The Hospital Problem : the Report of a Special Conference of Labour, Hospital, Medical and kindred Societies
1924 1924 1920s 12 pages 8 the independence of at least some hospitals in competitive consultation with the State hospitals would be to secure the "greatest common measure" of effort. There is now in existence a mechanism which could be made an effective instrument of co-ordination...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
| Published: |
London : The Labour Party ; printed at the Office of the British Medical Association
1924
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| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/D93D3ECE-7BBC-45E7-8148-0B479EC2D17D http://hdl.handle.net/10796/9D9846C7-47D8-4321-BD3A-2F44D88B5DA9 |
| _version_ | 1771659906943811585 |
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| description | 1924
1924
1920s
12 pages
8 the independence of at least some hospitals in competitive consultation with the State hospitals would be to secure the "greatest common measure" of effort. There is now in existence a mechanism which could be made an effective instrument of co-ordination in hospital affairs. The Voluntary Hospitals Commission and its local committees were intended to serve a temporary purpose. They have served that purpose well, and might now be promoted to a greater and more permanent sphere. The policy of the Association is : 1. The scope of these committees should be extended so as to make them the co-ordinating bodies for all the hospital accommodation required within their areas, including voluntary, municipal, and Poor Law, provided: (a) that the areas covered by the committees should be large; (b) that the personnel of these committees should include representatives of all the hospitals or hospital authorities concerned, voluntary, municipal, and Poor Law, and of the medical practitioners of the area. 2. That the terms of reference to these committees should include: The survey of all the hospital accommodation of the area; the determination of its adequacy; and the co-ordination of all accommodation in the area, both special and general voluntary hospitals, municipal, and Poor Law hospitals; the recommendation of any necessary additional accommodation, both as regards general and special hospitals, primary centres in rural districts, and convalescent homes. The committees should not interfere with the domestic autonomy of the hospitals : each type of hospital should be encouraged to work upon those lines of local initiative which have proved so vital in hospital work. 3. The scope of the Voluntary Hospitals Commission should be extended to make it a Standing Consultative Hospitals Committee for England and Wales which should act as between the Ministry of Health and the local committees in all matters concerning hospital policy, and the allocation of any grants which may be allotted to hospitals not directly supported by the State in its various functions. Poor Law Hospitals. The work of these State hospitals must be taken into account : they are numerous, and deal to some extent, and are capable of dealing to a still larger extent, with the same class of disease as the voluntary hospitals. At present these great hospitals do much good work, but the manner of their staffing renders them more or less isolated. A small whole-time staff working in a single building inevitably becomes cloistered. We wish this isolation broken down. It can be done, and it has already been done by some Poor Law authorities. They have appointed visiting consultants and specialists. In some that highest stimulus to medical work, the presence of medical students, has been brought about by arrangement with medical schools and post-graduate colleges. Further, we desire the pauper stigma to be removed from these infirmaries. It is the limit of absurdity that a patient treated at an infirmary, who pays the approved charges for his treatment, should count as a destitute person ! Bring to these State hospitals the inspiration which has made the voluntary hospitals what they are, and more will be done for the health of the nation than could be obtained by a scheme of "unification." And the improvements we suggest could be obtained in a minimum of time. The Voluntary Hospitals. These are the living evidence of the compassion of man for his fellow. Find what faults you will in their work, their chief merit remains. They are the pioneers of medicine. They have sprung up according to the needs of the time and place. Their founders have been philanthropists and often doctors interested in some special work. They are diverse in scope and methods, but there is one common hall-mark — they are hospitals free from statutory control. In our policy this is defined thus : Par. 7. The Association maintains that the essence of the voluntary hospital system is the independent and voluntary management. Some have sought to link with this voluntary (meaning gratuitous) support and treatment, but these are not essentials. Many hospitals receive large sums by way of payment for services rendered and remain voluntary; and some of the oldest hospital foundations have always paid their staffs, yet were the pioneers of the voluntary system. Most voluntary hospitals were originally charities. They are now less charities than formerly. The betterment of the general condition of the people has reduced the need for the free gift. The excellence of these hospitals has increased the demand for their services by those who can and are willing to pay for these services. There is now a process of evolution in these hospitals to enable them to cope with changing conditions. The Association policy recognizes the change. The Association recognizes a dual policy as regards the voluntary hospitals: (a) that the purely charitable side should be continued wherein the whole cost of the maintenance of indigent patients is met by the gratuitous contributions received by the hospital and on whose behalf the services of the honorary medical staffs are given gratuitously: (b) that other patients who are not indigent may be received for treatment at voluntary hospitals when they cannot pay for or cannot obtain adequate treatment elsewhere, and that for them payment should be received by the hospital either from the patients themselves or on their behalf from the authority or body referring them to the hospital, and that on account of their treatment some method of remuneration of the honorary medical staff should be arranged. I do not think there will ever be any lack of funds or services for those who are in need. The problem arises on the second part, and on this the Association policy is precise : Par. 11. Every patient of a voluntary hospital who is able should make contribution towards the cost of maintenance and medical treatment, unless the contributory method of subscription is adopted as essential in industrial areas. Contributory Schemes. There are a number of contributory schemes now being exploited. Most are in their infancy. We look upon them with a friendly eye. Many do not conform to our policy, but we are in conference with their sponsors, and believe that at no distant date essential principles will be recognized. We consider that in a matter of medical treatment the natural tendency of an intelligent man is to value that which he chooses for himself, pays for himself, and has some share in controlling, so that contributory schemes meet this natural desire rather than a general State provision. It may be that these contributions will eventually be made through some wide scheme of "all-in insurance"; that is not our affair, provided always the independence of management is maintained. On this our policy is clear : Par. 38. Where representation of benefactors, subscribers, or contributors to the funds of a voluntary hospital is given on the board of management or governors of the hospital, representation should be distributed so as to secure the representation of each interest in the hospital and so that no single interest should be in a majority. In our view the development of sound contributory schemes will abolish the greatest fault of our large voluntary hospitals — the overcrowded out-patient departments. We describe their proper purpose thus : Par. 25. The primary object of the out-patient department should be for consultation. With sound contributory schemes these consultations could for the most part be arranged for privately, to the greater comfort and saving of time for the patient. Par. 28. Where arrangements for consultations or specialist services for tariff patients are made under some contributory scheme or otherwise, such arrangements should provide that these services shall be given so far as is possible and consistent with the best interests of the patients by the private practitioner at his consulting rooms or at the patient's own home and not at the out-patient department of the voluntary hospital. Costs. The costs of hospital treatment are steadily increasing, and they are likely to increase. Altered money values, increase of wages, and shorter hours add to costs. The greatest increase is due to the increasing cost of scientific medicine. The old hospital was little more than a retreat for the sick. The modern hospital is an amazing organization. There is scarcely an advance in chemical, physical, or biological science which is not conscripted in the warfare against disease; both armamentarium and personnel increase. The work has to be done in detail; there is no wholesale medicine. Costs are likely to increase. There is no finality in medicine; with each advance there is increased complexity. But beyond this costs will rise, for it is inevitable that the medical staff will have to be paid for their services. The increasing use of institutional treatment makes a greater demand on the services of the doctors, whilst at the same time it deprives them, and the younger of them especially, of those patients who would formerly have been treated by them in private. Again, modern medicine is so jealous a mistress that there is less possibility for the young man engaging in general practice whilst preparing for his real work. He must give all his time to his chosen work if he is to be a master. It is therefore imperative that the hospitals should budget for this inevitable increase of cost. It may be thought by some that the change should be met by more or less whole-time salaried service of hospital doctors. In practice this plan is found neither good nor an economy. With whole-time hospital service there is a loss of that freshness of outlook and alertness which is gained by an alternation of work inside and outside hospital. It is not economy, for relatively small remuneration will enable the part-time hospital doctor to keep on until such time as he obtains the mainstay of private practice. The Part of the State. Let it be granted for the sake of argument that the State recognizes the work of the voluntary hospitals and desires to aid them in their work. How can it do this without injuring that autonomy which is the essence of their vitality? It can be done; it has been done.
36/L41/1/8 |
| geographic | UK |
| id | HEA-1642_867e9437de444a949bd803c49ff3a784 |
| institution | MCR - The Modern Records Centre, University of Warwick |
| is_hierarchy_title | The Hospital Problem : the Report of a Special Conference of Labour, Hospital, Medical and kindred Societies |
| language | English English |
| physical | TEXT |
| publishDate | 1924 |
| publisher | London : The Labour Party ; printed at the Office of the British Medical Association |
| spellingShingle | Iron and Steel Trades Confederation Labour Party Health care Hospitals--Great Britain The Hospital Problem : the Report of a Special Conference of Labour, Hospital, Medical and kindred Societies |
| title | The Hospital Problem : the Report of a Special Conference of Labour, Hospital, Medical and kindred Societies |
| topic | Iron and Steel Trades Confederation Labour Party Health care Hospitals--Great Britain |
| url | http://hdl.handle.net/10796/D93D3ECE-7BBC-45E7-8148-0B479EC2D17D http://hdl.handle.net/10796/9D9846C7-47D8-4321-BD3A-2F44D88B5DA9 |