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Page VII

My solution:

Government will not be able to do anything to reduce the overall costs for health care as little in this Country as elsewhere. Why not then keep a low profile and enjoin upon the major involved parties: AMA, AHA and maybe ABA and others to jointly work out a formula for comprehensive medical services for all citizens and have a workable organization within ten years acceptable to the Bureau of Health Planning and Resources Development.

access to health care.

Eugene J. Rubel is the 34 year old director of Bureau of Health Planning and Resources Development. He states that the reason for government intervention now in private medicine is dollars. He states that everyone should have easy The main problem thus being costs and maldistribution. He, for one, has to be rudely awakened. He should be told that this Country has the lowest hospital bedding and shortest hospital stays of any comparable country. I can foresee a lot of over-inflated bureaucratic planning superstructures investigating, recommending, regulating and intervening to absolutely no avail, simply because hospital are working on a near optimal level and so are doctors. I wish that certain other prestigeous professions could claim that. Here we have a big organization like AMA, who fears federal intrusion more than anything else, mostly because of the federal track record here and abroad. Given an ultimatum whether to cooperate or be reduced to neutralized spectators, they would hardly have a choice and this organization has a central management, a regional state-wide organization and local organizations and above all, a deep understanding of the subject in question. A physician is a pretty formidable character to tackle.

His

Page VIII

training has taught him to be an authority.

He does not stand in awe of anyone

and he is much more likely to give orders than to take them.

My solution, shocking as it may seem and highly unconventional as such, but a

truly American one: AMA and HEW

Unite your forces! Work together instead

of fighting each other. We have in America an excellent health care for most

of the people. Let's invite to the medical common those who today stand outside.

Prepared for the Health Sub-Committee of the House Commerce
Committee in Washington, September 12, 1975

HOSPITAL AND SPECIALIST CARE

in

THE BRITISH NATIONAL HEALTH SERVICE

by

Reginald S. Murley, M.S., F.R.C.S.

Surgeon to the Royal Northern Hospital, London
and St. Albans City Hospital, Herts.

Member of Council of the Royal College of Surgeons
President of Fellowship for Freedom in Medicine.

SUMMARY OF PAPER UNDER ABOVE TITLE.

1.

2.

3.

4.

5.

6.

7.

Inheritance of high medical & nursing standards.
Lack of Capital Investment in Hospitals.

The Economics of Excellence. The importance of pace-setters.
Risks of levelling down.

Effects of workload,
Confrontation with

Disastrous deterioration in morale.
financial stringency & staff shortages.
trades unions and "action groups".

Private practice in the Hospitals. The origin of pay-beds.
At present 2% of general beds or 1% of all N.H.S. beds.
"Phasing out" and proposed control of independent sector.
Dangers of Totalitarian State control. The idea of an
independent corporation.

Financing medical care. The vital importance of variety.
Personal responsibility. Consumer choice. Understanding

the economic facts of life. Priorities in Medicine &
differences between short-term and long-term problems.
Ways of helping those who are prepared to help themselves.

Waiting lists. Illogical to speak of these on a "National"
basis. Some interesting statistics. The "black spots".
and the reasons for them. A surgical and geriatric problem.
Socialist shibboleths about "queue-jumping". Some facts
about queues.

Disraeli and statistics.

Migration. Britons out & foreigners in. Changing pattern.
Registration of foreign doctors. The senior "brain drain".

8.

9.

10.

11.

12.

[blocks in formation]

Establishments & salary scales. The incubus of bureaucracy and centralised control. Where does the "buck" stop?

Contracts for Consultants.

Confrontation in relation to "open" and "closed" contracts. So-called "part-timers" and their work pattern. More a preferred way of life than a means of earning more money. Vital importance of private sector in preserving freedom for patient and doctor. Family doctor and specialist. The traditional British pattern. The built-in incentives, checks and balances. The "firm" system.

Organisation in hospitals.

Delegation

to juniors and training. The consultant's ethical obligation of continued responsibility. No personal guarantee about

surgical operation.

Liberty the luxury of self-discipline. The "general good"
and the individual. The dangers of womb-to-tomb welfare.
The vital importance of variety and choice in hospital and
specialist services.

Prepared for the Health Sub-Committee of the House Commerce
Committee in Washington, September 12, 1975

HOSPITAL AND SPECIALIST CARE

in

THE BRITISH NATIONAL HEALTH SERVICE

by

Reginald S. Murley, M.S., F.R.C.S.

Surgeon to Royal Northern Hospital, London
and St. Albans City Hospital, Herts.

Member of Council of Royal College of Surgeons
President of Fellowship for Freedom in Medicine.

1.1

1.2

The National Health Service in Britain is basically a
method of financing Medicine largely from Governmental
sources rather than a new system of medical care.

Much

of its early strength lay in the high standards of medical
and nursing care which it inherited from the past. The
first few years of the N.H.S. also resulted in a substantial
increase in specialist staff in many peripheral hospitals
outside the main teaching centres: that is one of the main
points on the credit side of the N.H.S.
But,

on the debit

side, it must also be emphasised that capital investment in hospitals was totally inadequate.

The planned expenditure on hospital building in 1961-2, thirteen years after the inception of the N.H.S., was, in terms of 1939 values, less than was spent on our hospitals prior to World War 11 ! In other words, Britain was spending more on hospital building (through voluntary and municipal

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