Health service crisis in U.K.

Press, Volume CXV, Issue 33806, 1 April 1975, Page 18

Health service crisis in U.K.

(N.Z.P.A.-Reuter—Copyright) LONDON. Britain’s “cradle - tograve” National Health Senice (N.H.S.) is seriously ill — the victim of acute bouts of cash starvation and staff militancy. On the surface, all appears normal. A bustling efficiency pervades hospital wards, ambulance fleets whisk away! emergency cases, a visit tothe doctor still costs nothing. But a closer look tells a different story about the mammoth institution which was set up in 1945 to dispense free medical treatment for all in the Socialist euphoria that swept post-war Britain. The symptoms: longer and longer waiting lists for treatment, booming enrolments for private health schemes, and increasingly angry calls to arms by doc- I tors over pay and other! issues. Suggested treatment: a large injection of money. And the treatment is urgent. The situation has become critical in recent weeks because of sanctions byembittered consultants — the most senior men in the entire N.H.S. pyramid. Because of their kev role.

in the health-care of their country, the consultants' dispute — it involves com-: plex issues of professional freedom as well as money — is the most serious for the i system’s future. Yet it is only the tip of an iceberg that touches other disgruntled sectors of the medical profession and the discontent goes back some time.

Britain’s doctors and( nurses have long said that: their good will and dedication have been exploited by the Government to provide the public with a cheap medical system. And it has been cheap. Britain spends only 6 per cent of its Gross National Product on its annual health bill, less than the United States, Canada, Sweden, the Netherlands, West Germany or France.

Britons have never had the problems of Americans who are sometimes bank-; rupted by doctors' bills, or I the tax-rebellion movements' [of the Danes baulking at the: ’high cost of State welfare. But now inflation, running at 20 per cent annually, has: worn the N.H.S. down to its 1 frail skin and bones. The good will has gone. The health service annual budget, raised from the. general tax pool, is £3ooom. j Insiders estimate another 1 £9oom is needed immediately to make up deficiencies. The lack of cash is lowering standards in an already, weakened system. Under- i staffing in one hospital, for instance, has resulted in a six-year wait for some patients needing treatment in the ear, nose, and throat department.

There is a constant threat, of a mass exodus of doctors: and nurses into the more lucrative private medical sec-1 tor, which exists side-by-side' with the National Health Service.

It is the co-existence of the ‘ public and private streams — and the links between them — that helps to explain what( the consultants’ dispute is all about. The consultants are an elite group of 11.000 doctors: who have reached the top of their chosen fields in medi-1 cine, whether it' he brain surgery or baby problems. Just under half of «hem;

I work full-time in N.H.S. hospitals: the rest commute between private practice and: : hospitals, where they do: I part-time work under contract with the national I scheme. The problem is that these so-called “part-timers,” because of growing workloads, have been working well over their N.H.S. contracted hours, or “sessions” — and want to [be paid for the extra time. [ I But Mrs Barbara Castle, i I the Social Services Secretary, | has turned down any idea of j ; “overtime” payments. She ! (proposed, instead, extra cash! for consultants who opt to | work exclusively for the (N.H.S. to encourage them to (give up private practice en- [ tirely. j The consultants reject this, I saying that it is too high a I price to pay for giving up i their professional independj ence. They talk of the salaried I civil servants’ “straitjacket” [but their critics say that the i reason is reluctance’ to forego I the plush pastures of private I work. , To back up their demand, the consultants have taken [ the unprecedented step of refusing to work beyond thencontracted hours—unless the Government pays “overtime”, , rates of £8 an hour. Mrs Castle refuses and | this has meant only the more lurgent cases are being seen. A steady backlog is building up of patients needing expert treatment. It is difficult to assess how [deeply these sanctions are: [biting into the N.H.S., but the militant Hospital Consultants and Specialists’ Association estimated that in January alone 250,000 appointments had to be cancelled. And more storm clouds [are gathering—this time from [the 23,000 family doctors, or (general practitioners, who (form the backbone of Bri-i (tain’s medical care system. The average G.P. who' (takes home about £6OOO ai year before tax. claims to! (have fallen way behind com[parative income groups in Britain. (His American coun-' terpart gets perhaps three[ times the figure.) So thev have threatened to resign en masse from the,: [N.H.S. unless their income is: brought up to date in April —and their “trade union,”;] ithe British Medical Associa-]

■jtion (8.M.A.). has started ; collecting undated resignations. : If they carry out the threat, Britons will be confronted with something most of them have never seen before —a doctor’s bill. The charges would be perhaps £3 for an office visit. £4O for maternity care—and the patient would have to claim payment back from the (Government. I Also waiting in the wing; for a better pay deal in [April, are the hospital doctors. One grade of hospital (doctors earn £2200 a year after working 102 hours a week, the B.M.A. says. The turmoil in the N.H.S. has triggered a boom in private doctoring and you don’t have to look far to see why. Last year, strikes by nurses, technicians, and others in the hospital service reduced by 90.000 the number of patients admitted. Some were turned away during the strikes and some of the “lucky” ones had to bring their own sheets because of laundry shortages. As a result, private prac- ; tice is increasing and private health insurance Schemes are enrolling record pumbers. In turn, this has presented more headaches because some of the “private beds” are located in N.H.S. hospitals — and militant hospital workers resent the so-called privileged position of private patients Private patients, thev claim, can jump the queue [waiting admittance. In hospital, they enjoy smoked salmon and colour television. while N.H.S. patients have to make do with fish and chips and the radio, critics say. The Government intends to phase out these “pay” beds and wants to encourage doctors to give up private practice and work for the N.H.S. [exclusively. Ironically, purging the Health Service of private patients is fostering the growth of the private sector which will be used increas- ' ingly by the wealthy who can pay for the extra “perks." The danger is that if the private sector attracts the (moneyed patients, it will ini creasingly cream off the doctors and nurses from the poorer-paying National Health i Service.