The doctors' case
Catalogue reference: MH 135/785


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 pressure.
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.)

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