The Health Services

The school medical service was the first national health scheme to be established in Britain. In the earliest days of compulsory education a constant source of anxiety for the capitalist state was the suspicion that it was wasting money on many of the underfed and underclad children in its elementary schools, simply because their physical condition prevented them from really applying themselves to their books. But what finally shook the reformers into action were the press reports of widespread physical defects found in the young workers recruited into the army at the time of the Boer War. It was feared that the bulk of Britain’s. “C3 population” was not even fit enough to die defending the imperialist interests of the ruling class. Hence in 1904 the Inter-departmental Committee on Physical Deterioration emphasised the need for a system of medical inspection of school children. This led to the Education (Administrative Provisions) Act, 1907. It is, of course, no coincidence that the other principal improvements to the school medical service are linked with the First and Second World Wars. The drafting of hundreds of thousands of working men and women on both these occasions again showed to what extent social conditions had undermined health. It is against this background that the Education Acts of 1921 and 1944 can be understood. These made it a duty for all education authorities to provide routine health inspections to be conducted on school premises.

However, the Education Act of 1944 was largely overshadowed by the discussion which raged around the Beveridge Plan and eventually materialised as the National Health Service Act, 1946. If ever there was a case of a government feeling it could simply plan away the problems of ill-health arising from the capitalist system, this was it. What was envisaged was a unified scheme available for the whole population, except for those who had the money and inclination to pay for private treatment. As can be seen from the diagram following, in theory every form of illness was adequately covered.

Under the Act the vast majority of hospitals were transferred to the Minister of Health (i.e. formal ownership of the State) on July 5, 1948. The Minister was charged with the responsibility for providing adequate hospital accommodation together with the required medical, nursing and other facilities—including the services of specialists. Eighteen years later accommodation, in terms of the number of hospitals and the number of beds, still remains inadequate. As one government publication put it: “Scarcity of capital resources seriously limited hospital building in the early years of the service.” But, it proudly goes on, “. . . the annual expenditure on hospital building rose from £12.5 million in 1956-57 . . . to an estimated £54.6 million in 1963-64 . . .” To put such figures in perspective they must be measured against the “defence” expenditure for comparable years (£1,483 million in 1957-58 and £1,837 million in 1965-66—see the SOCIALIST STANDARD, August, 1966).

But the problem is not just one of too few beds, even though the Guardian mentioned on June 9, 1966, that there are now about 10,000 patients waiting to enter a hospital. Low wages have resulted in a chronic shortage of nurses and doctors. Earlier this year the general secretary of the Confederation of Health Service Employees reported to his union that 13 per cent of the beds in the hospital service could not be used anyway at present—because of the lack of staff. Most doctors are continually overworked and reports of individuals putting in well over 100 hours a week are commonplace. However, despite all the statistics that could be quoted, perhaps the best appraisal of the hospital service can be made by referring to the comment of a Manchester consultant, reported in the Daily Mail, August 22, 1966:

“When I was doing my house training I’d do a stitching job in casualty after being up all night, and I’d know it wasn’t my best work.

“Today I should hate to be knocked down and become a patient. The odds are I’d get a young doctor who had been on duty for 48 hours. How could 1 expect his best work?”

Unless you can afford the fees of a private surgeon or those of the London Clinic, this is what the hospital service means for you.

The general medical and dental services are under the supervision of the local executive councils. There is one of these to each county and county borough and it is their function to organise the doctors, dentists, pharmacists and opticians in their areas so that a comprehensive medical service exists. Supplementing these are the local health authorities who are responsible for the ambulance and midwife services as well as employing health visitors, home nurses and so on. The fact is that everywhere in this supposedly “comprehensive medical service” there are gaps and inadequacies resulting from lack of staff and facilities. A few details should make this clear.

Ten years ago the report of a working party on health visitors (Min. of Health—1956) suggested that a total force of 11,500 would be required “for the Health Visitor to effectively discharge all the duties required of her.” Years later, when this estimate is outdated anyway, there are still only the equivalent of 8,000 whole-time health visitors employed in Great Britain. Similarly, there is still throughout the country a unsatisfied demand for home helps—especially among old people. At present the average for England and Wales is that for every 10,000 people only 68 are receiving some form of assistance in this way. Section 25 of the National Health Service Act places on local health authorities the duty of providing home nursing for invalids who require such attention. As one writer euphemistically put it: “The limiting factor for some time to come will probably be the number of nurses available.” (The New Public Health —F. Grundy, London, 1965). Again, under Section 21 of the same Act, the local health authorities were ordered to equip and maintain health centres in their areas. “(This) duty on local health authorities has not been enforced, largely because of the restrictions until recent years on capital investment in health and welfare projects . . . By the end of 1963 only 18 health centres had been opened . . .” (Health Services in Britain, HMSO, 1964).

One service not mentioned so far is that of health inspection. Every council, other than county councils, is required to appoint one or more public health inspectors who supervise slum clearance, inspect houses and factories, check food supplies and so on. In the same year that the National Health Service Act was passed, a report of the Central Housing Advisory Committee outlined a 16-point standard for a “satisfactory” dwelling. It should be stressed that these were minimum requirements and merely included such stipulations as that the house should be dry, equipped with a proper drainage system and have adequate heating facilities for each room. It was pointed out back in 1946 that it was not then practicable to put this standard on a statutory basis and immediately have the public health inspectors enforce it. Twenty years later this is still the case. Millions of workers continue to live in damp, insanitary, squalid buildings which the authorities label with the bureaucratic understatement of “unsatisfactory”.

The health services, just as much as the mines and factories, are organised and run by members of the working class. There can be no doubt that many of the overworked doctors and underpaid nurses stick at their jobs simply because of their conviction that they are doing worthwhile work. But, like all workers under capitalism, they find that their efforts are hemmed in and frustrated by a social system where health comes very low down on the list of priorities.
J.C.