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INFECTIOUS DISEASE IN ENGLAND AND WALES
766 have to be substantial and firm in its purpose. It is, of course, obvious that if the medical profession was so set against the Act that it felt unable to work under it such a decision would in no sense be illegal or in the nature of a strike. Doctors do not strike. They will always continue to serve the sick public. An Act is not necessary to make them do this. It would simply mean that they would not serve the sick public within the framework desired by the Government of this The Minister fully recognises the right of the country. individual medical man not to enter the Service, so a decision not to enter into it would be strictly legal and honourahle. DR. GUY DAIN
(chairman of council, B.M.A.)
We have just learned that a strong and concerted action will force the Minister to do something which he was entirely unwilling to do. The threat--it was no more than the whisper of a threat-that insurance practitioners would resign if he would not agree to implement the Spens Report brought him to heel at once. Here we have an opportunity of saying that we will not take any part in a service that does not concede our principles. Why should we not get our principles accepted as well as the conditions of service ? The conditions will have to be argued afterwards anyhow. Why not insist on our principles being established, by an amending Act or whatever it may be, before we agree for a moment to talk on terms and conditions ? We should be no worse off ; indeed we should be infinitely stronger in talking about terms and conditions if we had first by our own efforts secured the acceptance of our
principles....
We want to put into the Act the right ofevery doctor to come in, and the right of appeal to the courts from the Minister’s decision to take us out of the service ; we want removed from the Act the State ownership of hospitals, the embargo on the buying and selling of practices, all direction of general practitioners, and the salarv element in general practitioners’ remuneration ; we want altered the procedure of election on to the councils and committees so that we may nominate our own representatives instead of the Minister choosing them all, and in that way we may curb dictatorship in the service. (Brit. med. J. Nov. 16, p. 747.) MR. HENRY SOUTTAR
The Times With the ballot form sent to each doctor are enclosed the comments on the Act of the joint committee of the medical which has been negotiating with the Govern. disappointing and somewhat partial document has nothing to say in praise of an epoch-making measure beyond- a grudging acknowledgment that " the constructive proposals of the profession are reflected in certain sections It contains no appreciation of the very of the Act."
organizations ment.
This
substantial concessions to the interests of doctors which Mr. BEVAN either took over from Mr. WILLINK or later intro. duced or of the difficulties of carrying compromise any farther. The Act is assailed for its wide divergence from the " principles " laid down by the negotiating committee, without any awareness that this set of aphorisms and demands is in who are not Socialists and have part rejected by a great many nationalize " medicine.... no desire to The Act is not perfect, but its main principles have the approval of the public, whose interest in the medical services is greater even than that of the doctors. It joRers unprecedented opportunities for doctors, indeed fQr all health workers, to participate directly in the planning and manage. ment of their own service. A refusal to use those opportunities would exasperate public opinion, arouse the anger of those supporters of the Government in Parliament who are by no means happy about some of Mr. BEVAN’S concessions to professional interest, and might force the Government and local authorities to make the attempt of introducing a salaried service at least in some areas. The conflict in which the B.M.A. engaged the Government in 1911 and 1912 stirred up much ill-feeling against the doctors, even though the B.M.A. then fought with greater justification and on stronger ground. Dr. DAIN remarked at Exeter the other day that " those of us who have been in national health insurance practice have been quite unconscious of any restriction on our freedom." This was not the language of 1912, when the health insurance scheme was about to be launched and the medical profession stood, as now, on the threshold of great changes. Is it not conceivable that in the future the leaders of the medical profession will be speaking of the Act of 1946 as Dr. DAIN now speaks of the Act of 1911 ? (Nov. 15.) "
(late president, B.M.A.)
To me it is intensely disappointing that the association should now refuse to assist in the completion of a project to which they themselves gave birth, the great conception of a universal medical service for the whole nation, and it is of grave import that they should resist the implementation of what is now the law of the country. If they persist in their refusal it only means that they will have no share in the control of a great enterprise, for I am certain that the medical profession will never refuse to serve the nation. The points at issue are of secondary importance, upon many of them there is no general agreement, and they furnish no possible justification for the statement that the liberty of medicine is at stake. I trust that doctors throughout the country will refuse to be led into an untenable situation which could only bring discredit upon us all. (Times, Nov. 19.)
Medical Press What would be the effect of the decision " no " ? This, of primarily a matter for a Constitutional lawyer, and it is a field into which we would not presume to enter. But in the mind of the ordinary man or woman it would surely be tantamount to a decision not to cooperate with the Minister in the working of the new Bill, which again would be tantamount to a refusal to accept the decision of Parliament. In our view, for what it is worth, to vote against negotiations would be a very perilous course for the profession to take.... perhaps, as the British Medical Journal emphasised in its Editorial of November 16, it would not be a strike. " Doctors do not strike. They will always continue to serve the sick public. An Act is not necessary to make them do this. It would simply mean that they would not serve the sick public within the framework desired by the Government of this country." But if not, as we have said, technically a strike, such action would so very closely approximate to a strike that it might be hard to detect the difference, and we would certainly not expect the general public to make such a delicate differential diagnosis. It would almost certainly be construed as a defiance of Parliament, and it might well initiate a struggle in which no support from any responsible political quarter could be
Evening Standard Certainly the National
Health Service Act is open ta
question in individual details. Certainly there are dangers to be sedulously guarded against, of clogging medicine with the bureaucratic apparatus of departmental control. Yet the broad principles on which the Service is to be based
are for the general welfare. has now become law, enacted by the elected legislature of the British people. The supremacy of Parliament is not open to the challenge of the doctors.... Effective government in a democratic country must be entirely dependent on the loyalty with which the minority carry out the decisions of the majority. The B.M.A.’s leaders have had ample opportunity to state their case.... Now they should have the honesty to acknowledge that the fight is over. By persisting in stubborn faction they will forfeit the sympathy and respect of the people. (Nov. 16.)
command
general
Moreover, the
assent and
measure
course, is
Technically,
expected.
(Nov. 20.)
INFECTIOUS DISEASE IN ENGLAND AND WALES WEEK ENDED NOV.
9
Notifications.-Smallpox, 0 ;; scarlet fever, 1323 whooping-cough, 1590 ; diphtheria, 314 ; paratyphoid. 30 ; typhoid, 5 ; measles (excluding rubella), 3987; pneumonia (primary or influenzal), 601 ; cerebrospinal fever, 46 ; poliomyelitis, 21 ; polioencephalitis, 1; encephalitis lethargica, 2 ; dysentery, 65 ; puerperal pyrexia, 125 ; ophthalmia neonatorum, 57. No case of cholera, plague, or typhus was notified during the week. Deaths.-In 126 great towns there were no deaths from measles, 1 (0) from an enteric fever, 2 (0) from scarlet fever, 8 (0) from whooping-cough, 2 (0) from diphtheria, 57 (5) from diarrhoea and enteritis under two years, and The figures in parentheses are 16 (2) from influenza. those for London itself. Grimsby reported the fatal case of an enteric fever. There were 9 deaths from diarrhoea and enteritis at Liverpool.
The number of stillbirths notified during the week was 262 (corresponding to a rate of 26 per thousand total births), including 26 in London.
(chairman of council, B.M.A.)
We have just learned that a strong and concerted action will force the Minister to do something which he was entirely unwilling to do. The threat--it was no more than the whisper of a threat-that insurance practitioners would resign if he would not agree to implement the Spens Report brought him to heel at once. Here we have an opportunity of saying that we will not take any part in a service that does not concede our principles. Why should we not get our principles accepted as well as the conditions of service ? The conditions will have to be argued afterwards anyhow. Why not insist on our principles being established, by an amending Act or whatever it may be, before we agree for a moment to talk on terms and conditions ? We should be no worse off ; indeed we should be infinitely stronger in talking about terms and conditions if we had first by our own efforts secured the acceptance of our
principles....
We want to put into the Act the right ofevery doctor to come in, and the right of appeal to the courts from the Minister’s decision to take us out of the service ; we want removed from the Act the State ownership of hospitals, the embargo on the buying and selling of practices, all direction of general practitioners, and the salarv element in general practitioners’ remuneration ; we want altered the procedure of election on to the councils and committees so that we may nominate our own representatives instead of the Minister choosing them all, and in that way we may curb dictatorship in the service. (Brit. med. J. Nov. 16, p. 747.) MR. HENRY SOUTTAR
The Times With the ballot form sent to each doctor are enclosed the comments on the Act of the joint committee of the medical which has been negotiating with the Govern. disappointing and somewhat partial document has nothing to say in praise of an epoch-making measure beyond- a grudging acknowledgment that " the constructive proposals of the profession are reflected in certain sections It contains no appreciation of the very of the Act."
organizations ment.
This
substantial concessions to the interests of doctors which Mr. BEVAN either took over from Mr. WILLINK or later intro. duced or of the difficulties of carrying compromise any farther. The Act is assailed for its wide divergence from the " principles " laid down by the negotiating committee, without any awareness that this set of aphorisms and demands is in who are not Socialists and have part rejected by a great many nationalize " medicine.... no desire to The Act is not perfect, but its main principles have the approval of the public, whose interest in the medical services is greater even than that of the doctors. It joRers unprecedented opportunities for doctors, indeed fQr all health workers, to participate directly in the planning and manage. ment of their own service. A refusal to use those opportunities would exasperate public opinion, arouse the anger of those supporters of the Government in Parliament who are by no means happy about some of Mr. BEVAN’S concessions to professional interest, and might force the Government and local authorities to make the attempt of introducing a salaried service at least in some areas. The conflict in which the B.M.A. engaged the Government in 1911 and 1912 stirred up much ill-feeling against the doctors, even though the B.M.A. then fought with greater justification and on stronger ground. Dr. DAIN remarked at Exeter the other day that " those of us who have been in national health insurance practice have been quite unconscious of any restriction on our freedom." This was not the language of 1912, when the health insurance scheme was about to be launched and the medical profession stood, as now, on the threshold of great changes. Is it not conceivable that in the future the leaders of the medical profession will be speaking of the Act of 1946 as Dr. DAIN now speaks of the Act of 1911 ? (Nov. 15.) "
(late president, B.M.A.)
To me it is intensely disappointing that the association should now refuse to assist in the completion of a project to which they themselves gave birth, the great conception of a universal medical service for the whole nation, and it is of grave import that they should resist the implementation of what is now the law of the country. If they persist in their refusal it only means that they will have no share in the control of a great enterprise, for I am certain that the medical profession will never refuse to serve the nation. The points at issue are of secondary importance, upon many of them there is no general agreement, and they furnish no possible justification for the statement that the liberty of medicine is at stake. I trust that doctors throughout the country will refuse to be led into an untenable situation which could only bring discredit upon us all. (Times, Nov. 19.)
Medical Press What would be the effect of the decision " no " ? This, of primarily a matter for a Constitutional lawyer, and it is a field into which we would not presume to enter. But in the mind of the ordinary man or woman it would surely be tantamount to a decision not to cooperate with the Minister in the working of the new Bill, which again would be tantamount to a refusal to accept the decision of Parliament. In our view, for what it is worth, to vote against negotiations would be a very perilous course for the profession to take.... perhaps, as the British Medical Journal emphasised in its Editorial of November 16, it would not be a strike. " Doctors do not strike. They will always continue to serve the sick public. An Act is not necessary to make them do this. It would simply mean that they would not serve the sick public within the framework desired by the Government of this country." But if not, as we have said, technically a strike, such action would so very closely approximate to a strike that it might be hard to detect the difference, and we would certainly not expect the general public to make such a delicate differential diagnosis. It would almost certainly be construed as a defiance of Parliament, and it might well initiate a struggle in which no support from any responsible political quarter could be
Evening Standard Certainly the National
Health Service Act is open ta
question in individual details. Certainly there are dangers to be sedulously guarded against, of clogging medicine with the bureaucratic apparatus of departmental control. Yet the broad principles on which the Service is to be based
are for the general welfare. has now become law, enacted by the elected legislature of the British people. The supremacy of Parliament is not open to the challenge of the doctors.... Effective government in a democratic country must be entirely dependent on the loyalty with which the minority carry out the decisions of the majority. The B.M.A.’s leaders have had ample opportunity to state their case.... Now they should have the honesty to acknowledge that the fight is over. By persisting in stubborn faction they will forfeit the sympathy and respect of the people. (Nov. 16.)
command
general
Moreover, the
assent and
measure
course, is
Technically,
expected.
(Nov. 20.)
INFECTIOUS DISEASE IN ENGLAND AND WALES WEEK ENDED NOV.
9
Notifications.-Smallpox, 0 ;; scarlet fever, 1323 whooping-cough, 1590 ; diphtheria, 314 ; paratyphoid. 30 ; typhoid, 5 ; measles (excluding rubella), 3987; pneumonia (primary or influenzal), 601 ; cerebrospinal fever, 46 ; poliomyelitis, 21 ; polioencephalitis, 1; encephalitis lethargica, 2 ; dysentery, 65 ; puerperal pyrexia, 125 ; ophthalmia neonatorum, 57. No case of cholera, plague, or typhus was notified during the week. Deaths.-In 126 great towns there were no deaths from measles, 1 (0) from an enteric fever, 2 (0) from scarlet fever, 8 (0) from whooping-cough, 2 (0) from diphtheria, 57 (5) from diarrhoea and enteritis under two years, and The figures in parentheses are 16 (2) from influenza. those for London itself. Grimsby reported the fatal case of an enteric fever. There were 9 deaths from diarrhoea and enteritis at Liverpool.
The number of stillbirths notified during the week was 262 (corresponding to a rate of 26 per thousand total births), including 26 in London.