A Revision of Expectations

Richard Horton

The National Health Service: A Political History by Charles Webster
Oxford, 233 pp, £9.99, April 1998, ISBN 0 19 289296 7

On the evening of 10 March 1969, Richard Crossman, Harold Wilson’s new Secretary of State for Social Services (‘SSSS? Impossible!’ Crossman wrote in his diary), reached into one of his three ministerial red boxes to find a long report by a still rather obscure Conservative barrister. Geoffrey Howe had entered Parliament in 1964, only to lose his seat when Wilson increased Labour’s majority from four to 95 in 1966. Crossman’s predecessor, Kenneth Robinson, had appointed Howe to chair an inquiry into scandalous allegations, made in the News of thr World, of cruelty, torture and theft at Ely Hospital, a psychiatric institution near Cardiff. Howe’s final report had been submitted in September 1968, a month before Crossman took up his new portfolio. The Ministry had by then spent six months arguing that Howe’s explosive eighty thousand words should remain confidential; only a brief summary would be published. ‘Not on your life,’ Howe had said, according to Crossman’s diary. Eventually, with three drafts – complete, slightly curtailed and concise – in his red box, Crossman had two days to approve publication of the concise version.

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Vol. 20 No. 13 · 2 July 1998 » Richard Horton » A Revision of Expectations (print version)
pages 20-22 | 5533 words

Letters

From Harry Lockhart

In his piece on the history of the National Health Service and its imminent prospects (LRB, 2 July), Richard Horton tells us that ‘a dramatic improvement in the standards of hospital and high-technology medicine to match those found, for example, in the US could be achieved easily only by discarding the principles of universal, comprehensive and free health care.’ This zero-sum game approach to healthcare is all too typical when the problems of the NHS come up for discussion, and it’s high time it was abandoned. The fact that many Americans can get very advanced medical treatment when they need it, and the fact that 40 million other, poorer Americans don’t have health insurance, and will get either inferior or no treatment, are not connected by economic logic: they are connected by a failure of political will and by an apparent withering of the social conscience that should be arguing for reform. Setting the terms of debate in this country in the stark terms favoured by Horton, as if the high-technological and the free and universal were inevitably opposed, and as if no middle way were feasible between them, is the opposite of helpful. We should simply be asking that the divide between the best care available and the worst be made as narrow as possible, and that if we’re going to compare standards of treatment we do so between different parts of one country, not between this country and others.

Harry Lockhart
Manchester

From Ross Pratt

Richard Horton’s article on the National Health Service (LRB, 2 July) did not mention Canada’s successful health provision, Medicare. Last May I was stricken with life-threatening brain damage. I spent five months in hospital, in intensive care some of the time. In the first of three hospitals in which I received treatment, after a certain number of days I paid a minimal charge of $777 per month. In the second hospital there was no charge. In the third – a walk-in clinic to which I shall return for therapy – I paid for one meal and transport (in the US, one pays $1700 per day, plus, of course, charges for x-rays, scans etc).

A recent poll indicated that 97 per cent of Canadians are prepared to pay higher taxes to maintain the present standard of health services. In addition, the Federal Government in Ottawa has promised to spend millions of dollars more on Medicare after the next election. Nevertheless, we face some of the same problems mentioned by Horton, one of which is the increasing age of the population (I am 82). Ways of coping with these problems include cutting administration costs; recognition that patients with serious illnesses which are not life-threatening must wait until beds are free; meals on wheels; and local walk-in clinics with trained staff. The latter are located all around the city of Montreal; they are easily accessible for parents who bring their children for minor complaints and are less intimidating than large hospitals.

Ross Pratt
Montreal