The Hospital Problem : the Report of a Special Conference of Labour, Hospital, Medical and kindred Societies
1924 1924 1920s 12 pages 9 At the financial crisis of the voluntary hospitals in 1920 our Association gave evidence before Lord Cave's Committee, and urged that grants should be made to these hospitals in the same way as was done to the universities, through a "buffer state.&qu...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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London : The Labour Party ; printed at the Office of the British Medical Association
1924
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| Online Access: | http://hdl.handle.net/10796/2878D8C1-BA33-467C-B8FA-59A779641C7E http://hdl.handle.net/10796/0DD6D2C6-120B-463C-987D-ADF802220DDF |
| Summary: | 1924
1924
1920s
12 pages
9 At the financial crisis of the voluntary hospitals in 1920 our Association gave evidence before Lord Cave's Committee, and urged that grants should be made to these hospitals in the same way as was done to the universities, through a "buffer state." The coffers of the State were opened to such a body which acted as the almoner of its largess. The one duty charged upon it was to see that distributions were necessary and proper; there was no power of control. These schemes are an admirable illustration of a tendency in modern democratic government to recognize that there are more national activities than those directly within the sway of the Governmental machine. Through a widened Voluntary Hospitals Commission the State could develop voluntary hospitals where their services were required. I see no reason why the facilities of the Trades Facilities Act should not be extended to voluntary hospitals for development. In some of its dealings with the voluntary hospitals the State acts the part of the mean man who pretends poverty to get free treatment. If it paid fairly for services rendered the finances of the hospitals would be bettered. Statutory authorities send their sick to these hospitals for treatment and expert report and do not pay. The Post Office, police, sanitary, and Poor Law authorities all join in the game. If these paid fairly for work done there would be advantages on both sides and to the public health. The police hurry street accidents into those hospitals, and it is right that they should, but why does not the authority pay the costs involved as it does to the general practitioner whose services are required? Again, those hospitals should play a large part in public health matters through the statistics of their case records. The advantage of the tabulation of these records is almost wholly national. Their need was apparent to the Royal Commission on Venereal Disease, and again to the Committee on the Causes and Prevention of Blindness. An allotment by the State for the work of the registrars' departments of these hospitals would be a profitable investment. We put this suggestion before Lord Cave's Committee, which adopted it as a recommendation. Again, the medical education of the country, almost of the Empire, is carried out in the voluntary hospitals. This work greatly increases costs that should be a charge on the State and be made good through the University Grants Committee. The existing education grants are inadequate. The same applies to the training of nurses, who ultimately serve both in private and in State spheres. Much could be done to relieve the voluntary hospitals of a heavy charge upon their resources by more generous grants in aid of education. Conclusion. In conclusion I venture to adapt two quotations from recent speeches of Mr. Ramsay MacDonald, the Prime Minister. He was speaking of countries, but with a minimum change his utterances admirably sum up our view on hospital policy (the changed words are in italics) : "We find ourselves confronted with a voluntary hospital system, with its customs, habits, and institutions to which we are particularly attached; with an administration formed by centuries of practice and liberty; like everything in the world, this ancient and powerful organization is capable of improvement, but there is everything to be lost by destroying it." The second utterance, dealing with negotiations between two countries, admirably foreshadows the position of parties to this conference : "The ends we profess to serve cannot be attained unless we can get thoroughly to understand each other and unless we can carry with us the bulk of the responsible opinion in the two parties represented by both of us. If we begin by trying to deceive each other we shall go on to deceive those we represent, and end by deceiving ourselves." Discussion of Mr. Bishop Harman's Paper. The Chairman said that it would be more accurate to describe the contribution made by Mr. Bishop Harman as "The British Medical Association view," because the view of the doctors of this country was not necessarily the same, and there were many doctors who took the Labour view. The speaker could not help thinking that if the community were starting de novo, the organization of the medical service and the hospital service of this country would take a very different form. It would be regarded as the function of doctors to keep the community well, not to tend it in sickness. Anyone who had read the admirable presidential address delivered by Mr. C. P. Childe at the last Annual Meeting of the British Medical Association would realize that to keep people well and to tend them in sickness was not one and the same thing. The Fabian Society had honoured itself by publishing in extenso that wonderful address. Mr. Childe had pointed out that some of the most widespread diseases from which the community was suffering at the present time were the product of environment. He might, indeed, paraphrase Mr. Childe's conclusion by saying, what had so often been said on Labour platforms, that poverty was the disease. In considering the remedial treatment for the diseases which existed the Labour party was not ignoring, as some speakers had suggested on the previous day, the need for a better orientation, but it was necessary to face things as they were. He believed that the great necessity was for team work. Not only must the financial resources be pooled, but the medical resources also, if the problems were to be solved. He hoped doctors would repel the frequent libel that directly the doctor became a municipal or State servant he lost all initiative and also all loyalty to his profession. The Chairman went on to say that to him it had been an amusing comedy to read the debates in British Medical Association meetings as to the meaning of voluntaryism. The Voluntary Hospitals Commission had declared that the voluntary hospital was not necessarily an institution where medical treatment was free, but was one managed by a voluntary committee and wholly or mainly supported from voluntary sources. The Labour party would be prepared to go a very long way towards placing the management of the hospitals in the hands of the doctors themselves. Nor did the party expect the doctors to give voluntary service; it expected them to get a quid pro quo. He quoted from a communication from the Labour party and trades councils in Ontario, where the doctors appeared to take a view exactly the opposite to the view largely accepted by doctors in this country. Doctors in that province were opposed to the whole scheme for voluntary hospitals, and claimed that the voluntary hospitals system in England was failing; they favoured the maintenance of hospitals out of the rates. In conclusion he said that the Minister of Health had already set up a committee of inquiry into the inadequacy of the number of hospital beds in this country and their unsatisfactory distribution. Dr. E. A. Gregg (Medical Practitioners' Union) spoke on the relationship of the general practitioner with the hospitals. The probability was that the hospitals would not be called upon to treat a considerable number of the cases they were now called upon to treat, especially in the out-patient department, if a better relationship between the general practitioners and the hospitals could be established. The isolation of the general practitioner from the hospitals was a vital defect. A thoroughly honest, keen, and conscientious general practitioner, anxious to do his very best, had opportunities of doing a great deal of harm because of his limitations — limitations which he realized better than anyone else. The cure for that was to get the general practitioner into the hospital, as part of the hospital personnel, doing part of the hospital work as part of his day's work, and coming into contact with others engaged in the work. If such a scheme could be developed there would not be the present picture of practitioners growing stale in the practice of their profession. Another advantage of such a system would be that medical students at the hospitals would be able to associate with general practitioners who would be able to impart valuable information and give great assistance to those medical students in preparing them for their future work as general practitioners. At the present time medical students on leaving hospital and starting in practice discovered that there were many things which they had not learnt at the hospital and which would be of advantage to them, and that there were other things which they had learnt but which were of no value to them whatever in general practice. Mr. G. W. Canter (Labour Party Advisory Committee) stated that the proposals made by the Labour party were not like the laws of the Modes and Persians; the Labour party desired to co-operate with those who had greater experience than themselves. They were not claiming as a Labour party that the problem could be solved entirely by the proposals they had put forward; neither did he think it could be solved by the suggestions put forward by Mr. Bishop Harman; hut he certainly believed that by co-operation between all those interested in the welfare of the people of this country something could be produced for presentation to the Government which would assist in solving very materially the problem in the near future. Mrs. Dickinson Berry (Medical Women's Federation) remarked that before the war she had been strongly in favour of State management of hospitals, but her experiences during the war and since had rather led her to modify her opinions. One saw that everything done by collective or Governmental action seemed to lead to wasteful, unbusinesslike, and stupid methods. The argument had been used that the hospitals were in their present penurious condition because the people who formerly contributed to hospitals had not now the money; it had passed into the hands of people who had not been educated up to the duty of helping their fellows; but the instances which had been given the previous day went to show that progress was being made in that direction and that the old generous support to hospitals would soon again come about. In her opinion such a method was a much better one than forcing people to support the hospitals through a poor rate.
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