Socialized Medicine in England and Wales; The National Health Service 1948–1961: Almont Lindsey. University of North Carolina Press. 42s. 561 pp.

During the bitter winter, casualty officers were introduced to a new medical problem of the Welfare State; lonely people, especially old men and women were brought to hospital suffering from accidental hypothermia (chilling to death). Such ‘interesting cases’ might elude diagnosis as standard thermometers do not measure below 95°F; their temperatures could be 15° lower. These cases manifested a torpor and apathy as acute as that of the society which let them run down in neglect.

People like this do not exist in Dr. Lindsey’s study of the NHS. In this sense it is another contribution to the mythology of the Welfare State. As an American of liberal opinions he has been anxious to erase the stigma attached to the idea of ‘socialized medicine’, a term which the notorious American Medical Association has turned into a term of abuse. By the standard of American private medical enterprise the achievements of the NHS are necessarily impressive; it is, however, because Dr. Lindsey’s standards are conditioned by such a medical environment that he has not asked some fundamental questions which might reveal the faults of the Service. In many ways this book is analogous to a business efficiency expert’s survey of the Health Service. This is valuable, not only because the range of reading upon which this book is based is wide and thorough, but also because the efficiency of the relatively humane system we have today cannot be over-emphasised as against the inhumanity of the anarchy which existed before.

The early years of the NHS were characterised by many delays and difficulties. The emphasis which these failures, themselves an indication of the gross inadequacy of the previous medical facilities, received in the conservative press did not merely involve mockery of the unfortunate, but was symptomatic of a deep-rooted and primitive belief that ill-health is a form of punishment. A letter written in the British Medical Journal Supplement in 1942 is an illustration. The writer is replying to Prof. Ryle who had asked whether it could be considered right that people should have to forego or postpone treatment for economic reasons . . . or pay individually on account of childbirth, accident or disease due to no fault of their own. He writes, “We cannot answer this question with a plain ‘yes’ or ‘no’. It wrongly assumes in its very wording that patients are mere animals, with no responsibility for their childbearing, their accidents or their ill-health . . . and while it is true that there does not seem to be any reason for much suffering . . . it is equally true that there is much avoidable and unnecessary suffering for which the individual sufferers are themselves directly or indirectly responsible and for which that responsibility should rightly be brought home to them”. Dr. Lindsey has nothing to say about this attitude, although it is this kind of thinking which is partly responsible for the Conservative Government’s anxiety to economize as much as possible on the Health Service. Remember that the Guillebaud Committee was set up to investigate the rising cost of the NHS and that it was to prove an embarrassment in that it demonstrated that far from the Health Service costing too much, not enough was being spent on it. The stalwart opposition of the Tories to the nurses’ pay claim is only the top of the iceberg. The record of Building and Improvement is as bad. It is not unusual for the construction of new sections of regional hospitals to take as much as ten years from planning to construction. During the first ten years of the NHS the average annual expenditure on building and improvement was only £10 million. In 1955 the Guillebaud Committee recommended a minimum expenditure of £30 million per annum but by 1960–61 it was still only £25.5 million. Meantime, Messrs. Abel and Lewin, appointed by the Central and Consultants Committee of the British Medical Association, had suggested in 1959 an annual average of £75 million for the next ten years for this purpose. It should be pointed out, too, that of the £25.5 million spent in England and Wales during 1960–61, slightly less than £4 million was actually spent on new hospital building and furnishing. Compared with the Swedes (who spent 0.42%) in 1956–57 we spent 0.07% of the gross national product on hospital construction. Dr. Lindsey is more optimistic than many. Commenting on some of these facts, and bearing in mind the additional political pressure of the 1959 pre-election period, he writes: “With the political leadership pledged to an accelerated program, the prospects of an eventual solution of the problem no longer seemed remote.”

No account of the Health Service today is adequate without an analysis of private practice and the two-standard service it creates. Here Dr. Lindsey has simply not gone deep enough. “Since private beds constituted only slightly more than one per cent of the total number of staffed beds in the hospital service, the impact of queue-jumping, even if it were prevalent, could not have been very serious. Whether the existence of pay beds had created a two-standard service, as some alleged, was never demonstrated, though private patients did seem to be more quickly admitted than most non-emergency Health Service patients, could engage their own specialists, enjoyed a more liberal arrangement for visitors and were able to obtain more though not necessarily better nursing. In the fall of 1954 the Conservative Minister of Health denied that the abolition of pay beds could be of any possible benefit to the Health Service. ‘If a man wants to pay his coppers and his shillings every week to a hospital contributory scheme’, he averred, ‘rather than spend it on pools, so that he and his wife or children if they are ill may have some privacy—well, what on earth is wrong with that?’ ”