The Minister of Health agreed that the Cabinet should first discuss the question of principle: it was for that reason that he had refrained from discussing in his memorandum the details of any possible charges. Ministers had in fact considered this question already, in the discussions in the Economic Policy Committee in October 1949, about the reduction of Government expenditure (E.P.C. (49) 34th and 35th Meetings); and he had been under the impression that they had then satisfied themselves that the principle of charges should not be applied generally throughout this Service. A large proportion of the total expenditure on the Service was incurred by the hospitals, and there would be great difficulties in recovering a “hotel” charge from the occupants of hospital beds. For a wide range of hospital treatment, particularly in Scotland, no charge had ever been made even before the introduction of the National Health Service. And the deduction of sickness benefit which was already made after the recipient had been in hospital for more than eight weeks was in effect equivalent to a charge. Even if it were now decided that hospital patients should contribute ten shillings a week from the date of their admission to hospital the total revenue raised could not exceed £10 million. And he could not predict how much of this total would in fact be recovered; for he was satisfied that, if such a system had to be introduced, it must be operated by the National Assistance Board and not through a revival of the almoners’ functions in the hospitals, and he could not say what criterion the Board would apply in determining the patient’s capacity to make such a contribution. In the dental service he did not favour the introduction of charges: he would prefer to proceed by way of closer scrutiny of the dentists’ claims, if the Treasury would agree to the appointment of not more than twenty inspectors for this purpose. In the ophthalmic services he was prepared to reduce the choice of spectacle frames provided free of charge, and to increase the charges made for other kinds of frames; and he expected to secure by this means a saving of £1.

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