National Health Service

Part of the debate – in the House of Commons at 12:00 am on 15 July 1959.

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Photo of Mr Anthony Kershaw Mr Anthony Kershaw , Stroud 12:00, 15 July 1959

I think that the hon. Lady, who has been longer in this House than I have, will know that that is a Parliamentary device and that we are not deceived by it.

I was particularly gratified to hear of the progress made with the construction of new hospital buildings and to learn that four are already in use and ten are building. We all know the vital importance of new buildings to hospitals in this regard, and it is very gratifying, that—I was going to say almost at long last—the financial position of the country has made it possible for us to embark upon this ambitious programme.

The pay and conditions of those taking part in the Health Service are also a vital link in our Health Service which, up to fairly recently, was rather weak. As I understood the figures which my right hon. and learned Friend gave in his résumé, the pay and conditions have risen about one-third in value since 1951, and that must be a source of gratification to all of us.

I had the opportunity the other day, through the kindness of my hon. Friend the Member for Epping (Mr. Finlay) and the noble Lord, Lord Taylor, to visit the Harlow Industrial Health Centre. As I believe my right hon. and learned Friend also went there later, I am not telling him anything he does not know, but I was extremely impressed with this industrial experiment, which fills a gap in our arrangements. It is an aspect of the Health Service in an area in which mostly small businesses or small factories are situated. The very large industries, employing many hundreds of people, can afford—and it is financially to their benefit to afford—a health service of their own inside the factories, but in the case of smaller ones employing up to 200 people or so, it would be a waste of their resources, and a waste of medical resources, to have to spend money in this way in the confines of their own factories. It seems to me that this could fill a need in some parts of the country where the factories are of the right size and sufficiently concentrated to provide a sufficient number of patients, and that such provision should be made in such areas.

A centre like this needs a certain amount of money and a certain amount of guidance. In the first place, it needs organisation. It means bringing the general practitioners in, and they should be willing to work it, because they are the doctors who must work it in with their own private practices. All this means a certain amount of organisation and give and take between the parties, and that has to be organised by somebody in the position of Lord Taylor. The best thing would be a whole-time organiser, and, to settle these very difficult questions, he must be a medical organiser as well. A person of that status and calibre must be fairly highly paid. Besides that, we have to have the buildings, we have to pay the staff and we have to acquire the equipment, and all these things need a certain amount of money.

I wonder whether or not—and I think this is a matter for debate—the Government should help in the foundation of health centres of this sort. I know it can be said, and I think with force, that the Government should confine themselves to providing the minimum that is absolutely necessary, and that if private enterprise, industrial enterprise or anybody else wants to provide something a little better, it should raise the money to do so itself. A thing like this needs so much money to start and is so valuable to the community when it really gets going that any loans which the Government were able to make, in the way that the Nuffield Foundation did to Harlow, would soon be repaid, and the saving in industrial health and disease would be very great. I think the Committee is aware of the enormous number of days lost through industrial disease, far outstripping the number of days lost by strikes, which the public generally do not realise. It would be very valuable if that could be dealt with.

In going round the Centre, I was struck by the ingenuity by which X-ray machines had been acquired, often for a very small outlay, and that is illustrative of two things. One is the lavish equipment in the public service which causes these machines, which have many years of life in them, to be cast out so that they can be acquired by an enterprising person at almost derisory prices. Secondly, it illustrates what may become the merit of the block grant by which it is possible to make savings by intelligent buying, if the will to do so is there.

I welcome very much the announcement about salaries, because I had intended to say something about midwives who, as my right hon. and learned Friend knows, have been rather disturbed by their position until recently. In common with other hon. Members, I imagine, I have had a memorandum from the midwives asking that certain things should be done to improve their status and salaries. As I listened to my right hon. and learned Friend, I realised that every point that I had intended to make had been granted in the new arrangements that have been made, with the possible exception of one which my right hon. and learned Friend did not mention. I think that, too, might well have been dealt with. Up to now, the promotion opportunities in the midwifery service have been rather small, and it has been suggested that in each unit of, say, fifty beds in large hospitals there should be a matron's job, so that there would be a little more opportunity of promotion in that service and thus provide an opportunity to those anxious to get on to do so.

I want next to deal with the Young-husband Report. I know that no conclusion about it has yet been reached and that there have to be consultations about it in the profession. However, I think that the House will welcome the largely sensible proposals in the Report and that, in general, it will in due course receive the commendation of the House.

However, it raises two broad questions about which I should like to ask at this early stage. In these days of increasing specialisation leading people to concentrate on isolated points, so to speak, rather than on the whole sphere of their profession, it becomes increasingly the case that some sections of medical or social science are almost left out of account because nobody is particularly-interested in them. That is particularly the field which the social workers cover and which the Younghusband Report says they should be more adequately trained to cover.

However, the Younghusband Report expects that social workers will have far more specialist training than has been the case hitherto. I am sure we welcome that, but I hope that those workers will not become so specialist that in a few years we find that some of their functions are left out and we have to appoint another committee to tell us that specialist training for social work has left some branches of this work uncovered.

Secondly, the Younghusband Report says that the work which will face these trained social workers is constantly expanding. I should like some explanation of what is meant by that. If it means that the work in connection with old people is constantly expanding, then it is easy to understand, because more people are reaching retiring age than has been the case before. But if it means that people other than retirement pensioners will provide increasing work for the social workers which it is desired to train, then I am a little doubtful about it.

Is the assumption that as our bodily needs are met more adequately and as we live longer because of the better medicine which we have today, our moral and spiritual needs will become so great that we shall all have to have psychiatric treatment and call in the public service to help us when we have private difficulties? If that is the assumption, and if it is thought that as a nation we are becoming more juvenile and less adult and less able to manage our private affairs, then my right hon. and learned Friend should study the Report with a certain amount of caution, because that is not an assumption which should be accepted.

Lastly, I wish to refer to the position of the general practitioner who, after material construction, represents the most important factor in the National Health Service today. I hope that it will not be misunderstood if I say that the G.P. is not the man he was. He used to be more respected than he is now. He used to be a very good confident and mentor. [HON. MEMBERS: "He still is."] I say that he used to be more so. That is my point. He had a higher status in the past.

Perhaps I exaggerate in order to make my point, but I think that there is some danger of the G.P. becoming almost a medical mechanic, the chap one telephones to give one a certain note or to renew a prescription for mum's favourite medicine. His influence on personal matters is not exactly what it was. I believe that the mutual trust between the public and the G.P. has been somewhat damaged of recent years. [HON. MEMBERS: "How?"] I will not attempt to answer that, but I will put one or two facts to show why that is so.

At the beginning of the National Health Service, when many doctors suddenly had to look after longer lists of patients than before, there was bound to be a certain amount of dislocation, but I believe that those long lists have lasted too long and that they should now be reduced. I cannot but come to the conclusion that the basic reason why the lists have remained long is that G.P.s are not paid enough and have to keep long lists in order to earn a living commensurate with their professional status. I know that it would be very difficult to work out, but that is my belief.

I understand that the G.P. is paid approximately £1 per patient per year. In the rural areas, such as that which I represent, making four or five journeys in a motor car, ten miles each way, and making five or six telephone calls to local hospitals to find whether there is a bed available for a patient, can soon eat up £1. That patient, if the doctor is being economic, is thereafter a dead loss to him—[Laughter.]—from a financial point of view. Perhaps that was not a happy phrase.

However, we cannot blame the doctor if sometimes he is slow to turn out when he thinks that he knows what the condition of the patient is and when he knows that the patient is a little fussy about wanting to be visited. There was a letter in the Daily Telegraph this morning which was headed, "Crying Wolf Too Often", or words to that effect, in which there was discussed the case of a doctor who had been disciplined for refusing to make a visit. The writer rightly said that doctors so often get called out on errands which are not emergencies, that if they occasionally make a mistake, that is understandable, although it is very damaging to the relationship between doctor and patient and damaging to the public estimation of the medical profession, which is a great pity.