By and
EDITOR'S NOTE Britain's
14-year-old state operated
medical service, long a cause
0 controversy in the British
Isles and elsewhere, is termed
generally a successlul enter
prise now. But there are still
misgivings about aspects of its
operation, and many doctors
are plugging for changes.
By JOHN GALE
Of the Associated Presi
LONDON Fourteen years
ago, Britain's doctors were
united for better or worse with
a state-run national health serv
ice. The marriage, on the whole,
appears to be succeeding.
Officials claim the nation's
health has never been better.
Britons are growing bigger and
living longer.
Diseases that once were the
scourdge of childhood have
been put on the run. Diphtheria
killed only five children of
school age last year, polio only
12, tuberculosis 9. Scarlet fever
is no longer a menace.
Most of all, the National
Health Service (NHS) has suc
ceeded in the high purpose it
set out to achieve in the after
math of World War II. Nobody
is disbarred by lack of means
from receiving proper medical
attention. With the state pick
ing up most of the bill, Britain's
52 million people can at list
afford to be ill.
The cost of keeping the na
tion healthy is now running at
about 850 million pounds ($2,
380 million) a year. It is ex
pected to increase in the next
few years as it has almost an
nually since the Health Service
was launched.
A Tiny Minority
But in Britain, only a tiny
minority of the medical profes
sion would like to see the NHS
scrapped. Some 600 doctors have
remained in private practice.
The great majority approxi
mately 35,000 work in the serv
ice of the state.
There is today widespread ac
ceptance of the social factors
that brought the NHS into be
ing. No dispute exists Over the
Constitution
Plan Lauded
ByMaurine
WASHINGTON (Special)
Sen. Maurine Neuberger said
Friday "people of Oregon face
one of the most important tasks
that confront a self-governing
people" when the forthcoming
stale Legislature considers a
new constitution.
In a Senate speech reporting
on background of the .proposed
constitution, Mrs. Neuberger re
marked that states "could not
halt or reverse the drift of
state functions to Washington,
D.C., unless they face the task
of strengthening state and lo
cal government at home. A key
step toward this goal must be
the modernization of state con
stitutions." The Oregon senator lauded
the revised constitution pro
posed by a bi-partisan commis
sion as "consistent both with
Oregon traditions and with the
best developments in modern
state constitutions."
She said the method being
used for consideration and ac
tion on the new constitution is
an experiment. She added "Ore
gon s experiment is to see
whether a state can make nec
essary reforms while the record
is still good, and to do it on
the basis of the careful consid
eration of the constitution as a
whole by an expert, non-parti
san citizen's commission. Per
haps this cannot be done. Per
haps only the spur of imme
diate crisis can overcome in
ertia, disinterest and preoccu
pation and a proposal for con
stitutional change is inevitably
a tempting target for political
attack.
"But I prefer to hope that
Oregon's Legislature, in which
I was proud to serve, will rise
to the occasion."
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Large
principles underlying the
scheme. But in medical circles,
there are many misgivings over
the shortcomings of the service
and its method of operation.
A committee representing the
country's nine leading medical
bodies recently completed a
four-year review of this massive
Britisn social experiment.
It reported: "In general we
feel that this (the NHS) has
proved of great benefit to the
community, but there are many
defects and omissions." The
committee then listed a total of
232 conclusions, many of them
critical of the government's
handling of the scheme.
One of its chief conclusions
was that the Health Service is
too loosely integrated. The
NHS has three main operating
branches the family doctors in
general practice, the hospital
services and the public health
authorities. Many physicians
complain there is too little liai
son betweeiTthe three, resulting
in duplication of effort and a
general loss of efficiency.
The committee asserted that
the three-way division of re
sponsibility had prevented the
system "from operating success
fully as a team."
Complaints Voiced
Medical quarters also often
voice complaints that the gov
ernment does not work closely
enough with the profession in
planning such projects as hos
pital building programs: that
the1 government spends too lit
tle on medical research (about
$14 million a year); that doc
tors are overworked and under
paid; casualty and accident
services below standard; medi
cal recruiting lagging and too
little provision made for the
care of the aged and maternity
cases.
There is also a general desire
in the profession to see an ele
ment of private practice re
tained and it is frequently
charged that the NHS has tend
ed to stifle its preservation..
"Whatever arrangements are
made by the state to provide
medical care," said the review
committee, "there will always
be a section of the community
which prefers to pay the doctor
directly for his services by per
sonal contract."
Among the foremost critics of
the NHS is the Fellowship for
Freedom in Medicine which has
about 1,500 adherents among
medical practitioners.
The fellowship maintains that
the NHS is top heavy, cuts the
family doctor off from hospital
work and pays him with no re
gard for his experience, ability
or conscience. In fact, Health
Service doctors are paid 19
shillings 6 pence ($2.73) per
patient per year with an extra
14 shillings ($1.86) for every
patient within the range of 500
to 1,700 on his list.
3,500 Maximum
With a permitted maximum
of 3,500 patients, the most a
doctor can make out of the
NHS is around 4,000 pounds
($11,200) a year.
Said Dr. James Maxwell Al
ston, a consultant pathologist
and honorary secretary of the
fellowship:
"Our main objection to the
form of Health Service chosen
for this country is that it is too
rigid.
"We all accept that there
must be some system of help
ing people to provide against
illness. But here, there is too
much central control and the
service suffers as a result.
"In 14 years, the government
has made little progress. It has
built no new hospitals in the
whole of that time. It spends far
too little on medical research.
"It enforces a rigid division
of medical work with general
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practitioners in one category,
hospital doctors in another and
public health authorities in a
third. The result has been that
the G. P. S. don't do as much
specialized work in the hos
pitals as they used to and there
has been a general weakening
of the profession."
More Flexibility
Dr. Alston spoke in an inter
view at his home in London's
West End the headquarters
for his campaign to bring more
flexibility into the Health Serv
ice and to preserve intact the
remnants of private practice.
Pausing reflectively, he said:
"I and the peoole with me in
this organization would never
want to scrap the underlying
purpose of this Health Service.
"But given the chance, I
would scrap the service in its
present form and start again
on entirely new lines."
Dr. Alston said there had been
too little consideration in Bri
tain of health service schemes
such as Blue Shield and Blue
Cross, operated in the United
States. "These schemes deserve
our attention," he said, "and
might enable us to avoid some
of the difficulties that we have
met."
On a different level, the Brit
ish public has its own personal
complaints about, the Health
Service. Readers write to the
papers to complain that little
Tommy was kept waiting for
six months before his tonsils
were removed. Or that visiting
hours .at hospitals are too re
stricted. Hospitals Experiment
Some British hospitals ex
perimentally opened their doors
foi up to six hours a day. The
result was that swarms of fruit
carrying well-wishers invaded
the wards in such numbers that
doctors and nurses had to strug
gle through a party atmosphere
to reach their patients. Event
ually, it was the tired-out pa
tients themselves that begged
to be left alone.
' The other big public com
plaint is over-crowded surg
eries. Fewer than 10 per cent
of NHS doctors operate an ap
pointments system. As a result,
patients have been kept for up
to two hours waiting for the
20 people in front of them to
be seen.
Dr. John Fry, in partnership
with his younger brother Lionel,
cares for the health of some
7,000 people in a suburban mid
dle class area of London. He re.
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cently Introduced an appoint
ments system.
"I got tired of people coming
in to see me suffering from
some stress after sitting two
hours in the waiting room," he
said.
"I didn't want to keep them
waiting but I did want to plan
my work more effectively. The
result is that instead of seeing
40 persons one day and 20 the
next, I see 30 on both days and
everybody is happy.
"I get more time to plan my
private life and the patients
are not inconvenienced."
Dr. Fry, 40, served with the
Royal Navy in World War II
and had one year in private
practice before the Health Serv
ice came in. He now enthusias
tically supports the system.
"Of course we were apprehen
sive at the start," he said. "I
was worried that the relation
ship between my patients and
myself would be changed, that
my services would be abused
and that there would be inter
ference by the government.
'But none of this has hap
pened. It is a misconception
that there is a lot of govern
ment interference. I account to
nobody for my medical therapies
inside the boundaries set by the
ethics of the profession.
'There is no abuse of my
services, although mere nas
been a slight increase in the
people that come in with tri
vial ailments. But that is in
evitable with no financial bar
rier between them and me.
i . 'Subtle Distinction' '
"As for my relationship with
my patients, it has never been
better. The patients have no
fear or anxiety about coming to
see me. I have no fear or anxi
ety about not getting paid.
."Instead of being employed
by my patients, I am providing
a professional service. There is
an important and subtle distinc
tion." Dr. Fry reckons his partner
ship is worth about 10,000
pounds ($28,000) annually,
gross. Out of that, he pays all
overheads including secretarial
and nursing costs and improve
ments to the premises.
He has after that slightly
more than 3,000 pounds ($8,400)
left for his personal and family
expenses a wife and two teen
age children both being edu
cated at exclusive schools.
"In private practice with the
same number of patients, I sup
pose I would be earning four
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times as much," said Dr. Fry.
"But I don't regret the financial
loss.
"This type of practice is easi
er to run. One is on top of the
heap rather than at the mercy
of one's patients.
"They benefit too because
nothing is denied to them."
Occasionally though, the pa
tient must wait for hospital
treatment. Emergency cases get
priority attention, but there are
long waiting lists at most British
hospitals for those with minor
ailments.
One matron of a London hos
pital with 109 beds said the
whole lot were always full, "The
waiting list right now is nine
months," she said, "but that's
for non-priority surgery.
"I'm talking about bunions
and hernias and the sort of
thing where it doesn't hurt a
patient to wait a bit."
The Health Service is financed
mainly out of taxation, although
each employed man hands over
a weekly contribution of 2 shill
ings 8 pence (37 cents) from
his pay check. Employed women
and juveniles are assessed at
lower rates.
Favored In Poll
The great , majority of the
public 81 per cent on the basis
of a recent national opinion poll
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Service
considers it is getting value
for money. The same poll re
corded that 89 per cent of the
public evaluated the NHS as
satisfactory with only 11 per
cent disgruntled.
Mrs. Ethel Adeane Young,
73, a widow regards it as far
more than satisfactory.
To Mrs. Young in and out
of the hospital in the last three
years with a fractured hip the
NHS has been "a salvation."
"Without it, I just don't know
what I would have done," she
said. "I live on a fixed and lim
ited income. I suppose I would
have had to sell my furniture
and my house in order to pay
for medical treatment."
In her lonely home, Mrs.
Young has regular visits from
her doctor and a district nurse.
Her meals are brought to her
by a women's voluntary organi
zation. She gets a domestic help
for two hours a day and the
Health Service pays. She is pro
vided with a wheelchair and el
bow crutches by the NHS, free
of charge.
"I can't speak too highly of
the system," she said. "It is a
wonderful thing.
"And I have noticed this. All
the people who sneered about it
in the past are taking every
thing that they can out of it
now."
EUGENE REGISTER-GUARD,
... nP Airepnoioi.
. . . Calling Britain's state-run health service
"a salvation," Ethel Adeane Young, 73,
T ., talks of it in her home in Woodford
I lkpc Green, a London suburb. National
, Health Service provides crutches, one.'
of which stands alongside her, and a
I wheelchair free of charge. It paid for .
1L- frequent hospital stays for a broken.
,f i - , hip during the past three years. Ai
... widow living alone, she has domestic;
neip two
Sunday, Jan. 13, 1963 Pafe SA
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nours a day, through wtib.
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rt-9 W. Ith DI
881 WillamettV
Eatabllshad 1917
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