A National Health Service : Report of the Council of the B.M.A. to the Representative Body
1944 1944 1940s 11 pages 4 will be with exclusively local authority bodies which own the other type of hospital — the local authority hospital. They will receive less than the cost of the work they do, and be left to find the remainder in the atmosphere created by the Government "...
| 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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| Online Access: | http://hdl.handle.net/10796/A0A9CFDF-670E-43D9-9030-7D66AD177E52 http://hdl.handle.net/10796/39CD8154-C957-4FFE-A704-4B610E0664BA |
| Summary: | 1944
1944
1940s
11 pages
4 will be with exclusively local authority bodies which own the other type of hospital — the local authority hospital. They will receive less than the cost of the work they do, and be left to find the remainder in the atmosphere created by the Government "free for all" propaganda. Capital moneys are ignored. 35. The partnership between local authority and voluntary hospitals which the Government promised is to be achieved by virtually placing the voluntary hospitals under the control of the local authority "partner." They are afforded no effective place in the administrative or advisory machinery either at the centre or locally. Lip service is paid to these great institutions. What the White Paper proposals actually mean in practice is their elimination as autonomous organizations in a comparatively short time. These proposals would appear to illustrate once more the urge to control even a form of voluntary organization which, while uncontrolled, has achieved a magnificent standard of service to the community. The Health Centre 36. Group practice, generally in Health Centres, is put forward in the White Paper as the basis of general practice development. The Government speaks of an experimental phase, but the arrangements proposed do not provide a proper basis for experiment. A joint health authority, after consulting the Local Health Services Council and taking or not taking its advice, may with the Minister's consent decide to embark on a scheme of health centres. Thereafter the County and County Borough Councils will be required to proceed with their development. Action on these lines by a number of joint health authorities over the same period of time will not constitute a useful experiment. What is needed is to try out, in similar and contrasting areas, varieties of Health Centres, including both diagnostic and general practitioner centres, the experiments to include clinical, administrative, and financial arrangements. Such experiments should not preclude groups of medical practitioners financing and establishing health centres of their own. In the White Paper the Government appears to prefer the communal general practitioner surgery. At present little is known of the potentialities and the difficulties, the advantages and disadvantages of the Health Centre. To seek a centrally arranged and supervised experiment is not to oppose the conception of group practice inside or outside Health Centres, but rather to urge that trial and experiment should precede the adoption of any particular kind of Health Centre or group practice arrangement. 37. The Government's Health Centre proposals mean something more. According to the White Paper, practitioners working in Health Centres would be remunerated by salary or similar alternative, the practitioners being in contract both with the Central Medical Board and with the authority owning the Centre. The profession sees in this proposal the thin end of the wedge of a form of service to which it is overwhelmingly opposed — a State-salaried service under local authorities. This proposal is particularly objectionable when associated with the powers of the Central Medical Board. There is no reason why the remuneration of a general practitioner should not be related to the work he does or to the responsibility he assumes, whether inside or outside a Health Centre. The Health Centre should stand or fall on its merits, and not be judged by the possibilities it affords of transforming the character of general medical practice. SOME POSITIVE PROPOSALS 38. There follow, in response to the Government's request for constructive advice, the Association's own proposals showing how, in its view, the principles of the White Paper referred to in paragraph 20 may be implemented. These proposals are governed by the important general considerations set out in the preceding paragraphs, and especially by the general considerations in paragraphs 1 to 19. Taken together, and with this proviso, they constitute a framework within which negotiations with the Government could take place. The Central Body 39. The profession has expressed itself in favour of a corporate body as the central administrative body, with the Minister generally responsible to Parliament for its work. This desire for a corporate body arose mainly out of a feeling of dissatisfaction with the departmental method and a desire for a form of organization which would ensure that professional advice on national health policy was made really effective. Neither a corporate body nor a department can of itself prove satisfactory unless the arrangements within it and in association with it are such as to secure the fundamental requirement that, subject to the responsibility of the Minister to Parliament, responsibility for medical policy and medical advice is borne by the medical profession. Accordingly the Association lays less stress upon the type of central body than upon the machinery set up for this purpose. 40. The Association recommends: (a) That the central body should be concerned with all civilian health and medical functions of central government, and exclusively with these. (b) That the central body, be it department or corporate body, should be advised by a statutory body, predominantly medical in composition. (c) That this statutory body (similar to the Central Health Services Council of the White Paper) should play a prominent and effective part in advising on ministerial policy on health and medical services and on the means of achieving positive health. (d) That the medical members of the Council should be elected by the medical profession and should hold office for three years, one-third of its members retiring annually and being eligible for re-election. (e) That the main functions of the Council should be to consider and advise on any general medical questions affecting the country's health, the Minister to seek the Council's advice on medical questions before him and to be under an obligation to refer to the Council any draft regulations (other than those relating to the terms and conditions of service of medical practitioners) or conditions of grant. (f) That the Council should itself publish an annual report of its work. (g) That the Council should have the right to tender advice on its own initiative and, if it thinks desirable, to publish its advice; without modification, after the lapse of sufficient time for its consideration by the Minister. (h) That the Council should be entitled to call upon the Ministry to supply any reasonable and proper information. (i) That the Council should have power to co-opt to any committees or subcommittees set up to consider particular questions. (j) That the Council should meet at least quarterly and as often at other times as may be required, and should be free to appoint its own chairman and, jointly with the Minister, its own secretariat. (k) That the Council should not be concerned with terms and conditions of service, but such terms and conditions, including remuneration, in relation to all practitioners participating in the Service should be negotiated directly between the Minister and the medical profession, a permanent agreed machinery being established for this purpose. (l) That consideration should be given to the delegation by the Minister to the Council of specific powers and duties in defined fields of work. The Central Medical Board 41. The Central Medical Board should, if continued in existence for the purpose of entering into contract on the
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