943

-Vew members : Charles Grosch, M.B. ; H. H. Langston,F.R.C.S. ; Miss D. Morris ; H. T. Townsend ; Surgeon Lieut.-Commander Reginald Bennett, B.M., M.P. (until March 31,1955).

WELSH REGION

Reappointed: : William Berriman ; Alderman William

Casey, J.r. ; Alderman Thomas Davies, J.P.; AldermanWalter Davies ; Councillor Eddie Jones, J.r. ; ; AldermanJames Panes, o.B.E. ; Dyfrig Pennant, D.S.O., M.D., Sir IvorThomas, J.P., D.L. ; Prof. Owen Williams, F.R.c.s.New member: Alderman R. D. Briercliffe, C.B.E., J.r. (until

March 31, 1954)., BIRMINGHAM REGION

Reappointed : J. E. Roberts ; Mrs. V. Evershed ; AldermanH. Barber ; Prof. C. F. V. Smout, M.D. ; Alderman P. Williams,j.p.; Alderman L. Whitehouse, J.r. ; Mrs. S. A. Ward,O.B.E.; E. P. Major, F.C.A.New member ; David Rhydderch, J.P.; one appointment

outstanding.MANCHESTER REGION

Reccppoirzted : Walter Barnes, J.P.; Alderman G. D.Hastwell, o.B.E., J.P.; Prof. A. D. Macdonald, M.D. ; Alder-man W. Onions, M.B.E., J.P.; Sir John Stopford, F.R.C.P.,F.R.S. ; J. T. Waite ; Mrs. E. A. Watson, j.r.New members : H. Pigott, M.B. ; A. Poole, M.B.; one

appointment outstanding.

LIVERPOOL REGION

Reappointed : Miss A. L. Bulley; Sir Henry Cohen,F.R.C.P., j.r. ; G. N. Fullagar, F.C.A. ; A. A. Gemmell,Df.C.P.R.C.O.G. ; T. W. Harley, M.B.E., M.c. ; Alderman H.Platt, J.P.New member: S. Barton Hall, M.D.

1. See Lancet, March 28, 1953, p. 637.

Parliament

Hospital Pay-bedsIN the House of Commons on April 29, Mr. ARTHUR

BLENEJNSOP in moving the annulment of the recentregulations on pay-bed accommodation in hospitals,!charged the Government with a change of policy inrelation to pay-beds. Private pay-beds had always beenan anomaly in a health service which had tried to ensurea single standard of service for everyone, and there hadalways been complaints from those who were told thatthey must wait for treatment, while those who couldafford a pay-bed had been able to get treatment straightaway. The regulations, he held, were designed to ensurean increased use of pay-beds, and this would increasethe sense of injustice among those who found themselvespushed further back in the queue for free treatment.Furthermore, the regulations undoubtedly added to thefavoured position of the part-time as against the full-time specialist. Yet Mr. Blenkinsop thought that it wasthe position of the part-time specialist which should bere-examined, for there was a great deal of agreementthat the full-time specialist gave on the whole the mosteconomical service to the health service. No doubt hewould be told that the regulations were designed toensure that pay-beds were more fully used. But if therewere at present unused pay-beds why were they not beingused for patients receiving free treatment ? Many ofthese beds, he maintained, were being sterilised for theuse of specialists. The regulations were really an excusefor the Minister to avoid finding the extra funds to enablethe hospitals to provide an adequate service. Theyencouraged the extension of a two-level service, one forthose who could afford to pay and another at a lowerstandard for those who could not afford to pay so

much.

Mr. FREDERICK MESSER recalled that when the originalXational Health Service Bill was introduced many feltthat the pay-bed proposal was dangerous but that it wasjustified as an experiment. After five years it had beenshown that as a consequence of this provision there wereempty beds in hospitals and people waiting for treatment

and not able to get into them. The regulations wouldimprove the position of the specialists, who had alreadynot done too badly out of the health service.

Mr. SOMERVILLE HASTINGS pointed out that an

increased demand for these pay-beds would increase thecost of the N.H.S. At present almost half were keptvacant. He knew that the Minister wanted these bedsused for ordinary patients, but the doctors thoughtotherwise, and they were on the spot. He had had someexperience of these pay-beds and he maintained thatthere had been a great misuse of them. The doctorspressed to keep the pay-beds empty so that patientscould be admitted to them more quickly than to theordinary beds. Mr. Hastings also attacked the regulationson the grounds of their complexity and vagueness.Their many doubtful and undetermined points weredisastrous and would increase the difficulties of thosewho administered the hospitals.

Mr. ANEURIN BEVAN said that discussions with theRoyal Colleges had convinced him that if specialistswere not allowed to have private patients in hospitalsthey would be encouraged to go to nursing-homes. Butthe colleges believed a specialist could only do his bestwork in a hospital where the tools of his craft were to befound. Mr. Bevan admitted that he had been reluctantto agree because he saw the provision of pay-beds asa grave breach of the general scheme. The fact that therewere empty pay-beds was evidence of maladministration.There was no justification for a hospital to have a waiting-list and empty beds. He affirmed that these beds werekept empty so that specialists could offer a bed at onceto patients who could afford to pay. He had alwaysintended that a hospital should be a homogeneity, andthat public patients should have access to all the bedsof the hospital if there were any beds available. He neverintended that pay-bed blocks should be a physical partof the hospital. Some members of the medical professionhad proved themselves unworthy of the responsibilitywith which they had been entrusted. They had usedtheir considerable influence to deny beds to patients, tomake them available for their private patients. Further-more, the extra facilities granted to these part-timespecialists were causing a great deal of heart-burningamong the full-time specialists upon whom the hospitalservice mainly depended. Yet these regulations, insteadof narrowing the gulf between the status of the

part-time specialist and the full-time specialist,widened it.

Mr. IAIN MACLEOD, the Minister of Health, began hisreply by saying that with the new regulations he hadsent to hospitals a circular stressing that patients shouldhave the system of amenity and pay-beds explained tothem. He admitted that the new regulations werecomplicated but this was because the original regulationsin practice had proved inadequate in detail. Their object,he insisted, was not to reduce the charge to privatepatients, though they might have that result. The objectwas to carry out fairly the 1946 Act.

Turning to the question of fees, Mr. Macleod said thesehad been unaltered since 1948, and the profession suggestedearly in 1949 that alterations should be made. Sincethen consultations had taken place and the new figuresrepresented fairly general agreement. Boards andcommittees might, exceptionally, allow an increase from75 guineas to 125 guineas, for an operation in a fieldof surgery where complicated new techniques had latelybeen developed.The number of section-5 beds at the latest count in

February this year, Mr. Macleod said, was 6113, or 1’2%of all staffed beds. The proportion of section 4 beds was1-3%. It followed, therefore, that 97-5 % of all beds in theservice were absolutely free, and indeed a high proportion of the beds that were nominally pay-beds were infact occupied by people under the proviso to section 5.These figures, compared with those for the end of 1950,showed that there had been in 1951 and 1952 a decreaseof 4-5 % in the section-5 beds and an increase of 13 %in the section-4 beds, while the section-3 beds-thefree staffed beds-had increased by 18,156, or 4-1%.In view of these figures no-one could conceivably saythat the present Government had taken advantage, orwould take advantage, of section 5 of the Act to multiply

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the number of pay-beds beyond what was conceived inthe original Act.

Dealing with the contention that this was a new policy,which favoured the specialists, Mr. Macleod pointed outthat in their comments in the British Medical Journalof March 28 the joint committee of consultants had nota word of approval for him. The specialists had in factwanted to abandon the detailed schedule, but to this hecould not agree. They said that they did not want adetailed price ceiling, but a few general ceilings and thespecialists would adjust their amounts to the payingcapacity of the patients. It was well known how generousthe medical profession could be, but Mr. Macleod feltthat whatever might happen in the future the time wasnot ripe for this change. The specialists had also askedfor a reduction straight away in the case of pay-beds,but he had pointed out that this was impossiblewithout new legislation, and he saw no prospectof that.

Mr. BLENKINSOP asked what proposals the Ministerhad in mind to ensure that the empty beds were usedfor ordinary patients in the hospitals. and Mr. MACLEODreplied Tie had called for a special report on the questionof the occupancy of these beds. As soon as he had thedetails-and they were almost complete-he would behappy to discuss the matter. The motion was negativedby 261 votes to 233.

Home or Hospital ?National insurance, Mr. OSBERT PEAKE explained in

the House of Commons on April 28, provides for inter-ruption of earning power due to unforeseen misfortunes,or to cessation of earning power in old age, which wasinevitable. Motherhood, he admitted, did not readilyfall into either category, for most parents did not regardit as a misfortune, it was not inevitable, and it wasforeseeable though only for a limited time. But it some-times meant a loss of earnings and it always broughtextra expense to the family. It had therefore beenaccepted as a proper subject for national insurance.Mr. Peake was moving the second reading of the NationalInsurance Bill. whose provisions were lately briefly setout in our cohllnns.1Most of the discussion during the debate centred round

the new ’* home confinement grant " of £3 which isoffered to a mother who does not have her baby in afree National Health Service bed. There was a growingfeeling. Mr. Peake said, that it was unfair that themother who had saved quite a lot on food and householdexpenses by having her baby in free hospital acconi-moda-tiun should receive the same amount of benefit as themother who had her baby at home and had these extraexpenses to meet.

Dr. EDITH SUMMERSKILL believed that many harassedhospital authorities devoutly wished that the homeconfinement grant would induce mothers to stay at home,to leave hospital beds for medical and surgical cases.She was concerned lest the poor woman should betempted to sacrifice herself for the sake of a few pounds.It was useless to argue that the interests of these womenwould be safeguarded by midwifery services, because thewoman herself had the last word. The doctor, or thehealth service officials, might say that home conditionswere unsatisfactory, and that the woman should go tohospital. but she was free to stay at home. If the extra£3 tended tu make a woman sacrifice herself in this way,then the Bill marked the end of an era of enlightenedmidwifery. No-one would contend that there was norelationship between the record low maternal-mortalityrate and the provision of maternity hospitals in the last20 years. Dr. Summerskill looked forward to the daywhen every woman would be able to choose betweenhospital and home in precisely the same way as a wealthywoman could choose between a private ward in a hospital,or even a private nursing-home, and her home. Nor wasthe ubstetrical service offered in hospitals the onlyconsideration. A hospital afforded a mother rest afterher confinement which she was often denied in her ownhome. A hospital confinement, she urged, must not beregarded by the prejudiced as a waste of a bed, but as

1. Lancet, March 28, 1953, p. 634.

offering a safe delivery and a period of rest to a womanwho had emerged from a trying ordeal and was now tobe called upon to tax her resources to feed her baby.Was it surprising, Dr. Summerskill asked, that a thirdof babies were bottle-fed when we knew the pressurebrought upon women to remain outside hospital for theirconfinement ?

Mr. ARTHUR BLENKINSOP was also anxious lest the newproposals should encourage mothers, who on medicalgrounds should go to hospital, to have their confinement.at home, and he wondered whether provision was beingmade for the increase in home confinements which h*’thought we might expect. He did not himself believethat ideally every confinement should take place inhospital. There was a danger that by extending theuse of hospital facilities we might get the second best.for owing to pressure on accommodation shorter stay--in hospital were being accepted as reasonable. In areaswhere housing was bad the problem was different and wemust watch the effect of the new grant in these areas,where it should be our anxiety to encourage hospitalrather than home confinements. He was also anxiousthat smaller provision was made in the estimates furmidwifery services. If we were to encourage confinementsat home we must ensure that still higher standards wereset for our domiciliary services.

Mr. ENOCH PONVELL thought that any measure whichtended to take out of the hospital cases which could bedealt with as effectively in the home was a contributionto the efficiency of the health service itself. He sug-gested that the grant should be large enough to remove afinancial obstacle to domiciliary confinement and yetnot so large as to weigh the scales unduly in favour ofhome confinement. He did not think the sum of £3was excessive.

Mrs. EVELINE HILL pointed out that the women whojust could not get into hospital would be grateful for thehelp of this new grant. Mrs. E. M. BRADDOCK wasinclined to believe that the Ministry of Health mightuse the new grant to urge that there was no needto provide additional maternity-hospital accom-

modation.

Mr. R. H. TURTON, parliamentary secretary to theMinistry of National Insurance, assured the House thatthe new grant was fixed at such a rate as to offer themother compensation for the extra expense of having herbaby at home without providing an incentive in deter-mining her choice. The National Insurance AdvisoryCommittee had estimated £2 10s. as the extra cost ofhaving a baby at home. According to hospital costingreturns the average cost of maintenance in a maternityhospital was S13 16s. a week, and the cost of the itemsthe parents would have to pay for if the confinementwere at home was £3 5s. 8d. He was satisfied that£3 was a fair sum. In his view whether the baby wasborn at home or in hospital was not a matter to bedecided by politicians but by the mother on the adviceof her doctor.

Food HygieneIn the House of Commons on April 30, Mr. BARNETT

JANNER called attention to the need for further actionto encourage cleanliness in the handling of food. In It)515797 cases of food-poisoning were notified ; in 1952.6021 ; and in the first quarter of this year 1035. Haunderstood that doctors agreed that the actual numbt-iof cases was much larger.

Dr. CHARLES HILL, parliamentary secretary to theMinistry of Food, said that nowadays this problem wasprimarily one of germ infection. The old fears of metalliccontamination and the like had largely disappeared. Itwas also largely a problem of meat and milk products- mainly meat. The danger lay in dishes that were

not eaten as soon as they were cooked, if indeed theywere cooked, but were left exposed to flies. The pubhcshould realise that it was not necessarily the food thatsmelt that was dangerous ; the greater danger lay infoods that were not obviously contaminated. It wawrong in the home or in a food establishment for a personsuffering from dlarrhoea, or from a superficial infectionof the skin, however apparently trivial, to. handle food.

945

It was essential for people to wash their hands beforehandling food and also after using a lavatory. Unsatis-factory conditions, he pointed out, were preventable, andadmirable work in health education was being done bythe Central Council for Health Education, the St. JohnAmbulance Association, the Red Cross, and some

firms and trade associations. On the initiative of Dr.Belam, the M.O.H. for Guildford, food guilds had beenformed in various parts of the country to make clean-food principles better known among the general public.Today eating in the mass was much more common thanit used to be. and one careless food-handler could infect200 or 300 people. We could not deal with this problemon the basis of the Factory Acts as an offence. It was,Dr. Hill held, a matter for health administration, andfor persuasion rather than regulation. The solution mustlie in the field of personal conduct, but he admitted thatpresent legislation could be improved.

QUESTION TIME

National Health Service ExpensesMr. JOAN MORRISON asked the Minister of Health the total

cost of meeting loss of remunerative time and for travellingand subsistence expenses sustained by members of all boardsand committees established under the National HealthService Act for the year ended March 31, 1952.-Mr. IAINMACLEOD replied : About £105,000.

Mass RadiographyIn answer to a question, Mr. MACLEOD stated that since the

inception of the mass-radiography units 10,644,695 cases hadbeen X-rayed up to Dec. 31, 1952.

Dentists’ Fees

Mr. HENRY PRICE asked the Minister whether he was ableto make a statement on increased National Health Servicefees for dentists.-Mr. MACLEOD replied : The Secretary ofState for Scotland and I have informed the British DentalAssociation that we are ready to embark at once on an inquiryto obtain all the facts about dental remuneration, but thatthe information at present available is not in our viewsufficient to justify any immediate increase.

Mr. PRICE : Does this mean that the dentists’ demand forthe restoration of the 10% cut has been rejected ? ‘? Does herealise the disappointment and anxiety that this will causeamong what might be called the depressed section of thisprofession which is almost entirely dependent on the NationalHealth Service :-Mr. MACLEOD : Yes. It means that theclaim for the restoration of the 10% cut has been rejected,because I do not think I have sufficient evidence. I have a

duty to the dental profession, but equally I have a duty tothe taxpayer, and I must discharge both.

Ministry of Health Statistical UnitMr. A. BLENKINSOP asked the Minister whether he would set

up a statistical unit in his department to assist both in pub-lishmg more information for the general public and in providingdetailed figures for the use of the department.-Mr. MACLEODreplied : This method of collecting statistical material has notso far been adopted, but I always have this subject in mindand I shall have to consider, as experience grows, whetherit is necessary to alter the present arrangements for thepurposes mentioned. There is a flood of information comingin now about costing and other financial aspects of the healthservice. If I can set up a department without exceeding mypresent establishment, I think it will be more convenient tokeep it centrally within my Ministry.

Prices of Proprietary ProductsMr. BzExxmsor asked the Minister whether he was in a

position to make a statement arising out of his discussionswith manufacturers of pharmaceutical goods about the pricesof proprietary brands.—Mr. MACLEOD replied : Not at

present. Mr. B:LENKHsrsor : Can the Minister sav when hehopes to be able to take some action on this matter, which,after all, was referred to by the Public Accounts Committeesome considerable time ago ‘:-Mr. MACLEOD : I have taken agood deal of action on the lines recommended by the PublicAccounts Committee, and this is a matter which, withoutgoing into details, I can say is under very serious considerationby the Government.

’

In England NowA Running Commentary by Peripatetic CorrespondentsSURGEONS are strangely quiet in their official attire.

Once introduced to the blaze of academicals in otherbranches of the profession, a Martian or other foreignvisitor might well undervalue these douce blackbirdswith nothing more ornamental about them than a coupleof red stripes down the front. But when they receivedHer Majesty the Queen, their most distinguished Honor-ary Fellow, in Lincoln’s Inn Fields last Tuesday, the vastblue and white marquee supplied plenty of colour-fromthe massed flowers, and fine needlework chairs on thedais to the modest but telling creations worn by theladies. The memorial stone, with its simple inscription,dangled above its pillar, the band played popular airs,the arc lights shone, and the boards of the facultiesprocessed to their places* at exactly the momentsappointed. And so with royal punctuality did HerMajesty. All went perfectly : the casket filled withhistoric documents was closed and laid in its place, thestone, after a momentary hesitation, sank majesticallydown on it, and the Queen declared it well and truly laid.All who were there will remember that engaging look ofinterest and pleasure by which our national life is nowso often refreshed.

* * *

The versatility of the human mask is only equalled bythe variety of techniques for transferring it to canvas.This year’s Royal Academy exhibition fairly beams withportraits, and by far the greater part of them, in spiteof being orthodox, are good. It is perplexing to knowwhy a good, careful likeness by a competent artist shouldbe so much better than a photograph. A colleague tellsme it is because the camera can only crystallise a momentof time, while a painter can bring to his picture a wholebackground of knowledge-not only of his sitter’scharacter and qualities, but of the nature of physicalmovement-the notion of carry-through to the completedact. I think this theory applies well to the portrait ofRalph Vaughan Williams, O.M., by Sir Gerald Kelly. Acamera might equally have caught him turning in a chair ;it could hardly have conveyed this sense of a man ofmany friends, all of whom know this familiar movement,presently to be completed : that has been given us bythe painter’s apperception of many kinds of data.Harold Knight’s beautifully painted likeness of The Rt.Hon. Sir Travers Humphreys has this same kind ofinsight, and so has Dr. Henry Lamb’s portrait of Prof.T. R. Elliott. Once I was fairly launched on theportraits I sought familiar faces ; but, apart fromProfessor Elliott and the benign bronze head (by DavidMcFaU) of Hugh J. Taggart Esq., F.R.C.S. doctors,were strangely rare this time. There was, of course,Sir Alexander Fleming (by Henry Carr), lookingwell in red velvet sleeves ; and there were a fair sprinklingofD.sc.s, Mrs. Marie Stopes among them-the pale yellowtaffeta and scarlet cloth of her gown so exquisite (thanksto Sir Gerald Kelly again) that no other academic dresscould compare with it. Many faces might have belongedto doctors, and I hurried in turn from Sir ThomasBeecham (misleadingly wearing a white gown, and

looking, even under the inspired hand of Simon Elwes,every inch a senior surgeon) to Arnold Mason’s GilbertP. Norton, Esq., C.B.E., D.S.O., T.D., D.L., F.C.A. (whocould surely have squeezed in an M.B. somewhere amongthat lot) and Alfred R. Thomson’s Grahame B. Tubbs,Esq., F.R.LB.A., who seemed built for the part of familyphysician. One face which I had confidently decidedcould not belong to a doctor, bore the disconcerting title,Portrait of a Gentlemarz. The only other pictures ofmedical interest were a pleasant landskip, At -B?,rdham,Sussex, by Adrian Hill, the pioneer of art therapy inhospitals, John Wheatley’s very good painting of thechairman of the Sheffield Regional Hospital Board, anda jaunty little view by John Cole of a chemist’s shop inWigmore Street. ’

I spent so much time looking for a doctor-that I sawvery little of the other pictures. Here and there, however,my eye rebelled, and lingered on something pleasant :on the subtle pink of the sky in Edward Bawden’sHadrian’s Villa, on Stanley Spencer’s mongoloid butentirely delightful pale-coloured children climbing through