Joined in 2023 
82 
63 About this deal
When I was engaged in formulating the main principles of the British Health Service, I had to give careful study to various proposals for financing it, and as this aspect of the scheme is a matter of anxious discussion in many other parts of the world, it may be useful if I set down the main considerations that guided my choice. In the first place, what was to be its financial relationship with national insurance; should the health service be on an insurance basis? I decided against this. It had always seemed to me that a personal contributory basis was peculiarly inappropriate to a national health service. There is, for example, the question of the qualifying period. That is to say, so many contributions for this benefit, and so many more for additional benefits, until enough contributions are eventually paid to qualify the contributor for the full range of benefits. In the case of health treatment this would give rise to endless anomalies, quite apart from the administrative jungle which would be created. This is already the case in countries where people insure privately for operations as distinct from hospital or vice versa.
Those first few years of the Service were anxious years for those of us who had the central responsibility. We were anxious, not because we feared the principles of the Service were unsound, but in case they would not be given time to justify themselves. Faith as well as works is essential in the early years of a new enterprise. The second objection is even more serious. These schemes all have for their aim the consumption of the apparatus of health. But they leave the creation of that apparatus without plan and central direction. In place of a rational relationship between all its parts, there arises a patch-quilt of local paternalisms. My experience has taught me that there is no worse enemy to the intelligent planning of a national health service, especially on the hospital side. Warm gushes of self-indulgent emotion are an unreliable source of driving power in the field of health organization. The benefactor tends also to become a petty tyrant, not only willing his cash, but sending his instructions along with it. Exposing yourself to your fears can be an effective way of overcoming this anxiety. You can try setting yourself small, achievable goals for facing your fears. Know yourself Valiente-Gómez A, Moreno-Alcázar A, Treen D, et al. EMDR beyond PTSD: A systematic literature review. Front Psychol. 2017;8:1668. doi:10.3389/fpsyg.2017.01668
What makes you anxious?
Most of us might experience feeling uneasy when looking down from a high bridge, for example, but someone with acrophobia might feel so uneasy that they can’t even go onto the bridge in the first place. Since this chapter was written, new legislation on the National Health Service has been announced. It confirms our worst fears. If they are carried out the proposals will mutilate the Service in many of its most important activities. There is, however ample evidence that the British people are reacting sharply against them. This sustains my contention that no government that attempts to destroy the Health Service can hope to command the support of the British people. The great argument about priorities is joined and from it a free Health Service is bound to emerge triumphant. NOTE 1
But it is not only necessary to discover new knowledge and improve on old techniques. We must also see to it that useful aptitude and skills are not lost. Every war produces its tragic host of maimed, crippled and paralysed. Each time a pool of exceptional knowledge is accumulated to cope with the problem. As the number of patients declines with the passage of time, this contracts, is in danger of being lost and further improvements not pursued with the same drive. The department of the Ministry of Pensions which provides artificial limbs, eyes, ingenious chairs and cars, expanded at the end of the war and would have contracted after the normal pattern. But the civilian population also has its casualties, in the total sometimes as great as those in the services. Here the National Health Service performs an invaluable service. It maintains the pool of skill accumulated by the war and places it at the disposal of the civilian population. The technicians are not dispersed but are kept in continuous employment. If war comes again they will be there, ready immediately to mitigate disability and suffering to the limits of human ingenuity. Naturally when Britons go abroad they are incensed because they are not similarly treated if they need the attention of a doctor. But that also I am convinced will come when other nations follow our example and have health services of their own. When that happens we shall be able to work out schemes of reciprocity, and yet one more amenity will have been added to social intercourse. In the meantime let us keep in mind that, here, example is better than precept. And so it went on from one blown-out slogan to another. Indeed, I warned the leaders of the profession that they were making a fundamental mistake in strategy. They were mobilizing their forces to fight a battle that was never likely to begin. When later I was able to make a considered statement in Parliament giving a solemn undertaking to abide by principles that were my own from the very start, the B.M.A. found its forces leaving the field just when the crucial stage in the struggle was reached. This is an obvious defect in the British Health Service as it is now. I never intended it to remain. The present arrangements have always been regarded as temporary, to be replaced as follows. If the family doctor believes there may be something wrong with your eyes the best person to advise is the ophthalmic surgeon and not the ophthalmic optician. The latter is primarily concerned with those physical abnormalities that lead to defects of vision. The surgeon is interested in the physiological as well as the anatomical aspects. Under the revised scheme the patient would be sent to the surgeon, who would use the optician to give a reading of the eyes and so save his own time. Spectacles would then be provided only if the surgeon thought them necessary. Ophthalmic surgeons tell me that if this scheme were in operation fewer spectacles would be in use. And it would be to the advantage of the patient to be examined by the surgeon in the first instance, for he might find in the eyes evidence of morbidity of wider significance, and thus assist the patient to whatever other treatment might be necessary. I have a warm spot for the general practitioner despite his tempestuousness. There is a sound case for providing a little more money to help the doctor with a medium list who wants to make a decent living and yet be a good doctor. The injection of several million pounds here would refresh the Service at its most vulnerable point: that is, the family. doctor relationship. The family doctor is in many ways the most important person in the Service. He comes into the most immediate and continuous touch with the members of the community. He is also the gateway to all the other branches of the Service. If more is required than he can provide, it is he who puts the patient in touch with the specialist services.(note 4)But the hardest task for any public representative charged with the duty of making a free Health Service available to the community is overcoming the fears, real and imaginary, of the medical profession. His task is to reconcile the general public interest with their sectional claims. No pressure groups are more highly organized in Britain than the professions, and among these the medical professions are the strongest. In dealing with the medical profession it is wise to make a distinction between three main causes of opposition to the establishment of a free National Health Service. There is the opposition which springs from political opinion as such. This is part of the general opposition of Conservative ideas, and it is strong in the medical profession, though the expression of it tends to be supercharged with the emotions borrowed from other fears and ambitions. Second, there is the defence of professional status and material reward. The latter, of course, they share with other pressure groups. Then, thirdly, there is the opposition which springs from the fear that lay interference might affect academic freedom and come between the doctor and his patient. The third group is the most legitimate and will unite all the members of the medical world, from the self-seeking to the truly idealistic. Any health service which hopes to win the consent of the doctors must allay these fears. The fear of state interference in academic matters is very strong in the Western world, although it tends to ignore the power that patronage already has to influence the pattern of medical investigation. Nevertheless, entitlement to advancement on grounds of merit alone, free from any tinge of political nepotism, must be jealously guarded by any self-respecting profession. Nor should less informed opinion be allowed to influence the medical curriculum. Here there is no substitute for the refreshment of renovating influences within the profession itself. Freedom of discussion and a readiness to add to, and receive from, the corpus of accepted knowledge, are the only ways we have yet discovered to safeguard what we have gained, and to open ways to new discoveries. Van houtem CM, Laine ML, Boomsma DI, Ligthart L, Van wijk AJ, De jongh A. A review and meta-analysis of the heritability of specific phobia subtypes and corresponding fears. J Anxiety Disord. 2013;27(4):379-88. doi:10.1016/j.janxdis.2013.04.007 The word ‘anxiety’ tends to be used to describe worry, or when fear persists over time, often without any one cause. Anxiety is when fear is about something in the future or something that might happen, rather than what is happening right now.
Great Deal 
New Comment