posals were not carried into effect. A National Health Service: The British Sixteen years later similar proposals were made by a Voluntary Hospitals White Paper* Commission established by the Brit• ish Hospitals Association under the THE BRITISH WHITE PAPER on a Na• Health Insurance was enacted in chairmanship of Lord Sankey. tional Health Service was made pub• 1911; shortly after medical benefits lic on February 17. In it the Minister became payable it was recognized One of the most complete official of Health and the Secretary of State that there was a strong case for add• surveys of Scottish health services for Scotland recommend the estab• ing consultant services to the general and health problems ever attempted lishment of a National Health Service practitioner services provided. In was published in 1936 in the Cathcart "which will provide for everyone all 1920, a Consultative Council on Med• report of the Committee on Scottish the medical advice, treatment and ical and Allied Services, appointed by Health Services. Their recommenda• care they may require." The pro• the Minister of Health, with Lord tions assume throughout that the posals are offered at this time for dis• Dawson of Penn as chairman, re• separate medical services must be cussion in Parliament and in the ported and recommended a compre• integrated and that the coordinated country but not as fixed decisions. hensive scheme under which all forms medical service should be based, as "The Government will welcome con• of medical service would be made far as possible, on the family doctor. structive criticism and they hope that available, under suitable conditions, The latest official report on hospital the next stage—the stage of consul• to the population at large. The re• problems—issued by that Committee, tation and public discussion—will en• port recommended the establishment under the chairmanship of Sir Hector able them to submit quickly to Par• of health authorities for local admin• Hetherington—contains detailed liament legislative proposals which istration and contemplated, as does recommendations for setting up five will be largely agreed." the present Paper, the coordination of regional hospital advisory councils in The British Medical Association municipal and voluntary agencies as Scotland, makes various suggestions has given the proposals a "cautious the basis of the scheme. In the same for improved cooperation between welcome" and plans to send a copy of year a similar Consultative Council hospitals, and deals at length with the White Paper, together with an appointed by the Scottish Board of financial arrangements as affecting analysis of it in relation to the prin• Health, under the chairmanship of the future voluntary hospital system. ciples already adopted by the profes• Sir Donald MacAlister, urged that a sion and a questionnaire prepared by complete and adequate medical serv• Throughout the period between the the British Institute of Public Opin• ice should be brought within the two wars, the British Medical Associ• ion, to every doctor, whether civilian reach of every member of the com• ation was active in focusing the mind or in the armed forces, at home or munity; the report made a number of the medical profession on construc• abroad, member or nonmember of the of recommendations designed to en• tive proposals for extending and de• Association. sure that the family doctor (on whom veloping the existing health services. The Prime Minister, speaking to the the organization of the Nation's In 1930 and again in 1938 the Asso• Royal College of Physicians on March health service should be based) ciation issued comprehensive propos• 2, emphasized the desire of the Gov• would be provided with all supple• als for A General Medical Service for ernment for constructive criticism of mentary professional advice and the Nation, and in 1942 the Medical the plan. "We ask your aid. We assistance, and proposed that the Planning Commission, organized by invite your counsel." State insurance medical service the Association, issued a draft Interim should be extended to cover persons Report offering for the consideration of the same economic level as in• of the medical profession far-reach• Background of the Government's sured persons and dependents of in• ing suggestions for improving the Proposals sured persons. medical services of the community.1 The White Paper proposals have In 1921 the Voluntary Hospitals Other organizations making recom• been prepared and are put forward Committee, with Lord Cave as chair• mendations include Medical Planning against a background "of construc• man, recommended an Exchequer Research,2 representing for the most tive thinking and discussion during grant to meet the immediate needs part the younger elements in the pro• the last quarter of a century." These of the hospitals and proposed the fession, the Society of Medical Offi• recommendations for an improved establishment of permanent machin• cers of Health,2 and Political and Eco• health service, summarized in Ap• ery to coordinate the work and fi• nomic Planning (P E P) .1 pendix B of the White Paper, started nances of voluntary hospitals Without attempting to review the only a few years after National throughout the country through a whole field of recommendations, the central Voluntary Hospitals Commis• White Paper declares that, in very *This summary, prepared in the Divi• sion and local voluntary hospitals general terms, "the principles most sion of Publications and Review, Office of the Executive Director, is based on A Na• committees for county and county frequently recurring in the presenta- tional Health Service (Cmd. 6502, London, borough areas. The Government 1944, 85 pp.) and A National Health Serv• accepted the findings of the Com• 1A brief statement of some of the pro• ice, The White Paper Proposals in Brief posals was carried in the Bulletin, Decem• (London, 1944, 32 pp.), both issued by the mittee to the extent of providing an ber 1942, pp. 11-21. Ministry of Health and the Department of Exchequer grant for the voluntary 2 See the Bulletin, March 1943, pp. 43-48, Health for Scotland. hospitals, but the long-term pro• for a brief summary. tlon of plans for future developments possible help and expert guidance who uses the new service is assured are the following:— from the outset. It was arranged of ready access to whichever of its "(1) that there should be made with them that, for the first stage, branches he or she needs." Partici• available to every individual in the they should appoint small groups of pation in it will not be compulsory community whatever type of medical representatives of their own choice for either medical practitioners or care and treatment he may need; and that these groups should take the public. "(2) that the scheme of services part in general preliminary discus• The White Paper points out that should be a fully integrated scheme sions." much of what is required is already and that in particular a much closer Evolution of the Government's pro• provided in one or another of the linking up between general practi• posals was planned in three stages. existing health services. "The prob• tioner services on the one hand and In the first, a preliminary exchange lem of creating a National Health consultant and hospital services on of ideas would be conducted infor• Service is not that of destroying the other ought to be achieved; and mally and confidentially and without services that are obsolete and bad and "(3) that for certain services, par• commitment on either side, to enable starting afresh, but of building on ticularly the hospital service, larger the Ministers to get a general impres• foundations laid by much hard work areas of local administration are sion of the feeling of these represent• over many years and making better needed than those of any existing atives on some of the main issues in• what is already good." The need for kind of local authorities." volved and to help them to clear the a new attitude toward health care is ground. The second stage would be perhaps the most important point. In October 1941, the White Paper one of public discussion in Parliament "Personal health still tends to be re• continues, the Government an• and elsewhere, when everybody—the garded as something to be treated nounced their intention to ensure, by public generally, for whom the serv• when at fault, or perhaps to be pre• means of a comprehensive hospital ice would be designed, the doctors and served from getting at fault, but sel• service, that appropriate hospital the hospitals and the local authorities dom as something to be positively treatment should be readily available and other organizations which would improved and promoted and made to everyone in need of it. Responsi• be concerned in it or affected by it, full and robust." bility for the enlarged services was to and those men and women (including be placed with the major local au• doctors) who are now engaged in the The services proposed by the Gov• thorities, in close cooperation with armed forces—would be able to dis• ernment at this time are grouped voluntary agencies working In the cuss what was proposed and to voice into three main categories—a general same field; it was expressly recognized their opinions about it. To assist in practitioner service, hospital and that the service would have to em• this the Government would issue a consultant services, and local clinic brace areas larger than those of most White Paper to serve as a focus for and other services. Arrangements of the existing local authorities and detailed discussion. In the third for general medical practice are de• that the full use of the powerful re• stage, the Government would settle scribed as the most important part sources of the voluntary hospitals, as what exact proposals they would sub• of the proposals for a comprehensive well as the coordination of their re• mit in legislative form for the decision program and at the same time the lationships with the local authorities, of Parliament.