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THIS D O C U M E N T IS T H E PROPERTY OF H I S B R I T A N N I C M A J E S T Y ' S G O V E R N M E N T "
Printed
for the War Cabinet.
February
SECRET. 1944.
Copy N o .
W . M . (44)
21st Conclusions.
WAR
CONCLUSIONS
S.W.
C A B I N E T 21
(44).
of a Meeting of the War Cabinet held at 10 Downing
1, on Tuesday,
15th February,
1944, at 6.30 p.m.
Street,
Present:
T h e R i g h t H o n . WINSTON S. CHURCHILL, M . P . , P r i m e M i n i s t e r (in the
Chair).
T h e R i g h t H o n . ANTHONY EDEN, M . P . ,
S e c r e t a r y of
S t a t e for
Foreign
Affairs.
The^ R i g h t H o n . S i r JOHN^ ANDERSON, ( T h e R i g h t H o n . ERNEST BEVIN, M . P . ,
M i n i s t e r of L a b o u r a n d N a t i o n a l
M . P . , Chancellor of t h e E x c h e q u e r .
Service.
T h e R i g h t H o n . OLIVER LYTTELTON, T h e R i g h t H o n . HERBERT MORRISON,
M . P . , S e c r e t a r y of S t a t e for t h e
M . P . , M i n i s t e r of P r o d u c t i o n . H o m e D e p a r t m e n t a n d M i n i s t e r of
H o m e Security.
T h e R i g h t H o n . LORD WOOLTON,
M i n i s t e r of R e c o n s t r u c t i o n .
T h e R i g h t H o n . C. R. ATTLEE, M . P . ,
L o r d P r e s i d e n t of t h e Council.
T h e following were also p r e s e n t :
T h e R i g h t H o n . VISCOUNT CRANBORNE, T h e R i g h t H o n . LORD BEAVERBROOK,
S e c r e t a r y of S t a t e for D o m i n i o n
L o r d P r i v y Seal.
Affairs.
The
Right
Hon.
Sir
ARCHIBALD T h e R i g h t H o n . THOMAS JOHNSTON,
M . P . , S e c r e t a r y of S t a t e for Scotland.
SINCLAIR, Bt., M . P . , S e c r e t a r y of
S t a t e for A i r .
T h e R i g h t H o n . H . U . WILLINK, M . P . , T h e R i g h t H o n . BRENDAN BRACKEN,
M . P . , M i n i s t e r of I n f o r m a t i o n .
M i n i s t e r of H e a l t h .
T h e R i g h t H o n . LORD CHERWELL,
P a y m a s t e r General.
Secretariat:
S i r EDWARD BRIDGES.
M r . NORMAN BROOK$.
M r . W . S. MURRIE.
CONTENTS.
Minute
No.
1
2
Subject.
Poland
N a t i o n a l H e a l t h Service
[26948-3]
Page
98
98
Poland.
(Previous
Eeference:
W.M.(44)20th
1. T h e W a r C a b i n e t were given the latest i n f o r m a t i o n about t h e discussions w i t h t h e P o l i s h M i n i s t e r s . T h e discussion is recorded i n t h e S e c r e t a r y ' s S t a n d a r d F i l e of W a r C a b i n e t Conclusions. Conclusions, Minute 4.) National Health
2. A t t h e i r m e e t i n g on the 11th F e b r u a r y the W a r C a b i n e t
Service.
h a d a g r e e d t h a t the p r o p o s a l s for a N a t i o n a l H e a l t h Service
(Previous
( W . P . (44) 74) should be f u r t h e r discussed before a final decision
Eeference:
w a s t a k e n to publish the W h i t e P a
W.M.(44)18th
T h e following were the m a i n p o i n t s r a i s e d in the course of a
Conclusions,
f u r t h e r discussion of t h e scheme outlined in the W h i t e P a p e r : —
Minute 3.)
(a) W o u l d the scheme m e a n the end of p r i v a t e medical p r a c t i c e
a n d t h e family doctor ?
T h e W a r C a b i n e t w e r e i n f o r m e d t h a t t h e scheme would n o t
p r e v e n t the continuance of p r i v a t e p r a c t i c e ; in p a r t i c u l a r , doctors
t a k i n g p a r t i n the p u b l i c service would n o t be prevented from t a k i n g
p r i v a t e p a t i e n t s . N o r would it affect the relation between the doctor
a n d t h e p a t i e n t . T h e conception of t h e family doctor would indeed
. be s t r e n g t h e n e d , since d e p e n d a n t s of i n s u r e d persons would in
f u t u r e become eligible for free medical t r e a t m e n t .
I t w a s t r u e t h a t t h e eventual effect of the scheme m i g h t be to
l i m i t t h e scope for p r i v a t e practice—since, when free medical
t r e a t m e n t w a s available for all, there m i g h t be some r e d u c t i o n in the
n u m b e r s w i l l i n g to p a y for p r i v a t e t r e a t m e n t . A t the same time,
the scheme would not directly p r o h i b i t or r e s t r i c t the e x t e n t of
p r i v a t e medical practice.
(b) W o u l d the scheme m e a n the end of the v o l u n t a r y hospitals,
w h i c h h a d for so long t a k e n t h e lead in teaching a n d in research %
These h o s p i t a l s , s u p p o r t e d by v o l u n t a r y contributions, were r i g h t l y
j e a l o u s of t h e i r independence. Could they continue to p l a y the same
p a r t in the development of medical science if they became financially
d e p e n d e n t on public a u t h o r i t i e s a n d h a d , in consequence, to accept
public control ?
T h e W a r C a b i n e t were informed t h a t it w a s not proposed t h a t
the m a n a g e m e n t of t h e v o l u n t a r y h o s p i t a l s should be t a k e n over by
public authority.
T h e scheme contemplated t h a t these hospitals
should m a k e a c e r t a i n n u m b e r of beds available for public p a t i e n t s ,
a n d t h a t t h e y should be p a i d for t h i s service. B u t the p a y m e n t ,
w h i c h would be m a d e by the C e n t r a l Government, n o t by the local
a u t h o r i t y , would n o t meet the whole of t h e i r e x p e n d i t u r e : they
w o u l d still have to rely on v o l u n t a r y s u p p o r t for a s u b s t a n t i a l
p r o p o r t i o n of t h e i r revenue.
M i n i s t e r s h a d discussed these
p r o p o s a l s w i t h responsible r e p r e s e n t a t i v e s of t h e v o l u n t a r y
h o s p i t a l s , who were satisfied t h a t they could still enlist the s u p p o r t
of v o l u n t a r y c o n t r i b u t o r s , so long as it w a s m a d e clear t h a t t h e i r
i n d e p e n d e n c e w a s preserved a n d t h a t the revenue g u a r a n t e e d to
t h e m by t h e scheme w a s not sufficient to meet t h e whole of t h e i r
expenditure.
(c) To w h a t e x t e n t would the scheme i n t e r f e r e w i t h t h e r i g h t
of doctors to set u p i n p r a c t i c e as consultants 1
I t w a s e x p l a i n e d t h a t the proposals for a c o n s u l t a n t s ' service,
l i n k e d w i t h the h o s p i t a l s , would m a k e the service available to a f a r
w i d e r r a n g e of p a t i e n t s . T h e eventual result of t h e scheme would
be to increase the n u m b e r of consultants, a n d to improve t h e i r
d i s t r i b u t i o n over t h e c o u n t r y as a whole. T h i s would be b r o u g h t
about, not by any system of S t a t e selection of doctors for c o n s u l t a n t
w o r k , b u t by p r o v i d i n g g r e a t e r o p p o r t u n i t i e s for doctors to p r a c t i s e
as c o n s u l t a n t s . T h e scheme would not, however, p r e v e n t consultants
from seeing p a t i e n t s p r i v a t e l y , in a d d i t i o n to a n y p a r t w h i c h they
took i n the public m e d i c a l service.
(d) The Secretary of State for Scotland r e f e r r e d to the scheme
o r i g i n a l l y k n o w n as t h e Clyde B a s i n E x p e r i m e n t a n d subsequently,
a f t e r i t s extension to t h e rest of Scotland, as the S u p p l e m e n t a r y
M e d i c a l Service. U n d e r t h i s scheme general p r a c t i t i o n e r s were able
to r e f e r a n y p a t i e n t s for whom they felt t h a t specialist advice w a s
desirable to the R e g i o n a l Medical Officers of the D e p a r t m e n t of
r
-
H e a l t h and, t h r o u g h them, to consultants in p r i v a t e practice. U p
to t h e p r e s e n t d a t e n e a r l y 7,000 p a t i e n t s w h o m i g h t n o t o t h e r w i s e
have been able to obtain t h e services of a c o n s u l t a n t h a d been d e a l t
w i t h . No fees were c h a r g e d by the c o n s u l t a n t s for t h e i r services,
a n d all the consultants a t t a c h e d to Scottish h o s p i t a l s were in favour
of t h e scheme. T h i s scheme i l l u s t r a t e d both the need for extended
c o n s u l t a n t services a n d t h e method by which such services m i g h t be
provided u n d e r the proposals in the W h i t e P a p e r .
A s r e g a r d s v o l u n t a r y hospitals, the S e c r e t a r y of S t a t e said t h a t
in 1940 over 30,000 p a t i e n t s were on the w a i t i n g list of v o l u n t a r y
h o s p i t a l s i n Scotland. B y agreement w i t h the v o l u n t a r y h o s p i t a l s
a r r a n g e m e n t s h a d been m a d e u n d e r w h i c h p a t i e n t s on these w a i t i n g
lists w e r e a d m i t t e d to t h e n e w hospitals b u i l t for the E m e r g e n c y
Medical Service. 26,000 p a t i e n t s h a d been d e a l t w i t h u n d e r t h i s
scheme, a n d the v o l u n t a r y h o s p i t a l s h a d co-operated willingly i n
m a k i n g it a success.
(e) W i t h r e g a r d to the finance of the scheme, The
Chancellor
of the Exchequer
explained t h a t the e s t i m a t e of the cost of the
general p r a c t i t i o n e r service w a s based on t h e p a y m e n t of
£ 8 - 4 million m a d e to general p r a c t i t i o n e r s i n 1938 i n respect of
t h e 17,800,000 persons w h o w e r e t h e n i n s u r e d u n d e r t h e N a t i o n a l
H e a l t h I n s u r a n c e scheme. T h e basis of r e m u n e r a t i o n of general
p r a c t i t i o n e r s u n d e r the n e w proposals h a d been left o p e n ; probably
p a y m e n t would be in the m a i n by c a p i t a t i o n fees, a l t h o u g h in c e r t a i n
cases salaries would be p a i d .
T h e t o t a l cost falling on public funds would be £ 1 3 2 million
a year, of which about £ 4 0 million would p r o b a b l y be derived from
social insurance contributions. The rest would be s h a r e d between
the t a x - p a y e r a n d the r a t e - p a y e r in almost equal p r o p o r t i o n s .
T h e r e would be some increased b u r d e n on t h e rates, b u t the n e w
b u r d e n would fall m a i n l y on the Exchequer.
A f t e r a full discussion, the W a r C a b i n e t —
Re-affirmed t h e i r decision of t h e 9 t h F e b r u a r y t h a t t h e
documents a n n e x e d to W P . (44) 74 should be published
as the basis for public discussion a n d f u r t h e r n e g o t i a t i o n
w i t h t h e v a r i o u s interests concerned.
Offices of the War Cabinet, S.W.
lUh February, 1944.
1,