§ The Minister of Health (Mr. Aneurin Bevan)
With your permission, Mr. Speaker, and the permission of the House, I would like to made the following statement.
I think that the time has come for me to make a statement to the House about the medical profession and the National Health Service. Needless to say, I make this statement on behalf both of the Secretary of State for Scotland and myself, and of the Government as a whole.
I have been receiving representations from many quarters and I have studied the resolutions which both the Royal College of Physicians and the British Medical Association have sent on to me—and which have since been published and are familiar to the House. Meanwhile I have been trying, so far as I am able, also to determine for myself what it is that is really and sincerely worrying the doctor.
No doubt, as we gain experience, we shall find many modifications which would improve the scheme. That is always true of major legislation of this kind. But it seems to me that it is somewhere beyond all this that the key to the doctors' unease and restlessness lies, and that it consists of some instinctive fear—shared by many most well-meaning men and women—that, although the Act does not propose it and although the Government have themselves denied it, the real objective is a full-time, salaried, State medical service. It is this fundamental point which I want now to tackle once and 165 for all. As long ago as 1946, in this House, I said:Some doctors have expressed the fear that this is merely the beginning of a full-time salaried service. I cannot read into the mind of any future Minister or prophesy what may be done by future Governments, but that is not our intention."— [OFFICIAL REPORT, 4th November, 1946; Vol. 428, c. 1125.]But it seems clear that something more than my spoken assurance is needed, and I am certainly quite willing to do anything to banish this apprehension for good. The Royal College of Physicians has made the useful suggestion, with which the other Royal Colleges associate themselves, that I should now make it statutorily clear that a whole-time service will not be brought in by regulation, but would require further legislation to make it possible. My colleagues and I accept that, most cordially. In short, we propose that it should be clearly impossible to institute a full-time salaried service by regulation alone. It would then need express legislation if it were ever proposed.
As the House knows, I am about to set up an expert legal committee to advise me on the disputed effect of the Act on partnership agreements. I hope to announce details of this Committee at Question Time tomorrow. It seems likely that a short clarifying Bill may be needed as a result of its inquiries. If so, I shall take the opportunity—and, if not, I shall invoke an opportunity specially—to ask Parliament also to clarify our intentions about any full-time salaried service, in the way suggested above.
There is one further way, I think, in which we can eliminate these apparently widespread fears of a full-time salaried service. By many doctors the proposed fixed element of £300 in remuneration seems itself to be a menacing thing to freedom. I for my part have always conceived it rather as an assurance for the young beginner and for the older practitioner wishing to ease up in old age, and as a peg on which to hang additional assured payments for doubtful areas or other risks—and these are all worthy objects. However, if doctors are afraid of sinister intentions in this, I think these worthy objects can be achieved in another way, and no amendment of the Act is needed for this. Let all new entrants to practice have the advantage of this assured element of £300 for a period of, 166 say, three years. Then let each decide for himself whether he will forgo it and pass to a system of plain capitation fees, or stay as he is with his fixed £300 plus a lower proportionate rate of capitation. He will be able to do this at any time. Similarly, let any doctor in established practice be able to elect for himself at any time to go on to the system of £300 fixed payment, plus the lower capitation rate, if and when he wants to—for example, in old age—instead of the higher rate with no fixed payment at all.
So now it can rest with the individual doctor himself to decide the extent to which he prefers the combined system of £300 plus lower capitation, or all capitation—with the exception that beginners will start with three years on the former system.
One other point. I have already given assurances in this House that I do not for one moment intend to interfere with the ordinary rights of doctors to express themselves in speech or in writing with absolute freedom. Similarly I have already given assurances to the profession that the Chairman of the Tribunal under the Act will be a lawyer of high professional standing appointed by the Lord Chancellor. I need scarcely repeat such assurances now, but—for the removal of any vestige of doubt—I do so.
I trust that what I have said will finally free doctors from any fears that they are to be turned in some way into salaried civil servants." I look forward now to a future of active and friendly cooperation with the profession in putting into operation next July a great social measure, which can be made a turning point in the social history of this country and an example to the world.
§ Mr. Oliver Stanley
All of us in this House hope that when this National Health Service scheme comes into force, it will be in a form which will command the whole-hearted co-operation of the doctors. It always has been, and it still is, for them to decide, and I shall make no comment on the proposals which the right hon. Gentleman has made; but I am sure that speaking for everyone on this side of the House, we welcome anything which tends to break the deadlock which has occurred, and above all we welcome the tone in which the right hon. Gentleman has spoken today.
§ Mr. Clement Davies
May I, on behalf of my colleagues and, I am sure, on behalf of everyone in this House, congratulate the right hon. Gentleman upon the action which he has taken and the statement has has made. I am quite sure it is the desire of every one of us that the National Health Service should work smoothly and harmoniously. I should like to ask him whether he is prepared —as I am sure he is—to meet the negotiating committee at once if they desire to see him.
§ Dr. Haden Guest
May I also congratulate the Minister on this decision very largely on the ground that it will secure that the service will begin with the good feeling of the doctors and the good feeling of the whole country in this matter—a most important aspect of this new service?
Mr. Wilson Harris
Will the right hon. Gentleman clarify his very encouraging statement in two respects? First, will he give an assurance that no influence will be brought to bear on the doctors in the matter of issuing sickness certificates? Secondly, with regard to the basic salary, the formal suggestion of the Royal College of Physicians seems to leave it open —I am sure it is not the right hon. Gentleman's desire—to any Minister to raise the £300 by regulation to £600, £900 or any figure so long as it does not constitute a whole-time salaried medical service? Would the right hon. Gentleman be willing to go as far as to put into the amending Bill a provision that the original sum of £300 should not be increased except by a new Act of Parliament?
§ Mr. Bevan
That is a point of refinement which can be looked into later on. I am perfectly prepared to discuss the terms of the Amendment with the representatives of the medical profession. I should like to take this opportunity of pointing out that there is very considerable misapprehension on this matter. People appear to think that the power to make terms and conditions of employment by regulation is something the 168 Minister himself wants. The fact is that it is usually what the professions themselves desire, because it makes the whole system much more flexible. If we had to have an amending Act every time we altered the terms and conditions of remuneration, very often they would not be altered. The recent increase in capitation would not have been possible except by regulation.
§ Sir Ernest Graham-Little
The right hon. Gentleman has asked what the doctors and the profession want. He has only mentioned one very important objection, and that is the fear of a full-time salaried service. I was present at the meeting of the Royal College of Physicians at which this resolution was passed, and I should like to point out—
§ Mr. Speaker
I would ask hon. Mem-bers to remember that they are limited to asking questions on the statement.
§ Sir E. Graham-Little
I should like to ask this question—will the Minister take into consideration the second resolution which has been published in the Press, and which was moved at the meeting of the Royal College of Physicians, and accepted by them?
§ Mr. Baird
As the Minister today has been very generous to the British Medical Association, will he take into consideration the disquiet felt by Members on this side of the House about the delay in setting up health centres, and will he also consider making a gesture to this side of the House by speeding up the building of health centres?
§ Mr. Bevan
That lies rather outside the scope of the statement I have made, which is concerned with the terms and conditions of remuneration of the general practitioners I hope, however, that the statement I have made will elicit from the representatives of the doctors the same spirit of cordial co-operation.
§ Miss Bacon
Arising out of the last statement made by the hon. Member for London University (Sir E. Graham-Little), is my right hon. Friend aware 169 that any further concessions made by him will not be welcomed by many of us on this side of the House?
§ Mr. Rankin
Will my right hon. Friend clear up one point? If at the end of three years a doctor decides to continue receiving the £300 basic salary, will he have to accept the lower capitation fee?
§ Mr. Bevan
Most certainly. He cannot have the £300 basic salary plus the higher capitation rate. He must take one or the other. The advantage of the proposal that I made is that the extent to which a fixed element is in existence will depend upon the initiative of the doctors themselves, and upon no one else.
§ Mr. Bevan
Right hon. and hon. Members in all parts of the House will realise that the prestige of Parliament must be sustained. I am always ready to meet representatives of the medical profession. I should like to point out that we have sent to them in the course of the last few months a considerable number of letters asking for their co-operation on technical matters, and we have not received that co-operation.
While agreeing that it is very desirable that the National Health Service should start off in a healthy manner, would it be permissible for the Government or the Minister to advise the workers to show the same solidarity and tenacity as the doctors?