Health Care in Britain

My wife fell off a horse during a fox hunt, recalled the rich board chairman of a British appliance company, "and she went into Charing Cross for a tricky operation. They pinned her shoulder so it wouldn't go out." London's Charing Cross Hospital is one of the grimiest barracks of 3,119 hospitals run by Britain's National Health Service, and the fox-hunting wife went in as an NHS patient. Explained her husband, politically a Conservative: "In a private hospital, my wife's operation would have cost me $700, but we got it free. NHS takes a tremendous load off my mind."

Womb to Tomb. State-run health in surance for employed workers, which metamorphosed into NHS, celebrates its 50th anniversary in Britain this year. NHS as such is now 13 years old. Most Britons, while they are keenly and vocally aware of its shortcomings, would not want to get along without it.

A middle-class mother in the West End emphasized the emotional security it confers: "To go back to the kind of medicine we had before, to that fear of illness, would be a nightmare." A lift operator, who has had nine operations, said: "I couldn't get on without it. Walk into a hospital and it doesn't cost you a penny. Ring up your doctor and he'll be there straight away."

What does such security cost? When wartime coalition governments adopted the womb-to-tomb plan fathered by Sir William (now Lord) Beveridge, it was estimated that NHS might cost only $500 million a year. Workmen's payroll taxes, to be applied to NHS costs, were set at 9-c- a week, to yield an estimated 10% of total costs, with no charges for prescriptions, eyeglasses or dentistry. The deficit would come from the Treasury's general tax funds.

But it actually cost $1.1 billion in its first full year. Workers' contributions have been upped in stages to 39-c- a week, and there are now partial charges for prescriptions, appliances, eyeglasses and dentistry.* And the National Health Service will cost more than $2.4 billion in 1961-62, still with only 16% coming from payroll taxes, 6% from charges, and the balance from the Treasury.

Freedom of Choice. All Britons are taxed for NHS, and they are free to use as much or as little of it as they choose. In fact, more than 98% use it. Only rich and conservative holdouts rely exclusively on private care. But a growing number of Britons, 1,200,000 now as against 100,000 when NHS began, now have some private medical care as well. Some use this as a status symbol; others as a backstop to NHS, to get quicker care and more quiet and privacy.

NHS users are free to choose their doc tor and to change doctors when they wish. Britain's doctors are in turn free to choose whether they will join NHS or not; 98% have chosen to do so. They may join the service and still take private patients on the side, for fees. If they stay out, they rely on private patients entirely.

With all these freedoms on paper, many questions arise in practice:

sbDoes the government interfere in doctors' methods or practice? Not in detail. It urges them to prescribe inexpensive drugs and British-made drugs whenever possible. But most doctors say they can now prescribe what is best for the patient without worrying about whether he can pay for it.

sbDo patients have to wait too long because doctors are too busy? It depends mainly on where they live. Britain has almost enough doctors: one for every 1,100 people (as compared to one for 830 in the U.S.), but they are badly distributed. General practitioners are scarcest and in greatest demand. Most of southern England and the big cities have plenty, while rural areas and small towns in the north are doctor-starved. There, NHS sometimes has to let one G.P. sign up 4.000 patients. The general maximum allowed is 3,500, and the average list is 2,280.

sbDoes this lead to assembly-line medicine? In many cases, yes. Now that Britons have medical care as a right, they do not hesitate to use it. But hypochondriacs' abuse of the right, a problem at first, has subsided.

Sign & Site. NHS's biggest failure has been in not building enough new hospitals. Most of those it inherited were built before 1900. Many lack central heating and use sooty, coal-burning fireplaces to give a grudging, uneven heat. Some have no elevators, or plumbing is so scarce that nurses and male patients queue up for the same toilets. Except for wartime "temporary" units, Britain had not opened a single new hospital in 19 years until 1958. has opened only eleven since then. Outside a Midlands city stands a fading 1938 sign, "Site for new maternity hospital," but no hospital.

The ten-year postwar delay in getting new hospitals started is largely due to NHS red tape. A London surgeon complains: "When you plan a hospital, you figure two years for blueprinting, two years for planning, two years for getting it through this and that committee, and three years for the Ministry of Health and the Treasury. You start to build in ten years."

The result: patients have to wait interminably for beds except in urgent cases. Even doctors with genuine emergencies are often told: "Sorry, no beds." Then they dial 999, the all-purpose British emergency number, and get an ambulance. Somehow, a bed is always found for a patient who arrives in an ambulance.

G.P.s as Clerks. The major complaint of doctors comes from G.P.s. They say they are overworked and underpaid. Their average of $6,800 a year is close to par for all British professional men (generally underpaid by U.S. standards), but is only about half what the specialists make. Worst of all, for general practitioners, is their feeling that they are being reduced to the status of medical clerks. Says a Yorkshireman: "The G.P.'s job is to be a sorter and referrer."

But all in all, doctors and patients now take NHS for granted. Explained a Glasgow doctor: "It's like the income tax--part of our way of life. We moan about it, but we can't imagine being without it." At St. Bartholomew's Hospital's first-rate Medical College in London, Dean D. F. Ellison Nash said: "We couldn't have kept up with diagnosis, treatment and medical care without a national service." A London painter: "It's not all that good, not for what you get out of it. But abolish it? Not that, mate!"

*For each prescription, 28-c- (average cost to NHS has risen since 1949 from 40-c- to $1.02); from $3.50 to $5.90 for spectacles; up to $2.80 for dental treatment for a single condition; up to $14 for a set of upper and lower dentures. No charges are made for children's eyeglasses or dentistry.

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