SOCIETY TODAY

Medicine

The 'carrousel' patients

John Linklater

We live in amazing times. Nor is it Merely advancing years and the onset of arteriosclerosis of the cerebral vessels which creates an illusion of an ever-increasing acceleration of the rate of change and decay in our environment. When society said farewell to traditional standards, some twenty-five years ago, it also took leave of its senses. Wit o, for example, could have foreseen that this proud, ancient and independent realm would Shortly be numbered as one of the commercially unsuccessful members of a European marketing combine, or that the waves which Britannia actually ruled would soon be limited to those on the Serpentine and the Solent?

How many doctors, whatever their misgivings might have been, could actually have guessed in 1945 that the next quarter-century would produce a situation in which one doctor in every four doctors registered in this country would have been trained in the under-developed countries, while twentyfive per cent of the products of our excellent medical schools annually sought employment overseas, Where their high standard of training was more adequately rewarded and that, notwithstanding this disadvantageous, continuing dilution of the National Health Service, the government would be seeking Ways and means of paring down medical salaries yet further, and making professional working conditions even more intolerable? , The truth is that the public has oecome bemused and numb. The brainwash is complete. The days of commonsense public outrage are gone. We saw last week, on tele,viaion, to take another example, the 'toll details of the means by which a Liverpool meat importer is, quite legally purchasing carcases in Germany, and shipping them in container lorries to this country. On arrival, they are docketed by Customs officials and driven out of the port, once round the first roundabout and back through customs Onto the ship again. They then ert sail for France where the meat °e comes a delectable ragoiit, rdti or °0`euf bourgignon. The whole purpose of this fan;-...lstic roundabout journey, which is npwri by the French firm as the currouser trade, is so that the Ifrorting firm can collect an extra 0 f' 8111:1 per consignment in the form customs rebates, incentives, subsidies and refunds, while the French housewife gets the meat. In fact, the taxpayer foots the bill while losing his roast beef across the Channel.

A patient with whom I discussed both the carrousel trade and the dilution of the National Health Service succinctly epitomised public apathy by the comment "Well, doctor,

, what else can YOU

e

, what else can YOU

xpect these days?" Apathy within the medical profession is just as bad. Latest leaks at Owen Committee level suggest that a fresh dose of intra-oral gold, such as was once administered by Aneurin Bevan, will again soothe the collective conscience of the consultant hospital specialists, this time at the expense of private practice within the National Health Service. Last time, they sold the general practitioner, and this time they will probably sell the patient.

The general increase in consultant pay, which Barbara Castle is offering as a quid pro quo for closing down the pay beds, may look large today. It will certainly be substantial enough to trigger a new round of ignorant, envy and greedinspired general wage demands, but it will be held against the consultants for

irny a irny a to come and, when inflation and taXation have taken their toll, consultants will surely lap their residue of potage with deep regrets. National Health Service patients, on the other hand, will lose the services of many of the best consultant specialists to the purely private sector and, at an increaSing rate, to overseas countries as well. Supervision of the junior hospital medical staff under training, will deteriorate further and the taxpayer will have to find another £20 million annually to find that one per cent of hospital beds which are, at present, being paid for privately. Against this, Barbara Castle hopes, no doubt, to reduce the admission waiting list by one per cent.

Meanwhile, the self-employed citizen, and all those to whom an unpredictable delay might spell financial disaster, or who cannot afford for other reasons to spend long spells on social security, are queueing up to join the ranks of the British , United Provident Association (BUPA) and similar non-profit-making, private, health insurance schemes. No wonder membership of these schemes is rising rapidly as the results of the Owen Committee negotiations gradually become apparent. We are on our way, at last, to that two-tier, separated, health service .against which Aneurin Bevan so shrewdly stood out in 1945.

It is well known that BUPA -is already purchasing large hotel blocks all over Britain for conversion into private hospitals, in Which their members will continue to have guaranteed top grade care, rather on the lines of the private Manor House Hospital in North End Road, Golders Green, which is funded by trade union subscriptions, and in which trade union card holders with special claims to more equal equality are being treated today. It is also known that American funds will be available for investment in private hospital building projects if, at some time, local regional funding through BUPA proves to be inadequate.

In the last resort, it may even prove advantageous in certain, cold, surgical cases, to fly package tours of selected patients to foreign lands where they will receive top grade treatment at the hands of some of the cream of our emigrated surgeons. The details cannot, at present, be disclosed, but the plan is already being carefully costed by BUPA. Meanwhile, the Nil S hospitals will become progressively understaffed with competent doc tors, more rigorously controlled by an ever-increasing bureaucratic top-hamper of costly civil servants. The end product makes the mind boggle.

These are, of course, among the sad and ludicrous penalties for jettisoning tradition, and for hanging on grimly to an unworkable, theoretical ideology contrary to the dictates of common sense. We now, already, have abortion package tours from Europe, and carrousel carcase containers from Europe, and back to Europe again. At least the carcases themselves are not put to any additional suffering or inconvenience and the only loss is to the taxpayer. When the day of the carrousel patient finally dawns, however, we may again become the sorry laughing stock of Europe. The last time that this occurred was probably over 300 years ago, at the hands of the custodians of the Infanta of Castilla. The name Infanta of Castilla has today become corrupted into Elephant and Castle, and it is a curious and ironical chance that the present incumbent, Barbara, appears to be making an even better bid for the position of chief clown of the Common Market.