john powell 4/1/1 1957-september 1965, 6 files...
TRANSCRIPT
The Speeches of JohnEnoch Powell
POLL 4/1/1Speeches, November 1957-September
1965, 6 files
POLL 4/1/1 File 6, 1957-1961
Image The Literary Executors of the late Rt. Hon. J. Enoch Powell & content t. the copyright owner. 2011.
29/11/1957 The Economy/Industry Inflation Newcastle 1957-1961 Page 33
12/11/1959 The Economy/Industry The Location Of Industry Institute of Directors, Birmingham 1957-1961 Page 57
12/11/1959 The Economy/Industry The Distribution Of Industry (Alt.) Institute of Directors, Birmingham 1957-1961 Page 64
27/10/1960 Government and Nation. Health and the N.H.S.
Aims & Objectives Of The New Minister Of Health Executive Councils’ Assoc., Lllandudno 1957-1961 Page 50
9/3/1961 Health and the N.H.S. Integration (Published Version) National Assoc. for Mental Health, Church House, Westminster 1957-1961 Page 36
9/3/1961 Health and the N.H.S. Integration (Original) National Assoc. for Mental Health, Church House, Westminster 1957-1961 Page 24
22/4/1961 Memorial Speech/Toasts. Government and Nation.
St George's Day: The Spirit Of England St George’s Day Banquet 1957-1961 Page 18
26/4/1961 Health and the N.H.S. Cost Of N.H.S. Drugs Assoc. of British Pharmaceutical Industries, London 1957-1961 Page 14
10/10/1961 Government and Nation Importance & Significance Of Local Government
Local Government and Nation Conference, Brighton 1957-1961 Page 3
_CONSERVATIVE AND UNIONIST CENTRAL OFFICERELEASE TIME
LO= GOITER— C=EPENCE - B7‘IG'70-: 1961
7529 10015hrs/lOth Oct. '61
Text of a speech by Tho Rt. Hon. Enoch PO-'ELL, M.B.E.,M.P., (Wolverhampton S-7.) Minister of Health at theopening of the Thirteenth .:rinual Local GovernmentConference at The DoTe, Brighton on Tuesday, lOth
October, 1961.
A speaker who has tl.e honour to address this Local Government
Conference of the Conservative Party has one advantage over those
who address the Party Conference, to 7hich this is now the
traditional prelude. Those assembled at the Party Conference
represent the peoule who support and help to return a Conservative
Government. Those assembled here represent the people who are
actually engaged in carrying on Conservative government over the
length and breadth of the land. Conservative Ministers here are
in conference with their colleagues, and have the benefit of
listening to the delibeiations, and learning the views, of those
who, like themselves, carry the .'esponsibilities of administration.
The ancient authors of text books on rhetoric advise that the
first part of a speech should comprise what the Romans called a
captatio benevolentiae', a passage devoted to gainin=1 the goodwill
and patient attention of their audience. Some of you, on hearing
my opening words just now, may have thought that I had remembered
my Cicero and c)uintilian only too well, and had started off with a
nice bit of flattery, designed to get you in a good mood and begin
the proceedings in an agreca'ole atmosphere of self-satisfaction.
I will therefore at once dispel any such notion with a few
simple facts. Out of 83 County 3oroughs in England and :iales 41
have non-Socialist majorities - it is only a mayoral casting vote
which deprives me of the satisfaction of including Yolverhampton
and making the figure 42. Ci.ltof 62 counties, 53 have non-
Socialist ajorities; and wl'en we come to district councils,
the pronortion in the non-County 7oorouhs and Urban Districts is
/691 out of a total
Issued by the Press Department, Conservative Central Office, 32 SMITH SQUARE, IA estminster, S.W.I. (Telephone: ABBey 9000)
7529 POWELL - 2 -
691 out of a total of 910. Thus, taki- e, local government over
the country as a whole, ono-ti r and two-tier, by f r the greater
part of it is exercised on the oespensibility of elected councillors
who look to this Conference as the forum appropriate to their
political beliefs and their outlook on the role of govornment in our
society.
would not accept,nor 'would you, that the full importance of
local government canbe measured in financial terms; but ev-n in
financial terms it is evident that the word 'government' in the
expression 'local ooveonmentt is no mere metaphor. Taking the
estimates ofcapital expenditure in the public sector in the presont
financial year, that of local authorities accounts for fully two-
fifths out of the total of ,,7,1,730,000,000, and that is the total of
public investment in the widest sen3e, including not only government
items such as roads, but the commercial investole t items of the
nationalised industries. The current budget of local authorities
is running at some ,-02,000,0()0 9000 a yer. This is about two-
sovenths of the total current expenditure of local and central
Government touether. Thus, if you could make acon:posite photograph
of the chairmen of finance committees of local nuthorities, the
resultant individual would be a very censiderable 'Chancellor of the
Exchecuer° in his own right. Thu great majority of all this
spending takes place cn the responsibility of majorities whose
represntativco are in this room this fl rning.
People Ipay be heard to say, h(nev r, that this responsibility
is unreal, me-rely fornial and not factual, because the expenditure
is nearly all predeterboined, comoittod, laid down from Thitehall,
and that finance committees and councils do no more than rubber-
stamp the inevitable I want to t ke this fallacy and nail it
fnst to the counter, because this is a iyind of talk and a kind of
belief hich can do harm to locol vrna nt, anl indeed to the
public interest, ami une finds it osprond even maornmt
councillors themselves, vtho shati7d knw ttcr, let n.lono aoongst/those wl are
7529 POWELL - 3 -
those who are looking for an excuse to talc.e no interest and no part
in the local government of their own locality.
Both nositively and noatively - in deciding te spend and
deciding not to spend - local authorities have Very real and
effective independence, not only in minor and purely local matters,
but in the Provision and development of the great public services.
This is c-rtainly the case in health and welfare, where I can vouch
for it from direct personal knowledP7e. I am sure it cannot be
much different in the other main branches of expenditure. Let meptve
it from my own field.
There arc wide variations in scale and effectiveness between
one local authority's health and welfare services and another's,
after all differences of local heed have been allowed for. 7hat
is the reason for those vari,tions? To some extent, not I believe
very much, they may be due to difference in rateable resources.
But overwhelminly the reason lies in the simple fact that differentdecisions have been taken by diiierentauthorities. In some there will hi:,.ve been an officer, a committee
chairman, a group of councillors, of enthusiasm and drive, who have
been able thus to imprint their own asnirations on the services of
the locality. Elsewhere this vitality will have been less in
evidence. The simple deduction is that it does depend on the
council: the councillors do take decisions, big dicisions,
effective decisions, which no one else can take for them.
Nor are these by any means isolated, individual decisions.
On the contrary, a locol authority cannot have effective services
without deep thought and far-oi-;. u d planning on the part of
somebody. Often that somebody will bean officer; but I do not
have to tell this audience that the best of officers vcets nowhere
without chairman, committee-men and councillors who can and will
work through him, nor that those who complain of officers 'dictating'
policy have no-one but themselves to blame. It is ene of the
satisfactions of local gevaranant thot in it 1-)ople 1-vive a good
chance of devoting themselves te the shoring and excecution of a
/policy in the
7529 POWELL - L.-
policy in the long term and may hope often to seethe achievement in
after years of plans whicn they helQed to initiate. This is an
opportunity which might well be envied by finisters of the Crown
who, departmentally speaking, are condemned, to sow what they will not
reap, even if they also reap what they have not sownl
I shall return presently to say something mere of the planning
and deliberate development of services by local authorities. For
the moment I want to 5dd that the local authority's power of
independent decisiGn transcends the individual department. They
can and should, no less than the central Government on its plane,
be constantly concerned to give a deliberate shape to their total
spending. It is this that makes them truly the colleagues of the
Chancellor of the Exchequer, as they aro departmentally the
colleagues of the various departmental linistries. They have a
definite, independent share in determining priorities not only
within services., but between services.
Let me add, too, that they have a share in determining the
total quantum of public expenditure, current and, above all, capital,
from year to year. Almost irmediately after announcing his
financial measures on 25th July, the Chancellor of the Exchequer
called into counsol the representatives of the local authorities of
all hinds throughout Great Britain. The meeting was attended by
all the departmental hinistors concerned with local government.
This was not a simple gesture, not a deprecatory motion to forestall
criticism. It was the logical and inevitablo recognition of the
fact that local government's part in determining the make-up and
amount of public outlay is not a passive and debendent one, out an
active and independent one, which it is their duty te exercise in
the light both of local and n-tional circumstances.
To-day the vast majcrity of local authorities' capital
expenditure is financed by their direct borrowing from the public,
theu.n. the Public A:rks Lo,n Board remains a lender of last resort.
Indeed, through thr, rep , ent DfoLladic,r debts contracted to the/Public Wors Lean
7529 POWELL - 5 -
Public Works Loan Board, local authorities in recent years have been
a net source of cash to the Exchequer and thus ono of the channels
through which the nation finances its investment on central account.
Now, as a great borrower and investor, local government has the
duty to be ;guided year by year in its decisions by the same factors
asthose to which any other borrower and investor must have regard.
The level of bank rate - which determines the cost of short-term
borrowing. - and the level of longer-term borrowing rates are not,
as one would suppose from hearing our opponents talk, a kind of
arbitrary tax which is slapped on to the local ratepayer for reasons
that are none of his concern. They are indices of the real facts
of life, uhich demand the attention of local as well as national
government; and the authority which pays due regard to them in
steering its investment policy is dein:717 its duty to those whom it
serves no less than in paying regard to other ruling prices or to
the availability of building and other resources in its area.
It is thus no term of rhetoric, but a sober statement of fact,
Ito say that the finance officer, the finance committee and the
local authority itself arc 6he colleagues of the Chancellor of the
Excheouer in adopting and applying the policies appropriate to
current circumstances. Without local government, that application
would be less accurately and faithfully adapted to public needs and
local facts.
With your colleagues in the central Government, you in local
government share the practical limitations upon the scope of
decision at ;_ny given time. A very high percentage of current
expenditure and no small proportion of capital expenditure is.
committed' .1D./ previous decisions cad by policies in force. To
take the most obvious example, a big element in the budgets of all
committees consists or staff salaries and waes, where the rates of
pay are determined by forces beyehd the control C any individual
authority and often of 11 authorities cilectively, and where the
establishmnt is roi:7ist,3nt to altoration - at all ov,:ints to/altortion de,.,nards
7529 Pa7ELL - 6
alteration downwards it is true again, that many standards and
policies are centrally or statutorily discreed - at least, as minima -
i and that where this is so, the sceoo for decision is to that extent
i restricted. I have sometimes heand councillors and others arTmc
that these and similar built-in limitations reduce local authorities
to automatic machines and their members and officers to robots. Tut
all government, not just local government, is subject to theso
limitations, Independence and resbonsibility can rarely, if over,
mean the power to take decisions de novo over the whole field of
administration. What in practice government decisions are free to
affect is nearly always marwinal in the short run - a little more
here, a little less there; but in the life of men and nations it is
the margin that counts, and the power to influence the margin is the
power to do all that deliberate decision can, to shape the future of
a society which has a continuous and organic life. So let us not
despise the. scope for our free decision simply because so much seers
pre-empted and committed; for we shall find that continuous influence
at the margin, in pursuit of deliberate princibles and policies, can
bring about great results and accomplish big chan7es0
And here, for a few minutes, may I take advantage of this
platform to seek your co-oporatien in my own departmental field of
health and welfare. 1 feel I can do so without trespassing on the
/ patience of thoso whose special interests lie elsewhere, because this
field affords so splendid an example of the aPportunities open to
local governmont and the true rolationship 014'contral and local '
government as independent colleagues with mutual res-pect for eachother's special function.
This year tho hospital service of this country is for the first
time onga7ed in an attomrt to plan its future devolerpent for fifteen
years ahead. Fifteen years may sound a lorig stretch, but in fact it
is about the shortest period over which it is worth while pl_anning,
when you consider that the gostation period of a substantial scheme,
from conception to occupption, lasts at least five years. Car object,
therefore, is to forecast the wor: which • - think :eipht to be started
/in the next
7529 17'nELL - 7 -
in the next ten years and finished in the next fifteen. In order
to break clean away from the long era of 'make-do and mend in the
hospital service and to ensure a s .und application of the increasing
capital resources which will be available year by ye-r, we are trying
to project ourselves forward into the 1970s and assess, as the starting
point for our plan, the population as it will be th-n - its size, its
distribution, its make-up and its needs: how many babies, how many
people over a certain age and so on.
Such an assessment, however, although an essential preliminary,
does not in itself tell us the hospital provision which we should aim
at securing in the 1970s. Even when an estimate has been made of the
morbidity and total medical needs of such a Pepulation, We are still
not there. We still have to answer the all-important question: how
far will these needs be met inside hospital, how
far outside hospital? Until one has assessed the respective shares
of the hospital service on the ono hand and on the other hand of all
the services which give care and sup:eort in the home and in a whole
range of establishments and institutions collectively described as
'in the community', it is impossible to proceed to the planning of
the hospital service itself end the solution of all the problems which
are peculiar to it.
Lot me give just a few ex=r)les which illustrate thiz. Take
maternity. The hospital provision which is required for a jiven total
number of births depends n,t only_upon the proportion of those births:
which will take place in h-s-ital, but u-oon the averge duration of
stay in h spital. Both these factors depend in turn on the provision
which is to be mede for home confinements and for home care of mother
and child where the c nfinement has been ir hospital,
Take mental illness and subnerm lity, which even in future will
so far as one can see represent ene -f the principal der=ds upon the
hospital service. To a large extent the revision od cutside
hosital for the training anfcc ti of tho subn:,rmal junior
and adult is comoleentry to the provision needed in h-sDitl: the
hestels, the training centres of variuo hinds, the home sutpp-,.
/ •Iven ta
7529 POWELL - 8
given to families by mental health an other social workers belong
as integral parts to the same secuence and system of care as the
hospital. It is meaningless to say that such anJ such provision
for the subnormal is needed in hospital -ithout saying at the same
time that such and such prevision is needed outside. Likewise
the dramatic run-down which I confidently expect in hospital
places for the mentally ill, implies that a whole range of services
outside will enable the lesser number of hospital places which
remain to be used intensively and curatively.
Then take the old, whose care is one of the weightiest and
most problematic commitments of our society. We have turned our
backs on the old notion of so many hospital beds in which so many
aged sick will lie for an indefinite period. To-day We sot out
from the opposite conception, of services and establishments which
will prolong the independence and capabilities of the old to the
greatest extent that is possible in each individual case. It is
a conception in which the hospital has a more and more active and
supporting function, catering specifically for sickness rather
than for age, an,1 working almost to the end to restore rather than
serving as a receptacle. How do you set about estimating the
need fer geriatric or long-stay beds - I'm never sure I like either
word very much - till you know what is to be the policy and
provision for the old in the community?
Finally, to make an end of this string of instances, there is
the ordinary hospital bed, the 'acute bed' in the jaron, which
more and more will be suppliot Lnd supported with all the
specialities, the expensive specialities, of modern medicine. How
are we to estimate what output we can get from it, output in terms
of intensive care, if we do not al o estimate what services
outside the hospital will be available to preserve it for its
proper use?
I trust I have proved a thesis - indeej, I hope I have not
trespassed cn your p;5t1COC by ever-preving it - that to plan for
/the hoSjitciL
7529 POELL - 9 -
the hospital service, if it means anything, means to plan for
the health service as a whole. Of the circle which is thus
described, only a segment, albeit a. large segment, is filled in
by the hospital authorities. The remainder is filled in by whom?
By the family doctor service; yes, that gees without saying. -
perhaps it goes too often without saying: But by whom besides?
By local government, by the local health and welfare authorities;
for it is they upon whom rests the responsibility for providin
that whole great structure of services and institutions which the
hospitals must assume as their natural and necessary complement:
the health visitors and district nurses and midwives; the home-
helps and home teachers and trainers and the workers in social and
mental welfare; the training centres for physically and mentally
handicapped; the hostels and half-way homes for the mentally ill
and subnormal; the Whole gamut of services and accommodation for
providing care and attention to the old.
This is your work, the work of the branch of government to
which you belon7, the work of the authorities from which you come
or which you support. It is not work done at the dictation of
someone else. In the hespital service the Government, cc far as
it can provide the means, can also shape the ends: the Regionnl
Boards, the Board of Governors, the Hospital hanagement Committees,
though bodies designedly of great respect, authority and experience,
are yet my aents to discharge the duty laid by Parliament upon me.
Not so the local authorities. In them I am required to find
partners and comrades. Leadershig, if I can give it, they have
a right to expect from me: they are not there to be ordered.
This same operation that I have been speaking atout, which
will mark :Jut the field for the development of the hospital service
over the next ten to fifteen years, will at the same time, for the.
reasons we have seen, mark nut the fiell for the development of theiwork,of the/local authorities also. Indeed, the lk)cal authorities are already
co-operatin, thriall the :,ssociti,:ns which 1,,r000nt ther2, in the
work of TLkin,-: tho esti:71s, dotining the as=7Dtions, c.•nd
,/ebarirw cut the task
7529 PUVELL - 10 -
sharing out the task. For the local authorities, as for the
hospital authorities, the first edition of the 10-year plan is
to be a new startiaw point. ,Qs soon as I can place it before
the local authorities, I intend to invite each one of them to
define their own local plms and intentions for ten years ahead.
Within the general framework it will be for each authority in the
li.wht of what exists already and its knowled,T:e and assessment of
the local scene, to say how its share of the total provision shall
be made. Incidentally it will be strane indeed if, in this
process, the local authorities and the hospital authorities which
serve each area are not drawn closer toether.
Yuch more than on the hospital side, development on the local
government side represents staff, trained staff, men and women,
more th-n bricks and mortar; but bricks and mortar in plenty there
will nevertheless need to be. I sometimes wonder if people
sufficiently realise ho,a, measured in bricks and mortar alone, the
local health and welfare services have been leaping aP in recent
years. Only three years ago, in 1958/9, the total capital outlay
on these services was only .V-],000,000. Next year it is expected
to be up to ,c,22,000,000, and with the Chancellor of the Exchequer's
agreement I was able to indicate to local authorities recently
that, even in present circumstances, tbey should be lookinv to
further expansion. This serves to show what hiah importance the
Government attaches to thumeservices. Furthermore, within the
total sum which is forecast to be aveilable to the health services
as a thole over the next four years, I have intimated to hosPital
boards that in budgeting for them I sn 71 deliberately leave room
for a more than proportionate expansion in the local government
sector.
You will soe, thel-fore, tha_, an tab unolo ;Treat field of
health and welfare there is rept just a nominal cb for local
authorities sr.a their mem ers are officers. This is a real,
responsible, independent t county by
/county- the
7529 FUJIELL - 11 -
county, the outcome of which will deend on the keeness, the
imagination, the feresi7ht, and the public s•cirit which the
respective authorities bring to it. You must forgive me if I
have demonstrated this in relation to the one department, albeit
of large and growing importance, which is my own immediate concern;
but there is not one of my colleaues in partnershiT.) with local
government who could not demonstrate as much for his own peculiar
field. Away, then, with the notion that somehow local 7overnment
is tcabined and confinedl and languishing for lack of work or the
means to do it. Here, after ton years of Conservative government,
your colleagues in Whitehall - far from diminishing the status of
local r2.overnment, as ha. pened in the frustrating years before
1952 - come to you with fresh tasks and wideninp. persPectives.
And that is just where lies the importance of this Conference which
I open this morning.
TZ,L.TD
2E. N. r,1IMPORTANT TO BE CHECKED) AGAINST DELIVERY
NOT FOR ?U7LIC'TI°N
.S. 22 UV--7 S
HE:_LTH ICINISTER. ON RELATT:NS 011TH 7-ND7STRY
The Minister of Health, Mr. Enoch Powell, speaking at the annual dinner in London, tonight of the Lssociation of British Pharmaceutical Industry Dinner, said:-
. na., las often in recent months ben linked with that of the British Phar-maceutical Industry. The connection has nct always been of a complimentary nzture. In certain political circles I have been represented as the industry's lackey,concerned in all that I do to safeguard their allegedly astronomic and unwarrant-able profits. In other quarters I have seen myself referred to as the industry's sworn and determined enemy, tirelessly adopting one measure after another designedto bring about the destruction of the industry and its elimination from the tradeof this country.
Both these pictures cannot be true: for they Pre absolutely contradictorY;and it so happens that in fact neither is true.
I am here tonight to propose the toast of the Association of the British Phar-maceutical Industry, because I believe the Crovernment's approach and the polieywhich I am pursuing at the Ministry of Health is one neither subservient nor inimicaltc the industry, but one which affords the best basis for mutual understanding,respect and oo-operatien; and I have looked forgard dreatly to this occasion as one which affords me the opportunity to put that basis before you.
Fundamentally, the relationship beetWeen the industry and myself is that betweensupplier and ustomer, or rather that between a number of suppliers and one of their
. principal customers. am your customer, on behalf of the National Health Service,for about. a third cf your industry's production. This relationship of supplier andcustomer, producer and consumer, is the stuff of which cur commercial life is made,and I happen to believe, as a committed adherent of private enterprise, that inconditions cf competition and froedom of contract it yields greater benefits to allsections of the community than any alternative system.
But this said, 7et us admit straightaway that T r= no ordinary customer, and tthat the peculiarities of my situation introduce into cur relationship special fea-tures and unique problems.
MOMPSONIST"For all the druris used under the National Health Service in this country I pay
the bill, in the sense that I ask Parliament the money and am answerabae for itsexpeno7iture. I pay the bill, yes, but I don't ordpr the goads; and I don't con-sume them either. They are ordered by the doctors, and •onsuMed by the patients.So the three acilvities TYf '1 normal vustemer - erdering, cocseroirg and paying - arehere divided botween three sepbrate sets of peopletiorder- and- those, who
'It is this simple .
- 2 -
It is this simple fact of the separation between the flnction o.f deciding and the
function of paying which makes cur relationship as supplier and customer so different
fram the normal pne. There is, no doubt, also the fact that for a large range of your
products you are confronted in the home market with virtually a single customer - a
monorsonist, I believe the technicians call him.
17710 POLICY LI7CES
Now in this situation it seems to me that there are broadly only two lines of
colicy oren. One is for the customer to try to control and manage the supplier, or
even to make a take-over bid for him. This is a policy which might appeal to
certain ilaol -.as,and I have heard it advocated in some political quarters; but you
will not be surprised tc hear me say that I repudiate it equally on practical and on
p-litical grounds.
But if we reject this course, we are left with the alternative of doing all we
can to.reproduce the conditions of a normal supelier-customer relationship in the
circumstances created by the National Health Service. Te can never reproduce them
perfectly; for the independence of the medical profession and the comprehensiveness
of the Health Service are essential and (I trust) permanent features. That is no
reason for not doing cur best to get as close to normal conditions as possible.
Indeed, so far as I am concerned, I can.only discharge my responsibility to
Parliament and the taxpayer when T can satisfy myself that I am procuring what the
Natieral Health Service needs as nearly as may be under the terms on which it would
be obtainable in the conditions of a free and open market for the supplier and the
customel%
This then in the basis of our policy, and you will find, if you look, that the
various measures which have been taken in regard to the drug bill in the National •
Health Service can all be referred back to, it. Take, for example, the whole group
of moY,:aures related to doctors' prescribing, the latest of which is the recent pub-
lication of the Cohen Committee's advice on the prescribing of certain proprietaries.
The purpose here is to assist the profession to good and economical prescribing, in.
other -ords, to rrescribing in a manner which combines the highest interest of the
patient with regard to the fact that articles he e a cost and a varying cost-Tt is
thui an attempt, in some measure, to reunite the disjcined elementi, ef the customer
-7;itheut crejudice either to the independence ± the orderer cr to the interest of the
consumer.
-71-7 7'7 ATE FRZCI REGULI,_TI
Cr take again - to turn from the ite s ordered to the prices at vfnich those
item s arg- sold - take the voluntary Price Regulation Scheme to elaborating and
reerisng which your .Assocviation and my :..:nistry harE, de-o^ted sc much effort and
brought so much good will, This,tco, is recogrc.isabl-o a me-ns of reproducing some of
the con-7-;tons of a conretit we market. Where, for exami:le, as in the export field,
on adeout- laos f-r stabi7o?:ng =Xet rrioes can be formed, it adopts them as a/critericn;
critericn; blie,re no such basis is reg.dy-made, the 3ohemo seeks to. arrive as nearly as
nbssible at what might be the prices obtaining under comeetitive conditians.
believe that, though any such scheme can achieve cnly an dc,oroximatien ta its objoot,
the reTised scheme brought into ferce at tne beginning of the year represented a real
advanCe upon its credeoesscr.
If we are frank with each otherj;we bill 'admit that in cur relationship
customer and supnlier each . f us has a weakness In his bargaining positi,rn ,daich toa
the other is a corresponding scuwce of bargaining strength. IV weakness is that the
Health Service must have the drugs you suobly: aantrs 1-ife may depond on his
getting one particul,ar profrietary drug: cannot refuse on financial grounds to let
his dnctnr order it for him. Your weakness is that virtually your only home market
for your ethcal drugs is the National Health Service: 4f I limit the scoe or the
profitability of that market ycu have nc alternative cutlet. This surely creates for
each party not merely a moral duty but a practical necessity, in sheer self-interest,
tc be fair and reasonable in decdjng with the cther. Tf you seek to multiply your
-wares unnecessarily, or to charge prices bhich instead of yielding a reasonable profit
represent the maximum that the traffo will bear,you will endanger the continuance
of the customer/supplicr relationship -which I have described. If I try to use my
mcncpsenist position in such a t:ay az to brevent you from earning for your products
at hame the sort c:f reputation bhich austan your cower to sell them a'broad,
thenI might end by finding myself -vithout an efficient End vorsatile source of
home suloply.
Hem, then, I believe, is the ground of mutual understanding and respect between
the industry and the qovernment: a candid recognition that this ought to be, az nearly
as be can make it, a straightfcrvard nustomer-suPclier relationship, the one side
Seeking a good bargain in its vast expenditures, the, otd-er looking to to,,,rn a c,-oft
in fair competition, and both believing that the ctblic good is served by their
rescective efforts.
El...PORTS
In that public gnod I include the international trade of great Britain.
heard the fear expressed that rsgulation if prices and good, economical prescribind.
in the i..,Tational Health SArvice might threat to this country's large and
valuable pharmteutical =pert trade. 7 cannot bolieve that this fear has
any real foundation. The great export trades bhich yeur industry has built up cannot
decend either upon the National Health Service baying mere than combtitive prices
for its drugs or upon crescribing in National ':I.ealth SE:rvics 'being less than
sound and economical, S. far from beakening the soar:ort trade, a healthy custemor-
supplier relationship here at h:me betben qovernment and. industry cught tc strengthen
-,•
:ay I ea:" or -on In
Lnperf,,7,t -..7orld in 7,-hich h-.oc t rats. th:27
zh..2uld have thcu,fht) 111_1- tic Induztr.7 10 - in elk - an ::_:..7bociatine
661, —J.497 ITaa7
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73.1-97Za3U00 ::jUZ:: sa-TDI.T.dns
u-2,7,1 uc'T;Tunt=oc,
$ . George's Day Ban uet 22nd April 19=:1.aitxto41.-
Once or twice 44.4494.1 in a liftime a man ought to beallowed, as you have done me the honour to allow me tonight, topropose this toast. Introspection for a nation, as for anindividual, is an unInealthy attitude unless it be sparingly
77practised; but from time to time an ,ilgrlisnman amonng other64eic:Englishmen may without harn, and even with advantaze, 15,rek to
express in snoken -pords just cause to praise his country.Fhere was a saying, not heard to-)ay so often as form_rly,
"r:hat do they know of ,-nglend who only -Snsland known ?" It isa saying which dates. It has a -eriod aroma, like lpling'saecessional or the state,rooms at Osborne. The period is that which the historian Sir John Seely, in a no7 almost for ottenbut onee im ensely populn- book, colled 'The Tapansion of 'ngThend".In that incredible phase whinh cane upon the Dnglish unawares,as all true zreatness comes unawares upon a nation, the power andinfluence of 'Sngland expanded with the force and speed of anexplosion. Fhe strange brieernctare of C-442-44-oano invincible seapower with industrial potential brought the islandsand the continents under thiz influence, I almost caid under the?ell, of 2h7land; and It was the znc:lishman who carried -rith him to the Lockies or the hortk-est Frontier, to the ,ustrallandeser4-or the African lakes, 'the thoights gland ,..7iven"whoseer:led to nikeelf and to a part of his countrymen at hometo be pical dn7lishmen with the truest perspective of
-land.Tha t phase is ended, sn olanTy t::Lat even
generation born at it zenith for whom the realisationno longer deceive thmselvesL4 4.
-2 -
III That power & that .Fflory have vanished, as surely, if not
as tracelessly, as the Imper'Lal fleetA from fne waters of &pit-
head; in the eyes of historyjno doubt as inevitably as
"Ninevell and T-Te', as :Lome andSpain./ Aky,tI]n7land is not as1].inevg.11 and Tvre nor ,-.J. 72.ne nor as SfalLa_._)
CherodcK4s relates no-:: the :,_thehians, returnin17 to their
city after it had teen sacked and barnt ty rEeraes and the Yersian
army, were astonished to findlalive and flouritin-f in the midSt
of the blackened ruins, the sacred olive tree, the native symbol
of their country. So we today at the heart of a vanished
jimid the fra7ments of lemolished -i7lor, seam to find Fin4AAA
4R-rIg..=:_iiicm_iamsilicxxxxlixamcordx.4 like o.oe of her own caktrees, stand-
ing and :7owins7,thesa7 still risin7 from her ancient roots to
meet the spring, --Ln and herself. Per:oars ofter =,7l we know
meWof EnTland "who only l'n7land kh-107,."
There wls this deef, this nrovidential dif'erenc betw=.en
our Tmnire and tose others,that the nationhood of the hot}-aer
ofcountry remained trou7'h it all 77'4::. ), almost unconscioustzimillir/c,
the
narlanceit.:]he 44miwi citiz.ahs-. _klissolvea ln,4,
the citizenshin of tiheLanciont acrid;learnt to live on the
treasure of t'ne Lmerics• tIle hansbT7s ahd t e laenzol.rns
ezten their fnlit their no7er, -no.-and, which 4:7,01(
as an aai_on t. at the .American t'olonies could nat te reorese:nted
in :Is'arliament and 'hed to confess ta.t elancl ':vas nnt to
assirjicte:1, ,.)1aer':fent no arz. nic cam :e as the mistress of a
:orld 2 sire e 7a,s
lcasetfconectins
ents afal stran 'e races fell
- 3 -• 014.".c,7eneration is ilke one -which comes home a7ain
ft.m yg‘Prs of distant wan:erin7. discover affinities with
earlier 7.ererations of .1-1-=:lish,enerations before the "expansion
of .:a7land", who felt no cour_,try but this to their own.
look ucon the traces -hich left with a new cariosity, the
culricsity of firqin.7ourselves once more akin with the old ha, h 4444 _ _a-34our -trid-J=.'-vond the -renacflers and the
phi1oso7'oers of the ei2..:•teenth centulr:;, beyon the pikemen and
the preachers of the seventeert, back trou-7.' t 7-e avent-
rous daz,rs of the first aliza::et and t±e, hard :7:aterialisLi cf the
fudorS,ar, there we find et last, or see ff..to find the:1-_, in
many v'l'ae charc, beneat t',c tall tractigof a
7erpen'7olcular East winThw and the coffered ceilin of the chantry
c'narel. From brass and stone, from line and effi,7,-, t'neir
e7es out at us, and e 7aze into theL,as if we 7:Hlid 7!in some 461 hkAv444.1e fror:1 t:Teir inscrutable silence.
'Tell us 71 t it is tht to-ether*, as t',n;
that lead,t4w. a tio.qsaild :eats; 7ilispe:- t s te
secret of this ci_ai.:.ea life of that Te tiLe
knoT 'fl= to hol.7',it fast.'
can
That ToH_ITd sey ? 7oa.1-1 to. as in
ton e for tr' In, tl=ed
sc-17s t'f_at rer lika saries of
tell t:.s of t'.at -La2vr.,11 ,7uytand., no s7Teotly .L,ira-1 ofcosi'7,es in clitte tnat all the ,,-,eascia of t'e ap •ear
tere in their reatest oerfection; te fielthe:: 1:uilt their i ils , their cott7i:, :
F-!an7ie .black-torn s_ryere'fi its 7.etals tne:: -•=3the 1oala tell us, s72tel:7, rirers,
•sland coasts of :]nzle.nd. 2hey woeld tell us too of a palacenear the 7reat city which the -2:omans built at a ,oral'eiver Thames, a palace with many ch•bers and one lofty hall,with an eI faces carved on the hammer freues, te 7hich men
resorted out of all Yn;zland to speak n behalf of their fellows?a thina7 called "Farliement', and from that hall went out men withfur-trimmed :,,,:owns and stren7e ceps on their:e,,.ad-sj.to jud=re thesame ,iLdments, and disnense the seme ,iustice, to all people of:n=land.
Cne ebove all they aeeurely would not foreti:an-castrian or Yorkist, squire or lor,.1, priest a,r 1aym9n; they old
,e/vcA4.7c44,a,point to the kin=ship of --r_=4nnd, and its emblems 41v...s.i,esible.Ohe immemcrial arms, three leopards or.9tbou:eh quartered latP with France, azure, tree fleurs de lis arent3and olderstiL,the crcwn itself an, ttt,,..; sceptred eve, in.-eich lai
-dward tKe .nelis'eman sti eed to sit in his oven char toclaim the alleiance of all tjle '.."ymool, yet sourseof pewer; offlesh and blood, yet Incrnation of an idea; the kir.hip would have seemed to them, as it seems to us, toembrace the Qualities that are peculiarly
A.4.)Ohe effortless ahd unconstreined,
,k?ccepts the enlimited suprenacy of114-r
?&.1-. i-nent,so Kiittbrlly to 'ne 'ware of its/TS*. AzAies end the ,c1 141-4/61-71/4_,1-1- 4/t,41di"ve_ reeions meke s hobby tc.
erown5e coa.
„
ences end asserrpeculiarities,
he .
rs-tikeir-h • - 1.
%ASU- 4." blci4,
, 9
• 4 7
° ?Lh.C‘r1441'144-‘41:4; 43et.c,tj /434.4 4". tuApry-
lunc, 01;4%4 ' Pa-z,) /&1ç 4A4-4-444,`
- 5 -
411L-44=a,/*71A-?vv.
the unbroken I 1 -, of the'nationover a thousand years and more is a phenomenon uniquein history,the prodect of a sreeific set of circumstances like those, whichin biolo, ,Ty are supdosed to start b chance a new line of evolu—tion. Institations which eleew—ere are recent and artificiel
o;kscreations a=ear in :_,n7lend almosyas/ woi nature, spontaneous andunquestioned. fhe deepest instinct of the ne-lishmen -- how theworl "instinct" keeps fercine- ttself in aeiaain and aceain I -- isfcr continuity; he never acts more freely nor innovamore boldly than when he most is conscious of conservine: or even ofreactin7.
Fr-m this continuous life of an united peoPle in itsisland, home sprin7, as fro the soil of 7,7,n7l,'i,nd, all that impeculiFr in the 7ifts and the achievement of the :nvlien nation,its lewg., its literature , ite freedon, its self—discipline.kll its irmpact on the outer world, in earll colonies, in laterpax Britannica, in .e.overneent -red lawaivine7, in commerce and inthoe has floed from ieerulses ,Dererated here. .end this
604.4 41m4.a444continuous and of nreland is svmbelised andexpresezel,as hy nothin else, by the nrlisI kineship, ereeliseit is, for all the leeks and thistles and shamrocks, the Stuartsand the Han•verians, for all the titles F7refted upon it here endelsewhere, uLrealns and territories", Headships cf Common—wealths, ,,nd what not. 2he stock that received all these. 7-rafte ie erielish,"-/FhPiees thrnmh it to the extremities rsesfrem roote in Thrlish earth, the earth of n la 11'2 hietory.
dna cuaht wall to rind , as hihly or honour, thepare ' stem of and its royal taliseen; for we know
• —6—
not what br-.nc:les yet ,ILhat wonderful treo will Lave the power
to rut forth. 2he a4.4offty is not always violence and force:
them we l'aveod before and can ap:ain. 2he peril can also be
indifference Eind humbug., which mimht squander the accumulated
wealth of tra-'ition and devalue our sacred symbolism to achieve
some c'aeac cor.prorAse or s.ome evnescent o=ose. ,-nese are
not thou7hts for every day, nor words for every co,,_pany; tut
on St. ieorme's eve, in tkle ociet:,/ of St.'Aore, may we not fitlytAN.
think and soeak them, to renew and strenP7thevqrselves the
resolves and the loyalties which 21-44ish reserve keeps otherwise
and best in silence ?
kt ii- bcfat 471,- ‘-t No ea)
A year y predcesor 1-
thAs confersnce on the first -.:ocasion of its
after the passage into law of the -4enC.,l
la mtich bs himself bad s nal re.
This year I am se lea.
first occlusion oi vr mme
as Minister of Ue h but since
Mum he to
only aiiia
inceptia in Janury of
lowlier= plea-nine, is our ospit-1 service. The thei7.0 of rconference this is intogr 4 service 14:4- mehtA
disorder". Thss could z4,JosLibly be a Cleme trAch cttj
more porfectiv with tea
plauailul of the hospital sric hptexpr4ss.
Lie, important is thit la4n otrtton tiwt -44016
/ tend to relhte to it ii.. wy o other almost ev rtii
the wholefield CPf heal r or a re Iti..icomes a
rAc pr•occupation; and I hope you will bear wit:A os it
for a few minutes I talk about tha reLtionship :peen the
ten year hospital plea and that canc..I. for ure of
mental health which brings us all t thor here this morning.
The •ssential idea of the plan is tc t onto paper a
picture or •t4twsht of Ulf, pattarn of hospital provision which
tank riht aul prac:icablt ttL co-antry in ti td
s . om this statement and a o *son of it w ta
it s
f.* I
i r
Lt1 th,... 1--,itt-,ig ead A -..„ kw
iflnettd. g the ccAlrv.,,Ist cy. .
stci to -,-=_7-tat its ... . tiv-tt pi C.1! 1. t A.
mid 07 , -.1,...tot r,-,1--st la t -
i.,f the then ,,,1,,,,.i: i t c..iru I v .....
.--1,-1 think for ;:t.- r-,,,,)e,:::'at, y; t .
Is A.,.!:V. ng 1
wh c 4r Ce .4 t Lit 4,r 4 af ..-• 1 .. of t3,-:.
1-4 .1 C.: .:.rvico, idoed of th,:.. -..if.,-,t i,,:„:-.2...., !'.;:';-1 :.t.x,-,- 11,,:, 1 th
-.,
-.pe r te.mt7-yt '
tAr f;',•t3 t
Chic a4w t:
,
te t
in z t
j1.1 t•fit. t t
it I tQ Aa t., ttj-,t
t
:t_
well be tlece.t=1 n.eit
fot.7 .te-otal
if, numer e1 t
re:'1.1 !ill:icy of ao fcworb-e-
i 1,411A: ea.7 Ci“it if 1 err. .tit err av
of ivre,.3ti-r, tin.; t-eaa,! t to
in f • As-741
its if is only 21 i,,tatistic! "to/ t
ster Ifice ti).e 1,t111.
tnore
ttion::at
we :tre
.2itc1L r
or
14)0-v-AU
t1;;- t Cs: :
for t.,crt tai-
'or clunipsA
,-t
t e VO. 4 t1
we
4,0
4
,
44
^140
z.;t t- ti-'t
4Lout ,
la ilot Lc • t
of eact.tri-; t. t ..itYtt
V t t t--; - t _ t
-.-t
4-47 , r
t _
vice
e tr .t c
t
t -to Li t
V t ; • 'y•-•
01"47.ct
47. *
;s
7.
The rosista-,ve is not only physiciU.
of M4114 and women, professional or volurttary, iva
years,even lifetimes, to tho servi%c of a. :enty:11.
or a :coif? oi hos2itls, They ilJvc lc
devot Jly. L ot scarcity to
render the conoitioi:s ih them fao-i-c tolere,ble, arh,:= of
ldte they have soizetf with. ditlight upe:m th. new
possibilitios openihg p, and tIa tc re4orces
for thc old b;-4t s,..hf.iiov cherished ihstitvtir. From
boics it zacrai cai;ot t r.,:con se
that the institzt.nsticivet. a. t
more thAi fleshac.1 blood to €,..xpect the— to take the
inititive in eir OV aLOI it to
first to Eet the toren t t funt.:yai pTce.
thc; trsnsftior, cf
is J-ot only a tcz of
yk—cai ',:icAtcrt7,, it iL; tr-?,z-to
ie 1,rapx of ti fvi,A%a
at dea,1 of tho
it$eir tv
, ort...
tciy„:,n6fvrtht -;
t
drastic 4“1, votxitarily to briu L ttt .tter4 ot
org4,4xast4t!o4L 4iic1.1 1,4r in
uevi and vfac.1 t'
AC4 al4 t; t
t;,c);I.ti. I at ct,;;:tait.; c4..1 thig, t=-A, iJ th4:
.e 1 4- th44 a at4 t
'eutal it,ac
gto stil/
heveil It° 0- 4r prctic,4-.
r ttkav tal.1'; ol
t brtr 1r :lit. ,;r
.ot“.
u here in ,LcL
11v—
tro . ,,,, •L,1 tiftcbily :-.,
nit 4 atodt i „J
:-..siVA. ii.144.....cy.
hcepit
L r;.,..
i'r L..
dian,4ant.
ti; •
atic
iy
;a for Cat •rtik3ect
' ,p
r aff,a
,?je1,Z1 JO
f-31
aqa0TA1:- au4 a-pT.,no
•ev • 1:1d
.01"A.14$ r27,34,- 0•41; 0
i.:44 LITxua '.--.)13a,s 9T
4TicV?31244 31,, atf
.-q ualuT
.1--...1;1411.4fd 74q1 tvelp,:0011
no--;n,:eu!Aq (6111I
j01 , 7 3._ 11':-1 ano Jo uoT;aa4Tp uT
aTrIT.=t1=od o%p,a-aqx jo 4trriasaev.: 114'
aqof,4 1-12.04.!=vT1letaT37J:T3Tjap
:4 iq ,) aq kau441.1
4.Arci
- 111011:.am 1.-. .foT?sa.sT
4Af.,r4. I"T11-411r,:.0-; JO !".-01)e1114414-W6
uT4da33Eol
ArAr.-ad 3 ).tio
sutrity services for t:.e ol!, for -te. sic'-
mentally ill a 4 -a,erltalt1 stbnoroal.
i. v1 at carlitst i:ate
to cciI-.a locA wtIfare
bodies %r.ich represent t t, il.;ztd in
ioint future of the s2it- local "nuthority
Thera are tr„o .,-cts to. clonneA of te local
rity service, recr,it.
tri;e4 of Iskail
Iliag of t-c iece or.ef. of to,,,.? ri
ovisioi .r.,e-qc of c.ftV-,
ev, will be yei .sress the
chz7,r1ct,7:ristic oat: of te
qulities of local .auth,:4rite outnie
servicei C.4: precision wit - to tf;
cater for , gamut or .-tt. I t
need. it
for all t:,nA wc cf,n ever do toor
lecesrily he
,„ill
te ot.r if
it rieccsory c it t-o 1oes1
achieve t ur ii t I ri-rT.c of 61-
;Le :;,1, -1;
t. t e
,c1 for care tio7ai. littl -rt
of tsi, v,"Acla only a ilospitl
a;,.,
- lio*cv-or,
fillac,c77- iv.
tte Vctor which ita prt:At Li,1The c,.;FitA
exiseut.iiture of 1.4-
.flubt if th,
1115, t1,2t ro-ti, wilt
• ;-ic-Itta
has btl,en fully
ervic:c
rt or yaz..i.v6
aeced. ' 1r it, -It ,Lcr_
aiming.In I-Act, Cif-
hospitta pLtli ottr.;
t 3
its-cif iv inVi,_t04.
iCit.Z
t
ice
t.:3eLuu
iriv
Ufa ittfl Jiczthcu1u.11 It tie
in tha IocLRJ. At.ii4.!)sity z7,0rTic„14,t ttr. L t1.c,nt
r4sort, it lc thz:
be porform, .4a -41-a-t:
ia t ctIii . decade,
pot Into ity
but • 1,t t;115 0(,)i Ai; or-c•
the LlitiA cf.4dLui ‘,..)1 a
La-
4)
s,,L4d - tr:
tA4' te in Ulf.; st-qf
thc. 0,terted by
-4411 t.t tr
C.lat t:ita4,14A - 4ig
XV+
- ;
rt`Lt, 7.14 t
•IsZir
t tnik;„
t
y t 4
t 17_ • • .„
r • r '
t
„t. ttt 4t.'„,
t-t
t
NATIONAL ASSOCIATION FOR MENTAL HEALTH
EMERGING PATTERNSFOR THE
Mental Health Services & the Public
"Mental Health is Everybody's Business"
PROCEEDINGS OF A CONFERENCE HELD AT CHURCH HOUSE, WESTMINSTER, LONDON, ON
9m AND MTH MARCH, 1961
Programme
THURSDAY, 9th MARCH ef6,Morning Session
In the Chair: Leslie Farrer-Brown, C.B.E.
OFFICIAL OPENING OF THE CONFERENCE BY THE RT. HON. J. ENOCH POWELL, M.B.E., M.P.
Minister of Health
"INTEGRATION"
Speaker: Professor A. V. Neale, M.D., F.R.C.P., D.P.H.
DISCUSSION
Afternoon Session
In the Chair: Kenneth Robinson, M.P.
TREATMENT IN HOSPITAL
Speakers: Dr. William Sargant Dr. S. Smith
Dr. W. A. Heaton-Ward
DISCUSSION
FRIDAY, 10th MARCH
Morning Session
In the Chair: Brian Inglis
COMMUNITY CARE — FACT OR FICTION ?
Speakers: Professor R. M. Titmuss Dr. P. A. Tyser M. A. Gillespie
DISCUSSION
Afternoon Session
In the Chair: Mary Adams, O.B.E.
PUBLIC ATTITUDES
Speakers: The Rev. G. R. Dunstan Mary Grieve
Dr. J. P. Harder Kenneth Robinson, M.P.
DISCUSSION
2
THE RT. HON. J. ENOCH POWELL Minister of Health
It was a year ago that my predecessor, Derek Walker-Smith.came here to open your last Conference which, as your Chairmanhas reminded you, was the first one to be held after the passage intolaw—though not yet after the coming into effect—of the MentalHealth Act, in which he himself had taken an important part. Thisyear I am no less glad than he was to be with you at your openingsession—it is not the only thing to which I succeeded him as Ministerof Health since the inception in January of this year of long termplanning in the hospital service.
The theme of your Conference this year is an integrated servicefor mental disorders, and this could not possibly chime moreperfectly with the aspirations to which the long term planning forour hospital service is intended to give expression. So important isthat planning operation on which you are now engaged, that I amafraid I tend to relate to it, in some way or another, almosteverything in the whole field of health far and near.
I am afraid it has become a preoccupation with me, almost anobsession, and I hope you will bear with me, therefore, if for a fewminutes I talk about the relationship between this 10-year hospitalplan and that concerto:0i with the future of mental health, which hasbrought us all together this morning.
The essential idea of the plan is to get on to paper a picture orstatement of the pattern of hospital provision which we think rightand practicable for this country in the mid 1970's. From thatstatement and a comparison of it with what is "on the ground-today there must emerge logically a programme showing the workwhich needs to be completed or commenced—and also the premisesand provisions which need to be eliminated—during the course ofthe present decade. But that statement itself, that picture of thehospital pattern of the mid 1970's-15 years ahead—must rest inlurn upon a foundation. and an assessment of the then demand forhospital care of various kinds. Such an assessment is nothing lessthan a forecast and expression of intention which embraces thefuture of all branches of the National Health Service, indeed of everyaspect of the nation's provision for health.
However tentative, however qualified, however much in needof the revision which it will receive in each succeeding year, this planmust thus embody our aims and ambitions, our vision of the futurefor 15 ye.s. ahead. Let me apply this now to mental health, a fieldin whicVhe advances in psychiatric knowledge and methods offer astanding challenge to the National Health Service to provide thesetting in which that knowledge and those methods can yield theirfullest benefit. I have intimated to the hospital authorities who willbe producing the constituent elements of the national hospital planthat in 15 years time there may well be needed not more than half asmany places in hospitals for mental illness as there are today.
5
Expressed in numerical terms, this would represent a redundancy ofno fewer than 75,000 hospital beds. Even so, I would say that if weerr, we would rather err on the side of under-estimating the provisionwhich ought to be required in hospitals 15 years from now. This50 per cent reduction itself is only a statistical projection by theGeneral Register Office of the fall in demand based upon presenttrends. Yet there is not a person present whose ambition is not tospeed up those present trends. So if we are to have the courage ofour ambitions, we ought to pitch the estimate lower still, as low aswe dare, perhaps lower.Beds in General Hospitals
But that 50 per cent or less of present places in hospitals for thementally sick—what will they look like and where will they be ? Weknow already what ought to be the answer to that question: theyought for the most part to be in wards and wings of general hospitals.Few ought to be in great isolated institutions or clumps of institu-tions, though I neither forget nor underestimate the continuingrequirements of security for a small minority of patients.
Now look and see what are the implications of these boldwords. They imply nothing less than the elimination of by far thegreater part of this country's mental hospitals as they exist today.This is a colossal undertaking, not so much in the new physicalprovision which it involves, as in the sheer inertia of mind andmatter which it requires to be overcome. There they stand, isolated,majestic, imperious, brooded over by the gigantic water-tower andchimney combined, rising unmistakable and daunting out of thecountryside—the asylums which our forefathers built with suchimmense solidity to express the notions of their day. Do not for amoment underestimate their powers of resistance to our assault.Let me describe some of the defences which we have to storm.
First there is the actual physical solidity of the buildingsthemseb, es : the very idea of these monuments derelict or demolishedarouses an instinctive resistance in the mind. At least, we findourselves thinking, "Can't we use them for something else if theycannot be retained for the mentally ill ?" "Why not at least put thesubnormals into them ?" "Wouldn't this one make a splendidgeriatric unit, or that one a convalescent home." "What a pity towaste all this accommodation !" Well, let me here declare that if weerr, it is our duty to err on the side of ruthlessness. For the greatmajority of these establishments there is no appropriate future use,and I for my own part will resist any attempt to foist anotherpurpose upon them unless it can be proved to me in each case that,such, or almost such, a building would have had to be erected inthat, or some similar, place to serve the other purpose, if the mentalhospital had never existed."Not Building Pyramids"
We have to stri‘e to alter our whole mentality about hospitals.and about mental hospitals especially. Hospital building is not iike
6
pyramid building, the erection of memorials to endure to a remoteposterity. We have to get the idea into our heads that a hospital is ashell, a framework, however complex, to contain certain processes,and when the processes change or are superseded, then the shell mustmost probably be scrapped and the framework dismantled. The oldRoman virtue of pietas becomes a vice when it is directed towards ahospital building.
Then again much of what we have done in the last decade toimprove these mental hospitals has made the right course from nowon more difficult still. We have spent money—and who shall blameus if we have used the resources to our hand in making conditionsless inadequate for the present generation of chronic mental patientswhile it remains ?—on "up-grading" the old wards, buildingannexes and villas, improving here, modifying there; and then issomeone going to come along and put a "life" upon our handiwork.and say to us "All this must be swept away anyhow" ? There comesa point where the very improvement of existing facilities militatespowerfully against their supercession by something different andbetter.
The resistance is not only physical. Hundreds of men andwomen, professional or voluntary, have given years, even lifetimes,to the sersice of a mental hospital or a group of mental hospitals.They have laboured devotedly, through years of scarcity and neglect,to render the conditions in them more tolerable, and of late they haveseized with delight upon the new possibilities opening up, and thenew resources available, for these old but somehow cherishedinstitutions. From such bodies it demands no mean moral effort torecognise that the institutions themselves are doomed.
It would be more than flesh and blood to expect them to takethe initiative in planning their own abolition, to be the first to set thetorch to the funeral pyre.
Finally, the transformation of the mental hospitals is not only amatter of buildings, the change of a physical pattern, it is also thetransformation of a whole branch of the profession of medicine, ofnursing. of hospital administration. Politics apart, let us admit thatwe all have a great deal of the conservative in our make-up, and findit easier to envisage things going on much as at present, or withsmall or gradual modifications, than deliberately to choose andfavour the unaccustomed, the drastic and voluntarily to brin2 abouta pattern of organisation in which new tasks will be performed in anew and wider setting.
With all these built-in tendencies to perpetuate the old, I ame.2rtain of this, that it is the duty of a Minister of Health and the dutyof the National Association for Mental Health, to lean with all theirmight in the opposite direction: to choose and to favour whereverthey have the choice, the course of more drastic and fundamentalchange: for we may be pretty sure that even so the progress ofmedical thought and method will still be well on ahead of ourpractice.
Prospects for the SubnormalSo far I have been talking mainly of the hospitals for the
mentally ill, and I have been looking at the hospital side of theequation. When we look at the future of provision for the sub-normal, the prospects for change must seem far less dramatic—certainly if we discount, as I suppose we prudently ought, the chanceof some medical "break through" on this front. Far fromcontemplating the certainty of a heavy run-down in numbers, wehave here to reckon with the increase which flows automaticallfrom the lengthened expectation of life of the sub-normal and theirimproved prospects of surviving infancy.
This does not mean, however, that we ought passively to accepta corresponding increase in hospital places or the perpetuation of thepresent hospital pattern. I have the impression that we know muchless than we ought about the prevalence, variety and managementof subnormality, but handicapped though we may be at present b these deficiencies, the hospital plan has here also to be founded uponan assessment of need which leans as far as possible in the directionof the trends that we want to favour.
Community ServicesThis brings me of course„ to/the complement of the hospital
pattern, the pattern of provision in the community. It would bequite unrealistic to attempt to state what is intended, and what isnot intended, by way of hospital provision in the 1970's and not tospell out with as much precision and detail as is practicable all thatthis implies in terms of care outside the hospitals. I will go so far asto say that a hospital plan makes no sense unless the medicalprofession outside the hospital service will be able progressively toaccept responsibility for more and more of that care of patientswhich today is given inside the hospitals. It makes no sense thereforeunless the medical profession outside the hospital service can besupported in this task by a whole new development of the localauthority services for the old, for the sick and for the mentally ill andmentally subnormal.
That is why, at the earliest moment possible, I intend to call onlocal health and welfare authorities, through the bodies whichrepresent them, to take a hand in mapping the joint future of thehospital and the local authority services.
There are two aspects to the development of the local authorit services, the human and the physical—the recruitment and trainingof the necessary staff of the right kind and quality, and the provisionof the range of different types of building which will be required. Istress this characteristic of variety, because one of the importantqualities of local authority provision outside the hospital service isthe precision with which it ought to be able to cater for a wholetiamut or gradation of different degrees of need. The transitiontoctwen hospital and the outside world, for all that we can ever do
8
to narrow or bridge the gap, will always necessarily be an abrupt one.On the other hand, if armed with the necessary capital provision, thelocal authorities can achieve an almost unlimited range of gradationbetween the complete independence of full mental and physicalhealth and the almost complete dependence of the old or subnormalwhose need for care and attention is little short of that which only ahospital can provide.
FinanceIndispensable, however, though the appropriate physical
equipment is, I doubt if now the availability of finance is the factorwhich limits its provision. The capital expenditure of local healthand welfare authorities this year has been fully half as large as thecapital expenditure on the hospital service itself, and I expect thatsomething like that ratio will be maintained—with, of course,increasing absolute figures—for a number of years to come. What Ibelieve is urgent is a much clearer and more definite statement thanwe yet possess, of the need, and of the provision for it, at which localauthorities are aiming. In fact, the community counterpart of thelong-term hospital plan ought to be as effective a formative anddriving influence outside the hospital service as the hospital planitself is inside.
Its influence should also be felt upon the other element in thelocal authority services, the human factor. In the last resort, it is theconsciousness of a great and expanding task to be performed, of ai-eat service which is destined to develop in the coming decades,
which alone will secure the flow of personnel into community care.Here also is a region as yet but partially mapped. In this year, 1961we intend to erect the initial scaffolding of a professional training forthe social worker, and to link that with the training of other elementsin the staff of the community services. But it is the pull exerted by anevident demand and a conscious purpose which, alone, will ensurethat the training courses are filled and that the establishments arestaffed.
It might seem to you that although I am nearing the end of whatI have to say, I have so far scarcely referred at all to yourselves—tothat Annual Conference which I am opening. In reality, every wordof what I have said has been directed towards you: and that phrase"conscious purpose" is the key(None of these ambitions that I havebeen describing can be fulfilled, none of these changes, drastic anddifficult, in the pattern of our provision for the mentally ill andafflicted can be brought about, unless the endeavour is sustained by awidespread public understanding and resolve. Without this, theplanners may plan and the administrators may administer, but theface of the map will not be changed. And it wants a lot of changing.It is because your Association speaks for, and to, the public under-standing and resolve, and it is your work to do this here and
9
throughout the country as in this your Annual Conference, that Iconfide to you my purposes and call on you to help me.
The Chairman expressed the indebtedness of the meeting to theMinister for having disclosed his purposes so clearly, with suchwisdom and challenge. His words had received and deserved closeattention. The hope that he would give a clear view before theConference began its deliberations, so that they could see in whichdirection they could most effectively help forward the enterprise towhich they were setting their hands, had been fully realized. Onbehalf of everyone, he thanked the Minister most warmly, firstly, formanaging to come; secondly, for giving so full a measure of hiswisdom. He knew "Another Place" was impatiently awaiting himand the Session therefore would be immediately adjourned.
"LNTEGRATION"
The Chairman said the subject of integration—a word capableof many interpretations—was an important one. When consideringit he had recalled being associated with the Goodenough Committeeon Medical Education, which had in its time served its purpose, andwith which he was delighted to have been associated. It had made itssmall contributions to the developments of the past fifteen years,which were the basis upon which the future must be built. In thatCommittee's report two aspects of integration in relation to the workand services for mental health were emphasised. They considered itof prime importance that mental health services should no longer behandicapped by isolation from the general body of medicine butthat they should be part of medicine, and so advance the idea of itsessential unity. Fundamentally he thought that was still true—thatmental health was part of the general body of medicine and themental health services were a vital and intimate part of the servicesfor health. Everything done for mental health must be fully linkedwith what was done for social medicine, and particularly for childhealth.
It was particularly appropriate that the person about to leaddelegates' thoughts on this subject—which was the key subject of theConference—was himself a professor of chdd health. Delegateswould welcome Professor Neale most warmly and anticipated, withinterest, his address on this vital subject.
10
CONSERVATIVE AND UNIONIST CENTRAL OFFICERELEASE TIME
1H=TH SEhVICE3 SEVENTH SESSION
CC Or d' f4
THE 1VINISTER OF HEALTH (The Rt. Hon. Enoch Howell,
TAY Chairman, Ladies and Gentlemen, the time of this
Conference is always valuable, and never laore valuable than on a
Saturday mcrninc.;; but I ho7De you will not begrudge it if one
who has newly taken on responsibility for the National Health
Service should venture, before cnming to the terms of this :Notion,
to say one or two things more generally about the aims, and
perhaps even the prejudices, with which he appr[Daches his new
task.
7 (13a)
THE MINISTER.
Issued by the Press Department, Conservative Central Office. 32 SMITH SQUARE, Westminster, S.W.I. (Telephone: ABBey 9000)
71 -- •.:f7 '
'1 It is inicoJ a -,00nacrful rfo:ent t o ku ucictc1 oitk thL)
health Sorvic•. It is a tic at which aavLL1cos nc.:dical science
and chan:eo in techniques and treat:L.:cat are altcoinT
Ouni a7ainst -.:hich the Service falls to be on-7a-nized. This is
mwherc :fore strihinc;ly shown tlism in a.cTard to fteital illness and
reentr,1 dafic-Toncy. It is all.:ost iLrlossible to ol,:accerate the
revelution in the T_TosDects for reental iliac sac anj ncntal beficioncy
Thich has cone about in those last few yeErs. icinrj the no{Jected
Cinel.erollas of tho Service anJ of the sick, rtental -ratients havo co:se
into fne forefront of attontion, ani certainly not isefore
can Jo fm theentally afflicted todazr the thin:Ts Thich is a-ould h_r_]ve
aT-7ecrod visionary to dreafa cf oven ton years tv-7 0; and it is ry icc—
on that -Lersonal offcrts, sna I do not Icacita to to say :.17
jeroonal bias, nih be directei to onsuro that elel-asis io
brinTinc, at lonT las2t, to tl-z Eontally sick ana to the aontarLy
deficient, the 1-c-it a.-hich no care noa a:_:aio to lays to theil.
ThLro is Obviously a close oonnc:ctien 7,c..t-s7cf-_.:nthis -Ziolj_ of
-:-.-cntal illness anel the a:hole rinestion of hoslital luillina , faz. co
no-o envisfl70 nat is roc;uirod in acry different tcra.s. It is a soler-
i-c4: tic to roaliso that if ten yesis a-7o -oe haa had availaLle the
noney ThIch coo are onsufion tcaay co en nuo TAtiljinT, ac should It cbaIly
kayo laid cut a co.,Jci deal -of it in drirectic:ns which .,culd already bo
obsolote CZ' out of date. Likit is a very hiat'ainT reflection, anl °no
that all 7..-hc fos-;_onsibility for the I)i_ceenin: of a hos-fital : 0-
t C-; Ico n
(-2 ha nc e lac of t 11.0 laohoccccy yootordaj on t Li a t
nontionod tacotno hs,a in hand toj,':y Irojects thc tutal ccst of-:.hich
of-rcoods i7,10C 11-75.st o LIre cant ior thio vast invest:Lnt
a-e j'ot value l'or ac not ni:.rely nean saluc fur ilunoy in Cne
scuse th:at thLro skull not I -.c.sn tint , ton - lout
thzt is not the . lest :difficult thins-. I. con 7-zet cc should Tot val_c
TaLtC.r
il ifoney in the cense t Jo, t ojay tho Jc",„'-c :holt lent
h 0 SI) itE, S I c fn in lino t t•e :no st ao,:dern t!.,0 a k C.
000. -orac t ice t-,.nd_ shzll, au J:L2 a c can, tao ace. °rat of -t-rf: trends
of the fature 7-hich o O:c:ra. - u haY0 t LS far as 1:hoanly
can, -Llz..t C.Lat o jo today s'hall not tu kin;u:.anco to coo who ILo
c oraJ after us, -out that tho-,,,r will thank -asta thc foundati ons lai(1
f -Lie: C.TP: to to (done ty ii.:2; El Ur `....111..C; corm st yot Jis cur n uz.-J-sc
than tho, out lines. is tlaLoon, then uLot is c_o.ns Lot
4
hos-J:ital servi co tract be c lose:1y inteLtr oC,_ -k -Coo local em-
thar :Lc toco t o-
tali: a .7roat tual al-. cut C.7.11. 2ccLoo t IOVO 1a3rfuncti ons
ant r_oru s ur local antho-.2iti s , hero at any rate
in the fie ld of hoalth 4,:he ci,jcorrtonit-y- olon
in that thu inod.orn trent t oz::Y.rds :.,_-"roater ccccc C)::: aa cAlcut it
the c oloo:unity ane_ L.; a lc 72c 7,4,2
hositals. ILoro is cor1.-: hoTo scoe, horo cryin ornt for thQ off ..:rt
of thc local author i tie , aoL I into, ncl to E1CG that in the hac ic::::of
t lo-roctranl.o t h_e c - year s t.,11(o. o and ino ask of t -no local
auth(z-it ies are fully roc1-Lize'd aoL that that haVe t o do
t
77:ut tho •j.,icturc ic c-till not in ny o ni on oLnic to unti 1 ore
hr,s thun acc eunt of thu s c olunt ef ort . tIc ona
hoalth aurv ant t o uoal uff Lou sLo-: volulitEr.y
off crt. hip hati °nal Serruice is into nlo d to 7oe cot oolau:i.e-
yo s - 1,:at t hat is not nb sane ha as say i'toaiIcSL
71,o c::cLaLvc. It i s act t o ho ort , o:) ctt ncl to
su-2"r0 ot -her tr , other scu-r.sc s of kno- and
ac so .:rch,or to Jisc thous t.-loo in a th uc.s1 aru
vhauuc-ca'ily. In -this t thLr,o has 'boon a 71-cri:L; chatCa'
t 11C 1.-etter ovur tho last ton loro. r:c at the 7..o
tho Servi co , I thinl: it is that thoro
ea,:l at titujs of 110f auE.:1
(16)
1172.= fICL3 SE-=h a]ssiouninistcz.
and tov:ards voluditnry effort. I an .c.l.acd to say that that is
disaearinc, and I rion to ive the ,7reatest tooccitle cco7c that
I can to voluntary contribations of every kind. It should net 'on
res-t'icted to frills, to the inessentials cr to the Ezxcins of tin
Service. I believe ti-at if you c,ive a voluntary isr-,ani7.ation a real
job to do, if you shon that you are Eakinc a for thcE in your
-,7:lans for thn future, then Y:e shall be astonished by tbe outI,urst cf
effort and willin,,;ness to contribute and Lc1 that will rfreet crash
encouracezellt. Lnd so I :Jean to :Lake sure that voluntaty effort
in the health Service and in aid of tie h.ealth Service, far frum bein
discouied, is called. u-Don to :ut for-,:ard its utr:ost and its test.
Chairsan, lay I co;:1-J to the Eotion w-hich us before
Conference this Ecr niny ? This Eetion, roc oc;nisinf the fact that
the fereir:nvisit lays little tor no share of cur cnn b7rden of
takation, recui-nisfnr.: the fact that thn hational health Service Lot
restricts access, to the Ti.harleutical services to these ',-fho are
their ::eneral hedical treat:.-ent inside the 'health Services,
:sakes to dcands: first, that the fere:L7n visitor stall nct le
allowed to exlcit ova'h.1,tional health Service; and, secondly, nut
nc. shall Eakc _Erc-.7ress as far as anS: ae fact as we car in settinc
ocil-Erecal treatwent for c= awn nationals al.road. both
those de-zands I ::11ok-hearted-ly asssciate l',ational health
Service - and the tds cf tie Lot lx,ke this 7;:erfectly olocr - is in-
cndea fcr tic i:eon.le of L;nr-lancl an(i! It is not intended te 1-c
ex:loited ty the foroijn visitor. T-:0 say that, we
do not L.E. that wc crish tc Siej Good SaEaritan treatnent to the
stranr -,;:-;t:hin cur i7ates -Jho is evLrtaken by illness or hy a.seiant.
(17)FELL= SEaVICES Snn'h= SOS,ThiJ
Ihe Linistor
I am sure what Councillor halam an 7 Dalob s5ic.1woulTd be
fully accehtod lpy those who swc2hort thio 1. eThat io not That
we are talkini:T abbut; nor are we sayin, I am surc, that we want
to rcinstituto SAIn trahenious system of ihlontity cards or ask-. loeoli:;
for their pass-ports whenever they rro to a doctor or a hosIotal in order
to yhrttoot eursolves auinst this exploitation. -1.7_1-t; 0 arG sayin
that what stoi:s practicably can be takcn to I:re-lent tf:71.3e to be
taken.
.Lt the moment, as my friend Dr -Jarren remini..ea the Conference,
77,3doe:, the hurts make clv,ry andeuvour to secure that foroiners
onterinn- this country whon it is reasonaUe to crasoct mi,hht be Jeih,c.
so -with a view to c,Ati:14: free uciical troatraoht are either turneJ
back or tho tabs are kept on them. hs a matter of fact, year by year
many hund_reTas of visitcro enterino: this soantry are rocortod by the
immt7raticn authorities to thG Linistry of -.1eeith, 71Ij in tnrn yess
en tno in:Carnation to the hes-nital anl hoalth alitheritlos.
Dr -jarren also rominiodms that the hosl_dtal authorities have a
'7.1uty toscisru, -7e—ever r.,Jssi-dc, that 1::[.13,7_1af.,tis ebtathal from tn.::
ferein visitor who al-hhcars to have come to this coal:try simlay to ho
troatment. I bolicvo that theJe arran:T.meno tho rihtnot
lines, bat I would/say that 1 am satisfieJ that they are yet sufficiently
water tioht or that Leirements anl a(l.±itionc cannot b aci- ho thu;
an.1 I 7c1cAlic this i;art of the motion as an ce.cuarte:Tcoornt to sac:what
furthor can bo dne to ti[Joton the brevontion of atnec, and certainly
in niius so I shall wolcomo an, infoismatioh or any stnostiw)s ernich
ahybnb can sch.n to me.
:7 as rajardo the soceni ocint aeut L:_rre21:omohts
with ferein ceuntrieo, ih •xtra rlinarily Tell ihformel coeGch
with which Lro CesLrovc . oned thio lobatG she ne that wG have
at tho memoht Oil, roanly 3-:,:oaxi• • recihrol hrraho3monto with the
Scandinavian coantrios and one or tem, othol's. Jo have also oot
arran:on.laxts for rocilorocal bohofito oitn a mba::er f .A.hcr
JTsE:,_T;1100Y7 07:4 JC U737_..jj
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qscuq:n oug_ C."11002 0;'s,,TossooTc,ad4u0E- facA u7,s1
.c,uuminsulr- T1TsuoTsucci: ,To..12,s111TT; 9qq, .g17.
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2uT7100 uT 1215c1TsST1 5;aaacd TT'c TTTaq.T osn'soc,q. TICT.Tora sTuT
0=O-T15L1 'uT7-c, CJCII .ec,Taq.unco osoTql. III siuunT;u 'LILO Jno ,To
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SHDTATLES T77,q772111 =sac, HE.=
ADDRESSBY
THE RIGHT HONOURABLE
J. ENOCH POWELLM.B.E., M.P.Minister of Health
Presented at
LLANDUDNOON
27th OCTOBER 1960TO A JOINT SESSION OF THE
EXECUTIVE COUNCILS' ASSOCIATION (ENGLAND)
AND THE
ASSOCIATION OF WELSH EXECUTIVE COUNCILS
DURING THE
THIRTEENTH A NN UALMEETINGS
OF THE TWO ASSOCIATIONS
Mr. President, Ladies and Gentlemen,
I am grateful to the Executive Council Associations of thetwo countries for coming together in this room this afternoon andso affording me the opportunity to address at one time and place therepresentatives of those who organize the general medical, dental,pharmaceutical and ophthalmic services throughout England andWales.
I think we may all exclaim, in the words of the apostle, " It isgood for us to be here !" It is good for us all, because Llandudnois a splendid place both for holidays and conferences—politicaland otherwise ! lt is good for you, because I am sure that, despiteall the differences between conditions in our two countries,executive councils on both sides of the border have much to learnfrom one another. Dyma'r tro cyntaf i'r ddwy gymdeithas gyfarfod ,ochr yn ochr, ac 'rwy'n mawr obeithio y bydd iddo greu cynsail a !ddilynnir yn aml yn ydyfodol. 'Rwy'n sicr y bydd y naill wlad bobamser yn falch o gael cynnig croeso i'r Ilall. This is the first time that !both Associations have met side by side, and I hope it has created aprecedent that will frequently be followed in future. I am sure thatthe one country will always be glad to offer hospitality to the other.It is good for me too that we should be here, because I have therebyhad the occasion to see something of all three branches of theNational Health Service in this part of North Wales.
When I say " all three," I mean " all three"; for I have endea-voured in my brief programme, as I intend to do in every possible !way as long as I remain at the Ministry, to emphasize the co-equal !co-importance of the three great elements of the health service—thehospital services; the services which are organized by you; andthe services provided by the local authorities. No one of thesemakes sense without the other two, and no one of them can do itswork properly except in the closest co-operation with the others.Indeed, it would probably have been better to speak of one singleservice, with three aspects.
It is because of this conviction of the one-ness of the NationalHealth Service that I feel emboldened to ask your indulgence if,this afternoon, I speak to you not on matters which are primarilythe responsibility and concern of Executive Councils but about theNational Health Service generally. This is the first national—perhaps I should say " international "—occasion on which I havespoken officially as Minister of Health, and I am sure you will notbegrudge me the use of it to speak of the main aims and ideas which !aLe„ijkmy mind as I grapple with the duties of my new office.
A new Minister ought to come to his task with an open and/receptive mind ; but that is not to say that he ought to come to it with
3
an empty mind. On the contrary, the notions, the intentions, nay,the very prejudices which he brings are the essence of what he hasto contribute. I want to tell you some of mine.
The National Health Service, by the very fact of being acomprehensive State service, holds out dangers and possibilities ofharm as well as opportunities and possibilities for good. We cannever wholly eliminate the risks and be left with only the oppor-tunities. What we have to do is to discern as clearly as we canwhere those risks lurk and what they are. We shall then be in thebest position to counteract and minimise them.
The National Health Service is like a channel through whichflows the overwhelmingly large proportion or our national incomewhich we devote to the care of health and the treatment of sickness.The fraction so devoted has not, on average, been much largerduring the last decade than it was twenty years earlier—though, ofcourse, the national income itself has been larger and so, conse-quently, has been the absolute amount of resources applied tomedical care. Whether that amount of resources would have beenappreciably greater or smaller if' we had not decided to channelalmost all of it through the Health Ministries is a matter of merespeculation which I will not enter into for, in the nature or things, it isone on which no real evidence can be brought to bear. Possibly thefact that our own relevant fraction is not strikingly different from thatof other advanced Western countries is not without some bearing;but such comparisons can often mislead.
One thing is certain: as our national income continues to rise,the volume of effort and resources applied to health will rise too,though the proportion may vary a little upwards or downwardsfrom time to time. Another thing, too, is certain—that, with theinevitable changes ill the texture of society and in the content ofmedical knowledge and theory, the nature of the resources and theapplication of the effort which are devoted to health will alter to .In any giVen 'state of society and medical knowledge there i ' . ea
le available resources which w' ' le greatestof health, well-be' : 1 ort, reass rance—in—N
ss. We sh', er quite atta?„0 this idea but wc i4e tr ' get as clos to it as possible an success t
• =
It is in this context that a comprehensive State service has itsdangers. In such a service responsibility is inevitably centralised—in the Minister answerable to Parliament. Because responsibility
4
is centralised, so, in large measure, must be decision, since respon-sibility implies the power to take the decisions for which one isto be answerable. This in turn implies an administrative machinewhich will link all the parts together and secure conformity with thecentral policy and decisions. Now, all this brings with it a greatdanger—that of rigidity. Policies which are formed centrally and .executed administratively are bound to be slower to change and lessadaptable to alterations of circumstance and demand, than ifresponsibility were diffused and decisions were independent. Thegreat machine is bound to have a one-track mind, to be cumbrousand unresponsive, to abhor variations, to be insensitive to the worldaround it.
These disadvantages apply anywhere; but in the field of healthand medical care they could be specially dangerous, for here is afield in which it is the individual mind, the local experiment, eventhe chance observation, which bring about the great advances. Theman or woman who is (as we say) " before his time," at whomofficialdom is liable to look askance, whom contemporaries treatas an oddity or a nuisance, turns out to be the pioneer, doing workwhich determines the direction of future development. People likethis need an environment in which they have opportunity, evenencouragement, certainly not repression. But how is the machineto know them when it sees them ?
Not only the methods of medical care, but the nature of theneed for it are constantly changing. All sorts of alterations aregoing on in the nation—economic, social, demographic, changes inthe structure or the population, psychological. Some of these wecan with difficulty measure; others we perceive in general but cannotprecisely define; of' others we are unconscious altogether until theyhave already become part of past history. With these alterationsthe content of the medical care and health services which the nationreally requires alters too--inevitably, imperceptibly, all the time.In this changing world poor Leviathan is left lumbering behind;for the great machine is bound to be working on a conception of thenation as it no longer is, perhaps as it has long since ceased to be.There is always a time-lag before Parliaments, Ministers, bureau-crats, and politicians set off again in pursuit of the world which hasmoved on. Post-war legislation and planning for all the welfareservices reflected the conditions of the pre-war world: because thatwas all we then had to go upon. We are trying now to assess therevolution of the 1950's ; but it may be far into the 1970's before wecan adjust the machinery to take account of it.
This conflict between the characteristics of a comprehensiveState service and the facts of social change and medical progresscan never be fully resolved; for it is inherent. But if we recognise
5
appli ' tioi ofharves in ternshort, kf hippiiought 41w4s toor failu e ii d 'the chan
, o depends on the lature ans the functiqning ofirough which the available resourbes flow.
them, there is much we can do to limit and counteract them. Ofthis, and my own part in it, I want to s eak.
4.4ose who4framed and ammered out the National Health
Service were not unconscious of these dangers, and they deliberatelybuilt into its structure elements of' independence, both lay andprofessional to be a counterpoise. The contractual status of thegeneral practitioners, dentists and opticians, the separate represent-ation of the doctors and other professions in the structure of theHospital and Executive Council services, the power and authority ofthe professional colleges and professional associations--these mayseem to have a fine old English illogicality in a State service; but awise Minister of Health will see in them not hindrances but safe-guards to the soundness of his work, and in all that I do or seek todo I shall be as jealous of the independence of the professions asthey are themselves.
On the lay side, statute enjoins upon me to provide hospitalservices through voluntary, unpaid Boards and Committees, andto provide the general medical, dental, pharmaceutical and ophth-almic services through yourselves—Executive Councils. In law thesebodies are subordinate; in the eyes of Parliament I am answerablefor their every detail of omission and commission; in reality theyare my colleagues. In the Hospital Service I regard the Boards as ateam of which I am for the time being the captain, and I intend to giveexpression to that relationship by sitting down with tl eir Chairmen,.....)whenever I can, both individually and collectively. Outside theHospital Se ice, I am placed in a like relations
rp o yourselves;
and thouh we canUot, fos,,,meehanical reaspas, have the samefreque y-tif personal ' rchze,r;s,„arelii my view • da , injust e Same way, ork to or a synthesitet ocal consider-
ations and national policy.vow–
I Of the third great organ of the Health Service, the local, authorities, I shall say more later on. They too possess their own,, deliberately and jealously preserved, independent status. Neverthe-, less all these built-in counterpoises in the structure of the NationalHealth Service to the dangers of the great machine would not besufficient, if the great machine itself were all that there is. TheNational Health Service is intended to be comprehensive; it is
, not, in my view, intended to be exclusive. For the Service's ownsake, I attach the highest value to the fact that medical service andcare is also available outside it and that completely independentorganisations exist in the field to support and conduct research, tostudy and criticize, to supplement, assist and (why not ?) overlapthe services provided by authority of Parliame l_,et m'me tionsome. I hope it will not be taken amiss that rennot,ienti all.
6
An immense debt is due to the Nuffield Foundation, the NuffieldProvincial Hospitals Trust and the King Edward VII Hospital Fundfor London. The work of such powerfully supported bodies whichcan choose their own lines of action and investigation, can reportand criticize without fear or favour, and can throw their weight andinfluence where they themselves happen to believe it best, is literallyinvaluable. A Minister of Health cannot be grateful enough thatthey exist. Then there are all the channels through which resourcesflow to research or treatment without passing through a Parlia-mentary vote: they range from insurance schemes, which enablepeople to pay for advice and care if they wish to do so, to national,local or sectional appeals which raise funds and support for specificinterests. It seems to me a narrow and a mean spirit which would saythat because Parliament enjoins, and provides money for, a compre-hensive health service, therefore the flow of resources through otherchannels must be stopped or discouraged. I should have thought,
, the more the better; and,1 Welcome the flexibility and spontaneity!which these other channels bring to the nation's provision for health.
The same, surely, is true of the voluntary organisations at workin the health field. One cannot fail to be struck both by the presentscope and by the future potentialities of these organisations. If Iname the Women's Voluntary Services, St. John's, the Red Cross,the Friends of the Hospitals, it will be understood that I mentionthem only as typical of many other similar organisations. There aregreat reservoirs of effort and endeavour here still waiting to be fullytapped in the service of the nation's health. I am not going tocold-shoulder them or keep them out: I want to bring them furtherin. Their possibilities will not be fully realised unless the NationalHealth Service and the local authorities are both determined totreat them as genuine partners and collaborators; and that bringsme logically, to my second theme.
I have spoken of the dangers implicit in a monolithic Statehealth service, and how we can limit or neutralise them more;successfully, perhaps, than at present. But there are advantagestoo, about such a service, and I am not satisfied that we are reapingthese sufficiently. If Leviathan tends to be rigid and centralised,at least he can combine great power and force with singleness ofpurpose. I am not sure that we are yet clear enough about the;health services as we would wish them to be in 1970 or that, con-,'sequently, we are directing the resources available through theNational Health Service with sufficient logic or determination tcythat end.
This year hospital capital projects are in train totalling over£100 million in cost, and the annual capital outlay on the hospitalservice is intended to be doubled over this quinquennium. This
7
hospital progamme can, and should, be the driving shaft of thedevelopment of the whole health service; for the programme onlymakes sense if it takes full account of what we want the ExecutiveCouncils, the local. authorities, and the voluntary bodies to be doingten years hence. I Of course, we dare not be rigid. Of course, wemust not presume to think that we can fully forecast the needs andthe opportunities of the 1970's: it is a sobering thought to realisehow much we should have misapplied if we had had the resourcesfor the present programme only ten years ago. But that is all themore reason why we should be sure that what we are now doingyear by year conforms to our very newest knowledge and ourutmost forecast of the future trends. So we must plan while webuild, and build while we plan, ready all the time to change, tomodify, to learn better.
There are two great functions which the Ministry of Health cando in all this: they correspond to the short-term and the long-termrespectively.
In the short-term the Ministry must help to ensure that, as faras possible, the latest knowledge and doctrine finds expression inwhat is being built now, and reduces to a minimum the frustrationsand delays of the process of departmental criticism and approval.It is with this object that our series of Building Notes is being issued.They are intended to give guidance, based on the latest studies, as tothe features and standards which ought to be embodied in the designof the different parts of a modern hospital; at the same time theyenable approval to be given with the minimum delay to plans whichconform with these standards or diverge from them in stated respects.These building notes are the work of a new, important and growing!element in the Ministry of Health—the Development Unit. The!Development Unit will conduct, with the help of Regional Boards,'its own experiments and studies in lay-out and design. It also takesadvantage of the work done outside the Health Service by theNuffield and other organisations. In short, it is intended to be akind of' Clapham junction of current knowledge and ideas onhospital planning.
I hope to see increasing dividends from this side of the Ministryof Health's work in the next two or three years. However, I shallnot be satisfied unless I can feel that this short-term work sits firmlyin the context of the longer term. There are three trends in themodern approach to health and medical care which run side by side.One is the growth of community care and after-care of the sick,which takes off the hospitals work which can be done moreeffectively and more beneficially outside the hospitals. The secondis the development of preventive and remedial measures which willavoid patients requiring admission to hospital or lengthy treatment
8
if they go there. The third is the more intensive and efficientuse of hospital accommodation, which should express itself inhigher turnover of patients and lower ratio of beds to population.
When one looks at these three trends, one realises at once thatthey are mutually interdependent ; they are indeed three aspects of oneand the same movement: a shift of emphasis from institutionalcare of the sick in more or less isolation from the community towardsone integral approach towards the health and medical needs of allmembers of society. One notices another thing, that in two out ofthese three aspects the initiative in development lies with the localauthorities: if the new trends are to find full expression, the biggestexpansion within the health service in the next decade will have tocome on the side of local government. One should note finally thatas the link between the three trends is, from one point of view thepatient as an individual human being, so the link from another pointof view is the friend and adviser of the patient as an individualhuman being, namely, the general practitioner. On this visit ofmine to North Wales, I have meant to give a slight but symbolicalrecognition to this essential unity by dividing iny time equallybetween the Hospital Service, the Executive Councils' services andthe local authority services.
We ought, if we mean business, to see these trends reflected inall the plans which are made in the long term for the NationalHealth Service, whether they concern capital development or therecruitment and training of personnel. But here one is confrontedat once with a major obstacle. The natural expression of suchintentions is in terms of finance; finance indeed is the administrator'sprinicpal instrument for the achievement of his purposes --morecapital here, less there, a limit on expenditure removed in onedirection, imposed in another. Now, the financial structure of theNational Health Service could not have been devised more effectu-ally if the very object had been to put the three main elements intowatertight, non-communicating compartments. !There are in factthree separate financial systems and consequently the inter-relationbetween developments and decisions in each of the three lields isvirtually impossible to express in the clear financial terms whichwould so much help administration and public understanding.
However, I must say bluntly that a major reform in the financialstructure of the National Health Service is farther off at present thanthe eye of a politician can see. Anyhow. I have no intention ofsitting down to wait for it. We must work with the structure wehave got, and I shall not be content until I can see a long-termpicture in which the development (lithe Hospital Service is dovetailedin with the development of the local authority services, and thefuture function of' the family practitioner is related to both. The
9
speed at which that picture, when drawn, can be realised dependslargely on the rate at which it is practicable to channel resources toits accomplishment through the budgets of the National HealthService and the local authorities, and the rate at which is it decidedto do so. But a real contribution can be made, especially from theside of community care, by the voluntary organisations; and not theleast advantage of gaining a clearer conception of long-term aimsis that every kind of voluntary impulse will more easily be able todiscern the scope which is open to it.
Nowhere are the dramatic possibilities, inherent in moderntrends more apparent than in the field of mental illness and sub-normality. I have already avowed on more than one occasion thatI come to the Ministry of Health with the intention of tilting thescales of my own personal interest and influence towards mentalhealth; and it is here that the formulation of' a clear long-term Ianseems to me specially urgent and perhaps specially rewarding Allthe requirements about which I have been speaking are he sentin their clearest form. We have to achieve the transition as rapidlyas possible from one concept of a hospital's function to a quitedifferent one--if I may coin a slogan, to " fewer beds in newerhospitals "--while improving conditions in the old accommodationfor the dwindling older generation of patients as rapidly and as faras it is economical to do so. We have to recruit and train the socialworkers and others who will make it possible to expand the localauthority services for the mentally ill and the subnormal. We haveto foster the research, experiment and development of new methodswhich will lead more and more to the replacement of custody bycure and prevention. We have to create, not least through a clearpicture of our future aims, a new attitude towards mental illness andsub-normality.
Indeed, it is gratifying how fast this new attitude of enlighten-ment and interest is spreading. The Press has been helpful inpromoting the new climate of opinion, and both voluntary andprofessional workers in this field, who count among their numbersome of the most selfless and devoted people in the whole world ofthe health services, must rejoice that with wider interest and under-standing more recruits will come to join them. I admit that I havegladly seized this occasion too to proclaim the need and theopportunity, and by no means inappropriately, since the ExecutiveCouncils, providing as they do the general medical services for thecitizen, stand near the centre of this, as of all new trends in healthservices and medical care.
Mr. President, when I speak to you again, as I hope I shallbe able to do, this time next year, I shall no doubt want to talk about
a number of matters which perhaps more immediately concern thedaily work of the Councils whom you represent, but today I thankyou for having allowed me to share with you some of my thoughtson the future of the National Health Service as a whole and tospeak about some of my special ambitions. I could not have founda happier opportunity, nor a titter audience, to enable me to do so.
10
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The other line of ettack concedes that directoriA decisions pre-
duee the optimum economic distribution, but :ar ues th3t t; is in-
volvea social evils and should therefore be clo-,rected for the
resson, even at some economic cost. It will be convenient to deal
with each line of' attack separately, though one may often hear
the same person using both, as if unconscious that they are mutu-
ally destructive.
First, then, the far:Niue:A, that we don't knee, or at least eoe'tovm
do, our/business. T:is takes several forms. The crudest is fte
myth of the managing director's wife, 'eho persuades 3'im ,o estab-
lish e factory in one pleee rather than enother becPuae she -,refers
the shops and t''ea theatres. If tis means thet boards prefer less
to more economic locations, and for Viis kind of re'::son, Inc/
saf ely leave th,as to the tender mercj of thOlir oompetitors Pnd the
nyth to the contempt veeich it deservee. Usu 711y, evev, it is
alleged that these non-eoonoeiic coneiderations ewe int only
whore the eco iomic -Ay intazes of ;lite rnative locations 'Ire ly
balanced. I am not gpiree to saj th-)t there are never suo, c7,se of
fine balances though my pess is t t they ,ire )otually in 'Jeri
small minority. That I do :Jay is th for n outside euthority
to presume to pick t-Lert, out and then tip the b31ance by t'e refu3al
of an iniustrial de; elopment certifi cite or the offer of fin Ancial
benefit is no thing else than " the en tlema n in,hitebell" s old el -,irc
itself.
„sofrctir, es it is even 35id that locations te ustry
is coaxed or cajoled do in fact po seas erelonder-3nt 00 nomic
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any othe: existia; conurbation had becn -_redented t oe plyti-
cul3r .,1"P•"-ent in the oast. But to-d=ay is :.lso ;).rticull-r
ond %,.o inspired ,titeh'311 with the divine kvied e that con.:;(=stior
3n1 conurbation h3Jeexictly now re.c ed t'neir -redestined
optima?
But let me no coine e second 1,..ne o 1.."-,)ck Loon u
doctrine t!-I")t te now-tog:lc distri't)ution of industry ought to Pe
oor7"ected in or,.er to revent it fru roducin:; 2his
too is found in nufi2b('-r of vs,-ianP foans. One i$ tc rofer to
.:"..:hat is or,:lied qw..ste oL 5oci31 -•oldlotion ..;.oves
,3rePii of relatively dond for lcbour to ').ne ,f
hi4i denad.,-,"hat is ''soci1 c3pit•"? ao an cl 1 -t
of it in the sort of sre-is ict.. are in irdad. On
ting 1311,1noe-sheet it O•7.,rn ,-,ritten off lon-,; 9ne ;1.20; --3nd
for tl7e sake of droP-ry oct-,;es, snti-
gusted schools, L.;1y c oels, ex.)ectod to ac t oout making
induotry costs of iroduction -30 t‘7".,-"'t rui iOfl
raly Cr n tthue to be "!.- oloyed t Co - es, streats , sch
Ind ch')oels -'ierc:2 built 9. century ,9ii:o1 Oven ift.'7e
b,A.lnce-she«.:t sotTli, o i3cit1 11•33 flJt quite boon off,
o t!c rj continu in ", to use i e
than cuunternced o ta econ'ic loss on oroductthn. It
31w-aysoecn, ra.d be, industry oh it p fifiCs
th , soci"al ..;"1 nd t ice ver".1
.2he next, -,lightly nt 13 t
to asof "' i ;),, nt uneT A. or '1.„ L,
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area after another, sufficient anployment to ebeorb it ees relde to
go there. :bet eould be the result?
Let us try the historical test egein. :3uppose tt;lt such 3
policy, of preservirve the existin;e distribution of labour, had been
applied, and with success, in 179. The censeeuences are
grotesque that one refuses to entertain them. Or in 1859? e;eually
Inadmissible. Or 1879/ No. Or 1899? No. Or 1911? No, eelin•
And so 1,e come rieht doen to the present day before we are
prepared to contamplete Vie consef;uences of eezin3 the distri-
bution of eeployment.
ehen the opponent is cornerFd in this Nay by the shbstorical
tests, he tries one of tee) escape routes. One is to or[eue that In
the atomic 90 it no lon,eer metters '.11ere industry is loceted, end
that therefore one c3n now, as never in Une east, h-)ve industriU
and economic chInge -ithout rcculac.ribution. Of course
it mie,ht be so just Ra the millenium mieht arrive tomorroe; but
the chances ere e7eainet both, end I 3 uite erepered to leeve it
to those eilH.) ere Llef_lopin; our met eedern foreard-lookin;
Industries to say if they ere indifferent to locetion. The
alternative escape route is bi w;:ii of he "housemaidss baby"
argmment, that "it ees only 1 little one" - to say that the effect
of government ection, negetive and positive, uoon the distribution
of industry can efter all onle be ;e3rinal and co no ireet herm
will be done.
This, hwNever, only the lest fuve before 'mate: for to
defend a policy on the groun thet it does no more then a little
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IONSERVATIVE AND UNIONIST CENTRAL OFF CE• RELEASE TIME
6211 21.15 hours/29 Nov 57
Extract from a speech by Mr. ENOCH POWELL, M.B.E., M.P.,(Wolverhampton) Financial Secretary to the Treasury, atNewcastle on Friday 29th November, 1957
Inflation has been with us on and off ever since the war, and
rough the various phases all manner of diagnoses and remedies have
been put forward. Tho present Phase is marked by special attention
to the supply of money, and in this connection, to the role of
Government expenditur‹,. It is about this aspect of our current
situation that I t to say something this evening.
There are three main classes of Exchecuer commitment: current
expenditure, investment financed by the Exchequer, and maturing debt.
Unless all three arc mct - if not more than met - by taxation or by
non-inflationary borrowing - inflation is promoted. It is, however
the Government's declared intention to reduce the burden of taxation
still further (it has achieved a reduction of one-fifth in the past
five years); and the quantity of funds coming forward for lending to the
Exchcou r can only be partially and indirectly influenced by the
Government. It follows from this that the utmost importance attaches
tU the limitatinn of the total of the Government's commitments. These
are threefold: current expenditure, invcstmont finay.ced by the7-Picir /4474,
Excequeri and rdaturingvdeb+1. maturing_dobt444fri""-e-C " - ft-4,i EN-4,4 e f rp, # , 2 S -j
!-itjective flf lett mana7rament is reduce the floating debt, and by
selling longer term securities to lengthen the debt and push forward
maturities in the hands of the public. There ,n,re,however, limits to
what is -vssible. You can -nly sell tho kinds cf Government stock that
the invest r wf-nts t , buy. It is theref-ro necessrry t- conccntrate
nn tho ct er tw- bjcctivcs: f controlling xcheqd:Jr expenditure cn
capital arid cn revenue acc unt.
-,
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""erTrIff'y in 1951 V Cc
'
Issued by the Press Department, Conservative Central Office, Abbey House, 2-8, Victoria Street, Westminster, S.W I.
(Telephone: ABBey 9000)
6211 POWELL - 2 -
• 4 n - 9 9
The capital expenditure is 1:-:r.ely cf a prductive and progressive
nature; it includes the pruvisi:-n Tf capital fDr the Pc,st Office and the
nationalised industries; and also fr local authrties, thouh these
now cnly draw abcAlt one-fifth of their capital thrDugh the Exchequer.
The Government has set a limit cn the tctal cf public investment;
it will ccntinue at this year's recc:rd level but will r.,7t9 f7r the
present, accelerte.
The larest of the three main sectors of Government expenditure is
that nn revenue accunt. It contains large incompressible blocks such
as the service cf the Natinal Debt; but the imprtance uf limiting the
total is plaingly crucial.
We are bflund all to.: be asking 7Airselves whethr we are doing
everything we can to this end. The Financial Secretary to the
Treasury is, by pi sition and traditicn, delicate(11 to this task; but the
members of the -:(eneral public wh:: understand the facts have a
respinsibility, toc. Indeed, no Finncial Secretary ts the Treasury
and nc Government can !..rc much further than public npinin will allow
them t- do.
Is it n.7.,t true that the gre-lt ,,I,rgans of public opinion are left
almnst exclusively t the min.rity (interested or disinterested) who
in any particular sphere of expenditure Jrgue f[Jr mune? H,,Dw Dften do
we find pecple aitating f'r_:r less expenditure and less Dutlay - nat in
the abstract, fc.r that cuts nr) ice, but in the particular? I sugest
that in present circumst7Inces9 until ,_nflatin is definitely halted,
every pr:7psal that means higher cpen-Jiture in the Budp:et ouFht
instantly to be met by critical euestining and if need be by prtest
and cntradiction. It is by this test of self-discipline that we shall
succeed 7:1, fail in rest-,rinc,7 f r urselves, in the Chancellflr's wcrds,
"hinest m':,ney". The issue is whether we will keep uur expenditure
, Gvernment, at the level which cn be met by taxatin, (at falling
rTits) c:./.1d by true 1errwin;7 frm the public; an19 as a natiHn, at the
ivel Tf what we are able t pr.fLacc and willin