from the SHA archives, Hull University

D Stark Murray

176 Kew Road

Richmond

21st February 1946

Confidential

Rt Hon Aneurin Bevan MP

Minister of Health

Ministry of Health

Whitehall SW1

Dear Aneurin,

Many thanks for your last letter which cleared up the point about the method of payment of consultants and specialists. Your letter was as you had previously indicated to me in our private conversation but the impression left with the SMA deputation was very definitely different and I was glad to be able to tell them the gist of what you wrote to me which has settled at least one of the points on which some of them were feeling most strongly. We have had quite a lot of discussion as to whether there was anything we could usefully do at this moment, either to assist you before the actual bill is prepared or to influence your views on some of the points, which as you will appreciate are still likely to cause some discussion. Our general feeling was that we should not trouble you even with our written views on what you had told us until the actual bill was available and then to go into action as speedily as possible and let you know the points of detail on which we thought improvement could be made. We are all finding the position a little bit difficult at the moment and hope you will be able to let us have copies of the bill at the same time as the BMA so that we shall have a chance of getting a statement out to the press as early as they will.

So far as I am personally concerned I am still inundated with requests for meetings and find the subject a little bit more difficult than it has ever been before. I have been doing my best to present the possible lines of the government without making it appear that in fact I knew what the proposals were likely to be. You will be interested to know that I was in Pontypool at the weekend and had three very interesting meetings. Two were lectures at the Educational Settlement with lay audiences who were very keen indeed and wholeheartedly in favour of the new service and of the most speedy development. I also had an informal meeting with the local general practitioners and found very little disposition to fight against the introduction of a National Service. You know more of the details of how GPs in areas like that acquire thier present income and I did not find one who would have objected to becoming a Salaried Officer in the new service, and most of them seemed to expect that their financial position would be improved.

I hope I shall have a further opportunity of talking over some points with you before the bill appears and I hope you will help me to be ready for the innumerable newspaper queries I shall have when that happens by letting me know the date a little in advance. In the meantime may I raise three points that have been put to me by socialists in the last few days. The first is on the relationship of the university to the region which it is in the centre. Certain university people are going around saying that the composition of the regional board and the special priviledges of the teaching hospitals will give to the university centre and the consultants attached to it almost complet control of the service. I am quite sure that this is a wrong interpretation but it is the view that has been presented to the Royal Colleges. The second point comes from the same group, one of whom stated at a recent meeting that a patient going into a private ward in a hospital would be automatically deprived of all benefits of the service and would have to pay for all of them privately. Charles Hill on the other hand has been putting out the opposite story, that nay patient can obtain any item of service, either privately or publicly but the consultants deny that and while again I think Hill must be nearer your actual intention, it would be a help to know. The third point is, a really big one, and that is how we are to achieve unity or even co-ordination between the curative and preventive services if all the preventive services are to remain in the hands of the major local authorities while the hospitals and general practitioners have a separate administration. Will there be any form of staff liason between the three sections or will the ministry have some overriding powers which will ensure that the services, although administered separately , do in fact work together? It was this point, which in the past, influenced us to insist on a single health authority and while we appreciate the reasons for devising three separate administrative structures, this question of prevention of disease does present a great difficulty. I may say that it is one which impresses the lay public almost as much as socialist workers and i am constantly asked about it in my meetings.

I hope you have completely recovered from the influenza attack which prevented you being with us at Friends’ House. It was a very good meeting but would, I think have been a real bumper one had the announcement of your absence not appeared in the morning press. We are all hoping that at a later date we shall be able to arrange for you to address us perhaps after the bill has made some progress,

Yours sincerely,

David


11th March,1946.

Dr. D. Stark Murray, 176, Kew Road, Richmond,

Surrey.

Dear Stark,

Thank you for your letter of the 21st February. I am glad that the position on the payments to consultants is now clearer. You can be sure that you will be able to get a copy of the Bill as soon as the B.M.A. will, and we shall be glad to help you with newspaper queries by giving you an indication of the date of publication in advance.

On the three points you raise. it is clear that misunderstandings are abroad. First, it is certainly not the case that the University, and the consultants attached to it, will control the Service. They will together be in a definite minority on Regional Hospital Boards, although they will no doubt carry considerable weight in the Boards’ work.

Secondly, there is some confusion of thought about this question of private treatment. The intention is that any patient shall be able to obtain any part of the treatment he requires under the Service or privately, as he may desire. For example, a patient can have a private general practitioner and use the public hospital and specialist service, or he can have a public general practitioner and private specialist treatment. In the hospital, I contemplate that a patient receiving public treatment shall be able to obtain additional, privacy (always provided that the private wards are not wanted more urgently on medical grounds by other patients) by paying the additional cost involved, but I also contemplate that at some hospitals at least there will be private accommodation where private treatment will be given by specialists on the staff of the hospital and where the patient will pay in full for both accommodation and services. Private accommodation of this character will be provided only where I think it is reasonable to do so and also only if it is not wanted urgently, for a non-paying patient on medical grounds. It is the latter type of arrangements which may have given rise to the suggestion that a patient coming into a private ward would be deprived of all the benefits of the service.

On your third point, the Minister must clearly bear the major responsibility for co-ordination, and he will have powers of direction, if necessary. Locally we can secure some degree of liaison by the representation of the various parties (local health authorities and executive councils) on the regional and other hospital bodies. At the officer level there will certainly be functional liaison, for example, by the employment of hospital staff in health centres and elsewhere in a consultant capacity and by the use of local authority health visitor and similar staff in hospital clinics.

Another point that we must watch is to see that the medical officer of health is brought in to the operation of the hospital services in the most appropriate manner. But these are all questions for solution by administrative action (and probably by trial and error) when we have got our Bill. and I think the Bill itself will be found to give the basis necessary to enable us to do it.

Yours sincerely,

Aneurin

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