Building a Health Service1
| Author | L. John Edwards |
| DOI | http://doi.org/10.1111/j.1467-9299.1948.tb02638.x |
| Date | 01 June 1948 |
| Published date | 01 June 1948 |
Building
a
Health
Service‘
By
L.
JOHN
EDWARDS,
O.B.E.,
M.P.,
Pariimnent-my
Secretary
to
the
Ministry
of
Health
A
MEMBER
of
the Government who accepts
an
invitation to speak
on
some
topical
aspect
of
the work of his Depamnent must necessarily impose
certain
limitations
on
what he
says.
There are
always
a
large der
of
matters
which
are under discussion
and
which cannot be prejudged, and quite often delicate
negotiations going
on
in private which might
be
prejudiced were even
a
junior
Minister to speculate about them in public.
Nevertheless, the subject “Building a Health Service” is vast enough in
all conscience, even
if
one restricts oneself to the administrative parts
of
thc
subject. I do not need to tell you that administrative problems are all too
frequently neglected.
I
was
trained
in
the social sciences and naturally, there-
fore, believe
in
the value of the work done
in
the social sciences. I
am
convinced
that
a
large part
of
our
problems
in
the world today are caused precisely because
we have not found the means of matching our technical skills with approprirue
social skills. I share the view expressed
so
weu in the P.E.P.
Report
on
the
Health Services
that
“
It is
no
less necessary for those concerned with
national
health to examine the diseases
of
insurance schemes
and
of
the
general
practitioner
system than it is to study heart disease and cancer.”
I
think the persons who
are engaged
in
simplifying and reducing the number of forms to be used’in the
health services take their place alongside the research workers
in
cancer
and
heart disease. The person who devises simple criteria of the performance of the
various services should
be
granted a gold medal by the Institute.
It is, I think, as well
if
we remind ourselves that health is a positive
thing,
and
that
our essential health services are pre-eminently those which deal with
environmental factors like nutrition, food policy, priority classes for milk, schoo!
meals, living conditions, housing and public services, working conditions, leisure-
time
activities and social and economic security. These are
all
positive
health
matters. Most
of
my topics this evening are not
in
this
category. Perhaps
more properly we should
say
that we are discussing services for the sick, for
certainly the National Health Service Act is mainly concerned with dealing with
ill-health.
EXISTING
DEFECTS
Before the passing
of
the National Health Service Act in
1946,
there
was,
I think, substantial agreeinent
that
legislation was necessary to remedy the many
defects
in
the multiplicity of hslth organisations.
I
do not suggest that the
present service, whether by general practitioners or by hospitals, has been
bad,
but there are a number of defects which
it
is impossible
to
remedy without a
constitutional change.
Let
us consider some of them:-
(1)
Although
the National Insurance Scheme
has
on
the whole worked well,
it is
not
sufliaent
in
itself, as it
is
limited
to the
21
millions
of
insurable popula-
tion.
It does not cover either the self-employed or the dependents
of
the
insured, or those
in
the higher income groups. The result is that many people
arc
deterred from seeking medical aid
awing
to reluctance to undertake financial
Read
before
the
Institute
of Public
Administration
in
Laidon
on
14th Oaober,
1947.
66
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