NATIONAL HEALTH SERVICE. (Hansard, 7 April 1948)

§ THE LORD PRIVY SEAL (VISCOUNT ADDISON)
My Lords, I should like to intervene to make an important statement which is being made to-day in another place by the Minister of Health with regard to the position of medical men in relation to the National Health Service. It will, I think, be best if I report it to your Lordships in the Minister's own words. He said:
" 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 1195 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 doctors.
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' uneasiness 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 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 that into the mind of any future Minister or prophesy what may be done by future Governments, but that is not our intention.'
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 made clearly impossible to institute a full-time salaried service by regulation alone. It would then need express legislation if it were ever proposed.
1196 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 the partnership agreement. I hope to announce details of this Committee at Question time to-morrow. 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 advantages of this assured element of £300 for, say, three years. Then let each doctor 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 fee, 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 1197 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 into ' salaried civil servants.' I look forward now to a future of active and friendly co-operation 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."

§ THE MARQUESS OF SALISBURY
My Lords, the extremely important statement that has been made by the noble Viscount the Leader of the House on behalf of his right honourable friend clearly deserves and needs a good deal more consideration. In addition, we shall all no doubt wish to scrutinise the legislation, which I understand is envisaged, when it comes to your Lordships' House. For the moment, I would say that it is quite evident that the Government are making efforts to break the deadlock which exists between them and the medical profession. I am sure we all hope that the proposals which are now being put forward will lead to an agreement satisfactory not only to the Government but to the medical profession, to whom we all owe so great a debt for their selfless endeavours on our behalf.

§ VISCOUNT SAMUEL
My Lords, the statement that has just been made by the noble Viscount the Leader of the House may be taken to indicate the possibility, indeed, the probability, of a settlement between the two contending parties. As such, it will I am sure, be welcomed with great pleasure in all quarters of the House. It must be of special satisfaction to the noble Viscount, Lord Addison, himself to be able to announce what may be a measure of reassurance to his own old profession of which he was so distinguished a member. I think, that the House also would wish to congratulate the noble Lord, Lord Moran, who, as President of the Royal College of 1198 Physicians, has been able to do so much to promote a settlement of this prolonged and acute controversy.

§ LORD MORAN
My Lords, in the exceptional circumstances, and in view of the importance of the issues, I hope the House will forgive me if in a few words I thank the noble Viscount the Leader of the House for his statement and congratulate the Minister on what he has said in another place Let me say at once that I wholeheartedly welcome the Minister's statement. This Health Act, it has been said, is feared far less for what it is than for what it may become. Doctors have dreaded that the Act may be the prelude to a whole-time medical service. The Minister, by promising an amendment of the Act, has done all that is possible to remove that dread. He has done more. He has fully met the representations which some of us have made to him, by making the basic salary optional after three years in practice. The Minister has boldly met the main fears of the doctors. I hope he will be rewarded by the loyal support of all reasonable members of my profession, and that we shall now set our minds to the task of making this service, under very difficult circumstances, in the Minister's own words "a turning point in the social history of our country."