Orders of the Day — National Health Service (Doctors' Pay and Conditions

Part of the debate – in the House of Commons at 12:00 am on 17 March 1965.

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Photo of Dr Wyndham Davies Dr Wyndham Davies , Birmingham, Perry Barr 12:00, 17 March 1965

Obviously, there is not time to develop this theme, but I hope that there will be an opportunity for a full debate on this matter later.

The second problem which faces us today is that of priorities in the Health Service, and the right hon. Gentleman and his Department know that there is a problem of inter-Health Service priorities.

The third problem facing the Service is that of monopoly. We know what hon. Gentlemen opposite think about monopolies. There is a virtual monopoly of medical care in this country and there is an absence of substitutes for the patient and for the employment of dissenting workers, which means that if a doctor does not like the Health Service he has but a tiny chance of gaining a private practice here. Private practice accounts for only about 3 per cent. of the total medical care provided in this country. This was never intended in Beveridge's scheme, and this has led to a State monopoly.

Fourthly, there is a shortage of personnel—of doctors, nurses, and many other medical workers. I think that we must go back to the Willink Committee. This was an example of a group of experts being brought together by a Government Department to make a report to a Minister, and then to plan ahead for the future. Having laid their splendid plans, they considered the whole question of the future supply of doctors during the period 1961 to 1971. That is the period which we are considering. They reckoned that by 1961 the supply of doctors would be sufficient to enable the intake of medical students to be cut by 10 per cent.

We can argue whether it was right for the Minister of Health to accept the Willink Committee Report, but we are going to base many of our plans for the future on this type of Committee and its Report. In fact, I have no doubt that the Minister of Health will set up a Working Party to advise him on the Health Service, and I must remind him, therefore, that the Willink Committee made three fundamental errors.

First, it said that between 1955 and 1971 the population would increase by 4½ per cent. This underestimated fertility, because the population increase is actually about 7 per cent. Secondly, it reckoned that the retirement rate among doctors would not be significantly affected by the commencement in 1958 of payments under the National Health Service Pension Scheme. In practice, a large number of doctors retired in 1958. Thirdly, it suggested the migration of doctors was small and would decline. In practice migration is much greater than expected, and when Dr. John Seale, who took part in the original research, said that 25 per cent. of the output of our medical schools was going overseas, he was not received with any graciousness by the then Minister of Health, who I have to admit came from these benches.

Our next problem is the lack of status in the medical profession. This is a particular problem for the key worker, the general practitioner. Another problem is that of rapid change. A general practitioner requires freedom to change and freedom to adapt to keep pace with the increase in medical knowledge and it is here that the State sometimes tends to prevent this happening.

One of the great problems that is now arising, and which will shortly be of interest to us in the House, is that from the end of the 'forties there has been a tremendous growth in the number of valuable drugs which have been produced by the pharmaceutical industry, and a considerable rise in the use of antibiotics which have saved countless lives. These drugs have changed the whole face of medicine and have made it extremely important to make an accurate diagnosis and provide effective treatment.

A further problem is that of centralisation. Far too many decisions in the Health Service are centralised in the Ministry in London. This causes delay, with all the problems involved in dealing with correspondence flowing backwards and forwards between the central Ministry and the periphery.

Then there is the problem of communications. Communications throughout the Health Service are bad. They are bad between the Ministry and the medical profession, and the present Minister has done well to send a letter round to general practitioners explaining some of the things that he has been trying to do. The Ministry needs to be more in touch with the profession. There has been a lack of communication between doctors, nurses and patients, and we all know of the development of the Patients' Association, which is keenly interested in everything that is going on in the Health Service today.

There has been a breakdown in communications between the Ministry and private enterprise, such as the pharmaceutical industry. These two bodies have clashed in past years. Last but not least, there has been a clash between the public health service and general practitioners. It is only in certain areas that the public health service is co-operating with general practitioners and vice versa. Far greater co-operation of this sort is needed.

I want to sketch some broad outlines of a possible Conservative solution for the future. I hope that some of my ideas will be acceptable to hon. Members opposite. In our rethinking of the general practitioner service and the Health Service we must cater for maximum individuality, by which I mean that the Health Service should cater for the individual needs of the doctor and the patient. It is undesirable that either should be forced to conform to a pattern which does not suit his individual personality or requirements.

It has been suggested that many younger doctors would prefer a salaried service. That may be so, but that would not be acceptable to many older doctors, who fear that it might mean a return to the type of salaried service that they experienced in certain medical services of the Crown. They know that this type of service sometimes does not lead to the greatest efficiency or to the attraction of the best type of man to the job.

Therefore, let us have a little individuality, remembering that some doctors would like a salaried service, others would like to be paid per item of service, while the remainder would prefer to engage in private practice. Let the patients, too, have a choice. Some would prefer to go to health centre clinics which employed a salaried doctor, where they would benefit from all the modern advances in medicine. Some would prefer to have the personal service which can be provided in a doctor's surgery or consulting room. Some would like to have the time and convenience which is available in private practice.

Any such scheme must promote the maximum amount of social justice. The general practitioner service should provide standards of medical care for all members of the community irrespective of income or other personal circumstances. On the other hand, it would be undesirable to prevent those who wish to do so from paying for a better standard of medical care than it is possible to provide for everybody. Choice is available in almost every field of life. We have choice in our transport system and in our entertainment. We can choose to travel by car or by public transport. If we choose public transport, we can then choose whether to go first-class or second-class. We can choose what theatre or cinema to go to, as far as our pockets will stretch. Cannot we apply this sort of thinking to the National Health Service?

Two other points should be remembered in our rethinking. As far as possible, expenditure should be individually controlled. This principle is based on the belief that it is undesirable to incur expenditure from public funds on items which can be financed equally well by the individual. It is desirable to reduce public expenditure and taxation to a minimum. In this connection, we should bear in mind the cost of the National Health Service. Any scheme that we have for the future should allow for the growth of medical science. This should be encouraged, and the National Health Service should provide fully for medical advances.

This is not a new problem. The Labour Party has identified itself with a comprehensive, free-at-the-time National Health Service, but I believe that the Prime Minister has already shown that he is capable of jettisoning what we thought to be Socialist holy writ in seeking realistic policies in defence and foreign affairs. He and the right hon. Gentleman will have difficulties with the Socialist blowhards, but cannot hon. Members opposite see that the National Health Service is in great danger unless the doctors' charter is accepted and an entirely new relationship is created between the State, the medical services and the general public?