643

ESTIMATES FOR 1953-54

THE National Health Service estimates for 1953-54 1

allow for gross expenditure in England, Scotland, andWales of ;C487,984,040, compared with 515,381,500 in1952-53. These totals are made up as follows :

1953-54 1952-53(£) (B)

Central Council, &c..... 4500 4250Hospital specialist and ancillaryservices 305,150,110 304,656,300

Grants to local health authorities.. 21,558,020 21,233,000General medical and dental ser-

vices, pharmaceutical services,and supplementary ophthalmicservices........ 135,25,520 158,280,700

Training services, &c..... 1,689,750 1,751,650Civil Defence services.... 6,406,100 9,805,200Other services 17,960,040 19,650,400

Appropriations-in-aid (e.g., from National Insurancecontributions) in 1953-54 are expected to total71,603,680, compared with E76,480,000 in 1952-53,thus bringing the net cost to jE416,480,360, as againstjE438,901,500 in the present year. In arriving at the truecost of the service the expenditure on Civil Defenceshould be excluded.The difference between the two years is mainly due

to the exceptional expenditure in 1952-53 on retrospec-tive payments under the Danckwerts award on theremuneration of general practitioners. Originally thecost of general medical services for 1952-53 was estimatedat 48,500,000, whereas the cost now shown for thisyear is 86,913,000 ; in the coming year it is expectedto fall back to ;E58,217,000.According to the estimates, the cost of the hospital

.services will drop slightly in 1953-54 ; and this will bethe first year since the inception of the service in whichthere has been such a decrease.

The grant-in-aid to the Medical Research Council in1953-541 is set at :El,805,846, compared with z 1,898,287in the present year. Of the total 134,700 is for capitalexpenditure, and El,671,146 for general expenses com-pounded as follows (with deduction of 117,908 for

receipts) : administration, 70,652 ; provision for generalscientific purposes, 20,707 ; National Institute forMedical Research, 343,771 ; research units and externalscientific staff, ;9984,624 ; special grants to institutions,&c., 187,300 ; temporary research grants and trainingawards, 182,000.

1. Civil Estimates for the Year Ending March 31, 1954 : Class V :Housing, Local Government, Health, Labour, NationalInsurance, and National Assistance. H.M. Stationery Office.Pp. 185. 6s.

2. See Lancet, 1952, i, 661.

PRIVATE TREATMENT IN N.H.S.HOSPITALS

Memorandum from the Joint Consultants Committee

THE Minister of Health has now laid before Parliamentnew Pay Bed Regulations under sections 4 and 5 of theNational Health Service Act, 1946. These regulationsare designed to come into operation on April 1 next,when they will supersede the existing regulations.The new regulations, which have been the subject of

lengthy discussions between the Joint Consultants Com-mittee and the Ministry (and with the Minister himself),deal broadly with two matters :

(a) The manner in which the charges for private hospitalbeds shall be assessed.

(b) The maximum professional fees to be charged to

patients desiring private treatment in hospital.- PRIVATE BED CHARGES

Under section 5 of the 1946 Act, patients seekingtreatment in private hospital beds are required to paythe whole cost of the accommodation and servicesprovided. Since 1948 the charges for private beds haverisen to an alarming degree, and during the discussionson the new regulations, the Joint Committee sought apersonal interview with the Minister of Health, and

impressed upon him that unless some action was takento reduce the charge private practice would steadilydiminish. The committee reminded the Minister of thepromises of previous Governments that facilities forprivate practice would be retained under the new service.It pointed out that it was the experience of consultantsin many parts of the country that there was a fallingoffin the demand for private treatment-due largely intheir opinion to the high maintenance charges-and thatthis was bound also to affect hospital revenue. Thecommittee therefore urged the reintroduction of a

moderately priced private bed.In reply, the Minister stated that he thought the

possibility of introducing the necessary legislation duringthe next two or three years was extremely remote,having regard to the heavy parliamentary programme.The Minister added that while he was anxious not to

place any obstacle in the way of private practice hedoubted whether the falling-off in private hospitaltreatment was primarily due to the high charges. He

agreed, however, that if this could be substantiated, theposition would warrant further consideration becausethe provisions of section 5 were intended to implementthe promise given that private practice facilities shouldcontinue.The new regulations are still designed to secure that

the charges for private beds shall represent the wholecost, but there are certain changes in the method ofcalculating the charges that will, in many cases, resultin a reduction of the charge. Thus in hospitals wherethe total cost of the pay block cannot be determined

separately from the cost of the public wards, the percen-tage increases which are added to the average dailyinpatient cost to arrive at the private bed charge arereduced from 25% (single room), 15% (double room), or5% (multiple-bedded room), to 15%, 10%, and 5%respectively. Furthermore these percentage increasesare to be added to the net daily inpatient cost beforethe addition of the salaries of medical and dental staffinstead of after the addition of these salaries as hitherto ;and the cost of any service from which the privatepatient receives no benefit is excluded from themaintenance charge.

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MAXIMUM PROFESSIONAL CHARGES

The main criticism which is likely to be levelled bythe profession against the new regulations, so far as theyconcern the professional fees to be charged to privatehospital patients, is that the detailed classification of

operations is retained. -The Joint Committee made strenuous efforts to

persuade the Ministry-and the Minister himself-thatthe attempt arbitrarily to divide operations into categoriesof major, intermediate, and minor, without reference tothe condition of the individual patient, was unrealisticand unlikely to work satisfactorily. Unfortunately theMinister has adhered to the view that the classificationis necessary as a protection to the patient, despitethe repeatedly expressed view of the committee that theclassification afforded no protection at all but that, on thecontrary, the maximum fee for each category of operationwas likely to become the standard charge, whereas inthe past consultants normally related their fee to theparticular requirements of the case and to the patient’scircumstances.The Ministry sought the assistance of the Joint

Committee in improving the detailed classification of

operations, but because of its view that any classificationwas impracticable the committee declined to accept anyresponsibility for it.

Apart from this point of major principle on whichthe Ministry and the Joint Committee were unable toreach any agreement, there are certain improvementsin the 2nd Schedule, setting out the maximum pro-fessional fees. The maximum fee that may be charged