On Martin Rossdale’s ‘Socialist Health Service?’ (NLR 36)

No socialist would quarrel with Dr Rossdale’s attempt to show that more is needed to develop the nhs than money, though financial starvation is not to be dismissed as merely ‘secondary’. Thus, as a result of campaigning by the Labour movement, the principle of screening for cervical cancer, which could save the lives of 2,500 women yearly, is now accepted. But the money is not available for a full service.

We agree that socialist organization and attitudes are needed, and to continue our example, a co-ordinated service for cancer screening, linked to planned health checks, requires integration of gp, local health authority, and hospital, health education programmes, further research, and the active co-operation of the community. The sma, in its plans for Regional Health Authorities, democratically constituted from local authority, Labour movement and health worker representatives, could overcome the present separation of the tripartite system in this and every field of health, from child care to geriatrics.

A socialist might have made more of the basic social causes of illness—chronic bronchitis (30,000 deaths a year; one person in three over 60 has the disease) and its relation to occupation, social class, air pollution, smoking, or again smoking (a social) habit and lung cancer. Or to industrial accidents, now approaching 900,000 a year. The example Dr Rossdale quotes of perinatal mortality, he fails to teach on—the Perinatal Mortality Survey (Butler and Bonham, 1963) showed firstly the marked class variation, and other interesting geographical variations related to social factors, in perinatal mortality, and secondly, not that ‘perinatal mortality is greater in home deliveries although these mothers are selected’—but precisely the opposite. Where they are selected on agreed medical grounds (2nd and 3rd pregnancies, uncomplicated cases) mortality is the same or better than hospitals. But where, because of shortage of maternity beds, wrongly selected cases are confined at home, the mortality rate rises sharply.

I don’t wish to engage in polemics, but the sociological (psychoanalytic opening on the doctor-patient relationship) seems entirely out of proportion. Rossdale gets through it without mentioning a single disease, a single case or illustration, or differentiating between psychiatric and organic illness (there is such a distinction, you know) or discussing emotionally based illness as a factor, and not the whole of the doctor/patient set up. Moreover, he is quite unhistorical. The nhs has an internal dynamic based on its comprehensive nature, its reliance on the gp as a centre, and the fact that it is free at the time of use. So all the complaints he makes are discussed at length by liberal-progressive doctors, even the Minister of Health (Communication between doctors, nurses and patient, 1964). So there have been changes—better appointment systems, more patient freedom, more communication, studies of emotional illness in general practice, more social medicine in hospitals. Not enough, but there are contradictions to be explored, not this blanket sectarian approach.