The Hospital Problem : the Report of a Special Conference of Labour, Hospital, Medical and kindred Societies
1924 1924 1920s 12 pages 3 THE LABOUR VIEW. Mr. Somerville Hastings, M.P., F.R.C.S., opened the discussion and put forward the Labour view. He said that with insignificant exceptions practically the whole of the general hospital accommodation of Great Britain was provided to-day by what was known as...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
|---|---|
| Language: | English English |
| Published: |
London : The Labour Party ; printed at the Office of the British Medical Association
1924
|
| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/DA11FE52-DFA7-44B8-8BF2-0C0BBE2CB9E6 http://hdl.handle.net/10796/76D50EDD-586C-4FDC-BF65-85212CAFF660 |
| Summary: | 1924
1924
1920s
12 pages
3 THE LABOUR VIEW. Mr. Somerville Hastings, M.P., F.R.C.S., opened the discussion and put forward the Labour view. He said that with insignificant exceptions practically the whole of the general hospital accommodation of Great Britain was provided to-day by what was known as the voluntary system. While frankly admitting that this system had been of the greatest public service in the past, it must be remembered that it depended on circumstances that might not last for ever. The evolution of the voluntary hospital system in this country had depended on a condition of affairs which, if not unique in England, had been at any rate more marked here than in any other country in Europe — namely, the existence of an extremely wealthy class of people side by side with a miserable poverty-stricken class lacking the necessities of life. It had been the existence of this class which had in the past aroused the consciences and stimulated the charity of the rich to furnish or endow our great voluntary hospitals. But the anticipations of all reasonable people were that with the improvement of social conditions this stimulus to the charity of the rich must be diminished. Hence it was evident that in the future the provision and maintenance of hospitals, even if the very rich still existed, was likely to depend to a lessening extent upon their bounty. Experience had shown that when a social service was in its experimental stage it was best undertaken by voluntary agencies and financed by voluntary effort; but once it became a proved public necessity its organization and support by the local or central authority was called for. It was only right to point out certain disadvantages which were inherent in the present voluntary hospital system because of the lack of any organization by a central authority. The first of these was the absence of co-ordination; no hospital could efficiently carry on its work as an isolated unit lacking close touch with other hospitals in its area. Here Mr. Somerville Hastings read from the daily press of April 25th the strictures of the Lambeth coroner with regard to the action of King's College Hospital in refusing admission to two men who had met with serious accidents, and who afterwards were taken to Lambeth Infirmary, where they died. In the second place, the great voluntary hospitals were often entirely out of touch with the general practitioners of their neighbourhood who were responsible for the treatment of the patients before their admission and after their discharge. The patients lacked the advantage of continuity of treatment, and the doctors tended to lose interest in the cases. Thirdly, since the large general hospitals were supported by voluntary contributions and were chronically short of funds, those in authority over them had of necessity to keep on good terms with the subscribers. There was a tendency — which he was bound to say was often strongly resisted — to give preference for admission to patients sent by large subscribers, and thus the medical necessity of the patient, which should be the sole criterion for admission, was liable to be made secondary. Yet again the hospitals in the past had been greatly helped by public-spirited men and women, medical and lay, who gave freely of their time and energy in organization and administration. The present system, which necessitated the diversion of so much of this time and energy from more important considerations to the invention of fresh schemes for the collection of halfpennies, was very wasteful. The outstanding fact was that the present system, without State aid, had failed to provide completely what the nation so sorely needed. It was calculated that, apart from accommodation in sanatoriums and fever hospitals, about two and a half general hospital beds were needed per thousand of population. That gave, for the population in Great Britain, a need of about 160,000 beds. The voluntary system provided not more than a third of that number. Although the deficiency was made up to some extent by Poor Law infirmaries, it was steadily getting worse. Medical science was advancing, but few new hospitals were being built, and the housing difficulties and low wages made the need more urgent. Another fact was that the present-day system of patients' payments to general hospitals admitted to those hospitals a class of patients — the middle and professional classes — which did not previously so extensively use them, the result of which, again, had been to produce a shortage of hospital beds. Recently a good many attempts had been made to find new sources of income for voluntary hospitals. One plan was workers' subscriptions, which was in vogue a good deal in the North, and which made up 75 per cent. of the income of some hospitals. There was no reason why a workman or anyone else should not subscribe to a hospital, but in practice it became almost a compulsory levy. Moreover, it only applied to some workers in some factories, whereas all the individuals in the neighbourhood might use the hospital. Surely a rate or a tax which all would have to pay would be a much more equitable arrangement? Even stronger objection must be taken to a system of patients' payments, which was now becoming almost universal in hospitals. However much the management of a hospital might resist it, when funds were low there must be a tendency to admit under easier terms those who were prepared to pay for their treatment. Patients' payments acted as a deterrent, or robbed the poorest of the necessities of life. Of even more importance was the fact that, since payment was received and hospitals were no longer charities, more and more of the middle and professional classes were taking advantage of them. Nominally there was an income limit, but there was no power to enforce that limit. The result was that there was a serious danger of voluntary hospitals, founded by generous-minded men and women for the poor, becoming nursing homes for the middle classes, while those for whom the hospitals had been originally intended were forced upon the tender mercies of the degrading Poor Law system. It seemed to the Labour party that the only way out of the present impasse was for the State to accept the responsibility of providing hospital treatment for all who needed it. Labour looked upon health as a national concern, and believed that it was not without danger to have such an important adjunct to national health as hospitals dependent upon charity or private enterprise. It would like to see treatment centres established in outlying districts, local or cottage hospitals in the smaller towns, county hospitals and national hospitals in the larger cities and university towns, where research could be carried on and the training of medical men arranged. It would organize intimate co-operation between all hospitals, and would make arrangements for the easy and rapid transfer of patients from one hospital to another when necessary. Nevertheless, Labour did not imagine that such a complete system could be suddenly evolved de novo. It would begin by the transference of the Poor Law infirmaries (many of which frequently had a large number of empty beds) to the local health authorities to be organized as first-class general hospitals with visiting and consulting staffs. It would make these free to all, but without any taint of the Poor Law. It would give to the present hospitals three alternatives : (1) to remain as they were; (2) to be taken over by the local health authority; (3) to receive grants from local health authorities, or, in the case of the largest hospitals, from the Ministry of Health, provided they kept their standard of treatment at the highest and that the public authority giving the grants should be represented on the governing body in numbers proportionate to the size of the subsidy. It was probable that an increasing number of hospitals would be willing to accept this last solution of their financial difficulties, and would thus slowly but gradually be transferred into publicly managed State hospitals. Lord Knutsford, referring to the statement in the pamphlet published by the Labour party to the effect that voluntary hospitals built and endowed by charity for the really necessitous poor were now utilized to a great extent by the skilled artisan, and to an increasing extent by the lower middle and even professional classes, said it had appeared from a recent inquiry into the subject that 43 per cent. of the patients in the London Hospital were so poor that they could not pay anything at all towards their cost in hospital. Dr. Gordon Ward (Medical Practitioners' Union) criticized the statement of Mr. Somerville Hastings that it was desirable to take over Poor Law infirmaries and equip them as first-class hospitals. In the majority of localities further first-class hospital accommodation was not needed, and if the Poor Law infirmaries were taken over it would mean that in a comparatively restricted district there would be two first-class operating theatres, two first-class x-ray departments, etc., which would not be required. What was needed was something short of a first-class hospital, to which patients who were entering the stage of convalescence could be drafted. The ordinary patient entering a hospital needed first-class facilities perhaps for a week at the outside; after that his presence there was excluding other necessitous cases. Poor Law infirmaries were scarcely suited for first-class hospitals, but in the country they were very well suited for the particular purpose which he had just suggested. Mr. W. A. Lewis, as a member of a board of a Yorkshire hospital, gave his experience of the voluntary system, and declared that so far as the industrial classes were concerned the spirit of voluntaryism was not dead. Workmen in his area had responded to appeals for additional contributions consequent on increasing costs. Miss MacCallum (Secretary of the Professional Union of Trained Nurses) supported Mr. Somerville Hastings's view of the desirability of co-ordinating small cottage hospitals in small districts, county hospitals in counties, and the national hospitals in the larger towns. That was the system at present in vogue in Denmark, and from her own personal observation she had never seen better organization or better hospitals anywhere than in that country.
36/L41/1/8 |
|---|---|
| Physical Description: | TEXT |