THE DOCTORS' CASE
Some important points for the public
|The doctors want a comprehensive health service as much as anybody.
They are not fighting against the new Act because they want to get
rid of the whole thing. It is only a few parts of the Act they
object to, but these are vital parts.
|The doctors object to the Act as it stands because under it
they could not do their jobs properly. If a doctor cannot do
his job properly the public must suffer. That is why the doctors have
decided not to serve until the Act is amended. The fight is not about
money but about principle.
The Threat of a Full-time State Service
|The doctors believe that this Act is the first step towards making
doctors full-time salaried servants of the State. Why do doctors object
to receiving salary? After all, it may be said, most people in the
country are paid by wages or salary - M.P.s, miners, clerks, butchers,
works' managers, and so on - why not doctors?
|The reason is that the doctor's job is unique. Trust and confidence
are all-important and unless a patient has complete confidence in
the doctor (and this includes confidence in his ability to keep secrets
and to consider nobody else's interests but the patient's) the patient
may not get well. In certain respects the position of the doctor is
like that of the judge.
|A salaried employee naturally does what his employer wants. Until
some 200 years ago, judges were paid by the State and were thus under
the complete control of the State. As a result they were not trusted.
Their judgments in court were always being influenced by the wishes
of the State - their paymasters. Judges were corrupt and tended to
give decisions in court cases according to what the Government of
the day wanted. The country got so tired of the misery and uncertainty
caused by this untrustworthiness that it was decided that our judges
should be taken out of direct control by the State.* For the last
two centuries, accordingly, it has not been possible to dismiss a
judge except by Resolution of both Houses of Parliament, and judges'
salaries are not paid either by the Cabinet or Parliament. Their salaries
are paid direct from the Consolidated Fund. In other words, great
care was taken to see that judges should be above financial or other
|The absolute dependability of the
doctor is as important to the country as that of the judge. If the
doctor is paid by salary from the Government, he will be tempted to
think of what the Government wants, which may not be what the individual
patient wants or needs. The patient will not have the certainty that
his doctor is thinking only of him and his needs, and in the event
of a dispute it is the paymaster who has the last word.
|It is the official policy of the Labour Party to make
the doctor a full-time salaried servant of the State. † That
this was still the policy in 1946 was confirmed by Mr. Arthur Greenwood
in the House of Commons. He said:
|"What was published by my party in 1943, to which
the right hon. and learned Gentleman referred, we of course stand
by. We have never repealed any of our policy, and we shall continue
to march on in the light of that policy." (Hansard,
May 2, 1946.).
|Further confirmation of the political implications behind
present Government policy was given by the Socialist weekly Tribune
of December 12, 1947:
|"Politically, the Minister's firmness has been
most important If he had been weak in face of this reactionary profession
. . . it would have increased doubts as to the intention to carry
out a Socialist programme."
|The present act leaves the Minister of Health free to
settle the method of remunerating the doctors, and Mr. Bevan has decided
on a small basic salary for every family doctor. The salary "element"
is only £300 a year at first but this can be increased at any
time by ministerial regulation without reference to Parliament. In
other words, under the Act the doctor could be turned into a whole-time
salaried officer to-morrow with Parliament having to give its consent.
|* Act of Settlement (1701)
|† "In the Labour Party's opinion it is necessary
that the medical profession should be organized as a national, full-time,
salaried, pensionable service." (National Service for Health.
Published by the Labour Party, 1943.)