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    The Socialist Health Association (SHA) published its first Blog on the COVID-19 pandemic last week (Blog 1 – 17th March 2020). A lot has happened over the past week and we will address some of these developments using the lens of socialism and health.

    1. Global crisis

    This is a pandemic, which first showed its potential in Wuhan in China in early December 2019. The Chinese government were reluctant to disclose the SARS- like virus to the WHO and wider world to start with and we heard about the courageous whistle blower Dr Li Wenliang, an ophthalmologist in Wuhan, who was denounced and subsequently died from the virus. The Chinese government recognised the risk of a new SARS like virus and called in the WHO and announced the situation to the wider world on the 31st December 2019.

    The starter pistols went off in China and their neighbouring countries and the risk of a global pandemic was communicated worldwide. The WHO embedded expert staff in China to train staff, guide the control measures and validate findings. Dr Li Wenliang who had contracted the virus, sadly died in early February and has now been exonerated by the State. Thanks to the Chinese authorities and their clinical and public health staff we have been able to learn about their control measures and the clinical findings and outcomes in scientific publications. This is a major achievement for science and evidence for public health control measures but….

    Countries in the Far East had been sensitised by the original SARS-CoV outbreak, which originated in China in November 2002. The Chinese government at that time had been defensive and had not involved the WHO early enough or with sufficient openness. The virus spread to Hong Kong and then to many countries showing the ease of transmission particularly via air travel. The SARS pandemic was thankfully relatively limited leading to global spread but ‘only’ 8,000 confirmed cases and 774 deaths. This new Coronavirus COVID-19 has been met by robust public health control measures in South Korea, Taiwan, Hong Kong, Japan and Singapore. They have all shown that with early and extensive controls on travel, testing, isolating and quarantining that you can limit the spread and the subsequent toll on health services and fatalities. You will notice the widespread use of checkpoints where people are asked about contact with cases, any symptoms eg dry cough and then testing their temperature at arms length. All this is undertaken by non healthcare staff. Likely cases are referred on to diagnostic pods. In the West we do not seem to have put much focus on this at a population level – identifying possible cases, testing them and isolating positives.

    To look at the global data the WHO and the John Hopkins University websites are good. For a coherent analysis globally the Tomas Peoyu’s review  ‘Coronavirus: The Hammer and the dance’ is a good independent source as is the game changing Imperial College groups review paper for the UK Scientific Advisory Group for Emergencies (SAGE). This was published in full by the Observer newspaper on the 23rd March. That China, with a population of 1.4bn people, have controlled the epidemic with 81,000 cases and 3,260 deaths is an extraordinary achievement. Deaths from COVID-19 in Italy now exceed this total.

    The take away message is that we should have acted sooner following the New Year’s Eve news from Wuhan and learned and acted on the lessons of the successful public health control measures undertaken in China and the Far East countries, who are not all authoritarian Communist countries! Public Health is global and instead of Trump referring to the ‘Chinese’ virus he and our government should have acted earlier and more systematically than we have seen.

    Europe is the new epicentre of the spread and Italy, Spain and France particularly badly affected at this point in time. The health services in Italy have been better staffed than the NHS in terms of doctors/1000 population (Italy 4 v UK 2.8) as well as ITU hospital beds/100,000 (Italy 12.5 v UK 6.6). As we said in Blog 1 governments cannot conjure up medical specialists and nurses at whim so we will suffer from historically low medical staffing. The limited investment in ITU capacity, despite the 2009 H1N1 pandemic which showed the weakness in our system, is going to harm us. It was great to see NHS Wales stopping elective surgical admissions early on and getting on with training staff and creating new high dependency beds in their hospitals. In England elective surgery is due to cease in mid April! We need to ramp up our surge capacity as we have maybe 2 weeks at best before the big wave hits us. The UK government must lift their heads from the computer model and take note of best practice from other countries and implement lockdown and ramp up HDU/ITU capacity.

    In Blog 1 we mentioned that global health inequalities will continue to manifest themselves as the pandemic plays out and spare a thought for the Syrian refugee camps, people in Gaza, war torn Yemen and Sub Saharan Africa as the virus spreads down the African continent. Use gloves, wash your hands and self isolate in a shanty town? So let us not forget the Low Middle Income Countries (LMICs) with their weak health systems, low economic level, weak infrastructure and poor governance. International banking organisations, UNHCR, UNICEF, WHO and national government aid organisations such as DFID need to be resourced and activated to reach out to these countries and their people.

    1. The public health system

    We are lucky to have an established public health system in the UK and it is responding well to this crisis. However we can detect the impact of the last 10 years of Tory Party austerity which has underfunded the public health specialist services such as Public Health England (PHE) and the equivalents in the devolved nations, public health in local government and public health embedded in laboratories and the NHS. PHE has been a world leader in developing the PCR test on nasal and throat samples as well as developing/testing the novel antibody blood test to demonstrate an immune response to the virus. The jury is out as to what has led to the lack of capacity for testing for C-19 as the UK, while undertaking a moderate number of tests, has not been able to sustain community based testing to help guide decisions about quarantining key workers and get intelligence about the level of community spread. Compare our rates of testing with South Korea!

    We are lucky to have an infectious disease public health trained CMO leading the UK wide response who has had experience working in Africa. Decisions made at COBRA and announced by the Prime Minister are not simply based ‘on the science’ and no doubt there have been arguments on both sides. The CSO reports that SAGE has been subject to heated debate as you would expect but the message about herd immunity and stating to the Select Committee that 20,000 excess deaths was at this stage thought to be a good result was misjudged. The hand of Dominic Cummings is also emerging as an influencer on how Downing Street responds. Remember at present China with its 1.4bn population has reported 3,260 deaths. They used classic public health methods of identifying cases and isolating them and stopping community transmission as much as possible. Herd immunity and precision timing of control measures has not been used.

    The public must remain focused on basic hygiene measures – self isolating, washing of hands, social distancing and not be misled about how fast a vaccine can be developed, clinically tested and manufactured at scale. Similarly hopes/expectations should not be placed on novel treatments although research and trials do need supporting. The CSO, who comes from a background in Big Pharma research, must be seen to reflect the advice of SAGE in an objective way and resist the many difficult political and business pressures that surround the process. His experience with GSK should mean that he knows about the timescales for bringing a novel vaccine or new drugs safely to market.

    1. Local government and social care

    Local government (LAs) has been subject to year on year cuts and cost constraints since 2010, which have undermined their capability for the role now expected of them. The budget did not address this fundamental issue and we fully expect that in the crisis, central government will pass on the majority of local actions agreed at COBRA to them. During the national and international crisis LAs must be provided with the financial resources they need to build community hubs to support care in the community during this difficult time. The government need to support social care.

    COVID-19 is particularly dangerous to our older population and those with underlying health conditions. This means that the government needs to work energetically with the social care sector to ensure that the public health control measures are applied effectively but sensitively to this vulnerable population. The health protection measures which have been announced is an understandable attempt to protect vulnerable people but it will require community mobilisation to support these folk.

    Contingency plans need to be in place to support care and nursing homes when cases are identified and to ensure that they can call on medical and specialist nursing advice to manage cases who are judged not to require hospitalisation. They will also need to be prepared to take back people able to be discharged from acute hospital care to maintain capacity in the acute sector.

    Apart from older people in need there are also many people with long term conditions needing home based support services, which will become stressed during this crisis. There will be nursing and care staff sickness and already fragile support systems are at risk. As the retail sector starts to shut down and there is competition for scarce resources we need to be building in supply pathways for community based people with health and social care needs. Primary health care will need to find smart ways of providing medical and nursing support.

    1. The NHS

    In January and February when the gravity of the COVID pandemic was manifesting itself many of us were struck by the confident assertion that the NHS was well prepared. We know that the emergency plans will have been dusted down and the stockpile warehouses checked out. However, it now seems that there have not been the stress tests that you might have expected such as the supply and distribution of PPE equipment to both hospitals and community settings. The planning for COVID-19 testing also seems to have badly underestimated the need and we have been denied more accurate measures of community spread as well as the confirmation or otherwise of a definite case of COVID-19. This deficiency risks scarce NHS staff being quarantined at home for non COVID-19 symptoms.

    The 2009 H1N1 flu pandemic highlighted the need for critical care networks and more capacity in ITU provision with clear plans for surge capacity creating High Dependency Units (HDUs) including ability to use ventilators. The step-up and step-down facilities need bed capacity and adequate staffing. In addition, there is a need for clarity on referral pathways and ambulance transfer capability for those requiring even more specialised care such as Extracorporeal Membrane Oxygenation (ECMO). The short window we now have needs to be used to sort some of these systems out and sadly the supply of critical equipment such as ventilators has not been addressed over the past 2 months. The Prime Minister at this point calls on F1 manufacturers to step in – we wasted 2 months.

    News of the private sector being drawn into the whole system is obviously good for adding beds, staff and equipment. The contracts need to be scrutinised in a more competent way than the Brexit cross channel ferries due diligence was, to ensure that the State and financially starved NHS is not disadvantaged. We prefer to see these changes as requisitioning private hospitals and contractors into the NHS. 

    1. Maintaining people’s standard of living

    We consider that the Chancellor has made some major steps toward ensuring that workers have some guarantees of sufficient income to maintain their health and wellbeing during this crisis. Clearly more work needs to be done to demonstrate that the self-employed and those on zero hours contracts are not more disadvantaged. The spotlight has shown that the levels of universal credit are quite inadequate to meet needs so now is the time to either introduce universal basic income or beef up the social security packages to provide a living wage. We also need to ensure that the homeless and rootless, those on the streets with chronic mental illness or substance misuse are catered for and we welcome the news that Sadiq Khan has requisitioned some hotels to provide hostel space. It has been good to see that the Trade Unions and TUC have been drawn into negotiations rather than ignored.

    In political terms we saw in 2008 that the State could nationalise high street banks. Now we see that the State can go much further and take over the commanding heights of the economy! Imagine if these announcements had been made, not by Rishi Sunak, but by John McDonnell! The media would have been in meltdown about the socialist take over!

    1. Conclusion

    At this stage of the pandemic we note with regret that the UK government did not act sooner to prepare for what is coming both in terms of public health measures as well as preparing the NHS and Local Government. It seems to the SHA that the government is playing catch up rather than being on the front foot. Many of the decisions have been rather late but we welcome the commitment to support the public health system, listen to independent voices in the scientific world through SAGE and to invest in the NHS. The country as a whole recognises the serious danger we are in and will help orchestrate the support and solidarity in the NHS and wider community. Perhaps a government of national unity should be created as we hear much of the WW2 experience. We need to have trust in the government to ensure that the people themselves benefit from these huge investment decisions.

    24th March 2020

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    an interview with Michael Meacher

    Over the last four years Socialism and Health has made a point of interviewing each health spokesperson of the Labour Party to give them a chance to talk about what they see as the priorities in health policy. Our last interview was with Gwyneth Dunwoody who has been succeeded by Michael Meacher. We visited him at the House of Commons in April. This is a summary of that interview.

    What do you see as the priorities in health policy for the next Labour government?

    Michael Meacher felt it isn’t enough just to talk about how much we spend. In the West we’re getting diminishing returns in terms of age specific mortality and morbidity rates, for increasing expenditure. In such a system there is no point in looking for efficiency by trimming the edges; instead a new approach has to be found. In the area of health the right combination of social and economic policies is crucial. There should be less emphasis on curative technology and more on prevention, health promotion and health education; that is, on changes in our way of life, as the major causes of illness today are all to do with social conditions.

    He used the example of an overfed, under exercised person, who smokes and drinks in excess over a prolonged period and is then taken into hospital after a heart attack. Large amounts of money are spent on intensive treatment and care where­upon he or she returns home only to continue the lifestyle which is likely to generate further trouble. “We have got a health service, we’ve got health policies, but we’ve got anti-health social and economic policies.”

    Mr. Meacher believed that we will only succeed in producing a significant qualitative improvement in health, and at reducing the incremental costs of doing that, when there is a fundamental change of lifestyle. “It is trying to get across this alternative perspective of health care that I think is our prime task between now and the next election.”

    What do you feel the main effects of the last five years of Tory policies have been on the health service, and how do you see it developing in the future?

    Michael Meacher focused on two areas. Firstly, the Tories’ claims about their increased  spending on the NHS didn’t stand up when looked at in detail. For example in terms of NHS pay and price increases rather than RPI figures, the increasing numbers of elderly people and the increasing costs of medical technology. He felt that since 1983 there had undoubtedly been a cutback and that this was sure to continue. Secondly, privatisation is going to take a toll. Not only is it ideologically offensive but it also leads to lower standards and lower pay. This is in a service where many people, particularly women, are already paid at exploitative rates. Even discrete medical units may get privatised over the next few years, such as the kidney unit in Wales.

    In general Michael Meacher felt that the Tories are using a systematic and comprehensive approach in relation to their objectives and that none of this is good news for patients or the NHS. As a result, the health service is now set for a major fall in standards over the next few years.

    How does that tie up with the defensive anti-cuts position that many people are being pushed into?

    Michael Meacher felt that these positions weren’t in opposition but rather complementary. While it is essential to oppose the cuts in the context in which they are occurring now — i.e. as part of a general winding down of the NHS — we musn’t assume that what we had in 1979 or 1948 was okay. What is needed is an alternative scenario in which change and renewal of services and hospital stock occurs as part of the development of a better and more appropriate NHS. He reiterated this point by saying “It is not an adequate health policy to simply say that we’re opposed to the cuts and to privatisation and that when we get back in office we’ll restore it all.”

    Having mentioned that an alternative perspective is essential in the development of a better health service, what do you see as the ways and means of encouraging prevention and health promotion?

    While acknowledging that the opposition of vested interests within industry was fundamentally a power issue, Michael Meacher felt that there was much to be done in arousing public awareness of the issues involved. Dislocation in the food, tobacco and drugs industries would be inevitable if a health perspective was integrated into policies and the immensely powerful capitalist lobbies would indeed be hard to take on. However, if people were aware of the reasons for such a challenge they would be more likely to back policies for change and the chance of success would be much greater.

    He felt that people would alter their way of life if they were more informed of the consequences of their lifestyle and knew what changes to make. Taking food as an example, he suggested that the findings of the James Report, which are ex­extremely important but have only really reached health professionals, should be widely advertised to the public on tubes and buses. Effective use of the media and advertising could be useful in spreading such information and keeping people informed about issues which concerned their health.

    Michael Meacher has also set up a food policy group, the membership of which includes Professor James, Jeremy Bray, Bob Hughes (from the agricultural side) and himself and Frank Dobson. The aim is to publish a report, within a year, which will state clearly what a food policy intends to do, the reasons why, and good persuasive arguments to influence other people to support it. Such a policy would look for agreement with agriculture and the Treasury and would then be determined to negotiate for change. A Labour Party policy on food is long overdue; once produced, he felt it would be beneficial to liaise with other socialist groups in Europe in order to influence EEC policies.

    In addition to the food policy group. Michael Meacher has himself set up seven other working parties. These include an alternative vision of health care, community care — involving prevention and health promotion, democratisation in the NHS, privatisation, health care for women, dentistry and, through the SHA and Harry Daile, he has recently asked a committee to look into ophthalmic services following the recent moves to privatise the optical services.

    The formation of these small working partieis is intended to help overcome some of the problems faced by the previous social policy group of the NEC. With a fluctuating membership of between fifty and seventy people, the group spent much of its time making decisions at one meeting only to reverse them again at the next, depending on who turned up. The overall result was that policies were extremely slow to be developed. The new working parties will not be exclusive; papers and oral evidence from nonmembers will be an integral part of their working. Papers will be circulated in the party for modifi­cation and change but will be developed into policy in a far less amateurish and easy going fashion than has hitherto been used.

    Why hasn’t the Labour Party had health as a greater priority recently?

    Michael Meacher said there had been a bipartisan concensus about the NHS until Thatcher came into office. From now on he assured us it will have a higher profile in the Labour Party.

    While admitting that health should have been given more attention in the past, it does now appear from opinion polls that people not only see the health service as an important issue but also as one on which the Labour Party has overwhel­mingly the best policies. Having stumbled on the jewel in our crown again, the Labour Party is going to support it economically and politically.

    What do you feel about the Griffiths Report?

    Michael Meacher said he felt sceptical to hostile about the report, but thought it had some good bits in it especially in relation to doctors’ power. The main problem is that it will lead to an increased centralisation of power with a much smaller democratic element. Along with plans for the FPCs in which all their members will be appointed, it is going to be much easier for the government to keep the financial lid on the health service by the simple use of administrative power. On the other hand he felt there is something to be said for re­dressing the balance away from the lack of cost and outcome consciousness that can result from unfettered clinical freedom.

    How do you feel about the issue of nurses’ pay?

    Apart from any other reasons, Michael Meachers sponsorship by COHSE prompted him into enthusiastic support for a fair wage for nurses! Nurses, along with all women workers in the NHS, were paid appallingly low wages and were clearly used to subsidise the health service. He felt that the Pay Review Body should be used to assess and fix nurses pay at a level which would stop them having to fight each year to increase a sub­standard wage. However, Mr. Meacher was realistic in saying that the key factor was finding sufficient funds to make an appropriate pay award. He felt that much could be gained from reducing the rip-offs by the drug companies and the monopoly suppliers, such as BOC and London Rubber Company. Just as important though, he felt there was no way around putting in more resources. The Labour Party was committed at the last election to 3% extra in real terms, but he would like it to be increased to 5%. If were going to put our money where our mouth is, thats the sort of sum its go to be.

    During the interview with Michael Meacher, we were impressed by a number of points. First, his ideas seemed very much in line with current ‘progressive thinking about health and health care. Second, unlike many politicians, he welcomed ideas and discussion and was ready to acknowledge his own lack of expertise in specific areas. Third, his response to that was involvement of a wide range of individuals and groups. We felt he was genuinely concerned with the development of alternative perspectives in health care and was keen to work with all those who shared that concern. It seems that Labour Party health policies might in the future be much more respon­sive to the interests and needs of both the users and providers of health care. Hopefully we may now have the opportunity to start bridging the gap which has all too often separated politicians from those they represent.

    Graham Bickler & Alison Hadley

    July / August 1984


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    In the Nov/Dec ’80 issue of Socialism & Health‘ we published an interview with Stan Orme, who, at the time, was the shadow health minister. Since then Michael Foot has become the party leader and Gwyneth Dunwoody has taken over Stan Orme’s job. We felt that it would be interesting to see what her views were on broadly the same areas as those we asked Stan Orme about, so we interviewed her in early March.

    This is a summary of that interview:

    Alison: Which Tory policies are you most concerned with, with regard to health?

    G.D.:  It’s their general attitude to health care that worries me, their intent to undermine the N.H.S. from the inside & particularly a 75/25 division of health care between the N.H.S. & private medicine.

    Graham: What do you see as the next Labour government’s priorities for both reversing changes introduced by the Tories and in other ways?

    G.D.:   The economy is going to be in a bad way & we’ll have to fight for spending on the N.H.S.  The particular priorities should be   a) capital expenditure and b) how to restore the personal social services, as community care is a mess at the moment.  This will be made worse by the proposed reorganisation, and the ‘cinderella’ disciplines will need particular help.

    Graham: How would you link that with the Royal Commission & the Black Report?

    G.D.: I’m wary of stating detailed priorities partly because the Black Report hasn’t been sufficiently analyzed. Doctors must be given incentives to go into neglected areas and an immediate boost should be given to N.H.S. morale. Current management techniques are thirty years out of date. H’s also important to defend existing NHS structures. The Labour Party must work out what it feels priorities are by the next election and give up sloganizing and substitute it with more concrete policies

    Alison: How would a Labour Government tackle the tobacco industry?

    G.D.: I think there has to be a total ban on advertising. There’s no evidence that the present government is planning to do this. Tobacco industry profits should be creamed off into the NHS.  Stop business practices that British companies practice in the Third World which would not be allowed here.

    Alison: The   Black  Report   advocated  ‘phasing  out’  the British tobacco  industry  within  ten  years,  how do you  see that’?

    G.D.: Workers in the tobacco industry must be consulted & redeployed, with public money being used to create Jobs.  If the companies  won’t  diversify, they  should   be  told  that  the  state  won’t  tolerate  their activities.

    Alison:  The last Labour Government didn’t  do very much..

    G.D.: I think there’s been a shift amongst the public in attitudes towards smoking & smokers – the Labour movement has always been aware of the effects. Predictably, it’s the middle classes who are changing their habits & classes IV & V who aren’t. The press don’t campaign against the industry and the Sunday Times appears to have been ‘nobbled’ by a section of it recently.

     Graham: Do you think a Labour Government could stand up to the tobacco industry? that’s what  the  real  issue  is,  it’s  very  different  producing  educational  material from tackling multinationals.

    G.D.: “I  think that all governments  are able  to  withstand attacks where the majority of the people actually understand  what  they ‘re  doing  and why. I believe it now is something in which a Labour Government would have to lead.

    Graham: The Black Report uses the tobacco industry as an example of how health may be improved by political action & they later suggest  that  we need  a ‘food policy’ in much the same way as we need a tobacco  policy.   This would  presumably involve education, food  subsidies  and  tackling  the  food industry.

    G.D.: This  would  be a long  term  proposition.  While   I   feel  that nutrition should be made political and food policy  become   a priority   for   the  Labour  Party whether enough  work has  been  done  or  enough real political thought has been given to that sort of development I doubt . This sort of stuff is not yet a high priority for the party. Rickets may well soon appear, the school meals service is getting worse. This may make nutrition more political.

    Alison: Shouldn’t we  be  making  it  political before we get these problems?

    G.D.:Yes,  but  I’m  trying  to  avoid  a  commitment  to such policies   when  there will be enormous problems. We should  have   a  limited  set of proposals that you’ve  got to do & can do, & fights that you can defend. Nutrition is well up on my priorities but at the moment is low down on party priorities. That may change.

    Alison: How would you   like  to see occupational  health developing?

    G.D.: I’m in favour of it developing as part of the N.H.S. Some Trade Unions want it more closely linked  to the Health & Safety Executive.

    Alison :How’s about private health care, in particular occupational aspects?

    G.D.:I have  always  persuaded  Trade Unions not  to negotiate private healthcare as part of wages deals. Part   of   the   problem is that   many   people have forgotten what private healthcare was like. They don’t realise all its implications in particular the exclusions for long term support.

    Graham:  How do you solve that; as part of the  problem of how you project socialist health policies?

    G.D.: That’s part of our responsibility in the House of Commons & part yours. Once people see the real cost of private health  care  they’ll swing  back,  but the N.H.S. may be damaged in the interim. What will safeguard the NHS in the long run is people unders tanding the implications of private treatment.

    Alison: What about pay beds within the NHS.?

    G.D.: I think they should be phased out very y quickly indeed; even if the insurance companies would like this,  the  NHS has  to  be a  fully comprehensive health service & I  think  that private practice should be right outside it. There will be a growth of some kind of private medicine & it should be licensed. Private units use N.H.S. trained staff without any contribution to their training and I don’ t see why you should have, for example, private hospitals operating alongside NHS. hospitals that haven’t got sufficient nurses.   Maybe private units that use N. H.S. trained staff should have to contribute very substantially to the N.H.S.

    Graham: In the Black Report the abolition of child poverty is suggested as a means of combating preventable disease.  This  would   involve   taxation policy, child benefits & possibly an incomes policy. What do you feel about this?

    G.D.:       Incomes policies are very problematic.  We do need an extended view of health care,  but  the  implications of the Black Report have not  been  fully debated in the  Labour movement.

    Graham:   Why   has health had a lowish priority in the Labour Party for some years?  It had always been a central issue for socialists.

    G.D.: We’d got complacent ab o u t health care, t he problems were thought to be specific but overall things were O..K. Under this government it ‘s become clear t½h at the service is  not  good  enough  and  the Black Report came at the right time. Michael  Foot feels very strongly that health is one  of  the  most important  things  that  any socialist can ever be concerned about.

    Alison: Inequaliti1es in health  have  been   known  for  some time though.

    G.D.: Yes but mainly to experts and not  to ordinary Labour Party members. The Black Report was well written, very well argued & very cogently produced.’

    Graham:   What two or three areas of legislation would you like to see the next Labour Government enacting?

    G .D .:Difficult  because  in  the  past  we’ve  been  bound  to priorities  without  flexibility but

    • Improving management techniques t o get back some sense of purpose about the NHS among staff.
    • Neglected areas like mental health should be given a boost
    • I want to see   the  whole battle of private health care fought very energetically I really think that’ s one where we’ve got to stop pussyfooting about.
    • Lots   of   other things including day care abortion facilities.

    The next government must set out a simple set of steps & defend them in agreement with the workers, the party   &  the trade unions.  That   will   mean hospital services & something constructive in relation  to  the personal social  services .  We’ve got to think about how to channel money, how to monitor things, where our priorities lie and other difficult areas.

    Graham:    Can health considerations be brought into other areas of policy making?

    G.D.:  Inevitably and it’s happening now, because in local authorities, cuts in their revenue has led to worse social services which has produced increased dependence on the NHS which is itself  under attack. The personal social services need protecting.

    Throughout the interview, Mrs. Dunwoody emphasised the need   for the next Labour   government   to have a   list of priorities for    health & health-care  legislation  which could  be both fought for & implemented. While those priorities, & the details of policy,  have  not  yet  been formulated, she intends to see  that  they are during the period  before  the  next  election. We felt that she showed a good grasp of the  problems & was fairly   sanguine  about   th e  differences  between  her   views & likely party policy. We left feeling relatively hopeful.

    Graham Bickler

    Alison Hadley





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    A joint Labour Party and Socialist Medical Association conference on Labour health policies was held on Saturday October 18th 1980 in Central Hall, Westminster, with nearly four hundred delegates attending from all over the country. The morning session was addressed by Stan Orme MP, opposition spokesman on health and social security, and Cyril Taylor, president of the SMA. In the afternoon delegates were split into four groups to discuss prevention, reorganisation and democracy in the NHS, NHS financing, and the personal social services. At the end of the session there was time for summaries of the small groups and a wider discussion. Cyril Taylor’s editorial on the front page continues some of the areas he touched on in his speech, while a summary of the day’s conclusions should be appearing in the next issue of Socialism and Health.

    In order to see the ways in which a future Labour government might start to tackle the overwhelming problems of health and health care, Alison Hadley and Graham Bickler interviewed Stan Orme during the conference. The article beneath is a compilation of that interview and his opening speech — “Labour and the future of the National Health Service.”

    We began by asking Mr Orme what he saw as the health priorities of a future Labour government. Against a backcloth of cuts in services, made by the Tory government he considered there to be three main areas in which Labour energies should be concentrated.

    First, the commitment to restore a free health service, fully financed by taxation, and he hoped to see, “within the lifetime of that Labour government, the phasing out of all charges.”

    Secondly Mr Orme was concerned with the allocation of resources. “The 2% growth rate which the previous government had endorsed and which is now being cut by this government is not sufficient and I would see as a minimum a 3% growth rate for the health service…..and we may find that 3% is not sufficient.”

    The third priority was prevention, with the focus on firm action against smoking, legislation for seat belts, alcohol and its attendant problems and the availability of abortion and family planning on the NHS.

    Although Mr Orme listed these as the three main areas for action he mentioned the need for attention to democracy in the health service, our expansion in occupational health and for stricter measures to be taken with the drug industry.

    A concern which ran through many of these topics and one which was discussed by everyone during the conference, was the power of the medical profession and the difficulties in involving them in socialist health policies. Mr Orme talked about the “mystical vote of clinical judgment” as a source of reaction amongst doctors. Never the less he felt that many could be won over by providing good pay and working conditions and in particular he was in favour of a salaried service for GPs in inner city areas. However, it was suggested that many doctors would continue to resist, and would escape into the private sector thereby perpetuating private medicine. When asked how a Labour government intended to deal with the private health field, Mr Orme felt the priority was “to put a fence around it,” and to remove pay beds in their entirety from the NHS hospitals. The Labour movement must not be afraid of saying that it is “opposed to the principle of private medicine.”

    In the area of prevention Mr Orme had made several comments in his morning speech about the need for stronger action to be taken with the tobacco industry. As these had not been fully outlined, we asked him how he would see a future Labour government implementing policies that would significantly affect the tobacco industry, given that the government is so economically reliant on it.  Did he think there would be something in the manifesto about this?

    Mr Orme said he felt there should be something in the manifesto and said: “we have reached the stage now where we need legislation regarding advertising. . .I think sponsoring of sports has gone far too far.”

    He mentioned that the loss of revenue if smoking demand was reduced is no reason for not implementing policies to discourage smoking. In addition to this he wanted much more comprehensive education particularly with young people, as he felt they were particularly vulnerable to the images of virility and adulthood portrayed by the media and in advertisements. This “built in advantage” the tobacco industry had, should be stopped.

    Given that the hazards of smoking have been widely known for a long time and that the educational approach to the problem has always been the one used, we felt the issue was whether things were going to be any different under the next Labour government.

    In reply, Mr Orme said “I think we need to take a much- more aggressive approach” and went on to emphasize the necessity of fully educating the public on the health hazards of smoking and other preventable diseases.  He felt that with proper explanations there would be a large measure of public support for action against smoking.

    In response to the point that despite similar arguments when the Labour government was last in office no real change in the industry was made, Mr Orme agreed.

    The Labour government had tried to come to a voluntary agreement with the tobacco industry, but he felt that now, “with the breathing space that we’ve got..we must see what methods we can come up with.”

    We then asked Mr Orme that since the problem is an economic one, was the tobacco industry likely to be more amenable in the future and if so was it simply going to transfer its market to the third world?

    Mr Orme agreed, but pointed out that some parts of the tobacco industry had already diversified and that he hoped by international rulings we could make progress. The time had come to move off the defensive, “I would like to see a section in the Labour manifesto on preventive medicine, spelling out some of these …. you can’t just resolve it by legislation, you’ve got to win the arguments.”

    As we felt that the food industry is also important in its effects on health we asked Mr Orme to comment on the fact that despite the Health Education Councils’ views on nutrition successive government had done nothing to legislate in accordance with these proposals.

    Mr Orme replied that this was partly a class problem which had been made worse by the destruction of the school meal service. What knowledge there is of “health foods” mainly affects the middle classes. When we suggested that legislation on pricing in the bread industry might be an important contribution to healthier eating habits, Mr Orme said he was in favour of legislation in this area but would like to see it linked to a wider area of prevention. The time to hesitate is through.

    While many if not all the points discussed above are true, we felt some concern.

    Although it is important to pursue aggressive policies on cuts, to be committed to a free national health service and to oppose private medicine, it is the causes of ill health we must attack.

    Until the Labour Party can produce their policies for legislation on the tobacco industry, the food industry, housing, transport and conditions of  work to  name a few influential areas, we will not begin to change the social inequalities or health highlighted by the Black Report.


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    Wednesday 10th May 1978 7 p.m. in The Grand Committee Room, Westminster Hall, House of Commons, London, S.W.I.

    Dr. Maurice Miller, MP, Chairman of the Parliamentary Labour Party Health Group took the chair and represented the Labour Party. In opening the proceedings Dr. Miller said it was fitting that the memorial meeting to Dr David Stark Murray should take place during the 30th Anniversary Year and in the House of Commons since he made such a very great contribution to the creation of the NHS and passing of the Act in the House in 1948. He welcomed Baroness Jennie Lee, widow of The Rt. Hon. Aneurin Bevan.

    David Stark Murray had, Dr. Miller said, exploded the pretentiousness in his own profession and also of politics.  Dr. Miller had joined the SMA in his student days and was greatly honoured to take the chair at the memorial meeting.

    Dr. Leslie Hilliard (see enclosed notes) (not located)

    Dr. Meade from Kingston Hospital spoke of Dr. Murray’s professional life. When Dr. Murray had come to Kingston Hospital as Consultant pathologist the pathology department had consisted on one small room.  David Murray had believed fervently in an integrated service – even before the NHS came into being. He had seen it as the duty of hospital pathologists to offer a service not only in the hospitals but to the GPs and the local authority health services.  Fellow pathologists had strongly opposed this view but Dr. Murray had given such a service and it was now accepted by the profession.

    Dr. Elizabeth Bunbury paid tribute to the work of David Murray for the SMA, but he was a man of very wide interests and displayed an astonishing knowledge of poetry and the arts and innumerable other subjects unconnected with medicine. He was indefatigable in his work and propaganda for the NHS.  During the war people were determined to have a fairer society after the war was over. This was crystalised in the Beveridge Report in 1943, which supported the conception already propounded by the SMA, of a National Health Service. Then David’s work reached an even greater intensity all over the country.  The Coalition Government produced a White Paper which whittled down the original proposals and David worked unbelievably hard, insisting on the fundamental principles of a Health service free at the time of use, elected representatives on all governing bodies, and no private practice.

    Richard Clements (Editor of Tribune) said David was an editor and contributor based on human understanding and tolerance. His deepest quality was his tolerance of other people.  He put forward difficult medical problems very simply, yet he never spoke or wrote down to lay people. If he disagreed with one it was not in anger – and he was usually right. David was imbued with a deep socialism and was a very kindly man. In the last few weeks of his life he continued to serve the cause of socialism. – A totally sincere socialist. His determination to see a democratic health service underlined his greatness.

    Victor Freeman, introducing extracts from written tributes received, said he had known David for forty years. (See letters below)

    Arthur Blenkinsop, MP first met David when he, Arthur was the District Secretary of a Labour Party in the North East. “David was amazingly willing to go anywhere health matters were being argued. Later when Arthur Blenkinsop joined the Ministry of Health in 1948 David was a valued friend and critic. He was not just an easy friend. He was bitter about what had not been achieved. He was not willing to accept compromise, we valued him all the more for the vigour of his criticism as well as admiring his determination to secure real influence on the NHS.  He hated compromise. He always wanted to see closer association between all health workers. He would have fought vigorously against the growing narrowness of his profession. He wanted to see the NHS not only for -its direct benefits but also as a part of a wider socialist belief – totally contrary to our money based society, The best tribute to David would be to defend the N.H.S. and organise against the attacks which will come and to go on and achieve what David stood for.

    Mr John Brown spoke of the high esteem in which the South Place Ethical Society held David.  They were proud to have attracted to their ranks such an outstanding humanitarian.

    Dr Donald Swann before some readings, spoke of his Father Dr. Herbert Swann. His father would wish to pay his tribute to David Stark Murray.  Dr Swann had said the greatest day of his professional life was when he did not have to ask his patients to pay him for his services.  That had owed so much to David Stark Murray. David had spoken so eloquently at his Father’s funeral and he was struck by his religious energy.

    Jennie Lee said that during the intense struggle to create the NHS, David was “impossible”. There was to be no compromise – but Nye Bevan had welcomed his uncompromising stand – he welcomed the pressure to counterbalance the enormous pressure from the other side.  Jennie Lee was delighted that David’s contributing had been recognised by his being the first Fellow of the Aneurin Bevan Memorial Fellowship instituted by the Indian Government. It was a mistake to think that bringing the NHS into being was plain sailing, it had been extremely difficult and we almost did not get an NHS.  She had said that David was “impossible” but it was only through impossible people like him that things got done. It was a disgrace that 30 years after its inception the NHS was still so far from the dream which David Murray and Nye Bevan had. We had betrayed them. ‘She only hoped that there were among the younger generation in the SMA people with David’s courage and vision who would also prove impossible until the dream was achieved.

    Laurie Pavitt, MP said it was his privilege to speak of a friendship which went back to before the last war. He wished to pay tribute not only to David but also to Jean Murray. David was such a widely varied personality. It would need a very long time to cover the various facets of his personality and of his work.  It was his virtue never to be weary of well doing. If a battle were won today he was always eager to go on fighting tomorrow until we got all we wanted. David, when others “felt disheartened and defeated, gave you the courage and the tools to go on. David had worked hard to publicise socialised medicine in the U.S.A and if that country got a bill introducing any measure of it, it would owe so much to David Murray.  In paying our tribute to David we must say “OK David, it is not yet what we want and as you did not rest, neither shall we”.

    Eric Messer referred to David’s political skill.  He always knew exactly when to move.  He was completely dedicated to the democratisation of the NHS.

    From Audrey Jupp

    The first time I met David was when I was short listed for the job of General Secretary of the SMA in the autumn of 1954. When I looked down the long table to the other end where David was “in the chair’* of the interviewing committee, I felt at once that here was someone that I should be able to work with in complete harmony. I got the job and my first impression proved to be true. As David was the President during the whole of the almost eight years I was Gen Sec. he was in a sense “my boss” He made those eight years the happiest of my working life.

    I always felt that he was giving me the fullest possible support. He was generous with his praise and unlike many professional people he did not treat me, as a lay man, as any less deserving of respect than his professional colleagues.  I was the “expert” on organisation and publicity and so far as he was concerned my view on this whole area of the SMA’s work was given priority,

    Above all he was a good friend. We used to prepare press releases for the SMA together. He was of course the only person who could issue press statements in between meetings of the EC and Council of the SMA. Often I would draft something on a topic in the press that morning, ring him and he would either accept it or might make minor amendments. On other occasions he would have drafted something and rung me. If when this release was repeated to the EC or Council, if the committee thought the release praiseworthy he would at once say “Audrey drafted it” but if the reaction was critical than he would at once say “Oh I’m sorry you don’t like it, I thought it suitable” when I drafted it even when in fact I had drafted it.

    I think that David knew me very well and knew that in spite of the fact that when I came to the SMA I was already an experienced political organiser and had a reasonable reputation nevertheless my self-confidence was (and is) very easily destroyed by criticism so he would not let me bear the brunt of any criticism however slight.

    On one occasion it had been suggested by Elizabeth and agreed that we should have labels for people attending a weekend school to put their names on and pin on themselves (a practice it was known I did not like) but I genuinely did forget. When at a session to discuss future Schools Elizabeth asked why we didn’t have them David jumped in before I could apologise and said he had thought about it and decided it was better not to have them.

    What deeply impressed me was the deep respect in which everyone in the SMA held David. He had no difficulty in maintaining order as the chairman of any SMA meeting however controversial the subject might be. The result of this was as far as I was concerned that if he defended me no one would pursue any criticism of me. On one occasion I had put an advertisement in the Labour press for a weekend school at which two speakers were Labour Party and two Communists. By a coincidence the names of the Labour party pair were alphabetically before the Communists and by careless copying of the text one line was left out and it was the line which contained the two CP speakers. When the ad, appeared one of the irate CP speakers rang David and accused me of deliberately discriminating because of political bias. Apparently David immediately went into the attack and said that he was entitled to complain about what was clearly carelessness but he was not entitled to impugn the Gen. Sec’s integrity. The complainant was so dashed by David’s attack that he said no more about it,

    When I had been with the SMA for four or five years David told me that his only regret so far as I was concerned was that I had not been recruited by the SMA years before 1955 – and it was my regret too.

    When I told David I was leaving the SMA for the Nyasaland Student’s office he said that while he much regretted it for himself and the SMA, he felt that I would get a better deal from Dr. Banda. I got more money but in every other respect he was in fact quite wrong.

    I was uneasy in my new job because I knew that the British civil servants resented my appointment to Nyasaland office and would do anything to get rid of me (they succeeded eight years later), so I asked for references from people I had worked with and for in politics – among them David. The following is the reference he gave me (by the way he’d only known me 8 ½   years but he thought 12 years sounded better.

    “To whom it may concern: Miss Audrey Jupp

    24th May 1963

    I have known Miss Audrey Jupp for some 12 years and have great pleasure in writing a few words about her. If she is applying for a post her application will show that she has had a very wide experience in office administration of various types and in addition has acted in capacities which have required wide knowledge of both business and political affairs. Such an application however, will not reflect the energy she applies to problems that arise in any posts she holds, nor to her ability to work out best methods of dealing with a variety of subjects.

    She is a very pleasant person to work with and I have never known her, even when things have not been going smoothly to put blame on anyone else or to behave other than pleasantly even to those who might have contributed to her troubles.

    This letter is, of course necessarily phrased in very general terms but I cannot imagine Miss Jupp applying for apost for which I would not be prepared to support her in the very strongest terms.

    D. Stark Murray, B.Sc. MB Ch.B.

    From T.C. Thomas

    David Stark Murray ——— 30 years of comradeship and friendship

    I joined the S.M.A. in 1941 during the war but I did not become active immediately. It was in 1946-7 that I went to any of their meetings, eventually becoming a member of Council and ultimately a member of the Executive Committee; the late Somerville Hastings was the then President. I was instrumental with other S.M.A. members living in the North West Middlesex area in forming a Branch of the S.M.A. to function in the Willesden, Wembley, Harrow and Uxbridge sectors; this has remained throughout the years to become the basis of the London & Home Counties Branch by amalgamation of all the existing smaller Branches. It was then during the latter years of Somerville that the gifts for leadership and after his death, that David Stark Murray exhibited and pursued until his own death.

    He was long established as Editor of Medicine Today and Tomorrow by this time and his speaking activities in the lead up to the introduction of the National Health Service throughout the U.K. kindled and developed the nation-wide reputation he enjoyed in the Labour, Co-operative and Trade Union Movements, as a Pioneer in Health Service Politics.

    His speaking engagements would take him throughout the U.K. to union branch meetings, or to the ward labour parties; to co-op guild and political gatherings, to women’s’ guild meetings; to election platforms. He once stood as a Parliamentary Labour candidate, but he had no stomach for this hurly-burly. He would talk to the Ministers with other S.M.A. colleagues on all aspects of Health legislation, with Aneurin Bevan, with Hilary Marquand, with Kenneth Robinson, with Dick Crossman, with Barbara Castle and David Owen, and more recently with David Ennals. These official consultations and collaborations cover a period of over 33 years. His reports back to the S.M.A. Members throughout the years, indicated the clear thinking, often obstinate opinionated stance he would take, but his gentleness and kindliness of manner would cause no animosity or friction. These traits he would pursue also within the S.M.A. He did not set-up any factions or allow personal animosities to develop among members, for he was courteous and friendly towards everyone. As a Scotsman he was catholic in his tastes; a keen sports fan especially rugby and soccer or football; we saw many a game together at Wembley. As a Welshman England rugby or football were our joint hates.

    My most intimate contact with him was as members of an S.M.A. delegation to the Soviet Union at the invitation of the Medical Workers Union of the U.S.S.R. Our other comrades were Dr David Kerr one-time M.P, and our then S.M.A. Hon Secretary Fred Ballard, a dentist who died some years ago and Harry Daila, an optician, then and as now the Hon Sec of the S.M.A, Ophthalmic Group. This was in 1958 and the first official delegation from the S.M.A. to the Soviet Union. It was a multi-disciplinary team and as a Pharmacist I was able to request visits to the Polyclinics and to their Pharmacies, their Aptaki. My colleagues were also able to make their specific requests. We had previous to our going been asked by the Medical Workers Union for guidance as to our requests. Consequently when we arrived in Moscow our hosts had drawn up a schedule of visits, interviews, discussions and an exciting leisure programme, in each city and town we visited.

    The number of Toasts end the amount of Vodka were to me the first problems as a near tee-totaller. However I noticed the Treasurer of the Medical Workers Union put mineral water in his Vodka glass, and I followed suit. My other colleagues appeared to me to also have some minor problems for one or two non-appearances at breakfast time did occur. We were greeted with the utmost friendliness and cordiality, and David Stark Murray as the delegation leader responded with cordial good humour. We spent 18 days of intense interest and delight. Our hosts would burst into song and we would join in, with our mixture of English, Scottish, Welsh and Jewish voices.

    We were in Moscow and on the  Red Square for the 1958 Red Square Parade. Our companions in the coach to the Red Square were the Hungarians. In the front row of overseas visitors were the Chinese and our immediate guests were the Egyptians. It was cold and drizzly which spoiled the day but for me not the occasion. David Stark Murray was an excellent camera man and took a very wide range of photos over the years and during his visits abroad on behalf of the S.M.A. and for the N.H.S, to the U.S.A. to India, to the E.E.C. countries. To my knowledge his total collection of stills and cine photos must be very interesting.

    The itinerary prepared by our Russian comrades included visits to Leningrad, Krasnodar for re-fuelling, Sochi on the Baltic coast, than on to Stalingrad where we were shown a Film of the Battle for Stalingrad. This was very moving. From Stalingrad we were ferried across the Volga to visit a new town being established, to study their hospitals, poly-clinics and pharmacies. In between the professional content of our activities, we were taken to the Bolshoi to see ballet, to the puppet show and to the Lenin Stadium for an athletic display and a football match. In the stadium was Khrushchev and Nasser.  In Leningrad we were taken to the circus with the clown Poppy as the star. We also visited the Hermitage and the Summer Palace. In Sochi we stayed in a workers’ sanatorium and visited Thermaland Sulphur Baths.

    Throughout this strenuous tour David Stark Murray retained his good humour and unflappability which contributed greatly to its success and to the excellent relationships which were built up and remained among its members. Although David did most of the speaking on our behalf we were all given the opportunities to do so at formal and informal gatherings. I have spent some time on this aspect of our intimate relationship as it highlights his feeling of companionship and comradeliness.

    The whole of these years of my knowledge of him he had been the Editor of Medicine Today and Tomorrow and thus had shaped the thinking of the S.M.A and of course continued his speaking engagements. His retirement from the Editorship in the late 1960s ended a reign as famous in their contrary ways as that of Kingsley Martin from the New Statesman. David’s successors have a hard task to match his skills and expertise.

    One of the features of S.M.A activities over the years has been its Week-end schools. David and Jean were always guests, during the last few years because of increasing costs in travel to the venues and the cost of accommodation, Week-end schools are not viable and the S.M.A has used Day Seminars to keep in touch with the various working-class movements of which it is a special part, being responsible for health and social policies. David Stark Murray’s knowledge of specialist speakers and of suitable subject matter was used by the organisers of weekend schools. Now during these latter years, his collaboration has been much sought and utilised. He would speak or take the chair whenever asked and made himself available for any S.H.A. task or call. Up to the last he would attend London Branch House of Commons meetings. During 1977 he received a request to speak at a Conference in West Wales. He want although he had not been too well prior to this engagement.

    His regular attendance at Annual Conferences, at Council and Executive meetings was another unique feature of his constancy and loyalty. He was a strong debater and always prepared his brief, seldom would he come unprepared for any of the meetings. Consequently he was listened to and heeded by his colleagues on the many committees and councils he attended. He had an excellent memory and would quote much of what had been agreed as S.M.A policy over the years. So much of this policy had been argued for by him on platforms and in Medicine Today and Tomorrow.

    Evidence to the Royal Commission on the National Health Service was one of the last occasions on which his ready pen and facile thinking contributed to the debate and discussion. He prepared his own Evidence but he also discussed and contributed to the Evidence prepared by the S.M.A. Council for submission to the Royal Commission. He was a strong Advocate of the Scottish system of the organisation and administration of the N.H.S, and invariably quoted the Scottish system in discussions on policy within the S.M.A.

    The task of those who remain in the S.M.A at the present time is to continue his work and purpose in the lifetime of his campaigning for a socialist national health service, so that it will not have been in vain but rather act as an inspiration and guidance in our contribution towards these same goals. His life could be aptly described as unfinished business – which can be said of all our lives.

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    If you speak to any active member of the S.M.A. about Edinburgh they will automatically think of, and almost certainly speak of, one person, Dr. Julius Lipetz, general practitioner, activist and model of activity. Those who have read these Profiles will have observed one thing the subjects have in common, that they are never men or women with one track minds or restricted interests. They are all featuring in these columns because they have given great service to the cause of health and have seemed to put every minute into that cause; but all have shown a wide interest and sympathy with the human race and all have had time for study, work and help in other human activities. Julius Lipetz follows the same pattern and follows it with an energy and persistence equalled by few.

    Dr Jules Lipetz

    He has done so without, too often, arousing bitter opposition and usually with such a return of affection that everywhere he is spoken of and addressed as “Julie”. He returns that affection in a variety of ways, the best and most frequent of which is to try to stimulate his friends not only to greater efforts but to greater depth in their political thinking. Throughout he leaves no one in any doubt that human activities have their best developments and their inspiration in Edinburgh.

    Julius Lipetz was born in Edinburgh on 3rd October, 1903, where he was educated at the Royal High School. His education progressed but so did his ability on the playing field and he played for the first team in both rugby and cricket: and he kept up his interest in the latter for thirty years. He graduated at Edinburgh University in 1926 and after two years of hospital work joined his brother in practice in 1928. That practice still continues and has played its part in those G.P. activities which have made Edinburgh so important a place in the training of modern doctors. Practice, marriage and children occupied the next few years but Julius’s political awareness and activity were intensified by what was happening in Spain and in Europe. Medical politics soon came into his life and as the argument on health services became sharpened he and his brother were always in the forefront in discussions in the B.M.A. and in the newly formed Edinburgh S.M.A.

    But all this was interrupted by World War II in which Dr. Lipetz with the rank of Captain served for nearly four years in the 8th Army. His battle front experience started in a casualty clearing station in North Africa and then as the allied armies moved, in Sicily. In Italv he was closely engaged at the battle of Monte Casino; and concluded his service with eight months in Palestine. Photographs of that period show he has changed very litt’-e and on his return to Edinburgh his activities were all resumed, with even greater vigour.

    Julie makes no bones about how left wing his views in general are but they are tempered by a practical streak which wants results more than theories. The SMA in Edinburgh has held many meetings; con­ferences and demonstrations and all of them owe almost everything to Julie’s preparedness to work himself and to get others to work with him. His socialism means co-operation, co-operation to achieve a particular goal and he has, therefore, always understood that the working-class must not only learn to vote for policies, it must work for their policies. So the S.M.A.’s closest relationship in Edinburgh has been with the trade union movement in Scotland and with many other sections of the Labour and Co-operative movements. Speakers who have travelled to speak at an Edinburgh SMA meeting have all been amused (considering the meetings they have had elsewhere) at Julie’s deep regrets that he had only one hundred and twenty delegates present.

    He might have liked one of his family to have gone into medicine and joined him in his practice but that is never how things work out. But the family could not escape from the continuous example of social responsibility which Julie gave them and the equally continuous example of care for human beings which their mother, Marjorie, gave them. So his daughter trained as a nurse in Edinburgh and in spite of a career interrupted by marriage and four children is once more working as a nurse in London and keeps up her interest in the SMA. One son is a social worker in Lambeth, an area of London where he must find many problem children, his speciality to deal with every day. Julie’s eldest son is an engineer with the Coal Board but he maintains the family interest in politics. Like the writer of this profile he very often does not quite agree with the stand his father takes on certain subjects; but all are united in the need for a better life for all their fellow men.

    It would be interesting to do this tribute to an Edinburgh G.P. sitting invisible in his surgery, listening to his sympathy with, encouragement for, and sometimes orders to his patients. Whatever they needed he would give them to the fullest extent of which he was capable. So it has been in the SMA nationally and in Scotland. Whatever the SMA has in his view needed he has given to the full. Sometimes it has been anger and astonishment at other people’s slowness and lack of understanding, sometimes applause for jobs well done, but always work and more work for the great aim of his life, a health service better than he or anyone has yet been able to give. Edinburgh and the SMA would certainly have been poorer without him.


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    After five years of experience of the N.H.S. we are becoming increasingly convinced of the need for closer integration of the preventive and curative aspects of medicine.  This need for co-operation and integration should affect training for the service as well as the actual service itself.

    Though the public has benefited to a great extent from the service it has often involved considerable inconvenience to patients because of its organisational failures, and the public is often more aware of the benefits obtained by administrators,doctors and other health workers that the benefits obtained by the sick patient.  The bad conditions still often found in doctors surgeries, hospital out-patient departments,  the difficulties met with by patients in need of dental or other emergency treatment and the long waiting lists stand out among other difficulties.

    One of the basic facts to be taken into account when making plans for the future is that every patient must be seen as a whole person in his environment, and that includes his home as well as his work.   Undergraduate as well as postgraduate teaching in the past has been confined to patients in hospital, separate from their environment.  Preventive medicine, the study of minor ailments and industrial diseases have been almost completely ignored.  The isolation of the teaching hospitals from any local community has aggravated this problem.

    At present about 5% of the national income is being spent by the Ministry of Health.  We must convince the people that a larger amount must be spent and we should concentrate our attention on the periphery, that is, the service to the person and the family at home and at work.   Power must be less concentrated at the centre. The people at the periphery must feel that it is their service.  There must be coordination at district, regional and ministerial levels.

    The key to this development lies in enlightened general practitioner activity which must be integrated with all other health and social welfare organisation.   This can only be done by creating a new organisation; a local health authority.  What should this local health authority be based on?  A population of 250,000 is probably the absolute maximum; perhaps the optimum, would be a 100,000 to 150,000 inhabitants.  Many local authorities are thus too large for such an authority.   Similarly local executive councils are not suitable, but it appears that many management committee areas are convenient and in some of these there is already excellent liaison between the hospital service and the general practitioners.

    Eventually only a reform of local government can bring about an ideal solution to this problem. A local health authority of this size would also be an ideal one to administer the health centres which for such an area would, have to comprise one or two comprehensive ones and six to ten smaller ones.  We must educate the profession and the public to understand the need for these health centres without which an integration of the Health Service such as we envisage would be quite impossible.   On the preventive and occupational aspect this size of local health authority would also be convenient.   While we are working for this development to take place much can be done to prepare for it. Local committees can be formed to co-ordinate the work of the different authorities.

    We must examine the scope and structure of such a local health service more closely and consider the personnel it would employ. In doing so we would have to consider the training of this personnel for its special task.

    At present we have, often uncoordinated:-

    1. The General Practitioner and other services under the Executive Council.
    2. The Local M.O.H. and his staff.
    3. The Welfare Authority including the Children’s Officer.
    4. The Hospital Service
    5. The Tuberculosis Service.
    6. The Mental Health Service.
    7. The   Factory Health Service

    The main task of a local health authority would be to co-ordinate all these services.  It would help this task tremendously if many of the health workers in these different branches had part of their training in common, so that they better understood each other’s work.   This applies mainly to the social workers, such as almoners, psychiatric social workers, , welfare officers, children’s officers, health visitors, duly authorised officers, rehabilitation officers and perhaps   also the district school, clinic and factory nurses who could share one year of their course of training as a course in social case work.

    A unified administration could co-ordinate their work and see to the more reasonable distribution of these workers. At present for instance some hospitals are well staffed with almoners who often see every patient admitted or seen in the out-patient department, while in other hospitals there are no almoners. Trained social workers can then concentrate on what is their real function, that is to help, people, who have social and personal difficulties for which they need skilled assistance.   Untrained social workers can both waste time and do damage.  Under this same unified administration should also be the sanitary officers, factory inspectors and home helps.

    The person administering this social service would have to be specially trained, a medical man with a broad training in sociology is required who would work under the all purpose local health authority.

    In this new context the general practitioner’s work will gradually take on a new aspect. It will give him a chance of increasing specialisation for it is now no longer possible for one man to master all aspects of preventive and curative medicine. His contact with the preventive service and the hospitals would be improved and he could concentrate more on the effective scope of his work for which he will have to be specially trained, not only in hospital but also in health centres and in the field.

    To reorientate the training of general practitioners the undergraduate teaching schools should serve as district hospitals, taking a complete cross section of the sick of the local population, both acute and chronic.   It is wrong that the major teaching hospitals are situated in the centre of big cities and select their cases.  Health centres should also be associated with these hospitals so that students can have part of their training in them. If the teaching hospitals are also linked with the local health authority the student would get an insight into the working of the health service in the country.   There will have to be a reorganisation of the pre-clinical and clinical syllabus to provide a more balanced education.   Preventive medicine must become a part of the training and more time should be spent on the problem of the elderly sick.

    If doctors are to spend a good deal of their time on the preventive aspect then it is more essential than ever that they should be working on a salaried basis.  Preventive work takes up much time and cannot be related to a fixed number of patients. Practitioners lists will of course have to be cut down, even 3,500 is far too many. If the number is no more than 2,500 then the general practitioner will also have time to do school medical officers’ work as well as maternity and child welfare work from health centres.

    Even before we have health centres G.Ps. should start forming Group Practices as much as possible.  Specialisation within the group should be encouraged. Full equipment of surgeries should be ensured and pathological and radiological facilities provided for these groups.  Entry into practice will be facilitated by a salaried service and prolonged assistantships should be forbidden.The hospital can play its part in preparing the doctor for this work by making registrars posts a gateway to consultant and general practitioner work, especially if the registrar has the chance of working in a health centre attached to his teaching hospital.  The other way round many a general practitioner who has specialised may wish to enter hospital practice, starting as a. G.P. clinical assistant.  The path to consultant status should be broadened in this way and any great disparity in status between consultant and practitioner diminished.

    The hospital service will continue to need planning on a population basis larger than that of the local health authority already outlined, as there are many specialities which cannot be developed in a restricted locality.  However the hospital should serve the community in close cooperation with all other health and welfare provisions.  Until health, centres are provided and the desired modifications of local authority are made the district hospital with its management committee might serve as the focal point of health workers in the area.   So many problems demand immediate and increasing co-operation that meetings of those concerned are desirable. The hospitals need to discharge patients at the earliest moment.  This necessitates a close association of hospital doctor, practitioner, district nurse and social welfare administration.  This cannot be fruitful unless each understands the problems of the other and personal contact is essential. The team work of the hospital should extend to the district.  The dependence of the local community on its hospital should be reflected in the service of the people to it, for in future we should like to have much more recruitment of nursing and other staff from amongst those who we serve.  Conditions within the nursing profession have improved and they should remain good enough to attract intelligent local girls and any prejudice to local recruitment should be discouraged.  Every opportunity should be taken to interest the local population and practitioners in the hospital.

    Local interest and support for hospitals varies greatly in different localities and an increasing number of bodies of organised supporters known as “The Friends of X Hospital” or by a similar title have now developed. In general short-stay hospitals the members may be ex-patients, their relatives or any local citizen who has become interested in the hospital.  With Friends of Sanatoria, children’s long-stay e.g. orthopaedic hospitals, and particularly mental and mental deficiency hospitals the majority of members are relatives of the patients, as they have the maximum interest in and incentive to improve the particular hospital.

    Formation of these organisations is an indication of local interest and concern in the hospital and it is the development in the public of identification with its local hospital that can be our greatest safeguard when “economies” are directed to the lowering of hospital standards.

    Organisations of hospital friends can learn about the standard of care and the needs of their hospital; and their most useful function is to make known the need to focus attention on it and to stimulate those responsible to meet it.  Additional functions would be the visiting of patients who have no relatives; reading to blind or otherwise incapacitated patients and similar activities. They can also help in recruiting campaigns for nurses and other staff.

    The collection of funds for extra amenities should be a very minor function. The danger of such Organisations is that they may be used by people who are not representative and apparently represent no opinion but their own, and that they will be made an excuse for not providing amenities which the National Health Service should provide.

    On the other hand, if truly representative of the population the hospital serves they can make a valuable recruiting ground for members of Hospital Management Committees and Regional Boards.

    The deficiencies of hospital provision have been accentuated by the lack of any new hospital building since 1938.  If present methods of capital allocation persist this state of affairs will continue. We are patching up slum hospitals and are falling behind most nations in new building. Our conscience has become numbed about the needs of our ill people. The position is especially bad in the case of mental hospitals and mentally deficient institutions.  In tuberculosis also the situation is still serious in many parts of the country.  The waiting period for operations in the case of many women’s disorders and simple surgical procedures like tonsillectomies, operations for hernia or varicose veins is often months, if not years.  Co-ordination between some large and smaller hospitals has increased the service given but this must be extended. Too many vested interests frequently hold up planning and local prejudice perpetuates inefficiency. It is the function of regional boards so to plan existing resources that full use is made of all beds.

    We should study carefully the future of administration within this expanding service.  Undergraduate training has tended to produce a desire for professional freedom but it has neglected the need for co-ordinated activity.  Team work throughout is indispensable and some co-ordination of our efforts must be evolved.  Doctors should take their part in joint consultations with other health workers in all spheres of activity.

    Present methods of administration have taken the hospitals from the political field. Little pressure is exerted in Parliament on their behalf.  Regional Boards as selected are dominated by Chairmen who regard themselves as agents of the Minister. The status of the Minister of Health in relation to other Ministries is very low. When economy is in the air the health service is very vulnerable and it is essential that there should be a method of financing capital works other than from annual central allocation.  We certainly cannot wait for the completion of the national housing and rearmament programme before adding to our hospitals.

    The consultant staffing of our hospitals is still based on the uncoordinated activities of individual small all purpose hospitals which existed before the service.  Too many consultants-spend too much time travelling.  It is not unusual to find one management committee group served by five or six consultants in one specialty and they not having more than thirty beds in the various hospitals. The consequent inefficiency is obvious.  Often even serious emergencies are dealt with by comparatively junior registrars.While a considerable private practice persists and hospitals are staffed on a part-time basis it is often difficult for regional boards to discover the true consultant needs of a locality, for consultants often discourage increased competition.  An effective yardstick for consultant service should be evolved and this will entail further appointments, for few areas of the country can be said to have full provisions yet.  Whole-time appointments should extend throughout our hospitals.

    More highly specialised units should be established in regional hospitals for the increase of these in undergraduate schools has almost prevented the student from getting a correct perspective of medicine.

    The Junior Staffing of many of our hospitals is presenting great difficulty; this is in part due to the claims of the armed forces whose demands we hope will be temporary.   It is due in part to the fact that hospital experience brings no increased reward or status in general practice.  In fact the more post graduate hospital experience an applicant has had the less eligible is he often for an appointment by a local medical committee. This situation will continue until financial competition ceases to exercise such a strong influence and until the practitioners cease to assert an ability to cover the whole realm of preventive and curative medicine.  Another reason for the difficulty of junior staffing in hospitals is the division between teaching and non-teaching hospitals.  The young doctor who wants to specialise finds that he can only do so with any prospects of attaining consultant rank if he remains in his teaching hospital.

    The pre-registration house appointments will give some experience to all young practitioners but such experience should be extended to general practice as soon as conditions permit, for we cannot neglect training and experience in this field in which so many will spend the rest of their professional lives.

    Ambulance provision should be an integral part of hospital administration. The present divorce from its main user leads to wasteful lack of appreciation by all concerned.

    An Occupational Health Service integrated with a preventive and curative one can be seen to be so essential in mining and other heavy industries that it should soon be extended to the whole of industry.   The method of supplying these services from Health Centres will call for experiment and it may be that some centres can operate in factories where these are served by a local community.  Health centres too cannot be provided without a considerable capital outlay and this must be considered with the need for a capital expansion in the hospital service. We cannot hope to equip our nation for the effective increase of output if we allow our health service to remain in a state of poor development which was sufficient a century ago.

    If preventive medicine is to be encouraged practitioners and specialists will need many more convalescent and rest homes than are at present available.  Much organic disease and mental ill-health is resulting from strain both at home and at work.  This could be alleviated by preventive rest breaks.  These should be available for people of all ages. At present it is almost impossible to get adolescents or aged people away.  Teachers in school and university, health visitors, factory nurses and others should be encouraged to refer all who appear to be in need of such a change to their own practitioners for assessment.   Routine medical examination extending throughout life should be the aim when there are sufficient doctors and premises to supply it.  Health education also needs more imaginative handling than it receives at present.  A special study of it could be introduced into the medical curriculum. At the moment too much of it is left to ill considered articles in the press and too little has official and scientific backing.  The application of science to medicine and an increasing social awareness amongst its practitioners are resulting in revolutionary changes in treatment. Similarly great changes could be brought about in prevention. An efficient organisation of the health service can ensure our population reaping ever increasing benefits at the same time the health worker will have a more satisfying life freed from many daily frustrations.

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    By Leslie Hilliard 26.9.1952

    Before 1948 local interest and popular support was directed almost entirely to the few large and many small voluntary hospitals.   Little or no interest was shown in the municipal hospitals owing to their Poor’Law ancestry.   It was usual for the medical profession and the public to react emotionally to the two types of hospital and give fulsome praise to the voluntaries and run down the others often without sufficient knowledge of what really went on in either type of establishment.

    Today in the National Health Service a new dichotomy has been substituted for the old. In England and Wales the teaching hospitals are a semi-autonomous group which has inherited mantle and prestige of the former voluntaries while all the rest of the country’s hospitals, almost without exception, have been unified into a national service under the Regional Hospital Boards.

    The grouping of hospitals of different sizes and functions .under Hospital Management Committees has had the effect of giving prestige to the large general hospital of the group. Nearly always this will be an ex-municipal hospital and the former voluntary hospitals with their relatively small number of bed’s take on a minor ancillary role.   The bulk of the population needing hospital care will today receive it in the many units of the Hospital Management Committee groups.   Those now attending teaching hospitals are, therefore, many fewer than those who formerly attended and therefore supported, the voluntary hospitals.

    In the four years that the National Health Service has been in operation the effect on public opinion resulting from the above circumstances has already become apparent.   The attitude of patients and their relatives to the former rate-aided hospitals is rapidly, if unconsciously, changing.   The old distinctions have been abolished  by Law,   and the local hospital  is becoming “the”  hospital of the locality  whether  it  was previously  patronised or  ignored  by  those  who  were  not   its patients.     This would not have been possible without the recent physical   improvement of the municipal hospitals by progressive local   authorities and the even greater upgrading now made possible under the National Health Service.

    Although local  interest   and  support  for hospitals varies greatly  in different   localities an increasing number  of  bodies  of organised   supporters  calling themselves the  Friends of X Hospital or a  similar title  have  now developed.   In general short-stay hospitals the members may be ex-patients their relatives or any local citizen who has become   interested   in the hospital.  With Friends  of  Sanatoria,   children’s long stay e.g. orthopaedic hospitals, and particularly mental  and mental deficiency hospitals the majority  of members  are  relatives of the patients, as they have the maximum interest in and incentive  to   improve the particular hospital.

    The main function of these organisations is not primarily charity as   in the old days when the hospital was directly supported by voluntary contributions. The activities of Hospital Friends are an  indication of  local   interest  and  concern in the hospital and it is the  development  in the public of  identification with  its local hospital  that  will  be   our  greatest   safeguard  when “economies”are directed to the lowering of hospital  standards.    The Friends of St. Leonards Hospital showed their strength when they prevented a step being taken by the G.N.C. which would have resulted in the closing of the hospital for lack of nurses.

    Organisations of hospital friends can learn about the standard of care   and the   needs of their hospital.   Some of  these needs  can be met  out  of  their own collected funds but  the  Friends’  most useful function  is to make known the need,  to focus attention on it  and to   stimulate those responsible  to meet it.

    By way of example mention may be made of the ‘Friends of the Fountain”, a hospital for 600 mentally defective children. In the past three years they have set up an active and well organised committee of parents, and have a membership of about 400.   They have collected money from their members to provide amenities for the   children.   But by interesting outside persons and bodies in the work of the Fountain Hospital they have already collected over £5,000. They have  presented  a £500  occupations hut  for patients, contributed £1,000 towards the  furnishing  of a holiday home  at Hastings for  which they had  campaigned and were the prime movers in obtaining the much used hospital coach.



    They contribute to the hospital’s monthly magazine and arrange socials for parents and entertainments for the children.  Their most valuable function has been to inform the public of the problems of mental deficiency by developing the National Association of Parents of Backward Children which has given guidance to many parents and organised lectures and radio and. television talks on the subject.

    If Friends  of  Sanatoria were  developed  all  over the   country and became  as    active   in their   special  field  of  anti-Tuberculosis propaganda  it  would be  a great   step to  the achievement   of our stated aim  of  abolishing that  disease   in a  generations.

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