A National Health Service : Report of the Council of the B.M.A. to the Representative Body
1944 1944 1940s 11 pages 10 vices other than to private paying patients — were paid from public funds, the hospitals would have a less obvious claim to voluntary financial support from the public, and the voluntary hospital movement as it is now known would be endangered. It is neither th...
| 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/C0A6055A-2980-4F91-AD62-64E9F911D189 http://hdl.handle.net/10796/7573B2B5-7AF5-4D49-8404-2B0A7D1DC163 |
| Summary: | 1944
1944
1940s
11 pages
10 vices other than to private paying patients — were paid from public funds, the hospitals would have a less obvious claim to voluntary financial support from the public, and the voluntary hospital movement as it is now known would be endangered. It is neither the wish of the Government to see this happen nor their belief that the public wants it to happen. At the same time, while this principle seems important in the interests of the voluntary hospital movement, the financial arrangements must be such as will ensure that the hospitals can efficiently perform the services asked of them. The exact arrangements needed to ensure this will be fully worked out in consultation with the hospitals' representatives as soon as possible. Question 28.— Will there be any Exechequer grant for a voluntary hospital in order to enable it to carry out extensions necessary to provide an adequate local service as part of a joint board scheme? Or is such financial assistance to be provided entirely by or through the joint board? Answer.— This was not dealt with in the White Paper because there had been no preliminary discussions on the point with the hospitals' representatives. It is a point of obvious importance which will be discussed with them as soon as possible. Consultant and Specialist Services Question 29.— Is there to be free choice of consultant by general practitioner? If so, can the consultant be appropriately paid by salary for this part of his work? Answer.— The intention is that the approved area plan will determine generally the hospitals or groups of hospitals and the specialists to which particular classes of case should be referred within the public service, but within the general arrangements so determined as much free choice as possible, will be maintained. It is proposed in the White Paper that the specialists taking part, whole-time or part-time, shall be based for their public service activities on the various hospitals in the way which the plan provides, and they will look to the hospitals concerned for their remuneration ; but methods and details of remuneration remain to be discussed. Question 30.— Will the Minister give an assurance that the personal relationship between general practitioner and consultant shall be preserved? Answer.— It is the intention that a close personal relationship shall be assured between the general practitioners and the specialists to whom they will refer their patients within the arrangements of the area plan. Question 31.— What is to be the machinery for the provision of domiciliary consultations? Will the Minister amplify the passage on page 25 of the White Paper: "And—for certain consultants as circumstances may require — of visiting Health Centres and clinics, and, in case of need, the patient's home, at the request of the general practitioner"? Answer.— It is contemplated that the arrangements of each area plan for providing consultant services should include arrangements whereby consultants will undertake any necessary visiting of patients in their homes at the request of the general practitioner. Which of the available consultants undertake this function will be a matter for local arrangement with the hospitals within the area plan and, of course, with the individual consultants themselves. Question 32.— Are the details of remuneration for both consultants and specialists to be arranged centrally? On page 25 of the White Paper it is stated that "some central regulation of scales will be required." If all conditions of service for consultants and specialists are not to be arranged centrally what machinery is proposed? Answer.— No proposals on this have yet been formulated. But it appears likely that standards of remuneration will need to be settled centrally, in consultation with those concerned, and then prescribed for observance by all hospitals within the service. General Practitioner Services Question 33.— Does the Minister agree that the limited compensation proposals set out in the White Paper raise the whole quesion of compensation for loss of capital value of all general practitioners? What is the attitude of the Minister to this question? Answer.— Questions of compensation, of the possibility of providing a superannuation system, and of the desirability — and practicability — of discontinuing in future the sale and purchase of practices in the public service, all need to be considered together. The Minister hopes that the profession's representatives will join him in a general discussion of all these issues before the legislative stage arrives, and in this discussion he will particularly welcome the profession's own suggestions. Question 34.— Why should the Health Centres not be in the same relationship to the joint authorities as the hospitals? Answer.— The proposed demarcation of functions between the major local authorities acting on their own and the same authorities acting in combination over wider areas is, broadly, that services which belong to the sphere of the hospital, the specialist, and the consultant, and which therefore need to be planned and administered over larger areas, should rest with the combined authorities, while services which do not should rest with the single authorities. On this basis the provision of Health Centres falls into the latter group. Question 35.— What will be the administrative effects of a Health Centre being attached to a hospital, the hospital being under the joint board, and the Health Centre under the individual local authority, the participating practitioners being also under contract with the Central Medical Board? Answer.— In practice this situation, where it arises, should not create any serious administrative difficulty. Financial adjustments between authorities which share the same premises for their services have in the past proved perfectly feasible. Whatever the local authority organization, a similar question would arise anyway where a Health Centre was attached to a voluntary hospital. The position of the general practitioner would not seem to be affected by the fact that a particular Health Centre was attached to a hospital. Question 36.— Will the Minister give an assurance that experiments will be made in Health Centres of various types and functions under medical guidance before central policy is adopted, and that an experimental centre shall be set up only with the acquiescence and full co-operation of the local profession? Answer.—It is fully intended to make experiments in Health Centres of varied types and functions in varied kinds of areas, and to do this with the guidance of the medical profession through both the Central and the Local Health Services Councils. As stated in the White Paper, the wish of the local doctors to bring their work into the centres must obviously be a big factor in decisions to provide centres. Question 37.— Will the Minister give an assurance that experimental Health Centres shall be available to all the practitioners in the area? Answer.—No assurance can be given that at any particular time there will be enough Health Centres available for all doctors who desire to enter that form of practice. But the desire of doctors to do so, if backed by the success of the Health Centre experiment, would be an important reason for hastening developments in any area. So far as the question may relate only to special diagnostic or similar facilities set
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