(c) crown copyright
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 O F 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 1944.
S E C R E T . Copy N o .
W . M . (44) 21st Conclusions.
W A R C A B I N E T 21 ( 4 4 ) .
CONCLUSIONS of a Meeting of the War Cabinet held at 10 Downing Street, S.W. 1, on Tuesday, 15th February, 1944, at 6.30 p.m.
P r e s e n t :
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 . C. R . ATTLEE, M . P . , T h e R i g h t H o n . ANTHONY EDEN, M . P . , L o r d P r e s i d e n t of t h e Council. S e c r e t a r y of S t a t e for F o r e i g n
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 . P . , C h a n c e l l o r of t h e E x c h e q u e r . 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
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 . , M i n i s t e r of P r o d u c t i o n . M . P . , S e c r e t a r y of S t a t e for t h e 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 S e c u r i t y . 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 following w e r e 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.
T h e R i g h t H o n . S i r ARCHIBALD T h e R i g h t H o n . THOMAS JOHNSTON, SINCLAIR, B t . , M . P . , S e c r e t a r y of M . P . , S e c r e t a r y of S t a t e for S c o t l a n d . 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 i n i s t e r of H e a l t h . M . P . , M i n i s t e r of I n f o r m a t i o n . T h e R i g h t H o n . LORD CHERWELL, P a y m a s t e r G e n e r a l . Secretariat: S i r EDWARD BRIDGES. M r . NORMAN BROOK$. M r . W . S. MURRIE. Minute No. 1 P o l a n d CONTENTS. Subject. Page 98 2 N a t i o n a l H e a l t h S e r v i c e 98 [ 2 6 9 4 8 - 3 ]
Poland. 1. T h e W a r C a b i n e t w e r e given t h e l a t e s t i n f o r m a t i o n a b o u t (Previous t h e d i s c u s s i o n s w i t h t h e P o l i s h M i n i s t e r s . Eeference: T h e discussion i s r e c o r d e d 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.M.(44)20th 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 t h e 1 1 t h F e b r u a r y the W a r C a b i n e t Service. (Previous Eeference: W.M.(44)18th Conclusions, Minute 3.) h a d a g r e e d t h a t t h e 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 ( W . P . (44) 74) should be f u r t h e r discussed before a final decision w a s t a k e n to p u b l i s h the W h i t e P a r
T h e following w e r e t h e m a i n p o i n t s r a i s e d i n t h e course of a f u r t h e r discussion of t h e scheme o u t l i n e d i n t h e W h i t e P a p e r : —
(a) W o u l d the scheme m e a n the e n d of p r i v a t e m e d i c a l p r a c t i c e a n d t h e f a m i l y 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 w o u l d n o t p r e v e n t t h e c o n t i n u a n c e 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 p r e v e n t e d 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 w o u l d it affect t h e r e l a t i o n between t h e doctor a n d t h e p a t i e n t . T h e c o n c e p t i o n of t h e f a m i l y doctor w o u l d i n d e e d . 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 w o u l d i n
f u t u r e become eligible for free m e d i c a l 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 e v e n t u a l effect of t h e scheme m i g h t be to l i m i t t h e scope f o r p r i v a t e p r a c t i c e — s i n c e , when free m e d i c a l t r e a t m e n t w a s a v a i l a b l e for all, t h e r e m i g h t be some r e d u c t i o n in t h e 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 t h e s a m e time, t h e scheme would n o t d i r e c t l y p r o h i b i t or r e s t r i c t t h e e x t e n t of p r i v a t e m e d i c a l p r a c t i c e .
(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 h o s p i t a l s , w h i c h h a d for so long t a k e n t h e lead in t e a c h i n g a n d in r e s e a r c h % T h e s e 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 c o n t r i b u t i o n s , w e r e r i g h t l y j e a l o u s of t h e i r i n d e p e n d e n c e . C o u l d t h e y c o n t i n u e to p l a y t h e same p a r t i n the development of m e d i c a l science if they became financially d e p e n d e n t on p u b l i c a u t h o r i t i e s a n d h a d , in consequence, to accept p u b l i c c o n t r o l ?
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 i t w a s n o t p r o p o s e d t h a t t h e 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 p u b l i c a u t h o r i t y . T h e scheme c o n t e m p l a t e d t h a t these h o s p i t a l s s h o u l d m a k e a c e r t a i n n u m b e r of beds available for p u b l i c 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 t h e p a y m e n t , w h i c h w o u l d be m a d e by t h e C e n t r a l G o v e r n m e n t , n o t by t h e local a u t h o r i t y , w o u l d n o t meet t h e whole of t h e i r e x p e n d i t u r e : t h e y w o u l d still have t o 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 , w h o w e r e satisfied t h a t they could still e n l i s t t h e 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 l o n g as i t 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 p r e s e r v e d a n d t h a t t h e revenue g u a r a n t e e d to t h e m by t h e scheme w a s n o t sufficient to meet t h e whole of t h e i r e x p e n d i t u r e . (c) To w h a t e x t e n t w o u l d t h e scheme i n t e r f e r e w i t h t h e r i g h t of doctors t o set u p i n p r a c t i c e as c o n s u l t a n t s 1 I t w a s e x p l a i n e d t h a t t h e p r o p o s a l s 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 , w o u l d m a k e t h e service a v a i l a b l e 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 e v e n t u a l r e s u l t of t h e scheme w o u l d be t o i n c r e a s e the n u m b e r of c o n s u l t a n t s , a n d to i m p r o v e 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 a s a whole. T h i s w o u l d be b r o u g h t about, n o t b y 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 b y 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 a s c o n s u l t a n t s . T h e scheme w o u l d not, however, p r e v e n t c o n s u l t a n t s 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 t h e y took i n the p u b l i c m e d i c a l service.
(d) The Secretary of State for Scotland r e f e r r e d to t h e scheme
o r i g i n a l l y k n o w n a s 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 e x t e n s i o n to t h e r e s t of S c o t l a n d , as t h e 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 g e n e r a l p r a c t i t i o n e r s w e r e able to r e f e r a n y p a t i e n t s for w h o m they felt t h a t specialist advice w a s d e s i r a b l e t o the R e g i o n a l M e d i c a l Officers of the D e p a r t m e n t of
-H e a l t h a n d , t h r o u g h them, to c o n s u l t a n t s i n p r i v a t e p r a c t i c e . 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 h a v e been able to o b t a i n 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 w e r e 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 t h e c o n s u l t a n t s a t t a c h e d to Scottish h o s p i t a l s w e r e in f a v o u r of t h e scheme. T h i s scheme i l l u s t r a t e d b o t h t h e need for e x t e n d e d c o n s u l t a n t services a n d t h e m e t h o d by w h i c h such services m i g h t be p r o v i d e d u n d e r t h e p r o p o s a l s 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 h o s p i t a l s , t h e S e c r e t a r y of S t a t e s a i d t h a t i n 1940 over 30,000 p a t i e n t s w e r e on t h e 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 a g r e e m e n t w i t h t h e 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 h o s p i t a l s b u i l t for t h e E m e r g e n c y M e d i c a l 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 w i l l i n g l y i n m a k i n g i t a success.
(e) W i t h r e g a r d to t h e finance of t h e scheme, The Chancellor
of the Exchequer e x p l a i n e d t h a t t h e e s t i m a t e of t h e cost of t h e
g e n e r a l 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 g e n e r a l p r a c t i t i o n e r s i n 1938 i n r e s p e c t of t h e 17,800,000 p e r s o n s 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 g e n e r a l p r a c t i t i o n e r s u n d e r the n e w p r o p o s a l s h a d been left o p e n ; probably p a y m e n t w o u l d be i n 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 s a l a r i e s would be p a i d .
T h e t o t a l cost f a l l i n g on p u b l i c f u n d s w o u l d be £ 1 3 2 million a y e a r , of w h i c h about £ 4 0 million w o u l d p r o b a b l y be d e r i v e d from social 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 s t w o u l d be s h a r e d between t h e t a x - p a y e r a n d t h e r a t e - p a y e r i n almost e q u a l p r o p o r t i o n s . T h e r e w o u l d be some i n c r e a s e d b u r d e n on t h e r a t e s , b u t t h e n e w b u r d e n w o u l d fall m a i n l y on t h e E x c h e q u e r . A f t e r a full discussion, t h e 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 a s the basis for p u b l i c 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 i n t e r e s t s concerned.
Offices of the War Cabinet, S.W. 1,
