The NHS — nothing for something ? (1977)

From the April 1977 issue of the Socialist Standard

“The love or my life”, Barbara Castle called it, and her successors still try to tell British workers that they’re getting something for nothing.

But what are the facts? Dr. David Owen, until recently the Health Minister, says: “The NHS was launched on a fallacy. We were going to finance everything—cure the nation—and spending would drop. That fallacy has been exposed now we realise that no country, even if prepared to pay the taxes, can supply everything.”

“Supply everything”! What does it supply?

On the “free” health service a specialist consultation for a patient requested by a general practitioner has to wait for anything up to 10 months. In some places an appointment for a child with recurrent tonsillitis to see the ear, nose and throat surgeon may take 4-5 months and then, if the surgeon thinks removal of the tonsils is indicated—the wait for operation is measured not in months but in years. A middle-aged woman may have to wait as long as seven years to receive her hysterectomy.

And most of the hospitals where the operations are done are ramshackle, overcrowded and out of date. Beds are close together, operating rooms have damp-stained ceilings and peeling walls. Furniture is battered and linen thread-bare. Only 41 of Britain’s 2300 hospitals are less than 30 years old.

The sport at Oldham General Hospital among patients is taking bets on the number of cockroaches crossing the floor in a given time span. One local medical officer says: “This hospital is so permeated with the filth of the ages that the only answer is to raze it.”

One feels there should be an energetic programme to build new hospitals, but the reverse is the case. New hospitals are not being completed and existing ones being closed down. John Pilger in the Daily Mirror (25th Jan. 1977) tells us of the coming closure of the Connaught and Metropolitan Hospitals as part of the Government’s public spending cuts. Both hospitals' secretaries say that closure will mean “unimaginable suffering” for ill patients who will have to be sent home. Quote: “Mr. Peter Richardson, secretary of the Connaught, a 121-bed community hospital, which closes on Monday said last night, 'To close down now, in the middle of winter, is madness. We have a “yellow alert” at this hospital right at the moment and that means the beginning of an emergency. Many of our 100 patients are the elderly with chest infections, such as bronchial pneumonia’.”

Also from John Pilger, the Daily Mirror (26th Jan. 1977) quotes the surgeon at the impoverished Northampton hospital who pleaded: “How can I allay the fears of a woman who has to wait weeks and weeks for a breast cancer operation?” And at the Hackney General Hospital the casualty department was being forced to turn away children. The Daily Mirror continues: “Northampton and Hackney are typical of a great many British hospitals which have been starved of funds for years and are now being called upon to make cuts which are impossible without incalculable suffering and—as the doctors have said—deaths.”

But “solutions” appear to be on the way—though not very pleasant ones for the working class. Apparently the time has come for them to pay (even more) for their “free” health service. A front page headline in Medical News, 19th Jan. 1977, announces: “£2 a Day Charges for Hospital Patients would raise £300 million.” Below we read: "BMA Council believes that the Royal Commission should consider approving hotel charges for hospital patients . . . Council is recommending daily charges for bed and board in hospital, and increases in prescription charges. It believes a flat rate weekly compulsory payment for health services to be paid into an independent NHS fund should also be looked at . . . Basically the Council was unanimous in feeling that a totally free NHS at the point of consumption led to the undervaluing of the health service. Charges would impose a more thoughtful attitude on the part of the public, and also among doctors, who sometimes have no idea what the treatment they prescribe is costing.” Says Medical News: “. . . the feeling was that quite serious illness could be treated at home by a GP, and the patient there had to pay for his accommodation and food, so there was no reason why the hospital patient should not do so.”

And on the front page of Medical News 26th Jan. 1977: "Doctors Warned to Monitor Prescribing Costs —or Else.” The article reads: “If doctors do not monitor their prescribing patterns in terms of both efficacy and cost more effectively, they may have controls imposed on them.

"This is the underlying message for doctors following a report into the work of the Prescription Pricing Authority (PPA) published last week.

“The main recommendation of the report is that the work of the PPA should be computerised to speed up the processing of prescriptions and also to provide a better flow of information on prescribing patterns and costs.”

Mr. Tricker told Medical News, amongst other things: “The report makes no recommendations on the control of prescribing, and I argue for self monitoring by the doctor. However, the report does raise the question of alternative forms of control by the state if doctors seem unable to control prescribing for themselves.” Various forms of controlling prescribing were considered. Two suggestions were the exclusion of certain drugs from free treatment under the NHS, or restricting doctors’ prescribing to the BNF (British National Formulary).

Another form of control would be to introduce a local drug expenditure based on the population of an area. Funds would be allocated by the DHSS. The budget could be monitored by the local medical and “local peer group interest could be brought to bear” on a doctor. (In other words—set general practitioners to compete with each other to supply the least and cheapest treatment.)

In Doctor (10th Feb. 1977), however, we read: “Mr Ennals (Social Services Secretary) was full of praise for the prescribing standards of GPS. They were unequalled in the world, with the cost of drugs per head of population being lower in this country than elsewhere in the EEC.

“ ‘But there may still be scope for further economy (in drug costs) without harm to patients,’ he added.” Thus we learn from the boasters of the best community health service in the world that although we’re doing it the cheapest—we might still do — “better?”!

And now there are new worries for those professing to have the welfare of the sick of Britain at heart. Quote: General Practitioner, 21st Jan. 1977: “Fears Mount on Doctor Surplus. The BMA is demanding an immediate inquiry into the threat of unemployment among doctors in the early 1980s. Fears that medical schools are producing too many graduates have been highlighted by the Hospital Junior Staffs Committee after a four year investigation. The BMA is to ask for an interim report on whether these fears are justified in its evidence to the Royal Commission. The juniors believe that unless medical school places are cut immediately by 1000 a year, there will soon be too few jobs for newly qualified doctors.”

And in Medical News, of 26th January, 1977, Cyril Clarke, the retiring president of the Royal College of Physicians, has urged Britain’s 26 medical schools to consider cutting back student intake to prevent the hardship of an unemployed “bulge” later.

“The situation, he said, could not wait for the Royal Commission. It was far too urgent.”

“We must not run into a school teacher situation,” said Sir Cyril. “We should not bank on too much NHS growth.”

So, while patients wait for months for appointments, years for operations and queue up for hours in outpatients’ departments to see junior doctors who are elsewhere and working 80 hours a week, the powers that be are at pains to decrease medical manpower. Tragically—like other unenlightened workers—some junior doctors think that this is a “solution”. They fear the threat more help from an increased number of colleagues would make to their industrial bargaining power. There is, of course, and will be for a long time to come, a dreadful shortage of doctors in real terms. Apart from the dearth in existing premises there is a desperate need for them to man many vital hospitals. The trouble is that those hospitals are either not being built, or not being completed or being closed down.

The situation is similar with trained nursing sisters. They find themselves redundant whilst their colleagues desperately try to cope with endless lines of patients.

It is a “teacher situation”. Students rallied to the call for more teachers to reduce the numbers in school classes. Result—most of them out of work and still we have overcrowded classes.

And it’s all because people aren’t working hard enough, isn’t it. Mr. Callaghan? They’re not getting their backs into it and paying their way. Why don’t you leave it to the Tories to tell the working class that the trouble is they don’t like work? They’ve had (a bit) more practice at it than you have!

All this rottenness doesn’t have to plague us. There are enough men and women who want, and have the ability to be—good doctors, nurses, teachers, hospital and school-builders and organizers, to make mankind healthy, happy and secure. Only the capitalist system, which the vast majority of workers support, maintains need amidst potential plenty in every sphere of human life. Why not vote that system out of existence?

R. B. Gill