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ROYAL MEDICAL BENEVOLENT FUND: CHRISTMAS APPEAL
1034 ROYAL MEDICAL BENEVOLENT FUND: CHRISTMAS APPEAL
SIR,—May I remind your readers who are intending to respond to the President’s appeal that we like to distribute gifts to our beneficiaries in good time for Christmas. I would ask all individuals, societies, and groups who have not yet done so, to send their contributions as soon as possible to the Director, Royal Medical Benevolent Fund, 24 King’s Road, Wimbledon, London, SW19 8QN. Royal Medical Benevolent Fund, 24 King’s Road, London SW19
GEOFFREY BATEMAN Hon. Treasurer
8QN
Commentary from Westminster The
Coming Debate on the National Health Service FROM A CORRESPONDENT
ALTHOUGH the major debate on the future of the National Health Service may have to await the final report of the Royal Commission in two years’ time, signs of political skirmishing are already with us. Reports that the Conservative Party is preparing radical plans for reshaping the N.H.S. have met with a predictably hostile Labour reaction and a warning from the Secretary of State: "Hands off our National Health Service. You wreck it at your peril". So what exactly are the Conservatives up to? The Party’s recent strategy document, The Right Approach, lifted a corner of the veil which has concealed Party thinking. It said quite bluntly that there was no case for holding down charges and spoke of encouraging the trend towards private medical insurance. But that was all. Behind the scenes, however, a working-group under the chairmanship of Dr Gerard Vaughan has been thinking deeply about the Health Service and considering what a future Conservative Government would do. At present nothing has been decided. But the fruits of this thinking are expected to result in a document within the next few weeks. It is possible already to trace the trend of Conservative thought, which is based on a number of propositions. One is that there can be no major cuts in Health Service expenditure. The N.H.S. will be one of the few areas which will avoid any major cutback under a Tory Government. But, equally, increased taxes cannot be counted on to provide any more resources. So, having ruled out cuts and increased taxes, the Party has been looking at new sources of revenue from medical charges and private insurance, supported by tax relief. Great interest is being shown in experience abroad, particularly the French system of health finance and the Australian, where the Liberal Government is trying to shift more of the cost of health care on to the individual and private medical insurance. The argument for new and increased charges is not only that they would raise vital new revenue but also that they would make people aware of the cost of treatment. Having to pay directly for something impresses people with the need for economy and efficiency. Dr Vaughan’s committee is looking beyond higher prescription charges towards new charges. One possibility is a doctor’s visiting charge, which has been considered by various administrations and even mooted by Labour Ministers. But it has always been rejected because of its likely disincentive effect and the objection that it would be a bar to early diagnosis. Supporters of
a charge point to dental charges and ask whether the have deterred people from regular treatment, raising the whole question of the state of the nation’s teeth. Other, point out that it might be a good idea if a charge were to deter some of the unnecessary calls made on doctors. In France the patient pays directly for medical treatment at the surgery and is reimbursed for all or part of the cost from sickness insurance funds. The Conservatives are considering a similar scheme. In England the average number of visits to the doctor per year works out at between three and four, or between 1’70 and ,230 per consultation. A £1charge per visit would yield for the N.H.S. an additional 160 million a year, although after allowing for exemptions, administrative costs, and a reduction in the number of visits, the net gain would be much less. Another idea is a hospital board-and-lodging charge. The average weekly cost of hospital meals for patients in England is now £3.44. If, after widespread exemptions for the mentally ill, the aged, the very poor, and others, a ,5 a week bed charge was levied on 100 000 beds the annual yield would be only ,26 million. And against this has to be weighed the disadvantage of the administrative bureaucracy it would involve. But if the charge was extended to 250 000 inpatients and fixed at 20 a week, the additional income would be more than ,200 million. Another charge might be put on surgical operations. But here, as with other charges, the theory is that most people would in effect become private patients and have their bills eased by medical insurance. The principal aim of the Conservatives would be to reduce the present proportion of taxation in the finances of the Health Service. At more than 90% it is much higher than in any other European country. Many Conservatives believe it is not fortuitous that Britain’s waiting-lists are much worse than in other advanced countries. Conservative M.p.s are being predictably shv about their rethinking and the work of their backbench committee. They recognise only too well the extreme political sensitivity of the path they are treading, although they believe it would have widespread support in the country. But proposals for extensive charge’ would inevitably become a major political issue. Already, with only a hint of what the Conservatives might say, Labour politicians are on the offensive. Mr David Ennals, Secretary of State for Social Services, speaking at a by-election meeting last week, said it was incredible that the Conservatives wanted to move to the sort of American private-insurance system at a timc when more and more Americans were demanding some kind of N.H.S. like our own. "The British people", h said, "are not prepared to see health bought and soldir the market-place". So the battle lines are being drawr up even before anyone knows precisely what the fight i: about. The Labour Party and Government remain com mitted to abolishing all charges when economic circum
permit. But, as Tory Nt.P.s are quick to poir. charges were first introduced by Labour in 1949 extended by them in 1951, and, although they were ab lished by them in 1965, they were reintroduced thre years later. It is too early to say whether Dr Vaughan group will be prepared to stick to their guns sc. whether their proposals will be endorsed by Mr. stances
out,
Thatcher and the Shadow Cabinet. If they are, the debate on the future of the N.H.S. may be closer tiw: we think.
SIR,—May I remind your readers who are intending to respond to the President’s appeal that we like to distribute gifts to our beneficiaries in good time for Christmas. I would ask all individuals, societies, and groups who have not yet done so, to send their contributions as soon as possible to the Director, Royal Medical Benevolent Fund, 24 King’s Road, Wimbledon, London, SW19 8QN. Royal Medical Benevolent Fund, 24 King’s Road, London SW19
GEOFFREY BATEMAN Hon. Treasurer
8QN
Commentary from Westminster The
Coming Debate on the National Health Service FROM A CORRESPONDENT
ALTHOUGH the major debate on the future of the National Health Service may have to await the final report of the Royal Commission in two years’ time, signs of political skirmishing are already with us. Reports that the Conservative Party is preparing radical plans for reshaping the N.H.S. have met with a predictably hostile Labour reaction and a warning from the Secretary of State: "Hands off our National Health Service. You wreck it at your peril". So what exactly are the Conservatives up to? The Party’s recent strategy document, The Right Approach, lifted a corner of the veil which has concealed Party thinking. It said quite bluntly that there was no case for holding down charges and spoke of encouraging the trend towards private medical insurance. But that was all. Behind the scenes, however, a working-group under the chairmanship of Dr Gerard Vaughan has been thinking deeply about the Health Service and considering what a future Conservative Government would do. At present nothing has been decided. But the fruits of this thinking are expected to result in a document within the next few weeks. It is possible already to trace the trend of Conservative thought, which is based on a number of propositions. One is that there can be no major cuts in Health Service expenditure. The N.H.S. will be one of the few areas which will avoid any major cutback under a Tory Government. But, equally, increased taxes cannot be counted on to provide any more resources. So, having ruled out cuts and increased taxes, the Party has been looking at new sources of revenue from medical charges and private insurance, supported by tax relief. Great interest is being shown in experience abroad, particularly the French system of health finance and the Australian, where the Liberal Government is trying to shift more of the cost of health care on to the individual and private medical insurance. The argument for new and increased charges is not only that they would raise vital new revenue but also that they would make people aware of the cost of treatment. Having to pay directly for something impresses people with the need for economy and efficiency. Dr Vaughan’s committee is looking beyond higher prescription charges towards new charges. One possibility is a doctor’s visiting charge, which has been considered by various administrations and even mooted by Labour Ministers. But it has always been rejected because of its likely disincentive effect and the objection that it would be a bar to early diagnosis. Supporters of
a charge point to dental charges and ask whether the have deterred people from regular treatment, raising the whole question of the state of the nation’s teeth. Other, point out that it might be a good idea if a charge were to deter some of the unnecessary calls made on doctors. In France the patient pays directly for medical treatment at the surgery and is reimbursed for all or part of the cost from sickness insurance funds. The Conservatives are considering a similar scheme. In England the average number of visits to the doctor per year works out at between three and four, or between 1’70 and ,230 per consultation. A £1charge per visit would yield for the N.H.S. an additional 160 million a year, although after allowing for exemptions, administrative costs, and a reduction in the number of visits, the net gain would be much less. Another idea is a hospital board-and-lodging charge. The average weekly cost of hospital meals for patients in England is now £3.44. If, after widespread exemptions for the mentally ill, the aged, the very poor, and others, a ,5 a week bed charge was levied on 100 000 beds the annual yield would be only ,26 million. And against this has to be weighed the disadvantage of the administrative bureaucracy it would involve. But if the charge was extended to 250 000 inpatients and fixed at 20 a week, the additional income would be more than ,200 million. Another charge might be put on surgical operations. But here, as with other charges, the theory is that most people would in effect become private patients and have their bills eased by medical insurance. The principal aim of the Conservatives would be to reduce the present proportion of taxation in the finances of the Health Service. At more than 90% it is much higher than in any other European country. Many Conservatives believe it is not fortuitous that Britain’s waiting-lists are much worse than in other advanced countries. Conservative M.p.s are being predictably shv about their rethinking and the work of their backbench committee. They recognise only too well the extreme political sensitivity of the path they are treading, although they believe it would have widespread support in the country. But proposals for extensive charge’ would inevitably become a major political issue. Already, with only a hint of what the Conservatives might say, Labour politicians are on the offensive. Mr David Ennals, Secretary of State for Social Services, speaking at a by-election meeting last week, said it was incredible that the Conservatives wanted to move to the sort of American private-insurance system at a timc when more and more Americans were demanding some kind of N.H.S. like our own. "The British people", h said, "are not prepared to see health bought and soldir the market-place". So the battle lines are being drawr up even before anyone knows precisely what the fight i: about. The Labour Party and Government remain com mitted to abolishing all charges when economic circum
permit. But, as Tory Nt.P.s are quick to poir. charges were first introduced by Labour in 1949 extended by them in 1951, and, although they were ab lished by them in 1965, they were reintroduced thre years later. It is too early to say whether Dr Vaughan group will be prepared to stick to their guns sc. whether their proposals will be endorsed by Mr. stances
out,
Thatcher and the Shadow Cabinet. If they are, the debate on the future of the N.H.S. may be closer tiw: we think.