A National Health Service : Report of the Council of the B.M.A. to the Representative Body
1944 1944 1940s 11 pages 2 ideal of a healthier people is, and always has been, the ideal of the medical profession. Our profession is rightly proud of its past and present contribution to human knowledge and happiness, its zeal and progress in scientific research, and the high standards it has imp...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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1944
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| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/52A2A6DB-573F-4C32-BF35-D6FBC5F935CA http://hdl.handle.net/10796/A21DC060-79AE-458E-8DDA-CCC6AA2849B0 |
| Summary: | 1944
1944
1940s
11 pages
2 ideal of a healthier people is, and always has been, the ideal of the medical profession. Our profession is rightly proud of its past and present contribution to human knowledge and happiness, its zeal and progress in scientific research, and the high standards it has imposed upon itself in its daily work. Nor need it apologize for claiming a prominent place in advising the Government on the paths to be followed and the methods to be employed in achieving this ideal of better health. There is a tendency in some quarters to foster the illusion that there is nothing good in the free institutions and the free professions of this country — an attitude usually accompanied by a belief in organization as the remedy for all our troubles. 7. Health is not mainly a question of medical services. The public must not be misled into believing that good health depends chiefly upon hospitals or clinics or doctors, or bottles of medicine, or indeed upon organization. Among the principal factors which determine a people's health are sanitation, provision of public water, housing, nutrition, conditions in factory and office, facilities for recreation, and education. Here is ample room for improvement, and for action by the State. 8. An individual's health depends in part on his or her own efforts, on healthy living, on a right attitude towards health and disease. In the field of health education there is still much to be done, if only to compete with that type of disease education which this country, like few others, allows, in the shape of patent medicine advertisement. 9. The work of doctors is conditioned by the state of medical knowledge. Investigation and research are the life blood of medical practice. The discovery of penicillin is likely to prove of more importance to the people of this country than all the health centres and all the intricacies of organization. The State's attitude to medical research may be judged by the fact that its official annual contribution to this work is a mere quarter of a million pounds! This is an indication of what a Treasury-conditioned outlook means. 10. The State is rightly concerned with problems of environment and prevention, with communicable disease, and with some forms of institutional provision. Another function of the State is to co-ordinate good existing facilities for the prevention and treatment of disease, whether they have evolved as a result of State or of independent action. Under its aegis much can be done which might otherwise remain undone. 11. To-day there are overlapping of organization, incoordination of effort, and gaps in service. These should be remedied by co-operative action between the State and the profession, and not by the assumption by the State of control of an expert field and those who work in it. The record of the State in health and medical matters contains little to justify the suggestion that either the Ministry of Health or local authorities are sufficiently equipped with knowledge and experience to assume so vast and so potentially dangerous a responsibility. 12. The medical profession has developed, over the centuries, as an independent profession. It has imposed upon itself strict standards, and the whole foundation of its work has been built in an atmosphere of intellectual and scientific freedom. Doctors have jealously fought for their freedom to think and to work in their own way, to hold views which seem to them right, and to practise their profession as they deem to be in the best interests of their patients. They must preserve their freedom to criticize the scientific work of their fellows and the organizations in which they work. The doctor's first allegiance is to his patient, and there has grown up a conception of a doctor-patient relationship which is confidential and wholly personal. Doctors are not prepared to sacrifice these things, and it is not in the public interest that they should be asked to do so. They are not prepared to substitute obedience to the State for loyalty to the patient. 13. In examining or promulgating any plans for a comprehensive medical service the medical profession will resist any control by the State, either political or administrative, which is inconsistent with their intellectual and professional freedom. They fear political influence in medical matters. They fear bureaucracy and red tape. They fear subservience of the clinical to the administrative. Theirs is essentially human work, related to human values, and they fear that it is likely to be submerged in a "service." 14. It is not enough to promise that there shall be no interference with the doctor-patient relationship, or that there shall be no regimentation of the profession. The plan must of itself, by the nature of its arrangements and provisions, ensure that there shall be no risk or chance of such interference or regimentation. And any plan must be free from features which suggest that the attack on these essential freedoms may be insidious and delayed rather than obvious and immediate. 15. It is in the light of these considerations that the Association has examined the White Paper. It is inclined to suspect that the inspiration of the Government's document is political rather than medical. It certainly detects in that paper what fatalists call a "trend of the times," a move towards a planned and deliberate central control by the State. 16. The Association believes that in so far as the State engages in the planning of health services it should plan a framework within which individuality and independence can flourish. The State should not seek to do for the people what they can do for themselves. It should not unnecessarily limit their freedom of choice or thought or action. It should do what is necessary, but refrain from the unnecessary. The State should spare from its bureaucratic attentions this form of human activity which, in an atmosphere of independence and freedom, has made more progress than it could possibly have made under the aegis of the State. The medical profession is not prepared to see itself converted into a branch of central or local government, or to become a "collectivized" unit within a free economy. 17. The Government's scheme is based on the principle that a comprehensive medical service should be available as a right, and irrespective of means, to all who want it, such service being paid for from insurance, taxation, and rates. The attitude of the profession is that the service should be available to all who need it, but that it is unnecessary for the State to make provision for those who are both willing or able, indeed prefer, to make it for themselves. Freedom is involved. 18. This is not merely or mainly a financial issue. It is true that under the Government's plan — the so-called 100% plan — private practice will be diminished, as will income from this source. This of itself may be a serious matter for some members of our profession. What is even more important is that a profession which derives its emoluments wholly or mainly from State resources is likely bit by bit to be controlled by the State which provides its emoluments. Here lies the greater danger both to the profession and to the public. 19. Until full details are known of the proposed administrative and professional arrangements and of the social security plan as a whole, and until more information is available as to the proposed machinery for safeguarding private practice among that section of the community which prefers it, the Association cannot commit itself to any acceptance of the 100% principle. Pending fuller information on these points, it reaffirms the wholly reasonable policy that the comprehensive service should be available to those who need it, and that the State should not make provision for those who are willing and able and anxious to provide for their medical service themselves. Principles 20. The Association approves the general principles set out in the White Paper, emphasizing that what is more important than their enunciation is their translation into action in the developments to come:— (i) Freedom for people to use or not to use these facilities at their own wish ; no compulsion into the new service, either for patient or for doctor.
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| Physical Description: | TEXT |