The National Health Service
| DOI | 10.1177/026455054900501902 |
| Author | James Ross |
| Published date | 01 January 1949 |
| Date | 01 January 1949 |
| Subject Matter | Articles |
246
THE
NATIONAL
HEALTH
SERVICE
By
SIR
JAMES
ROSS,
K.B.E.,
C.B.,
A
Regional
Officer
of
The
Ministry
of Health
Introductory
Note:
In
October
last
I
was
invited
to
open
a
discussion
on
the
National
Health
Service,
at
a
Conference
of
the
Mid-
Southern
Branch
of
the
National
Association
of
Probation
Officers.
In
this
article
I
have
set
out
the
substance
of
the
address
I
then
gave.
My
aim
then-as
is
my_
aim
now
-was
not
at
all
to
furnish
specialised
notes
on
the
National
Health
Service
Act
for
probation
officers;
that
would
be
beyond
my
competence;
but
rather
to
give
a
general
outline
of
the
policy
and
plans
of
the
National
Health
Service
as
a
whole
and
an
estimate
of
how
it is
working.
I
am
consciously
speaking
to
probation
officers,
as
I
write,
and
particularly
to
student
officers ;
and
I
suggest
that
by
this
way
of
approach,
that
is
to
say
by
first
seeing
the
National
Health
Service
in
its
own
setting,
you
will
be
the
better
able
to
study
it
and
use
it
for
yourselves
from
within
your
own
specialised
field
of
action.
~
.
~ §
&dquo; The
evacuation
of
our
cities
and
the
findings
of
our
Medical
Recruiting
Boards
have
laid
bare
such
a
mass
of
preventable
disability,
of
under-
nourishment
and
poor
development,
that
we
are
ashamed.
There
is
much
to
be
done;
we
know
how
it
should
be
done,
and
it is
within
our
capacity,
if
we
have
the
will
to
do
it.&dquo;
I
That
is
the
case
for
the
Act.
These
are
the
final
words
of
the
classic
Hospital
Survey
(for
Berkshire,
Bucking-
hamshire
and
Oxfordshire)
carried
out
by
Professor
Gask
and
his
colleagues
in
1.944/45.
The
Act
gives
the
means
to
meet
that
need..
But
the
purpose
of
the
National
Health
Service
is
even
wider;
it
is
to
provide
one
of
the
essential
elements
in
the
great
social
plan
of
our
time.
So
I
invite
you,
within
this
plan,
to
think
of
the
Service
as
a
great
enterprise
offering
a
series
of
problems-first,
its
place
in
the
plan,
and
then
its
own
problems
of
policy,
of
organisation,
and
of
administration.
Look
at
these
problems
from
the
base-line,
so
to
speak,
as
if
you
were
yourselves
responsible
for
their
solution.
Indeed,
in
the
course
of
my
staff
work
I
have
met
no
body
of
laymen
with
a
more
varied
range
of
practical
concern
in
the
social
reconstruction
measures
of
these
four
years-ranging
from
the
Education
Act
of
1944
through
to
the
National
Assistance
Act,
the
Children
Act,
and
the
Criminal
Justice
Act
of
1948.
On
the
first
point,
our
place
in
the
plan,
it
is
difficult
even
for
ourselves
as
administrators
to
keep
pace
with
all
these
Acts
in
their
policy
and
inter-relationships,
but
the
big
things
stand
out.
And
I
am
sure
it
is
good
for
us,
each
for
himself,
to
think
out
a
working
philosophy
of
the
movements
in
which
we
are
taking
part.
Here
is
my
out-
line,
for
what
it
is
worth:
I
like
to
think
of
the
National
Health
Service
as
one
of
the
four
great
pillars
on
which
the
well-being
of
the
nation
depends.
And
I
believe
that
most
of
us
would
agree
that
these
four
pillars
are
Education,
Health,
Social
Security
and
Production.
These
four
things
are
all
inter-
dependent ;
you
cannot
have
any one,
in
its
proper
measure,
unless
you
also
have
each
of
the
other
three.
By
Education,
I
mean
not
merely
schools
and
colleges,
but
arts
and
crafts
and
the
teaching
of
citizenship;
the
teaching,
also,
of
the
things
of
the
spirit.
By
Health,
I
mean
the
word
in
its
widest
and
best
sense,
not
only
advance
in
clinical
medicine,
but
planning
for
Health
as
a
positive
policy,
the
radiant
ringing
health
of
a
happy
schoolgirl.
By
Social
Security,
we
mean
the
family
con-
ditions,
including
Housing,
Food
and
the
rest,
with
no
entrance
for
the
five
giants
of
the
Beveridge
Crusade-
Want,
Disease,
Ignorance,
Squalor
and
Idleness.
And
Production
has
the
proud
privilege
of
finding
the
ways
and
means
of
its
three
sisters.
One
could
go
on
to
say
that
all
four
are
in
their
turn
conditioned
by
the
integrity
and
endurance
of
our
people;
for
without
faith
and
freedom
of
soul,
all
our
planning
is
vain.
I
have
said
all
this
because
in
plain
practice
the
Health
Service
will
stand
or
fall
by
it.
II
It
is
important
to
keep
the
case
for
the
Act
clearly
in
mind,
and . to
continue
keeping
it
in
mind
through
the
difhcult
years
ahead.
In
spite
of
the
magnificent
ele-
ments
in
our
health
services
in
the
past
these
services
had
grave
deficiencies-want
of
provision,
want
of
power,
want
of
organisation.
Read,
for
example,
the
account
of
our
existing
hospital
provision
in
the
White
Paper
of
February,
1944
(Cmd.6502,
H.M.S.OJ.
To-day
we
have
60,000
hospital
beds
unoccupied
and
unstaffed;
we
have
some
40,000
nurses
short.
Progress
has
been
made
in
some
areas
to
correlate
hospital
provision,
but
it
was
only
under
the
stress
of
war
that
a
real
stocktaking
of
assets
and
liabilities
was
done.
We
have
had
some
1,200
voluntary
hospitals
in
the
country,
each
under
independent
man-
agement,
and
hundreds
of
them
with
about
30
beds
or
less,
and
this
is
parallel
with
the
growing
provision
of
municipal
hospitals
under
the
Act
of
1~929.
And
the
voluntary
hospital
system
had
completely
broken
down
on
finance.
One
great
hospital,
for
example,
had
a
record
income
of £ 103,000
in
1947
from
voluntary
sources,
and
yet
that
hospital
needed
£ 60,000
from
public
funds
to
square
its
accounts.
Capital
costs, too,
have
gone
right
beyond
the
possibilities
of
voluntary
finance.
The
General
Practitioner
Service,
fine
as
it
was,
did
not
nearly
meet
the
needs
of
the
people;
it
has
been
said,
for
example,
that
the
general
practitioner
stood
too
far
removed
from
the
children’s
physician
and
that
the
growth
of
the
Local
Authority
Child
Welfare
Service
had
been &dquo; provoked
into
existence &dquo;
by
the
need
to
fill
this
gap
in
the
nation’s
defences
against
ill-health.
The
con-
dition
of
the
teeth
of
the
country
was
unbelievably
bad,
and
one
could
quote
a
whole
range
of
other
things
on
which
the
provision
for
a
large
part
of
the
population
was
wholly
inadequate.
What,
then,
does
the
Act
do?
I
cannot
do
better
than
quote
Lord
Beveridge’s
words
in
the
House
of
Lords
on
the
Second
Reading
of
the
Bill,
when
he
preferred
to
the
two
main
things
tfiat
the
Act
does:
&dquo; The
first
is
that
it
removes
completely
the
economic
barrier
between
sick
persons
and
the
best
possible
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