The Transition to a State Medical Service
1942-08 1942 1940s 8 pages (25) Nor is the voluntary hospital so situated that it can assume any constant partnership responsibilities. It is neither a statutory undertaking, nor known to the Charity Commissioners, nor yet a private undertaking such as might be registered under some existing Act. It...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
| Published: |
August 1942
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| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/99FC9409-E055-4B5A-A23A-14AE06F57661 http://hdl.handle.net/10796/F749B2FC-ECF7-4809-8DF4-C8ED4C07ACAE |
| Summary: | 1942-08
1942
1940s
8 pages
(25) Nor is the voluntary hospital so situated that it can assume any constant partnership responsibilities. It is neither a statutory undertaking, nor known to the Charity Commissioners, nor yet a private undertaking such as might be registered under some existing Act. Its effective ownership of land is often without legal sanction, and its corporate responsibilities and liabilities almost defy definition. (26) For these and other reasons, the Union believes that the voluntary hospitals must be taken over in toto and administered directly by the Ministry of Health, very much as the Poor Law institutions were recently taken over from the Guardians by the Municipal Councils. (27) This does not mean that every voluntary hospital could claim a right to be taken over. Those, for example, which make a point of avoiding the use of alcohol, would be able to stay outside the national scheme if they so wished, but, if included, could not insist upon their particular limitations of treatment. (28) By the expression "taking over" the Union means that the hospitals concerned, their debts, investments, stock and buildings, would pass absolutely into the possession of the State. Practically the whole of the voluntary hospitals in this country would be taken over in this way, including the very smallest (with 10 beds or less), although these latter would not necessarily continue to be used as such. (29) The most considerable changes in administration which would follow would be the appointment of a medical superintendent and steward in place of the secretary, and the payment of the medical staff, with the abolition of pound days, flag days and other forms of solicited charity. (30) Hospital committees would still be needed, although in a somewhat different form, and there can be no doubt that many of those who now manage the affairs of voluntary hospitals would be willing to give their services to the State for the same purpose. They would have less real executive power, for this would vest in the medical superintendent acting as an officer of the Area Health Committee, but they would not lack an ample sphere for their activities; but both the Hospital Committees and their corresponding Medical Staff Committees should have the right of independent access to the chairman of the Area Health Committee and should not be wholly dependent on the attitude of the Medical Superintendent. (31) The responsibility for financial arrangements would rest eventually with the Exchequer, and it is extremely probable that due economy would be maintained by a system of block grants allocated to particular hospitals by the Ministry of Health through the Area Health Committee. But there would also be other sources of income; the most important of these are likely to be shares of the payments under precept made by the local rating authorities. These would justify their representation upon managing committees, as in Area Health Committees, and induce them to observe due economy on expenditure. Although contributory schemes and the payments of hospital savings associations would come to an end, it would remain possible for private subscribers to make donations for particular purposes. These are quite likely to prove inconsiderable, but there is no reason why they should cease to exist, especially if adequate publicity is given to needs which cannot conveniently be met by the State, for articles of equipment surplus to the standard which the State can afford to provide. (32) No charge would be made for treatment or for the standard type of accommodation. Single wards would be abolished except for the use of cases which require isolation from others. Those who desired the conveniences of a Private Ward would have to find their own accommodation at home or in Nursing Homes. (33) The taking over of hospitals will mean the taking over of their consulting staffs. These will become whole-time Government officials, but their work will not undergo any great alteration. The most striking difference will probably be that a consultant who now ranges in his private capacity over a very wide area will find himself with a definite and very much smaller area to serve, without competition from other specialists. His rate of pay will be such that he can enjoy the social surroundings essential for all those of like intellectual and cultural capacity, but he will never, in a State service, be able to make the fabulous incomes enjoyed from time to time by the best known specialists under our present system. (F) TAKING OVER THE MUNICIPAL HOSPITALS (34) All types of municipal hospital should be taken over in the same manner as the voluntary hospitals. These would include sanatoria, mental hospitals, maternity, fever and smallpox institutions. (35) The resulting changes in administrative method would not be very great. The medical superintendent would be paid from a different source and would administer a national rather than a local policy. The steward might draw his supplies from central stores under different financial arrangements and the managing committee would cease to have any executive authority and would report to the Area Health Committee instead of to the county or borough council. This committee would also find that it contained an increased medical representation, but a much reduced political significance. (36) The position and authority of the medical officer of health would undergo considerable change. His contract with the local authority would not be disturbed, and he would continue to be protected from undue political pressure in virtue of a security of tenure guaranteed by higher authority. He would perforce confine himself to environmental services. In this sphere some medical officers of health have been extremely remiss for many years past, chiefly because they have been overwhelmed by duties in connection with the personal medical services, such as clinics, hospitals and maternity services. They have seldom been able to inspect or control, far less to extend, the environmental services, and it will be a great advantage to the community if they can have the opportunity for such work. Notwithstanding the new arrangements, there may be occasional duties in connection with the work of the Area Health Committee which can best be fulfilled by a medical officer of health who happens to be under contract to a local authority. In such case a part of his salary may be 4
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| Physical Description: | TEXT |