How Is The Health Service Working?

In September 1948, a few weeks after its launch, John Alldridge set out to answer this question –

His findings make very interesting reading 75 years later – Jerry F

On Monday, July 5, nearly 49,000,000 men, women and children became entitled to a free health service. That service has now been in force for two and a half months. It is no longer a nine days’ wonder. How is it working? Far better than we had ever dared to hope, reports the Ministry of Health, responsible for organisation and administration.

From its offices in Sunlight House, Manchester, the North-west Region of the Ministry, comfortably decentralised, keeps in touch with its 24 executive councils which between them draw a fine net over Lancashire, Cheshire, North Derbyshire, and Westmorland. It is these executive councils which really do the work. And for the past eight weeks they have been working very hard indeed.

Take, for example, the Lancashire Executive Council, with its headquarters in Preston, which has a zone of responsibility second only to the metropolitan area of London. In its card-index system will eventually be recorded the health of 1,980,000 people. But before that system could be said to be functioning properly every one of those two million people has to be registered; so has the name of every doctor, dentist, optician, ophthalmist, and chemist practising in the area and co-operating in the service.

The bulk of these two millions were already identified when the service came into force. They were former “insured persons.” But the Executive Council’s staff of 300 permanent and temporary clerks (which includes 80 part-time workers) still had to cope with the flood of new applications, which have just passed the 900,000 mark.

To date — with one clerk dealing with 25 of these applications in an average hour — about half this enormous total has been dealt with. The percentage of error is remarkably small (Manchester Executive Council reports only 500 completed cards returned through the post “unknown” out of 300,000 dealt with).

On the Lancashire executive’s books are recorded by now the names and addresses of 1,550 doctors and assistants, 350 dentists, 320 opticians and eye-specialists, and 600 chemists. This is a very high percentage of the professional men practising in the area.

This enormous figure of new applications suggests that the public is prepared to take full advantage of the scheme. Random visits by me to surgeries and consulting rooms confirm that impression.

Not generally communicative, doctors interviewed cautiously admit that they are holding their own under the pressure of increased business. But they point out that the service came into force at a season when sickness incidence is low. The real test, they comment, will come with the arrival of winter, when sickness figures inevitably increase.

Some of them are worried about the strain on existing surgery accommodation. And they complain that long after surgery hours are over they are occupied filling in forms.

Form-filling, too, bothers most of the 1,288 dentists working for the service in the North West. For on dentists and opticians has fallen the heaviest wave of patients eager to take advantage of free treatment.

Evidence of this eagerness shows up in black-and-white in dentists’ appointment books. One such dentist, typical of the 165 working the service in Manchester, opened his appointment book for September 6, 1948 and found 15 clients to be dealt with on that day. Opening his surgery for business at 9.30 and allowing himself an hour for lunch he hopes to have finished by 7.30 in the evening. Then comes the business of form-filling, which will absorb him for a further two hours.

Significantly, his appointment book for the same day last year showed only eight patients. All these eight were private patients. But of the 15 treated on Monday September 6 this year, only one was a private patient.

Financially he is better off if he treats non-paying patients. State reimbursements are remarkably generous. Prior to July 5 his charge for a filling rarely exceeded one guinea. But the State pays him a standard of 30 shillings for each and every filling. From the State, too, he receives a standard examination fee of 10 shillings for each patient.

So generous, indeed, is the present scale of fees that he wonders how long his sudden windfall will last. This is a common anxiety among dentists. For, as Mr. H Parker Buchanan, secretary of the British Dental Association, has said publicly: “At the moment 30,000 estimates are being received by the Dental Estimates Board every day, and the average cost is certainly more than £5. This means that the scheme at present is costing £150,000 a day, or £46,000,000 a year, and the Government estimate for a full year is only £7,000,000.”

Opticians and opthalmists inundated with applications from new patients, have the same worry. One well-known consulting ophthalmist with a practice in a working-class district of Manchester reports a 50 per cent increase in business. So busy is he that he can make no new appointments until into October.

Many of his new clients are elderly people who have never been able to afford expert optical attention before.

Here, again, State fees are, to say the least of it, generous. For every non-paying patient sent to him by a doctor the ophthalmic medical practitioner gets £1 11s. 6d. for testing the eyes, 25 shillings for dispensing glasses, and the actual wholesale cost of the glasses, plus five per cent of this for “breakages.”

The ophthalmic optician gets the same except that his testing fee is only 15s. 6d. And if a patient requires two pairs of glasses — one for reading and the other for out-of-doors — then the optician gets another 25s. for dispensing the second pair.

Formerly the friendly societies paid half or two-thirds of the cost of the glasses: the patient paid the rest. In actual fact the friendly society payment was in most cases not more than half a guinea. Charges being made on behalf of State-sponsored patients suggest that the extra cost of the new scheme may be astronomical.

Opticians, realising this, are anxious about their future. Many of them will need soon to increase their staffs. But they are chary of taking on fresh responsibilities while there is a definite possibility that the Ministry may at any moment drastically cut its scale of payments and instead employ them direct as Civil Servants.

Chemists, almost all of whom are now co-operating in the service, report an average 80 per cent increase in the volume of work. Here there are few complaints. While a few are worrying about their overheads, vastly extended by the sudden increase in business, others are glad to be more actively employed in the real work for which they were trained — dispensing.

Hospital services report few abnormalities. But here, as in the case of the doctors, the winter months will bring the real test. And experts admit that there will be some disappointments. For at least another year there will not be enough hospital beds (charges for private patients have shown a marked tendency to rise since July 5). The shortage of hospital beds is due chiefly to a shortage of nurses, and nursing will not become attractive as a profession until working conditions are improved.

The responsibility for supplying surgical appliances and special medicaments has been passed to the hospitals. In many cases these special appliances are in short supply. This is particularly true in the case of “deaf aids,” for which there has been an inevitably heavy demand.

This new responsibility entails the building of new health centres equipped to examine, fit, and maintain surgical appliances. And building of any kind today is a formidable bottleneck.

But the fact remains that in spite of practical difficulties and unexpected upsets the service is working — working surprisingly well. If there be any pre-eminent reason for this it is that the people working the scheme — the doctors and dentists and opticians, the clerks at the executive council headquarters, the officials at the Ministry of Health — politics set aside, believe that the job is worth doing.

And some of those professional men making the best use of the scheme are those very men who twelve months ago said that it just could not be worked.

Jerry F 2023