(c) crown copyright
Catalogue Reference:CAB/129/5
Image Reference:0039
T H I S D O C U M E N T I S T H E P R O P E R T Y OP H I S B R I T A N N I C M A J E S T V S
Printed
for the Cabinet.
December
1945.
SECRET.
C P .
(45)
C o p y No.*j o
6 O
339.
ISth December,
GOVERNMENT
1945.
CABINET.
PROPOSALS
FOR A NATIONAL
HEALTH
SERVICE.
MEMORANDUM BY THE MINISTER OF HEALTH.
1. I s u b m i t m y g e n e r a l 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 S e r v i c e .
I s h o u l d l i k e t o be a u t h o r i s e d t o p r e p a r e a B i l l on t h e l i n e s of t h e s e p r o p o s a l s now, so a s to come b a c k to m y colleagues w i t h i t a s e a r l y as p o s s i b l e i n t h e n e w y e a r . I do n o t seek d e t a i l e d d e c i s i o n s u n t i l t h e n . B u t I n e e d a decision n o w a s to w h e t h e r t h i s is t h e b r o a d s h a p e w h i c h t h e B i l l s h o u l d t a k e . 2. W h e n m y p r o p o s a l s f o r t h e h o s p i t a l p a r t of t h e service w e r e a p p r o v e d
i n p r i n c i p l e b y t h e C a b i n e t o n t h e 1 8 t h O c t o b e r [ C M . (45) 4 3 r d m e e t i n g ] some
f u r t h e r d e t a i l s w e r e a s k e d for, p a r t i c u l a r l y a s t o t h e n e w r e g i o n a l a n d local
a d m i n i s t r a t i o n . T h e s e a r e i n c l u d e d i n t h e p r e s e n t p a p e r . M i s g i v i n g s a m o n g some
of m y c o l l e a g u e s a t t a c h e d t o t h e effect of m y p r o p o s a l s o n local g o v e r n m e n t
a n d — m o r e g e n e r a l l y — t o t h e r i s k of losing f r o m the h e a l t h service t h e benefits
of local i n t e r e s t a n d local k n o w l e d g e in d a y - t o - d a y a d m i n i s t r a t i o n . I a m alive
to t h e i m p o r t a n c e of b o t h p o i n t s .
3. I h a v e r e v i e w e d , n o t only t h e h o s p i t a l service, b u t t h e h e a l t h service
as a whole, i n t h e l i g h t of t h e v i e w s e x p r e s s e d a t t h e C a b i n e t m e e t i n g . I t is
only by s e e i n g t h e n e w service a s a whole t h a t w e c a n j u d g e t h e r i g h t s h a p e f o r
its parts.
4. A s I see it, t h e u n d e r t a k i n g t o p r o v i d e all p e o p l e w i t h a l l k i n d s of
h e a l t h c a r e , u s i n g v i r t u a l l y t h e w h o l e of t h e m e d i c a l a n d o t h e r h e a l t h p r o f e s s i o n s
to d o it, c r e a t e s a n e n t i r e l y n e w s i t u a t i o n a n d calls for s o m e t h i n g bolder t h a n
a m e r e e x t e n s i o n a n d a d a p t a t i o n of e x i s t i n g services. H e r e i s a n o p p o r t u n i t y ,
w h i c h m a y n o t r e c u r for y e a r s , for a t h o r o u g h o v e r h a u l a n d r e c o n s t r u c t i o n of
t h e c o u n t r y ' s h e a l t h p o s i t i o n . I see i n t h i s r e c o n s t r u c t i o n a p r o p e r p l a c e b o t h f o r
local a n d f o r c e n t r a l g o v e r n m e n t , a s t h e c o m p l e m e n t a r y i n s t r u m e n t s o f t h e p u b l i c
w h o w i l l be p a y i n g for t h i s service t h r o u g h i n s u r a n c e c o n t r i b u t i o n s a n d t a x e s
to t h e e x c h e q u e r a n d t h r o u g h local r a t e s . I n a fully m o d e r n i s e d service t h e r e
w i l l be some t h i n g s w h i c h t h e S t a t e c a n d o b e t t e r t h a n local a u t h o r i t i e s , a n d
some t h i n g s w h i c h local a u t h o r i t i e s can do b e t t e r t h a n t h e S t a t e . T h e r e is also,
i n m y view, b o t h r o o m a n d n e e d f o r g i v i n g a voice, i n t h e g u i d i n g a n d p r o v i d i n g
of t h e service, t o those p r o f e s s i o n a l p e o p l e w h o w i l l in f u t u r e be a l m o s t w h o l l y
absorbed i n i t a n d on w h o m i t s success w i l l d e p e n d . T h i s w i l l i n v o l v e i n s o m e
cases—as i n t h e p r o v i s i o n f o r a f a m i l y d o c t o r s e r v i c e — n e w f o r m s of e x e c u t i v e
m a c h i n e r y , i n w h i c h t h e r e p r e s e n t a t i v e s of t h e p o t e n t i a l p a t i e n t s a n d t h o s e of
the p r o f e s s i o n a l people u n d e r t a k i n g t h e i r c a r e c a n combine.
5. I s e t o u t m y p r o p o s a l s i n t h e a p p e n d e d s t a t e m e n t , as s h o r t l y a s t h e
r a n g e of t h e s u b j e c t allows. I believe t h a t t h e y w i l l achieve a s e n s i b l e — a l t h o u g h
n e w — d i s t r i b u t i o n of r e s p o n s i b i l i t y b e t w e e n local a n d c e n t r a l g o v e r n m e n t , t h a t
they w i l l p r e s e r v e p r o p e r d e c e n t r a l i s a t i o n (in f u n c t i o n s w h i c h c e n t r a l g o v e r n ­
m e n t a s s u m e s ) so a s to k e e p u p a h e a l t h l y local i n t e r e s t i n a d m i n i s t r a t i o n , a n d
t h a t t h e y w i l l g i v e a useful a n d r e a s o n a b l e s h a r e in f u t u r e t o p r o f e s s i o n a l p e o p l e
in h e l p i n g t o s t e e r t h e s e r v i c e a l o n g t h e r i g h t lines.
[31041]
6. T o k e e p t h e p r o p o s a l s a s s h o r t as possible, I h a v e o m i t t e d a r g u m e n t .
T h e r e is m u c h g e n e r a l m a t t e r i n t h e o r i g i n a l W h i t e P a p e r w i t h w h i c h I a g r e e —
i n p a r t i c u l a r w i t h t h e scope of t h e service to b e p r o v i d e d , w i t h t h e c o n c e p t i o n
of t h e H e a l t h C e n t r e a s t h e n e w f e a t u r e of g e n e r a l m e d i c a l p r a c t i c e , w i t h t h e
i m p o r t a n c e of r a t i o n a l i s i n g t h e h o s p i t a l services for t h e first t i m e , w i t h t h e
n e e d t o t a k e t h e p r e s e n t b i t s a n d p i e c e s of t h e h e a l t h s e r v i c e s as t h e y h a v e
h i s t o r i c a l l y e m e r g e d a n d t o r e c a s t t h e m i n t o a c o h e r e n t s i n g l e n e w service, a n d
g e n e r a l l y w i t h t h e o b j e c t i v e of a u n i v e r s a l a n d f r e e service. O n m e t h o d , h o w e v e r ,
I often disagree; hence these amended proposals.
7. A l l of t h i s is c o n c e r n e d o n l y w i t h t h e g e n e r a l t r e a t m e n t services.
It
h a s t o be b a c k e d b y a r e v i e w , a s w e g o on, of t h e e n v i r o n m e n t a l p r o v i s i o n for
h e a l t h — d n local g o v e r n m e n t a n d o t h e r w i s e — a n d b y a v i g o r o u s p o l i c y of h e a l t h
e d u c a t i o n . I t l e a v e s u n t o u c h e d , for t h e p r e s e n t , t h e q u e s t i o n of i n d u s t r i a l h e a l t h
a n d h y g i e n e . I t w i l l n e e d t o b e s u p p l e m e n t e d , n e x t session, w i t h m e a s u r e s for
t h e g e n e r a l o a r e a n d w e l f a r e (other t h a n h e a l t h t r e a t m e n t ) of y o u n g c h i l d r e n ,
t h e a g e d , t h e b l i n d a n d t h e p e r m a n e n t l y c r i p p l e d — a l l of w h i c h m u s t become
t h e r e s p o n s i b i l i t y of some n e w service (and, I' h o p e , a local g o v e r n m e n t service)
w h e n t h e p r e s e n t s y s t e m of P u b l i c A s s i s t a n c e is s u p e r s e d e d .
8. B u t t h e i m m e d i a t e n e e d is to settle t h e s h a p e of a N a t i o n a l H e a l t h
S e r v i c e , b a c k i n g N a t i o n a l I n s u r a n c e , for a B i l l t h i s session. I f t h e a p p e n d e d
p r o p o s a l s c o m m e n d t h e m s e l v e s t o m y colleagues, I w i l l p r e p a r e t h e B i l l . W h i l e
I d o t h i s , I p r o p o s e to m e e t t h e r e p r e s e n t a t i v e bodies of t h e local a u t h o r i t i e s ,
m e d i c a l p r o f e s s i o n a n d o t h e r s , f o r some d i s c u s s i o n of t h e p r i n c i p a l p o i n t s in
t h e B i l l . B u t I d o n o t p r o p o s e , n o r w o u l d t i m e a l l o w , to e m b a r k u p o n a n y long
s e r i e s of n e g o t i a t i o n s b e f o r e t h e B i l l is s e t t l e d . N o r w i l l t h e B i l l itself h a v e
t o s e t t l e all t h e d e t a i l s ; i t w i l l p r o v i d e t h e g e n e r a l s t r u c t u r e , w i t h i n w h i c h m a n y
m a t t e r s w i l l h a v e to b e l a t e r d i s c u s s e d a n d n e g o t i a t e d .
A. B.
Ministry of Health, S.W. 1, 13th December,
1945. APPENDIX.
SUMMARY OF PROPOSALS FOR A NATIONAL HEALTH SERVICE.
1.
The Minister
as the central
authority.
1. G e n e r a l r e s p o n s i b i l i t y f o r t h e s e r v i c e w i l l r e s t on t h e M i n i s t e r of H e a l t h .
T h i s w i l l e x t e n d to m e n t a l , a s w e l l a s p h y s i c a l , h e a l t h s e r v i c e s — t h e a d m i n i s t r a t i v e
f u n c t i o n s of t h e B o a r d of C o n t r o l i n m e n t a l h e a l t h b e i n g a b s o r b e d by t h e M i n i s t e r ,
a n d t h e B o a r d e x e r c i s i n g o n l y t h e q u a s i - j u d i c i a l f u n c t i o n s r e l a t i n g to t h e l i b e r t y
of t h e s u b j e c t u n d e r t h e l u n a c y a n d m e n t a l deficiency A c t s .
2. T h e M i n i s t e r w i l l d i s c h a r g e h i s g e n e r a l r e s p o n s i b i l i t y t h r o u g h t h r e e m a i n
channels:—
(1) F o r p a r t s of t h e service best o r g a n i s e d n a t i o n a l l y — t h e h o s p i t a l a n d
s p e c i a l i s t s e r v i c e s — h e w i l l a s s u m e d i r e c t r e s p o n s i b i l i t y ; b u t h e will
d e l e g a t e t h e b u l k of a d m i n i s t r a t i o n to n e w r e g i o n a l a n d local bodies,
a c t i n g o n h i s b e h a l f a n d d e s i g n e d t o g i v e s c o p e t o p e o p l e w i t h local
e x p e r i e n c e a n d k n o w l e d g e to s e r v e on t h e m .
(2) F o r p a r t s of t h e s e r v i c e best o r g a n i s e d l o c a l l y — a w i d e v a r i e t y of domi­
c i l i a r y a n d clinic s e r v i c e s — d i r e c t r e s p o n s i b i l i t y w i l l r e s t o n local
government, acting in its o r d i n a r y relationship w i t h t h e M i n i s t e r ;
t h i s r e s p o n s i b i l i t y w i l l be unified i n t h e p r e s e n t m a j o r a u t h o r i t i e s , the
county a n d county borough councils.
(3) F o r n e w f a m i l y p r a c t i t i o n e r s e r v i c e s — d o c t o r a n d d e n t i s t — n e w local
e x e c u t i v e m a c h i n e r y w i l l be set u p , composed p a r t l y of m e m b e r s d r a w n
f r o m local a u t h o r i t i e s , p a r t l y of p e o p l e selected by t h e M i n i s t e r , p a r t l y
of r e p r e s e n t a t i v e s of t h e d o c t o r s a n d o t h e r s e n g a g e d i n t h e service.
T h e s e n e w local bodies will a c t w i t h i n n a t i o n a l r e g u l a t i o n s m a d e by
t h e M i n i s t e r ; a n d b y t h e s i d e of t h e M i n i s t e r t h e r e w i l l be a special,
m a i n l y p r o f e s s i o n a l , body to r e g u l a t e t h e d i s t r i b u t i o n of general
m e d i c a l p r a c t i t i o n e r s over t h e c o u n t r y as a w h o l e .
New central advisory
machinery.
3. T o p r o v i d e t h e M i n i s t e r w i t h e x p e r t a d v i c e , i n t h e t e c h n i c a l p l a n n i n g
a n d c o n d u c t of t h e service, t h e r e w i l l be a n e w C e n t r a l H e a l t h Services C o u n c i l .
T h i s w i l l be a s t a t u t o r y a d v i s o r y b o d y d r a w i n g m e m b e r s f r o m all t h e m a i n h e a l t h
professions—doctors, dentists, nurses, midwives, p h a r m a c i s t s — a n d from other
fields of r e l e v a n t t e c h n i c a l e x p e r i e n c e , s u c h a s local g o v e r n m e n t a n d h o s p i t a l
m a n a g e m e n t . I t w i l l b e a p p o i n t e d by t h e M i n i s t e r a f t e r c o n s u l t i n g t h e a p p r o ­
priata organisations.
4. I n a d d i t i o n — t o free t h e C o u n c i l for i t s g e n e r a l w o r k o n t h e s e r v i c e as
a w h o l e — i t w i l l h a v e S t a n d i n g A d v i s o r y C o m m i t t e e s on s p e c i a l a s p e c t s of t h e
service ( m e d i c a l , h o s p i t a l s , n u r s i n g , m e n t a l h e a l t h services & c ) . T h e s e w i l l be
appointed in the same way, after consultation. They will directly advise the
M i n i s t e r , b u t t h e i r a d v i c e w i l l be m a d e k n o w n t o t h e C e n t r a l C o u n c i l a s w e l l
so t h a t t h e C o u n c i l c a n p i c k u p p o i n t s o n w h i c h i t s collective views m a y call for
a d j u s t m e n t of t h e s e c t i o n a l a d v i c e of a p a r t i c u l a r c o m m i t t e e . T h e m a i n C o u n c i l
w i l l r e p o r t e a c h y e a r o n i t s w o r k a n d t h a t of t h e c o m m i t t e e s — a r e p o r t w h i c h
t h e M i n i s t e r w i l l n o r m a l l y p u b l i s h , i n f u l l , u n l e s s t h e r e is a n y r e a s o n of p u b l i c
i n t e r e s t f o r n o t d o i n g so, w h e n h e m a y w i t h h o l d i t i n w h o l e o r i n p a r t .
I I . — H o s p i t a l and Specialist
5.
Services.
T h i s p a r t of t h e service w i l l cover t h e f o l l o w i n g field :—­
(a) I n - p a t i e n t c a r e i n a l l t y p e s of h o s p i t a l , i n c l u d i n g m a t e r n i t y homes,
s a n a t o r i a , m e n t a l h o s p i t a l s , m e n t a l deficiency i n s t i t u t i o n s , c o n v a l e s c e n t
homes a n d m e d i c a l r e h a b i l i t a t i o n c e n t r e s .
(b) O u t - p a t i e n t c a r e at o u t - p a t i e n t d e p a r t m e n t s of h o s p i t a l s , a n d a t s p e c i a l i s t
clinics a s s o c i a t e d w i t h h o s p i t a l s a l t h o u g h n o t n e c e s s a r i l y s i t u a t e d a t
t h e m ; i n c l u d i n g mental clinics, tuberculosis dispensaries, venereal
d i s e a s e c l i n i c s , e y e clinics.
(c) A c o n s u l t a n t service of a l l k i n d s ; b a s e d on t h e h o s p i t a l s , b u t p r o v i d i n g
services n o t only a t t h e m b u t also a t t h e p a t i e n t s ' h o m e s , w h e r e
necessary, a n d a t H e a l t h C e n t r e s , clinics, &c.
Taking
over the existing
hospitals.
6. T h e o w n e r s h i p of t h e p r e s e n t p u b l i c h o s p i t a l s , v o l u n t a r y a n d m u n i c i p a l ,
w i l l be t a k e n over by t h e M i n i s t e r (subject to s p e c i a l a r r a n g e m e n t s i n t h e case of
t h e t e a c h i n g h o s p i t a l s , d e s c r i b e d l a t e r ) . P r o v i s i o n w i l l be m a d e for t h e p r o t e c t i o n
of e x i s t i n g officers a n d s e r v a n t s . N o c o m p e n s a t i o n w i l l be p a y a b l e i n r e s p e c t of
b u i l d i n g s , e q u i p m e n t a n d o t h e r a s s e t s — i n c l u d i n g e x i s t i n g f u n d s of t h e v o l u n t a r y
hospitals.
E x i s t i n g l i a b i l i t i e s w i l l be t a k e n over.
Where particular hospitals
h a v e h i t h e r t o been p r o v i d e d by v o l u n t a r y s u b s c r i b e r s for p a r t i c u l a r classes o r
g r o u p s of p a t i e n t s only, i t w i l l be t h e a i m — c o n s i s t e n t l y w i t h t h e r a t i o n a l p l a n n i n g
of t h e n e w service—-to r e t a i n t h e i d e n t i t y of t h e s p e c i a l p u r p o s e s for w h i c h t h e s e
h o s p i t a l s h a v e p r e v i o u s l y b e e n s u p p o r t e d , e.g., i n a s e p a r a t e w i n g o r o t h e r
identifiable p a r t of t h e o r g a n i s a t i o n .
Regional
Hospitals
Boards.
7. T h e c o u n t r y w i l l b e d i v i d e d i n t o a b o u t t w e n t y n a t u r a l a r e a s o r r e g i o n s
for h o s p i t a l o r g a n i s a t i o n . E a c h a r e a w i l l be b a s e d on one of t h e eleven u n i v e r s i t y
m e d i c a l t e a c h i n g c e n t r e s — t h e n a t u r a l focal p o i n t s of s p e c i a l i s t m e d i c i n e a n d
t h e r e f o r e of h o s p i t a l services.
T w o or more areas will sometimes base on the
same m e d i c a l t e a c h i n g c e n t r e , t o a v o i d t h e a r e a s b e c o m i n g too b i g f o r p r a c t i c a l
organisation.
8. F o r e a c h a r e a or r e g i o n t h e r e w i l l be set u p a R e g i o n a l H o s p i t a l s B o a r d
of some 2 0 - 3 0 m e m b e r s , a p p o i n t e d by t h e M i n i s t e r a n d d r a w n f r o m t h e m a j o r
local a u t h o r i t i e s in t h e a r e a , f r o m local p e o p l e selected by t h e M i n i s t e r for t h e i r
g e n e r a l s u i t a b i l i t y f o r t h e w o r k i n v o l v e d (some of w h o m m a y be e x - v o l u n t a r y
h o s p i t a l e x p e r t s ) , a n d f r o m people r e p r e s e n t i n g t h e u n i v e r s i t y t e a c h i n g c e n t r e
and s p e c i a l i s t a n d g e n e r a l m e d i c i n e i n t h e a r e a . P r i n c i p a l officers of t h e B o a r d s
will be a p p o i n t e d by t h e B o a r d s s u b j e c t to t h e a p p r o v a l of t h e M i n i s t e r .
9. E a c h R e g i o n a l B o a r d w i l l be r e q u i r e d to a p p o i n t , s u b j e c t t o t h e M i n i s t e r s
a p p r o v a l , a n u m b e r of s m a l l e r L o c a l H o s p i t a l M a n a g e m e n t C o m m i t t e e s .
There
will be one of t h e s e c o m m i t t e e s for e a c h local g r o u p of h o s p i t a l s w h i c h t o g e t h e r
[ 3 1 0 4 1 ]
B 2
f o r m a n a t u r a l h o s p i t a l u n i t i n a p l a n n e d service—d.e., one o r m o r e m a i n h o s p i t a l s ,
w i t h some o u t l y i n g s m a l l e r " f e e d e r " h o s p i t a l s , t o g e t h e r p r o v i d i n g a b o u t 1,000
b e d s u n d e r a c o m m o n s p e c i a l i s t staff, a n d c a p a b l e of d e a l i n g a s a g r o u p w i t h all
t h e m o r e n o r m a l h o s p i t a l n e e d s of t h e i r i m m e d i a t e a r e a . - S o m e t i m e s a l a r g e
h o s p i t a l n o t n e e d i n g to be so g r o u p e d — e . g . , a m e n t a l h o s p i t a l — w i l l h a v e o n e of
t h o s e c o m m i t t e e s to itself. A l l t h e c o m m i t t e e s w i l l be e s s e n t i a l l y local e x e c u t i v e
b o d i e s , a l t h o u g h t h e i r field of o p e r a t i o n c a n n o t be r e s t r i c t e d t o e x i s t i n g local
g o v e r n m e n t b o u n d a r i e s . T h e i r m e m b e r s w i l l be d r a w n f r o m t h e local a u t h o r i t i e s
of t h e a r e a s served by t h e h o s p i t a l s a f t e r c o n s u l t a t i o n w i t h t h o s e local a u t h o r i t i e s ,
a n d f r o m o t h e r local p e o p l e selected by t h e R e g i o n a l B o a r d s ( i n c l u d i n g , w h e r e
d e s i r a b l e , p e o p l e of local v o l u n t a r y h o s p i t a l e x p e r i e n c e ) , t o g e t h e r w i t h some
professional members.
10. T h e M i n i s t e r w i l l d e t e r m i n e w i t h e a c h R e g i o n a l B o a r d t h e best
r e o r g a n i s a t i o n of all a v a i l a b l e h o s p i t a l a n d s p e c i a l i s t r e s o u r c e s i n t h e i r r e g i o n ,
a n d w i l l s u p p l e m e n t t h o s e r e s o u r c e s as a n d w h e r e n e c e s s a r y , a s soon a s t h i s c a n
be d o n e . O w n i n g t h e h o s p i t a l s , h e w i l l e n t r u s t t h e i r a d m i n i s t r a t i o n t o t h e
R e g i o n a l B o a r d s . T h e B o a r d s will settle w i t h t h e M i n i s t e r e a c h y e a r a b u d g e t
of n o r m a l e x p e n d i t u r e , a n d w i t h i n t h a t b u d g e t w i l l be given a s m u c h i n d e p e n d e n c e
a s p o s s i b l e ; a b n o r m a l , or e x c e s s , e x p e n d i t u r e w i l l be u n d e r m o r e d e t a i l e d c o n t r o l .
The B o a r d s will m a k e all consultant a n d specialist a p p o i n t m e n t s in t h e
h o s p i t a l s — r e g i o n a l a d v i s o r y p a n e l s of e x p e r t s b e i n g set u p t o a d v i s e o n t h e
p r o f e s s i o n a l s u i t a b i l i t y of c a n d i d a t e s .
1 1 . T h e d a y - t o - d a y w o r k of r u n n i n g t h e h o s p i t a l s w i l l t h e n be e n t r u s t e d by
t h e B o a r d s to t h e L o c a l M a n a g e m e n t C o m m i t t e e s . T h e s e w i l l b e t h e effective
m a n a g e r s o n t h e spot, a p p o i n t i n g all o r d i n a r y staff of t h e h o s p i t a l s , d e a l i n g w i t h
supplies, handling ordinary r u n n i n g and minor capital expenditure, and generally
acting as the " governing bodies." I n m e n t a l hospitals they will t a k e the place
of t h e p r e s e n t V i s i t i n g C o m m i t t e e s . T h e p r i n c i p a l officer of e a c h C o m m i t t e e w i l l
be a p p o i n t e d b y t h e C o m m i t t e e w i t h t h e a p p r o v a l of t h e R e g i o n a l B o a r d , a n d w i l l
a c t also a s t h e chief a d m i n i s t r a t i v e officer of each h o s p i t a l covered b y t h e
Committee.
Special
Provision
for Teaching
Hospitals.
12. S p e c i a l p r o v i s i o n w i l l be m a d e i n r e l a t i o n to h o s p i t a l s p r o v i d i n g t h e
bases for t h e c l i n i c a l t e a c h i n g of m e d i c a l s t u d e n t s . T h e y w i l l be t a k e n over by
t h e M i n i s t e r l i k e o t h e r h o s p i t a l s , a n d p l a y t h e i r p a r t in t h e n a t i o n a l s e r v i c e ; b u t
t h e y w i l l b e g i v e n t h e s p e c i a l s t a t u s a n d m e a s u r e of i n d e p e n d e n c e n e c e s s a r y t o
e n a b l e t h e m t o t a k e t h e i r p r o p e r p l a c e a s a c a d e m i c i n s t i t u t i o n s s t a n d i n g i n close
a s s o c i a t i o n w i t h t h e u n i v e r s i t i e s w h o s e e d u c a t i o n a l n e e d s t h e y m u s t be o r g a n i s e d
t o meet. U n i v e r s i t i e s m u s t be e n a b l e d t o exercise a n effective influence on t h e
policy a n d a c t i v i t i e s of t e a c h i n g h o s p i t a l s . E s s e n t i a l f e a t u r e s of t h e o r g a n i s a t i o n
of a t e a c h i n g h o s p i t a l e m p h a s i s e d by t h e G o o d e n o u g h C o m m i t t e e a r e a g o v e r n i n g
b o d y w h i c h is p e r s o n a l t o t h e h o s p i t a l a n d h a s w i d e d i s c r e t i o n a s t o e x p e n d i t u r e
w i t h i n a r e a s o n a b l e b u d g e t ; r e p r e s e n t a t i o n of t h e u n i v e r s i t y a n d of t h e t e a c h i n g
staff on t h a t g o v e r n i n g b o d y ; a n d selection of m e d i c a l staff (other t h a n h o l d e r s
of u n i v e r s i t y p o s t s ) by a s p e c i a l a d v i s o r y c o m m i t t e e , r e p r e s e n t a t i v e of t h e
g o v e r n i n g b o d y of t h e h o s p i t a l a n d of t h e u n i v e r s i t y .
W i t h t h e s e objects i n m i n d i t is p r o p o s e d t h a t t h e h o s p i t a l s w h i c h a r e f r o m
t i m e t o t i m e r e g a r d e d by t h e u n i v e r s i t i e s a n d t h e M i n i s t e r a s p r o v i d i n g t h e m a i n
f a c i l i t i e s for u n d e r g r a d u a t e o r p o s t - g r a d u a t e c l i n i c a l t e a c h i n g a n d r e s e a r c h s h a l l
' be d i f f e r e n t i a t e d from o t h e r h o s p i t a l s i n t h e f o l l o w i n g m a n n e r : ­
(1) I n s t e a d of b e i n g e n t r u s t e d to t h e o r d i n a r y R e g i o n a l B o a r d s a n d local
m a n a g e m e n t c o m m i t t e e s d e s c r i b e d above, t h e t e a c h i n g h o s p i t a l (in
some i n s t a n c e s t h e m a i n a n d a s s o c i a t e d h o s p i t a l s w h i c h t o g e t h e r
constitute the teaching centre) will have its own specially constituted
B o a r d of G o v e r n o r s .
(2) T h e B o a r d of G o v e r n o r s will, a s r e c o m m e n d e d by t h e G o o d e n o u g h
C o m m i t t e e , i n c l u d e r e a s o n a b l e r e p r e s e n t a t i o n of t h e u n i v e r s i t y a n d of
t h e t e a c h i n g staff. I n a d d i t i o n , i t w i l l h a v e m e m b e r s n o m i n a t e d b y the
R e g i o n a l H o s p i t a l s B o a r d a n d by t h e M i n i s t e r (some of w h o m w i l l be
d r a w n f r o m t h e p r e s e n t g o v e r n i n g bodies).
(3) T h e t e a c h i n g h o s p i t a l w i l l h a v e a s e p a r a t e a n n u a l b u d g e t a p p r o v e d by
t h e M i n i s t e r , a n d w i t h i n t h a t b u d g e t t h e G o v e r n o r s w i l l h a v e the
fullest d i s c r e t i o n in e x p e n d i t u r e (subject a l w a y s t o o b s e r v a n c e of any
n a t i o n a l l y a g r e e d t e r m s of service a n d r e m u n e r a t i o n ) .
T h e y can
also be a l l o w e d to r e t a i n v a r i o u s e n d o w m e n t s i n t h e i r possession.
F u r t h e r , t h e Governors will receive a d d i t i o n a l funds from university
sources, a n d w i l l be a t l i b e r t y t o a c c e p t t h e m f r o m p r i v a t e s o u r c e s f o r
experimental work and innovations in organisation.
(4) T h e G o v e r n o r s w i l l h a v e f u l l f r e e d o m t o a p p o i n t t h e i r o w n staff, a n d in
m a k i n g m e d i c a l staff a p p o i n t m e n t s w i l l b e a d v i s e d b y a s p e c i a l selec­
t i o n c o m m i t t e e c o n s t i t u t e d i n t h e l i g h t of t h e G o o d e n o u g h C o m m i t t e e
recommendations.
13. I n L o n d o n o n e a d d i t i o n a l r e f o r m is n e c e s s a r y if t h e s e p r o p o s a l s for
the d e v e l o p m e n t a n d i m p r o v e m e n t o f m e d i c a l e d u c a t i o n a r e t o t a k e f u l l effect—
namely, t h e i n c o r p o r a t i o n of t h e m e d i c a l schools (as d i s t i n c t f r o m t h e t e a c h i n g
hospitals u s e d by t h e schools) a s s e p a r a t e l e g a l e n t i t i e s . A t p r e s e n t t e n of t h e
twelve L o n d o n m e d i c a l schools a r e l e g a l l y m e r e l y c r e a t u r e s of t h e t e a c h i n g
hospitals, a n d u l t i m a t e p o w e r a n d r e s p o n s i b i l i t y f o r t h e i r c o n d u c t l i e s w i t h t h e
governing body of t h e h o s p i t a l . T h e G o o d e n o u g h C o m m i t t e e s t r o n g l y recom­
mended t h e e n d i n g o f t h i s h i s t o r i c a l a n o m a l y a n d t h e g r a n t i n g of l e g a l i n d e ­
pendence t o t h e schools b y o m n i b u s l e g i s l a t i o n .
T h e r e o r g a n i s a t i o n of t h e
teaching h o s p i t a l s p r o p o s e d above m a k e s t h i s r e f o r m e s s e n t i a l , a n d i t is t h e r e f o r e
intended t o i n c l u d e i n t h e B i l l p r o v i s i o n f o r t h e i n c o r p o r a t i o n of t h e L o n d o n
medical schools.
I I I . — L o c a l Clinic,
Domiciliary
and Welfare
Services.
14. T h i s p a r t of t h e service w i l l be t h e d i r e c t f u n c t i o n of local g o v e r n m e n t
- o f t h e c o u n t y a n d c o u n t y b o r o u g h c o u n c i l s — a n d w i l l i n c l u d e -;—
(a) School m e d i c a l services.
(&) M a t e r n i t y a n d c h i l d w e l f a r e ( i n c o - o p e r a t i o n w i t h t h e h o s p i t a l service
o n t h e s p e c i a l i s t side),
(c) D o m i c i l i a r y m i d w i f e r y . \d) H e a l t h v i s i t i n g . (e) H o m e n u r s i n g services. (/) H o m e h e l p s e r v i c e s for h o u s e h o l d s i n t i m e of s i c k n e s s . (g) V a c c i n a t i o n a n d i m m u n i s a t i o n services.
(A) V a r i o u s f o r m s of c a r e a n d a f t e r - c a r e for t h e sick a n d t h o s e r e c o v e r i n g
from s i c k n e s s .
(i) A g e n e r a l a m b u l a n c e service.
(j) T h e p r o v i s i o n a n d m a i n t e n a n c e of H e a l t h C e n t r e s , D e n t a l C e n t r e s , a n d
s i m i l a r local p r e m i s e s a s bases f o r t h e F a m i l y P r a c t i t i o n e r service
(to be d e s c r i b e d l a t e r ) .
(k) A s c e r t a i n m e n t of m e n t a l cases.
15. T h e r e is n o n e e d t o d e s c r i b e t h e a d m i n i s t r a t i v e m a c h i n e r y for t h e s e
services; i t w i l l be t h e f a m i l i a r m a c h i n e r y of l o c a l g o v e r n m e n t . T h e g e n e r a l
nature of t h e services is o u t l i n e d below. I t i s p r o p o s e d t h a t a l l local a u t h o r i t y
e x p e n d i t u r e on t h e s e services s h o u l d b e a s s i s t e d by a n a v e r a g e 5 0 p e r cent.
l E x c h e q u e r g r a n t , a p p r o p r i a t e l y w e i g h t e d t o fit t h e n e e d s of t h e different a r e a s .
Also—-so a s t o e n s u r e t h e r e l a t e d p l a n n i n g of t h e h e a l t h service a s a w h o l e — t h e
local a u t h o r i t i e s w i l l n e e d t o o b t a i n M i n i s t e r i a l a p p r o v a l ho t h e g e n e r a l c o n t e n t
of t h e services w h i c h t h e y p r o v i d e ( j u s t as t h e y d o n o w i n M a t e r n i t y a n d C h i l d
Welfare a n d i n t h e School M e d i c a l S e r v i c e ; i n t h e case of t h e School M e d i c a l
Service t h e a p p r o v a l w i l l c o n t i n u e t o be t h a t of t h e M i n i s t e r of E d u c a t i o n ) .
(a) School Medical
Service.
16. T h i s is a l r e a d y p r o v i d e d f o r i n t h e E d u c a t i o n A c t , 1944. T h e u l t i m a t e
object m u s t be t o m a k e u n n e c e s s a r y t h e p r o v i s i o n of m e d i c a l t r e a t m e n t by t h e
school services as s u c h — m e d i c a l i n s p e c t i o n , t h e s u p e r v i s i o n of t h e h e a l t h of t h e
child i n t h e school itself, t h e c o n d u c t of s p e c i a l i n v e s t i g a t i o n s , a n d t h e g u i d a n c e
and p e r s u a s i o n of p a r e n t s , r e m a i n i n g w i t h t h e m . F o r s o m e t i m e , h o w e v e r , m u c h
of t h e s p e c i a l school t r e a t m e n t p r o v i s i o n — p a r t i c u l a r l y d e n t i s t r y — - w i l l n e e d t o
continue, u n t i l t h e s t a g e is r e a c h e d a t w h i c h i t d u p l i c a t e s , a n d d o e s n o t s u p p l e I Hent, t h e g e n e r a l h e a l t h p r o v i s i o n . T h e school service is a l r e a d y i n t h e s a m e
I hands a s is p r o p o s e d for t h e o t h e r local services b e l o w — t h e c o u n t i e s a n d c o u n t y
troughs.
(b) Maternity
and child
welfare.
17. T h e c a r e of n o r m a l m a t e r n i t y a n d child w e l f a r e — p r e - n a t a l a n d post­
n a t a l clinics, c h i l d clinics, confinements i n t h e home, & c . — w i l l be t h e responsibility
of t h e local a u t h o r i t i e s . B u t p r e s e n t p o w e r s w i l l be c o n v e r t e d i n t o a d u t y , and
w i l l be c o n c e n t r a t e d in t h e c o u n t i e s a n d c o u n t y b o r o u g h s .
18. T h e s p e c i a l i s t a n d i n s t i t u t i o n a l a s p e c t s of m a t e r n i t y w i l l be i n the
c a r e of t h e h o s p i t a l a n d s p e c i a l i s t service, o r g a n i s e d r e g i o n a l l y i n t h e manner
a l r e a d y p r o p o s e d . Also, for c o n t i n u i t y of case t r e a t m e n t , t h e h o s p i t a l service
m u s t itself be able t o p r o v i d e p r e - n a t a l c l i n i c s for c a s e s d e s t i n e d for confinement
i n t h e h o s p i t a l s r a t h e r t h a n i n t h e i r o w n h o m e s . I n a p p r o v i n g local a u t h o r i t i e s '
a r r a n g e m e n t s t h e M i n i s t e r w i l l s a t i s f y h i m s e l f t h a t t h e s e p r o v i d e for t h e early
d e t e c t i o n a n d r e f e r e n c e to t h e s p e c i a l i s t service of a b n o r m a l or c o m p l i c a t e d cases,
a n d for ease of access to s p e c i a l i s t f a c i l i t i e s f o r a l l c a s e s — f o r e x a m i n a t i o n and
advice.
19. T h e local a u t h o r i t i e s ' c h i l d w e l f a r e f u n c t i o n s w i l l b e s u b j e c t t o the
s a m e k i n d a n d d e g r e e of d e l e g a t i o n — d i v i s i o n a l a d m i n i s t r a t i o n w i t h i n t h e local
a u t h o r i t y ' s a r e a — a s t h e school m e d i c a l service, so t h a t t h e c a r e of t h e children
u n d e r five a t school a n d n o t a t school c a n r u n closely i n p a r a l l e l .
(c) Domiciliary
midwifery.
20. A s p a r t of t h e i r m a t e r n i t y f u n c t i o n s t h e c o u n t y a n d c o u n t y borough
c o u n c i l s w i l l be r e s p o n s i b l e for s e c u r i n g a d o m i c i l i a r y m i d w i f e r y service for their
areas.
2 1 . T h e r e a r e a t p r e s e n t v o l u n t a r y a s s o c i a t i o n s w h i c h p r o v i d e a domiciliary
m i d w i f e service on b e h a l f of s o m e local a u t h o r i t i e s . S u b j e c t t o s a t i s f y i n g the
M i n i s t e r t h a t t h e i r a r r a n g e m e n t s w i l l be efficient, t h e local a u t h o r i t i e s c a n still
be a l l o w e d to p r o v i d e p a r t or a l l of t h e i r s e r v i c e by c o n t r a c t w i t h such agencies—
o n t e r m s t o be a g r e e d or, f a i l i n g a g r e e m e n t , s e t t l e d b y t h e M i n i s t e r .
(d) Health
Visiting.
22. L o c a l a u t h o r i t i e s n o w p r o v i d e H e a l t h V i s i t i n g services u n d e r their
m a t e r n i t y a n d c h i l d w e l f a r e f u n c t i o n s , a n d t h i s w i l l g o on. B u t i t w i l l be
i m p o r t a n t t o e x t e n d t h e scope of i t t o i n c l u d e m a n y o t h e r t y p e s of case t o which
t h e H e a l t h V i s i t o r ' s a t t e n t i o n m a y be d r a w n by t h e f a m i l y d o c t o r service—par­
t i c u l a r l y f r o m t h e H e a l t h C e n t r e s . T h e d u t i e s of t h e c o u n t y a n d c o u n t y borough
councils w i l l b e e n l a r g e d a c c o r d i n g l y .
(e) Home
Nursing.
23. A n e w d u t y w i l l be p u t u p o n t h e c o u n t y a n d c o u n t y b o r o u g h councils to
m a k e sufficient p r o v i s i o n i n t h e i r a r e a s for t h e a t t e n d a n c e of p r o p e r l y qualified
n u r s e s on p e o p l e w h o r e q u i r e n u r s i n g i n t h e i r o w n h o m e s — u s u a l l y o n t h e recom­
m e n d a t i o n of t h e f a m i l y d o c t o r service. S h o r t a g e of n u r s e s w i l l a t first limit
t h e scope of t h i s service, b u t t h e u l t i m a t e o b j e c t w i l l be t o s e c u r e t h a t wherever
t h e r e i s g e n u i n e n e e d for a n u r s e i n t h e home, o r v i s i t i n g t h e h o m e , t h a t n u r s e will
be p u b l i c l y p r o v i d e d .
24. T h e s a m e q u e s t i o n of t h e u s e of v o l u n t a r y a g e n c i e s ( t h e p r e s e n t County
a n d D i s t r i c t N u r s i n g A s s o c i a t i o n s ) w i l l a r i s e , a n d t h e local a u t h o r i t y c a n be
s i m i l a r l y e m p o w e r e d to c o n t r a c t w i t h s u c h a g e n c i e s for t h e p r o v i s i o n , in p a r t or
i n w h o l e , of t h e service for t h e m — s u b j e c t t o s a t i s f y i n g t h e M i n i s t e r t h a t the
a r r a n g e m e n t s w i l l be efficient.
(f) Home
Helps.
2 5 . U n l e s s t h i s is covered b y a g e n e r a l p r o v i s i o n , w i d e r t h a n t h e health
services, t h e c o u n t y a n d c o u n t y b o r o u g h councils w i l l be e m p o w e r e d t o provide
d o m e s t i c h e l p for h o u s e h o l d s w h i c h a r e i n n e e d of i t t h r o u g h illness.
(g) Vaccination
and
immunisation.
26. T h e c o u n t y a n d c o u n t y b o r o u g h councils w i l l be g i v e n a n e w d u t y to
m a k e a r r a n g e m e n t s , t o t h e M i n i s t e r s s a t i s f a c t i o n , for a n y o n e i n t h e i r a r e a to be
able t o be v a c c i n a t e d a g a i n s t s m a l l p o x o r i m m u n i s e d a g a i n s t d i p h t h e r i a . They
w i l l h a v e p o w e r t o do t h e s a m e for o t h e r diseases, a n d a d u t y t o d o so if the
M i n i s t e r so r e q u i r e s . T h e y w i l l n o r m a l l y d o t h i s by a r r a n g e m e n t s w i t h the
g e n e r a l p r a c t i t i o n e r s of t h e a r e a ; b u t t h i s w i l l be a s p e c i a l a r r a n g e m e n t , with
separate r e m u n e r a t i o n , a n d n o t p a r t of t h e " f a m i l y d o c t o r ' s " t e r m s of s e r v i c e ;
special i n d u c e m e n t w i l l be offered, i n fact, to e n c o u r a g e d e v e l o p m e n t of t h e
practice. T h e p r e s e n t obsolete l a w o n c o m p u l s o r y v a c c i n a t i o n w i l l be r e p e a l e d .
(h) Care and after-care
of the sick.
27. C o u n t y a n d c o u n t y b o r o u g h c o u n c i l s w i l l be e m p o w e r e d to m a k e s u c h
supplementary a r r a n g e m e n t s (other t h a n c a s h p a y m e n t s ) a s t h e M i n i s t e r m a y
approve for t h e b e t t e r c a r e a n d w e l f a r e of p e r s o n s suffering from, or h a v i n g
suffered frorm sickness o r i n j u r y . E x a m p l e s of t h i s w o u l d b e t h e a f t e r - c a r e of
mental p a t i e n t s , t h e p r o v i s i o n of m i l k a n d a d d i t i o n a l n o u r i s h m e n t in c e r t a i n
cases, t h e l o a n of b l a n k e t s , a n d g u i d a n c e a n d h e l p i n g e t t i n g s u i t a b l e l i v i n g
conditions (e.g., i n t u b e r c u l o s i s ) .
(i) Ambulance
Services.
28. T h e c o u n t y a n d c o u n t y b o r o u g h c o u n c i l s w i l l be g i v e n t h e d u t y of ­
providing a n a d e q u a t e a m b u l a n c e service f o r t h e use of t h e i n h a b i t a n t s of t h e i r
areas, b u t w i t h p r o v i s i o n f o r t h e vehicles t o u n d e r t a k e all n e c e s s a r y i n t e r - a r e a
journeys w i t h o u t r e g a r d t o b o u n d a r i e s . T h e h o s p i t a l s e r v i c e will, n o d o u b t ,
need itself t o p r o v i d e c e r t a i n h o s p i t a l t r a n s p o r t , b u t i t w i l l i n t h e m a i n look to
a r r a n g e m e n t s w i t h t h e local a u t h o r i t i e s for i t s a m b u l a n c e services.
(j) Health
Centres.
29. T h e f u n c t i o n s of t h e local a u t h o r i t i e s i n t h i s c o n n e c t i o n a r e d e a l t w i t h
under t h e F a m i l y P r a c t i t i o n e r S e r v i c e s below.
(k) Ascertainment
of Mental
Cases.
30. C o u n t y a n d c o u n t y b o r o u g h councils w i l l h a v e t h e d u t y of m a k i n g
a r r a n g e m e n t s for t h e e a r l y d e t e c t i o n a n d r e f e r e n c e t o t h e h o s p i t a l a n d s p e c i a l i s t
service of m e n t a l p a t i e n t s or m e n t a l deficients r e q u i r i n g c a r e o r t r e a t m e n t u n d e r
the l u n a c y a n d m e n t a l deficiency A c t s .
IV.—Family Practitioner
Services.
3 1 . T h i s p a r t of t h e s e r v i c e w i l l cover g e n e r a l m e d i c a l c a r e by a p e r s o n a l ,
or f a m i l y , d o c t o r — w i t h n e c e s s a r y m e d i c i n e s , d r u g s a n d a p p l i a n c e s — t o be a v a i l ­
able t o t h e w h o l e p o p u l a t i o n as f r o m a n a p p o i n t e d d a y . G e n e r a l d e n t a l care—:
with n e c e s s a r y d e n t u r e s — w i l l be d e v e l o p e d as f a s t a s t h e s u p p l y of d e n t i s t s
allows. T h e r e w i l l be p r i o r i t y d e n t a l p r o v i s i o n from t h e o u t s e t , h o w e v e r , for
mothers a n d c h i l d r e n . ( T h i s p r i o r i t y d e n t i s t r y w i l l b e p r o v i d e d by local a u t h o r i ­
ties t h r o u g h t h e i r m a t e r n i t y a n d child w e l f a r e services a n d school m e d i c a l s e r v i c e
- a n d i t is n o t affected, t h e r e f o r e , by t h e f o l l o w i n g p r o p o s a l s f o r t h e m o r e g e n e r a l
service.)
32. A p r i n c i p a l o b j e c t i v e f r o m t h e o u t s e t , i n t h e g e n e r a l m e d i c a l a n d g e n e r a l
dental services, w i l l be t h e d e v e l o p m e n t of t h e H e a l t h C e n t r e system, e q u i p p i n g
the p r a c t i t i o n e r w i t h p u b l i c l y p r o v i d e d p r e m i s e s , a p p a r a t u s a n d a n c i l l a r y staff.
This system w i l l be developed as f a s t a n d as w i d e l y a s possible. T h e a r r a n g e m e n t s
for t h e p r o v i s i o n of t h e C e n t r e s a n d t h e e n g a g e m e n t of t h e d o c t o r s a n d d e n t i s t s
in t h e m a r e r e f e r r e d t o below.
33. W h i l e t h e H e a l t h C e n t r e system i s d e v e l o p i n g , i t w i l l be s u p p l e m e n t e d
by a r r a n g e m e n t s w i t h d o c t o r s i n s e p a r a t e p r a c t i c e — t o j o i n i n t h e service f r o m
their own s u r g e r i e s . T h i s w i l l be so a r r a n g e d t h a t e v e r y o n e c a n b e a s s u r e d of
a family d o c t o r f r o m t h e o u t s e t — e i t h e r i n a H e a l t h C e n t r e o r n o t . F o r d e n t i s t r y ,
this a s s u r a n c e c a n n o t be g i v e n u n t i l m o r e p r a c t i t i o n e r s a r e a v a i l a b l e , b u t d u r i n g
the d e v e l o p m e n t of t h e H e a l t h C e n t r e system a r r a n g e m e n t s w i l l be m a d e t o
supplement i t as m u c h a s possible by e n a b l i n g i n d i v i d u a l d e n t i s t s t o t r e a t p a t i e n t s
at t h e cost of t h e n e w service w h e r e v e r t h i s c a n be a r r a n g e d .
local Executive
Committees.
34. T h e r e w i l l be a n e w system of L o c a l E x e c u t i v e C o m m i t t e e s for t h e f a m i l y
practitioner services. T h e r e w i l l be a C o m m i t t e e for e a c h c o u n t y a n d c o u n t y
borough a r e a , b u t w i t h p o w e r t o t h e M i n i s t e r t o c o m b i n e t w o or m o r e a r e a s
under one C o m m i t t e e , w h e r e v e r d e s i r a b l e . E a c h C o m m i t t e e w i l l h a v e a c h a i r m a n ,
appointed b y t h e M i n i s t e r , a n d o n e h a l f of i t s m e m b e r s w i l l r e p r e s e n t t h e
"consumer " i n t e r e s t , t h e p u b l i c , w h i l e t h e o t h e r h a l f r e p r e s e n t s t h e p r o f e s s i o n a l
p e o p l e p r o v i d i n g t h e s e r v i c e — d o c t o r s , d e n t i s t s a n d c h e m i s t s . Of t h e public t
r e p r e s e n t a t i v e s , t w o - t h i r d s w i l l be n o m i n a t e d by t h e L o c a l A u t h o r i t y of t h e area ?
a n d the other t h i r d by the Minister.
35.
T h e f u n c t i o n s of t h e L o c a l E x e c u t i v e C o m m i t t e e w i l l b e :—
(a) m a k i n g all a r r a n g e m e n t s t o s e c u r e g e n e r a l p r a c t i t i o n e r services for their
a r e a in a c c o r d a n c e w i t h t h e A c t a n d r e g u l a t i o n s m a d e u n d e r t h e Act;
(6) e n t e r i n g i n t o t h e n e c e s s a r y c o n t r a c t s w i t h — a n d r e m u n e r a t i n g - t h e
doctors, d e n t i s t s a n d c h e m i s t s t a k i n g p a r t i n t h e f a m i l y p r a c t i t i o n e r
services, b o t h i n H e a l t h C e n t r e s a n d o u t s i d e ;
(c) p r o v i d i n g t h e necessary d i s c i p l i n a r y m a c h i n e r y ( t h r o u g h sub-committees
or o t h e r w i s e , as t h e A c t a n d r e g u l a t i o n s w i l l prescribe) for t h e hearing
of c o m p l a i n t s a n d d i s p u t e s b e t w e e n p a t i e n t a n d doctor, p a t i e n t and
c h e m i s t a n d so o n — w i t h p r o p e r a p p e a l s to t h e M i n i s t e r ;
(d) c o m p i l i n g , a n d m a k i n g k n o w n to t h e p u b l i c , l i s t s of t h e d o c t o r s , dentists
a n d o t h e r s a v a i l a b l e f o r t h e i r service, i n t h e H e a l t h C e n t r e s and
o u t s i d e ; a n d g e n e r a l l y a r r a n g i n g for t h e selection of doctors, & c ,
by t h e p a t i e n t s a n d t h e a l l o c a t i o n to d o c t o r s of t h o s e u n a b l e - o r
u n w i l l i n g — t o make t h e i r own selection;
(e) p r o v i d i n g r e g u l a r i n f o r m a t i o n a s to t h e s i t u a t i o n of t h e general I
p r a c t i t i o n e r services of t h e i r a r e a (e.g., of t h e need f o r m o r e doctors, 1
o r less, t o m e e t local r e q u i r e m e n t s ) .
j
Health
Centres.
36. T h e p r o v i s i o n a n d m a i n t e n a n c e of H e a l t h C e n t r e (including- Dental
C e n t r e ) p r e m i s e s a n d e q u i p m e n t — a n d of n u r s i n g , s e c r e t a r i a l a n d o t h e r ancillary
staff—will r e s t w i t h t h e c o u n t y a n d c o u n t y b o r o u g h councils. I t c a n t h u s be
c o r r e l a t e d w i t h t h e i r p r o v i s i o n of c h i l d w e l f a r e clinics, school clinics, a n d other
a c t i v i t i e s . T o a r r a n g e for t h e u s e of t h e C e n t r e s by d o c t o r s a n d d e n t i s t s i n the
f a m i l y p r a c t i t i o n e r services, t h e local a u t h o r i t y w i l l i n each case d e a l w i t h the \
n e w L o c a l E x e c u t i v e C o m m i t t e e , w h i c h w i l l be c o n t r a c t i n g w i t h t h e d o c t o r s and
d e n t i s t s for t h e s e services g e n e r a l l y — a n d on w h i c h t h e local a u t h o r i t y w i l l have
s u b s t a n t i a l r e p r e s e n t a t i o n . T h e d o c t o r s ' a n d d e n t i s t s ' g e n e r a l t e r m s of service
covered by n a t i o n a l r e g u l a t i o n s , w i l l cover t h e t e r m s a n d c o n d i t i o n s governing
t h e i r u s e of H e a l t h C e n t r e s p r o v i d e d by local a u t h o r i t i e s . T h e d o c t o r s and
d e n t i s t s w i l l t h u s r e m a i n i n c o n t r a c t w i t h t h e L o c a l E x e c u t i v e C o m m i t t e e and
b e r e m u n e r a t e d by it, w h e t h e r i n s i d e o r o u t s i d e t h e C e n t r e s , to s e c u r e u n i t y and
m o b i l i t y t h r o u g h o u t t h e f a m i l y p r a c t i t i o n e r services.
Remuneration
of
Doctors.
37. D o c t o r s w o r k i n g i n H e a l t h C e n t r e s , w h o l e - t i m e or p a r t - t i m e , w i l l be I
p a i d a b a s i c s a l a r y , a s p a r t of t h e i r p u b l i c i n c o m e ; t h e r e s t of a " s u m d u e " !
t o e a c h of t h e m w i l l be pooled i n t h e C e n t r e a n d d i v i d e d a m o n g t h e d o c t o r s under I
s o m e t h i n g like a p a r t n e r s h i p a g r e e m e n t . T h e " s u m d u e " w i l l b e calculated 1
on a c a p i t a t i o n r a t e for all p a t i e n t s in t h e c a r e of t h e d o c t o r s i n t h e Centre, I
w h i l e b e i n g d i s t r i b u t e d a m o n g t h e m a s above. D o c t o r s w o r k i n g o u t s i d e t h e i
H e a l t h C e n t r e s (while t h e s e a r e b e i n g developed) w i l l s i m i l a r l y be p a i d a basic 1
p a r t - s a l a r y , t h e r e s t of t h e i r r e m u n e r a t i o n d e p e n d i n g on a c a p i t a t i o n r a t e in I
r e s p e c t of p a t i e n t s on t h e i r l i s t s .
38. A l l r e m u n e r a t i o n of doctors, u n d e r e i t h e r system, w i l l be fixed by 1
n a t i o n a l r e g u l a t i o n s a n d w i l l h a v e r e g a r d t o a n y n a t i o n a l s t a n d a r d s recommended 1
by t h e p r e s e n t S p e n s C o m m i t t e e o r a n y s u b s e q u e n t body set u p for t h e p u r p o s e . !
Scales of r e m u n e r a t i o n w i l l be so a r r a n g e d as t o a d m i t of e x t r a i n d u c e m e n t to I
p r a c t i s e i n less a t t r a c t i v e a r e a s (probably by i n c r e a s e i n t h e b a s i c p a r t - s a l a r y I
scales i n a r e a s r e c o m m e n d e d for t h i s p u r p o s e b y t h e C e n t r a l C o m m i t t e e on t h e !
D i s t r i b u t i o n of P r a c t i c e s ( b e l o w ) ) a n d of e x t r a r e w a r d s for s p e c i a l qualifications. I
Remuneration
of
Dentists.
39. D e n t i s t s , w o r k i n g — w h o l e - t i m e or p a r t - t i m e - — i n H e a l t h C e n t r e s o r l
D e n t a l C e n t r e s w i l l be r e m u n e r a t e d e n t i r e l y b y s a l a r y , in p r o p o r t i o n t o theirI
a t t e n d a n c e a t t h e C e n t r e . S u p p l e m e n t a r y a r r a n g e m e n t s will be m a d e , w h i l e t h e !
C e n t r e system i s developing, w h e r e b y d e n t i s t s a c c e p t i n g a n y p a t i e n t u n d e r t h e i
p u b l i c service i n t h e i r o w n s u r g e r i e s can be p a i d o n a scale of fees for approved I
w o r k done. T h i s scale c a n p r o v i d e for p a y m e n t for m i n o r o r u r g e n t w o r k on I
claims s u b m i t t e d a f t e r t h e e v e n t (to a v o i d d e l a y f o r t h e p a t i e n t ) ; b u t for m o r e
s u b s t a n t i a l w o r k , t h e d e n t i s t w i l l s u b m i t w h a t h e p r o p o s e s to d o for a p p r o v a l b y
a n e w s m a l l p r o f e s s i o n a l body, w h i c h w i l l h a v e b r a n c h offices a b o u t t h e c o u n t r y .
4 0 . A l l r e m u n e r a t i o n of d e n t i s t s , by s a l a r y o r u n d e r scales of fees, w i l l be
fixed b y n a t i o n a l r e g u l a t i o n s a n d w i l l h a v e r e g a r d to n a t i o n a l s t a n d a r d s recom­
m e n d e d by a body a n a l o g o u s t o t h e S p e n s C o m m i t t e e f o r d o c t o r s , o r o t h e r b o d y
set u p for t h e p u r p o s e .
Central Committee
on the Distribution
of Medical
Practices.
4 1 . T h e M i n i s t e r w i l l set u p a n e w C e n t r a l C o m m i t t e e , w o r k i n g u n d e r t h e
g e n e r a l d i r e c t i o n s , to s u p e r v i s e t h e d i s t r i b u t i o n of m e d i c a l m a n - p o w e r i n t h e
f a m i l y d o c t o r service. T h e C o m m i t t e e w i l l be s m a l l a n d m a i n l y p r o f e s s i o n a l . '
I t w i l l be a p p o i n t e d a f t e r c o n s u l t i n g t h e p r o f e s s i o n a l o r g a n i s a t i o n s , a n d w i l l be
p r o v i d e d with, staff a n d offices by t h e M i n i s t e r .
42.
S u p e r v i s i o n w i l l be e x e r c i s e d by t h i s C o m m i t t e e in t h e f o l l o w i n g w a y : —
(a) a l l d o c t o r s w i s h i n g t o s t a r t n e w p r a c t i c e s or t o c h a n g e f r o m one p r a c t i c e
t o a n o t h e r — w h o l l y or p a r t l y i n t h e p u b l i c s e r v i c e — w i l l n o r m a l l y
a p p l y to the Local Executive Committee for the area t o which they
wish to go;
(b) t h e L o c a l E x e c u t i v e C o m m i t t e e w i l l i n f o r m t h e C e n t r a l C o m m i t t e e of t h e
a p p l i c a t i o n , of t h e i r v i e w s on t h e n e e d for t h e n e w p r a c t i c e or r e p l a c e ­
m e n t a n d o n t h e s u i t a b i l i t y of t h e a p p l i c a n t , a n d of a n y o t h e r r e l e v a n t
facts; a n d the Central Committee, in consultation with the Local
E x e c u t i v e C o m m i t t e e a s necessary, w i l l t h e n d e c i d e w h e t h e r t h e p r a c ­
t i c e in q u e s t i o n i s n e e d e d — t o be s t a r t e d or to be t a k e n over by t h e
n e w c o m e r — a n d , if i t is n e e d e d , w i l l d e c i d e w h i c h a p p l i c a n t (if t h e r e
i s m o r e t h a n one) s h o u l d fill i t ; t h e y w i l l t h e n give a n y n e c e s s a r y con­
sents, a n d the Local Executive Committee will inform a p p l i c a n t s
accordingly;
(c) t h i s c o n t r o l w i l l a p p l y t o a l l d o c t o r s g o i n g i n t o a n a r e a t o staff n e w
H e a l l l r ^ e n t r e s or t o fill v a c a n c i e s i n e x i s t i n g C e n t r e s o r to t a k e p a r t
in the public service—in any degree—from their own surgeries; it
n e e d n o t a p p l y to d o c t o r s , a l r e a d y i n a n a r e a , s i m p l y c h a n g i n g f r o m
t h e i r own surgeries into H e a l t h C e n t r e practice, or to doctors t a k i n g
p a r t i n t h e p u b l i c service i n a r e a s wdiere t h e y a r e a t t h e o u t s e t of t h e
scheme;
(d) q u e s t i o n s of r e a s o n a b l e s p e c i a l d i s c r e t i o n i n cases of sons t a k i n g over
f a t h e r s ' practices, relatives j o i n i n g existing p a r t n e r s h i p s , & c , can be
d e a l t w i t h u n d e r t h e M i n i s t e r ' s p o w e r of g e n e r a l d i r e c t i o n of t h e
Committee.
Sale and Purchase
of Medical Practices.
Compensation
and
Superannuation.
4 3 . T h i s c o n t r o l of d i s t r i b u t i o n w i l l d e s t r o y t h e selling v a l u e of p r a c t i c e s .
P r o p o s a l s i n r e g a r d to t h e c o m p e n s a t i o n of e x i s t i n g p r a c t i t i o n e r s , a n d for a
s u p e r a n n u a t i o n scheme for t h e f u t u r e , h a v e a l r e a d y been a p p r o v e d by t h e
C a b i n e t on t h e 3 r d D e c e m b e r a n d need n o t be r e p e a l e d h e r e ( C M . (45) 5 8 t h
meeting).
Drugs, &c.
44. P e o p l e w i l l be e n t i t l e d to o b t a i n all n e c e s s a r y d r u g s , & c , on p r e s c r i p ­
tion, e i t h e r f r o m qualified c h e m i s t s i n t h e i r o w n s h o p s or f r o m d i s p e n s a r i e s
p r o v i d e d a t t h e H e a l t h C e n t r e s , a s t h e p a t i e n t finds c o n v e n i e n t .
45. F o r s u p p l y by i n d i v i d u a l c h e m i s t s , t h e L o c a l E x e c u t i v e C o m m i t t e e w i l l
have t h e d u t y of m a k i n g a r r a n g e m e n t s w i t h i n g e n e r a l r e g u l a t i o n s of t h e
M i n i s t e r . L i s t s w i l l be p u b l i s h e d of t h e c h e m i s t s a v a i l a b l e , w i t h a r i g h t to t h e
M i n i s t e r to remove a n y c h e m i s t from t h e l i s t a f t e r p r o p e r i n q u i r y .
Chemists
will be p a i d by t h e C o m m i t t e e a t n a t i o n a l l y p r e s c r i b e d r a t e s .
46. F o r s u p p l y in t h e P l e a l t h C e n t r e s , t h e local a u t h o r i t y p r o v i d i n g t h e
C e n t r e w i l l be able t o e m p l o y s u c h d i s p e n s i n g c h e m i s t s a s a r e n e e d e d , as p a r t
of t h e o r d i n a r y staffing of t h e C e n t r e .
D i s p e n s i n g a t t h e C e n t r e will be
designed, v / h e r e p r o v i d e d , f o r t h e c o n v e n i e n c e of p a t i e n t s — a n d will, t h e r e f o r e ,
riot a m o u n t to a m o n o p o l y ; t h e p a t i e n t m u s t be free t o t a k e h i s p r e s c r i p t i o n s t h e r e
or to a n y i n d i v i d u a l c h e m i s t (e.g., n e a r e r h i s home).
[31041]
V'.-Other
Services.
(1) Eye
Service.
47. T h e objective w i l l be t h e p r o v i s i o n of s p e c i a l c l i n i c s , a s p a r t of t h e
h o s p i t a l service, a t w h i c h a l l w i l l be e n t i t l e d to e y e - t e s t i n g a n d t h e s u p p l y of
spectacles.
T h e s e c l i n i c s w i l l b e staffed by o p h t h a l m o l o g i s t s (i.e., full eye
s p e c i a l i s t s o n h o s p i t a l staffs) a n d r e f r a c t i o n i s t s (i.e., s i g h t - t e s t i n g o p t i c i a n s ) .
T h e o p h t h a l m o l o g i s t s w i l l be i n c h a r g e , b u t t h e e x t e n t t o w h i c h t h e y d e l e g a t e
e y e - t e s t i n g t o r e f r a c t i o n i s t s w i l l be a m a t t e r of i n t e r n a l a r r a n g e m e n t .
48. P e n d i n g t h e d e v e l o p m e n t of t h i s c o m p l e t e c l i n i c service, t h e clinics
w i l l be s u p p l e m e n t e d on t h e f o l l o w i n g l i n e s :-—
(a) P e o p l e n e e d i n g e y e - t e s t i n g a n d a p p l i a n c e s w i l l be f r e e t o g o —
(i) t o a n o p h t h a l m o l o g i s t o r o t h e r m e d i c a l eye s p e c i a l i s t r e c o g n i s e d
as c o m p e t e n t for t e s t i n g a n d p r e s c r i p t i o n , a n d t o a d i s p e n s i n g
o p t i c i a n for a p p l i a n c e s ; o r
(ii) to a s i g h t - t e s t i n g o p t i c i a n r e c o g n i s e d a s c o m p e t e n t for s i g h t ­
t e s t i n g a n d t h e p r o v i s i o n of a p p l i a n c e s .
(b) T h e L o c a l E x e c u t i v e C o m m i t t e e s (for t h e F a m i l y , P r a c t i t i o n e r Services),
r e i n f o r c e d for t h i s p u r p o s e b y r e p r e s e n t a t i v e s of m e d i c a l a n d non­
m e d i c a l s i g h t - t e s t i n g p r a c t i t i o n e r s , w i l l be m a d e r e s p o n s i b l e for t h e
p r e p a r a t i o n a n d p u b l i c a t i o n of l i s t s of a p p r o v e d p r a c t i t i o n e r s for
t h e i r a r e a s , for t h e i n s p e c t i o n a n d s u p e r v i s i o n of p r e m i s e s , for t h e
p a y m e n t of n a t i o n a l l y p r e s c r i b e d fees, a n d for t h e h e a r i n g of
c o m p l a i n t s ( w i t h a p p e a l to t h e M i n i s t e r ) .
(2), Public Health
Laboratories.
49. A p u b l i c h e a l t h p a t h o l o g i c a l l a b o r a t o r y service w i l l be p r o v i d e d o n a
n a t i o n a l b a s i s by t h e M i n i s t e r , i n t h e first i n s t a n c e t h r o u g h t h e a g e n c y of t h e
M e d i c a l R e s e a r c h C o u n c i l . T h e p o w e r s of local a u t h o r i t i e s t o p r o v i d e l a b o r a t o r i e s
w i l l c o n t i n u e . T h e o b j e c t of t h e M i n i s t e r s s e r v i c e w i l l be t o s u p p l e m e n t w h a t
is d o n e a l r e a d y a n d to p e r p e t u a t e t h e u s e f u l d e v e l o p m e n t s of t h e w a r - t i m e
e m e r g e n c y service.
(3) Blood
Transfusion.
50. T h e M i n i s t e r w i l l be e m p o w e r e d t o m a k e n a t i o n a l a r r a n g e m e n t s for
o b t a i n i n g s u p p l i e s of h u m a n blood, for m a k i n g t h e s e a v a i l a b l e for t r a n s f u s i o n
a n d f o r p r e p a r i n g a n d s u p p l y i n g blood p r o d u c t s .
V I . — C h a r g e s for Certain
Services.
5 1 . T h e n o r m a l p o s i t i o n w i l l be t h a t t h e w h o l e r a n g e of t h e h e a l t h service
w i l l be a v a i l a b l e free of c h a r g e t o all w h o w i s h t o use i t — t h e cost b e i n g m e t p a r t l y
from, t h e E x c h e q u e r , p a r t l y from local r a t e s ( w i t h E x c h e q u e r s u b s i d y ) , p a r t l y
f r o m t h e p r o d u c e of n a t i o n a l i n s u r a n c e c o n t r i b u t i o n s . T h e r e w i l l be some p a r t s
of t h e service, h o w e v e r , o r s u p p l e m e n t s t o t h e service, i n w h i c h some p a y m e n t by
t h e p a t i e n t w i l l a r i s e , as follows :—
(a) Home Helps ( p a r a g r a p h 25 above) w i l l n e e d to be t h e s u b j e c t of a c h a r g e
a c c o r d i n g to t h e a b i l i t y of t h e h o u s e h o l d to p a y .
(b) C e r t a i n supplements,
l i k e t h e p r o v i s i o n of s p e c i a l foods i n m a t e r n i t y a n d
c h i l d w e l f a r e or t h e p r o v i s i o n of b e d d i n g i n a f t e r - c a r e services, may
n e e d t o be t h e s u b j e c t of c h a r g e s o r p a r t - c h a r g e s .
(c) Appliances
w i l l be s u p p l i e d f r e e , u p t o a s t a n d a r d sufficient t o restore
t h e fullest possible w o r k i n g c a p a c i t y a n d w i t h r e a s o n a b l e a m e n i t y .
B u t t h e r e w i l l h a v e to be c h a r g e s for p r e m a t u r e r e n e w a l (in c a s e of
n e g l i g e n c e , & c ) . A l s o i t m u s t be p o s s i b l e (eg., i n t h e case of spectacles
or d e n t u r e s ) f o r t h o s e w h o w i s h t o o b t a i n a r t i c l e s of " l u x u r y
s t a n d a r d — i . e . , over a n d above t h e good a n d s o u n d a r t i c l e publicly
p r o v i d e d — t o do so b y p a y i n g t h e difference.
id) I n h o s p i t a l , t h e f r e e service w i l l p r o v i d e a l l t h a t i s n e c e s s a r y — t o a good,
a n d n o t a m i n i m u m , s t a n d a r d . B u t i t w i l l be o p e n t o p e o p l e t o obtain
a d d i t i o n a l a m e n i t i e s (e.g., p r i v a t e rooms, w h e r e t h o s e a r e n o t medically
n e c e s s a r y ) b y p a y m e n t of t h e e x t r a cost involved.
(e) I n s o m e h o s p i t a l s p r o v i s i o n w i l l b e m a d e (in s e p a r a t e p a r t s of t h e hospital)
t o e n a b l e a n y s p e c i a l i s t staff e n g a g e d only on a p a r t - t i m e b a s i s t o see
t h e i r p r i v a t e p a t i e n t s t h e r e a n d t o a d m i t t h e m to p a y - b e d accomrho­
d a t i o n if t h e y so choose; p r o v i d e d t h a t —
(i) t h i s i s r e s t r i c t e d t o s p e c i a l i s t s s e r v i n g in t h e h o s p i t a l ;
(ii) t h e p r i v a t e p a t i e n t s ' fees a r e w i t h i n a controlled s c a l e ;
(iii) t h e r e is n o e n c r o a c h m e n t o n n e c e s s a r y g e n e r a l
hospital
accommodation;
(iv) t h e w h o l e a r r a n g e m e n t is so d e s i g n e d a s t o f u r t h e r i t s p u r p o s e s ,
w h i c h a r e t o p r e v e n t t h e n a t i o n a l h o s p i t a l service d r i v i n g a l l
p r i v a t e w o r k i n t o a r i v a l n u r s i n g h o m e service a n d to e n c o u r a g e
t h e f u l l e r a s s o c i a t i o n of t h e s p e c i a l i s t s w i t h t h e i r h o s p i t a l s
in a l l t h e i r p r o f e s s i o n a l a c t i v i t i e s .
V I I . — F i n a n c e of the
Service.
52. I n 1938-9 t h e e x p e n d i t u r e on t h e p a r t i a l services t h e n p r o v i d e d
a m o u n t e d to a b o u t £ 6 6 million, of w h i c h local a u t h o r i t y services a c c o u n t e d for
£ 4 1 m i l l i o n , v o l u n t a r y h o s p i t a l s f o r £ 1 1 ^ m i l l i o n , a n d m e d i c a l benefit u n d e r
n a t i o n a l h e a l t h i n s u r a n c e for £ 1 3 ^ m i l l i o n . T h e e x p e n d i t u r e w a s m e t a s follows
( i g n o r i n g the effect of t h e block g r a n t t o local a u t h o r i t i e s ) :—
£ ^million.
National health insurance contributions
T a x p a y e r ...
...
...
...
...
R a t e p a y e r ...
...
...
...
...
Voluntary sources
...
...
...
...
...
...
...
...
...
...
...
11-2
3-0
40-3
11-5
66 0
5 3 . O n l y very a p p r o x i m a t e e s t i m a t e s a r e possible of t h e cost to p u b l i c f u n d s
of t h e c o m p r e h e n s i v e h e a l t h service p r o p o s e d i n t h i s p a p e r . I t w i l l be m u c h
g r e a t e r because the service is c o m p r e h e n s i v e i n s t e a d of p a r t i a l ; because n o c h a r g e s
will n o r m a l l y be m a d e to p a t i e n t s ; because s a l a r i e s w i l l be p a y a b l e to doctors
at h o s p i t a l s ; because of t h e p a y m e n t of c o m p e n s a t i o n for t h e a b o l i t i o n of sale
and p u r c h a s e of p r a c t i c e s ; because of t h e cost of s u p e r a n n u a t i o n s c h e m e s ; a n d
because of t h e g e n e r a l r i s e in s a l a r i e s a n d p r i c e s . I n t h e e a r l y y e a r s of t h e service
the a n n u a l e x p e n d i t u r e m i g h t be £ 1 4 5 million, of w h i c h h o s p i t a l a n d s p e c i a l i s t
services w o u l d a c c o u n t f o r £ 8 7 m i l l i o n , local a u t h o r i t y services f o r £ 1 2 million,
general p r a c t i t i o n e r , d e n t a l a n d eye services f o r £ 4 1 million, a n d c o m p e n s a t i o n
and s u p e r a n n u a t i o n for £ 5 m i l l i o n . T h i s e x p e n d i t u r e w o u l d be m e t a s follows
(again i g n o r i n g the effect of the block g r a n t ) : —
£
million.
National insurance contributions
...
...
...
35-7*
R a t e p a y e r ...
...
...
...
...
...
...
6-0'
Taxpayer
103-3
145-0
A g a i n s t t h i s w o u l d be offset some s a v i n g to t h e e x c h e q u e r by r e d u c t i o n i n block
g r a n t c o n s e q u e n t on t h e r e d u c t i o n i n local a u t h o r i t y e x p e n d i t u r e , a n d t h e benefit
of t h e a c c u m u l a t e d f u n d s of v o l u n t a r y h o s p i t a l s d e d i c a t e d to h o s p i t a l p u r p o s e s .
V I I I . — G e n e r a l Position
of the Patient,
in
summary.
54. U n d e r t h e a r r a n g e m e n t s d e s c r i b e d everybody w i l l be e n t i t l e d to the
following h e a l t h f a c i l i t i e s : —
(1) A p e r s o n a l o r f a m i l y doctor, of t h e i r o w n choice, w o r k i n g i n a publicly
p r o v i d e d a n d e q u i p p e d H e a l t h C e n t r e (or, d u r i n g t h e t r a n s i t i o n
p e r i o d , f r o m h i s own s u r g e r y ) , a n d u n d e r t a k i n g t h e w h o l e care of
t h e p a t i e n t i n h i s h o m e o r a t t h e C e n t r e , a s t h e case m a y r e q u i r e ,
t o g e t h e r w i t h all n e c e s s a r y d r u g s , &c.
* This assumes t h a t the contribution for health services is not reduced as proposed by the
Minister of National I n s u r a n c e in C P . (45) 315, parag.-i.ph 13.
( 2 ) T h r o u g h t h e f a m i l y d o c t o r , a full r a n g e of h o s p i t a l , sanatorium,
c o n v a l e s c e n t a n d r e h a b i l i t a t i o n services ( i n c l u d i n g a n y necessary
a p p l i a n c e s ) i n a h o s p i t a l scheme n a t i o n a l l y p r o v i d e d - t o g e t h e r with
a f u l l r a n g e of s p e c i a l i s t ' ' second o p i n i o n s ' ' a n d c a r e , i n t h e hospitals,
in the H e a l t h Centres a n d a t his home.
(3) N u r s i n g i n h i s h o m e — p r o v i d e d t h r o u g h t h e local a u t h o r i t y — w h e n e v e r
t h e c a s e r e q u i r e s it, a n d d o m e s t i c h e l p i n h o m e s w h e r e sickness makes
t h i s necessary.
(4) S p e c i a l d e n t a l a n d eye services ( i n c l u d i n g d e n t u r e s a n d s p e c t a c l e s ) , a s fast
a s t h e s e c a n be developed.
(5) A f u l l m a t e r n i t y s e r v i c e — p r e - n a t a l c a r e , d o m i c i l i a r y o r i n s t i t u t i o n a l
m i d w i f e r y a n d p o s t - n a t a l c a r e — w i t h s p e c i a l i s t resources, b e h i n d it.
(6) H e a l t h v i s i t i n g i n all a p p r o p r i a t e cases, m C h i l d w e l f a r e services a n d school m e d i c a l services. (8) A n a m b u l a n c e service, f r o m h o m e t o h o s p i t a l , f r o m h o s p i t a l to hospital,
from accident to hospital.
(9) V a c c i n a t i o n a n d i m m u n i s a t i o n a g a i n s t i n f e c t i o u s d i s e a s e s .
(10) V a r i o u s f o r m s of s u p p l e m e n t a r y c a r e a n d a f t e r - c a r e i n t i m e of sickness
1