A History of the Ministry of Information, 1939-46

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MINISTRY OF INFORMATION
HOME INTELLIGENCE SPECIAL REPORT
PUBLIC REACTION TO THE WHITE PAPER ON A NATIONAL HEALTH SERVICE

An interim report.

This investigation was made at the request of the Ministry of Health. Interim reports were received from the Intelligence Officers attached to the Regional Information Officers in the Civil Defence Regions of England and Wales, and Scotland. Regional reports were themselves based on reports from up to 60 intelligence correspondents.

I. INTRODUCTION

The most striking feature of the public reaction to the White Paper is the small degree of interest shown. Almost all correspondents agree that it is not being discussed spontaneously by the general public, and that, when the matter is raised, people have only hazy ideas as to the nature of the proposals. This fact must be constantly borne in mind in reading the main part of this report.

The reasons advanced for the lack of interest are:-

1. A mood of general scepticism about postwar problems .

For months, the general public have been becoming increasingly sceptical about postwar reconstruction. This appears to date largely from the Government's announcement of its attitude to the Beveridge Report; there is no realisation as to what has been accepted. On the contrary, it is generally believed that nothing is to be done about Social Security. Similarly, despite the general approval of the Education Bill, there is still much doubt as to whether education is to be improved. In the case of the Health White Paper, few people seem to see the Service proposed as a reality; and there are many comments of the type: “All very fine, if it ever comes to anything”.... “Its certain to get watered down before it gets onto the Statute Book”.

2. Specific scepticism .

Many working-class people suggest that the scheme is an excuse for not accepting the Beveridge proposals.

3. Insufficient publicity .

After one day of press comments, it is thought that the newspapers have dried up.

More press articles, and broadcasts are asked for.

3a. A surfeit of reports .

In the past two years, it is thought the general public have had their fill of reports and white papers.

4. Other interests .

The impending second front, and the crises in the coal industry are said to have turned people's thoughts away from the White Paper

5. The complicated nature of the proposals .

6. The absence of anything very obvious to attack or criticise .

It is suggested that, had there been anything of which people generally had violently disapproved, they would have been only too ready to voice their views.

Discussion is, however, quite considerable among the following minorities:-

a. Doctors.

b. Other health workers.

c. Local authority members and officials.

d. “Politically conscious” working people, and active members of left wing parties.

II. GENERAL REACTION .

Almost everyone expressing any opinion voices general approval of the proposals. Usually this is vague. Sometimes it is qualified.

Many people have no idea at all as to the nature of the proposals; and they are criticised for not including features which they do in fact include thus; the comment has several times been heard: “The Service ought to be universal” or “it ought to be free”.

The points which get the most general welcome are:-

1. The retention of free choice of general practitioner .

It is frequently asked whether there will also be free choice of consultants and hospitals inside the scheme.

2. The inclusion of a specialist service .

The most generally criticised points are:-

1. The retention of private, as well as public practice .

It appears to be almost universally believed among working-class people that the paying patient receives better treatment than the panel patient. A typical remark is:

“I'd rather give my doctor my last half crown than go on his panel”.

It is feared that the distinction will inevitably continue. Indeed, some working people carry their dislike of panel practice so far that they welcome the retention of private practice - for fear all doctoring may be reduced to the mediocre level of the panel.

2. Among middle-class people, dislike of the idea of sharing waiting-rooms with the poor .

3. Fear of bureaucracy, excessive officialdom, regimentation, and interference with people's lives - this again particularly from the middle classes.

4. Vague feeling that the proposals do not go far enough - particularly from working-class people who do not know what the proposals are.

5. In connection with the voluntary hospitals

a. A majority feel they should be taken over completely by the state.

b. A substantial minority, who believe in them, are very anxious about their future. They feel that their sources of funds will inevitably dry up.

6. This is not really a Health Service but a Sickness Service . Health depends on food, housing, education etc.

III. DETAILED VIEWS .

A. General practitioner service

The arguments for and against the retention of private practice are elaborated.

Those who favour its retention point out that people value more what they pay for.

There is little realisation of the benefits which should follow the extension of general practitioner care to dependents.

There has been little discussion of health centres. Women, who are already familiar with clinics, welcome the idea. Some fear the loss of the personal touch; they expect to be seen by an assistant who will only call the proper doctor when he thinks there is something serious. There is some fear that the salaried doctor will think more of his employers and his hours of work than of his patients; and that Health Centres will be staffed by the less efficient doctors, who are unable to make a success of practice outside.

B. The Clinics

No substantial comments are made.

C. Consultant and specialist service

This is almost universally approved; but it is feared that:-

a. The poor will not really get the best.

b. There will not be enough specialists to go round.

c. The big towns will do better than the small towns and rural areas.

D. Hospitals

The arguments for and against the abolition of the voluntary hospitals are elaborated.

The main reasons given for favouring their abolition are:-

a. Only the State can afford to give a really good, and really universal service.

b. Their income from bequests and hospital savings schemes is bound to dry up, so they are doomed anyway.

c. Appeals, and flag days are a nuisance.

Those against their abolition fear “soulless state control”; they have no confidence in the Local Authorities; and they point to the value of the voluntary hospitals in stimulating local patriotism. They are very anxious for the future, though a minority of hospital managers express themselves privately as being glad that the days of begging and scraping will be ended.

Contributors ask what is going to happen to Hospital Savings Schemes. The proposal for a hospital inspectorate is welcomed.

E. Drugs and appliances

Working-class people feel that all appliances should be free. They say that it is particularly unfair to ask them to contribute specially to the expensive ones.

Those who favour some payment for glasses and dentures point out that people only value what they have to pay for.

F. Administration

This is a matter of interest only to groups specially concerned, and those living in poor areas where rates are already high.

a. Local Authority members say they do not want to lose their hospitals. They say the suggested areas are too large. They fear central control and Whitehall interference.

b. Those of the general public who express views are against the Local Authorities. They say that some are lazy and incompetent, while those where the need for the new service is greatest will be least able to afford it. They suggest that the Clinics should be taken over by the new Joint Authorities.

c. The doctors fear any extension of Local Authority control. They do not welcome Joint Authorities composed only of Local Authority representatives; and they think that Local Health Services Councils will have no real power.

d. Friendly Societies are reported to feel that the scheme was bound to come, but hope the Government will find a part for them to play.

G. Finance

Two general reactions are:-

a. If we can afford the war, we can afford a complete health service.

b. Where is the money to come from?

The only considered criticism is that the extra cost should all be borne centrally and not be added to the rates, since these will certainly have to cover additional costs for education, housing etc.

H. Doctors' attitudes

The younger doctors appear to adopt the attitude: “Better than we expected”. Older doctors tend to say: “Not as bad as we feared”.

Their greatest anxiety is a fear of an increase in form-filling and bureaucracy. Younger doctors, in particular, fear that promotion will be by administrative rather than medical capacity; and that the better posts will go not to practising doctors but to administrators.

Medical students are said to welcome the proposals.

It is widely expected by the general public that the doctors will be difficult and obstructive.

HOME INTELLIGENCE DIVISION

MARCH 14, 1944 .

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