Kemsley Scholar in Great Britain) British medical standards, as reflected by the general practitioner who must be the backbone of any healthy medical system, are in. danger of entering' upon a decline as a result of the way in which the country’s new health service is operating. If the British public is to get the service to which it is entitled, this is a threat that must be met.

There is much to be said for Britain’s new social security services.. The reorganisation of hospitals and other attendant services has undoubtedly brought benefits to many. The service is here to stay. It has now been in general operation for a little more than two years.

It is too early as yet to indulge in general criticisms of it, but it has become apparent, despite the claims that Ministry of Health officials advance to one, that the position of the doctor has been undermined and his economic security imperilled, that his standards of practice and those of some of his fellows —dentists, for example—are threatened with a general lowering, and that it is not wholly desirable that hospital administration should be so completely geared to the State.

The principles underlying the Act that established this far-reach-ing scheme are not new to Britain. What has happened has been that they have been extended to a point where the whole population is covered —and covered more fully than ever before—whereas only sections of it were provided for previously. On a much smaller scale the National Health Insurance Act of 191 L ensured that for a few pence a week lower-paid industrial workers could get medicines and the services of general practitioners. That Act created lists of patients for doctors. The advantages of that early Act were to give some financial security to doctors in poor . industrial areas and to provide a certain sickness insurance to about one-quar-ter of the country’s workers, thougn

it was extended until at the end of the recent war about 20,000,000 workers could use it. The effect of the new Act has been to extend what was formerly a family doctor and general sickness service into a general health service covering all sections of the population and including dental and optical services. People can now have themselves placed on a doctor’s list and avail themselves of his services. If they become ill, they get free hospital services, though if they want private rooms and other extra facilities they nave to pay for them. The scheme leaves the patient the right to change his doctor, and the doctor the right to remove a patient from his list.

There can be no doubt that come such scheme was needed, especially for the lower-paid groups. These comprise a large portion of the population. The result has been that not only are the demands upon it extremely heavy, but they are also very costly. Health services are cdsting about £40,000,000 a year • —a very substantial slice of ' the national income.

Doctors’ leaders recently described the scheme as “the most costly and complete fiasco our social history has ever seen.” This was exaggeration, but there, is a grain of truth in it. It appears that while British doctors have accepted tb.J principles underlying' the scheme 1 , they are not happy about the way it is being run.

The attitude of the more thoughtful members of the profession who discussed this with me was determined by a fear th,at eventually the doctor might be reduced to the status of a salaried State servant. To him that is a real fear for the general practitioner, as distinct from the specialist, lacks the economic freedom under the scheme that his New Zealand counterpart gets under the system of payment to doctors in use in New Zealand. The fixed capitation payment to doctors for each patient on their lists ties down their income no matter how much work they do in a year. Some of them therefore feel that under such a set-up they could be reduced to the mercy of the Ministry, which has power to vary the capi-r tation grants.