Medicine
Petty cash
John Linklater
The largest slice of the cake goes to those who make the loudest noise. We all wholeheartedly endorse much of the vociferous and effective militancy of the longexploited nursing profession. Let us hope that their robust common sense permeates the doctors with whom they work. The time may, indeed, be ripe to emulate the junior hospital doctors and bypass the British Medical Association which simply blocks the voice of the rank and file, and panders to government pressure not to rock the boat.
There is much to be said for some vigorous rocking, however. It proves sea-worthiness or, alternatively, demonstrates the need for a re-think. British medical schools are among the finest in the world. They produce some 2,000 doctors each year. How many of us realise that 400 British graduates then take the American qualifying (ECFMG) examination, which they usually pass with flying colours, and emigrate forthwith to America, to earn five times as much as they could in this country?
A large number of doctors from underdeveloped countries take the same examination at the same time. A high proportion of them fail to qualify. Having failed, they practise in Britain instead. Some of them eventually learn enough to move on to America. Can we really afford to behave with such absurd altruism? And what prevents a five-year emigration embargo on all doctors trained at public expense?
The total number of doctors in Britain thus keeps pace with the population growth: it is only the quality of the service which suffers. More than one third of all hospital doctors and about one fifth of all general practitioners are, by now, immigrants. These proportions are steadily rising.
The cost of each five-minute, psychiatric, out-patient consultation is about £5. If neither party to the consultation, in which communication is the very essence of treatment, fully understands what the other is saying, that money might be put to more profitable use.
It is difficult for the lay public to judge the quality of medical treatment but, if that curious organisation, the Patients' Association, could refrain from acrimonious, anti-doctor propaganda and, instead, carry out some scientifically based time and motion, cost and result surveys on' these lines, it might produce interesting and thought-provoking data.
One of the main sources of NHS inefficiency has always been the overcrowding of hospitals. The inevitable government solution is to spend more on huge contracts to build more hospitals. The sacred, welfare state cow of totally "free" medical service at present precludes the rational and economical alternative, which is to impose a small, uniform, deterrent, consultation charge when a patient first attends his doctor for any illness. Such a system is highly successful in reducing the workload and thus raising the quality of medical care in other EEC countries. If the general practitioner is then paid an itemof-service fee of, say, DI per attendance, for looking after any bedbound patient at home, the whole problem of hospital crowding ceases to exist. The general practitioner could afford more staff for routine duties and, himself, spend more time caring for his own patients. Money thus invested pays handsome dividends in better patient care.
The public gets what it pays for. If it pays for bigger buildings and top-heavy bureaucracy, instead of well trained doctors or, at least,
Spectator June 1, 1974 doctors who can communicate with their patients, then it must not be surprised if treatment is often cursory, and sometimes at a veterinary level. If the public is happy to let general practitioner expenses be governed, on an average, countrywide basis by a handful of backroom Treasure accountants, it must not be surprised that many general practitioners rely almost exclusively on a stethoscope, notwithstanding that they have been trained in the use of modern diagnostic aids. They simply cannot afford to purchase them out of their own pockets, paying VAT into the bargain.
The whole pay scale of doctors is ridiculous. All our values are wrong. Mrs Mop and a trained nurse in a cardiac team both earn sixty pence an hour, while the NHS doctor earns £1.50 an hour and pays £2 an hour for labour to have his car repaired.
There is no reason why doctors should not form a powerful professional union specificially to negotiate a realistic pay structure and a re-allocation of the NHS vote to give better value for the money spent, and to pay the doctor realistically for the work that he actually does, while fully compensating him individually for his actual, necessary expenses. Fewer doctors would then leave the country and we could impose an entry examination with a standard at least equivalent to that of the American ECFMG.
The NHS costs about £60 per head of population per year.Much of this is wasted but, if Mrs Castle insists upon spending so vast a sum, let her at least ensure that she is not purchasing an inferior service at the price of an excellent one.
If Mr Gormley can bring down the Government by letting the whole nation freeze, how much more elegantly and easily could Dr Cameron, or some other respected leader of the medical profession, obtain satisfaction by means of a discrete campaign of selective ad hoc, impromptu, pay negotiations prior to catheterising any distended ministerial or parliamentary bladder, to take but one example. Thus properly negotiated with, the Government would loudly and cuanaen.imously support the doctors, and readily offer any slice of that k
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