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.

‘Sectarian’ brings me to my real complaint. There is a total failure to differentiate between the more reactionary bma leadership—Royal College—Harley Street hierarchy, and the rank and file doctors and health workers (Dr Rossdale is as doctor based as any anti-socialist; no one else gets a mention) who have real aspirations to do socially useful work. (Please see the sma’s ‘A Socialist View of Social Work’). Of course, doctors’ organizations make reactionary statements at times (he quotes immigration and vd). Why not tell us the many more progressive ones which the Press don’t pick up (is this real naivety, or does he forget the Press is not objective in reporting ‘news’?). What about the bda and fluoridation, the work on smoking, or air pollution, on accidents, car design, and traffic?

This sectarianism produces his final failure. At a time when health centres run by ordainary gp’s and health workers are increasingly being seen as necessary (24 built up to 1964, 9 new since and 149 planned) and when in general, only a campaign to transform the nhs with Regional Health Authorities, an Occupational Health Service, a Health Centre programme—to mention the leading points, and to link this with the need for a socialist society to provide the finance and the environment for a socialist nhs; in the face of this we are offered a health centre run by dedicated socialists! And the warning not ‘to exploit discoveries of inadequacies’ in case we ‘create alarm’. Really, how kindly. In the real world, in the campaigning the sma, all too limited as it is, carries out, what we want above all is alarm, anger and action to change society now. Come and join us.