BRITISH HEALTH SCHEME

Greymouth Evening Star, 22 March 1946, Page 6

BRITISH HEALTH SCHEME

BILL INTRODUCED IN COMMONS FREE SERVICE FOR ALL LONDON. March 21. The Minister of Health (Mr Aneurin Bevan) has introduced the National Health Service Bill. Another bill providing for Scotland will be introduced later. The bill imposes duties, on the Minister of Health, local health authorities, and various new bodies to be established. This is in contradistinction to the existing legislation, which is largely permissive. The bill provides that all hospitals, except teaching hospitals, will come under the administration of regional hospital boards. It prohibits the buying and selling of practices..' It allows compensation of about £58,500,000 in England and, Wales and £7,500,000 in Scotland. Private practice will be permitted, except by specialists engaged in whole-time service. . All or any of the services will be available to everyone. This will not be conditional on any insurance qualification and there will be no waiting or qualifying periods. No fees will be payable by patients except for a few special cases, though it is open to people who wish to do so to pay for special amenities, for example, more expensive appliances or additional privacy. Free choice by patients of doctors and vice versa will continue. It is hoped the scheme will begin to operate at the beginning of 1948. Financial Details

It is estimated that the total cost in the early -years will be about £152,000,000 a year. The Government will bear the full cost of pital and specialist service (£87,000,000) and family doctor, dentist, pharmaceutical, and eye services (£45,000,000), and pay about half the cost of various local authority services (£6,000,000). Allowing for a contribution of £32,000,000 from the national insurance fund (at the rate of TOd a week for a man and 8d for a woman) and savings on existing grants, the net additional cost to the Exchequer is estimated at £95,000,000 a year. At present British hospitals are, broadly, in two classes: first, the socalled voluntary hospitals, ranging from the great teaching hospitals to cottage hospitals staffed by local general practitioners; second, public hospitals provided by local authorities.

The bill provides that premises and equipment of all these hospitals (but not endowments of voluntary hospitals) shall be transferred to the Minister, except where he is satisfied the transfer is unnecessary. Special provisions are made for teaching hospitals, but the administration of all others which are transferred to the Minister will be entrusted to between 16 and 20 regional hospital boards charged with management and planning. Each region will be formed so that its services can conveniently be associated with a medical university school. Boards will appoint local hospital management committees for each large hospital or related group of hospitals forming a reasonable self-contained hospital service unit. Although the regional boards will look to the Exchequer for finance, they will be given as much financial freedom as possible for local initiative and enterprise. Extra Payments.

Attached to the ability of patients to pay extra for greater privacy is a condition that patients needing such accommodation on medical grounds will have it without payment. The Minister is empowered to provide separate pay rooms or blocks for which people can pay the whole cost privately and in which part-time specialists within »the service can treat private patients, again subject to the above condition. Private patients using the accommodation ' will pay their own specialists’ fees within the prescribed maximum. Under the heading “General and personal health care by doctors and dentists whom the patient chooses,” the bill provides for the establishment of publicly equipped health centres under municipal control. These services will be available both from the health centres and the practitioners’ own surgeries, but the centres will also provide for many special clinical services and serve as bases for health education. Comprehensive Services Every man, woman, and child will have placed at his or her disposal at home, at a doctor’s surgery, or at a health centre, even when away from home, a free, comprehensive -health service, including hospital and specialist services for the prevention, diagnosis, and treatment of illness, together with drugs, medicines, and appliances. People will choose a doctor from a list of those joining the service, subject to tho doctor’s consent. Thereafter, the relationship between them will be the same .as at present, except that the doctor’s remuneration, will come from public funds, not from the patient direct. Doctors may arrange to treat privately a person wishing to remain outside the service.

Detailed terms of remuneration for doctors joining the service have still to be negotiated, but they will consist of a fixed salary, varying according to experience and circumstances, plus an annual fee for each person whose care is undertaken, plus in the case of established doctors interest on the computed compensation value of the practice, which will be payable normally on death or retirement. The contract of service will be not with the Government or local authorities but *with executive councils to be established in each county or borough, half of whose members will represent local doctors, dentists, and chemists, and a third of whom will be appointed by the local authority. The- remainder will be appointed by the Minister. The bill establishes a medical practices committee for the regulation of succession to old practices and the opening of new. Remuneration conditions for dentists who enter the scheme have' still to be settled. Dentists working their own surgeries will submit claims for payment, but for certain forms of treatment they will have to submit estimates to the Dental Board, on April 4.