976

An occult neuroblastoma has been revealed in only one ofthe five dancing eyes children (follow-up 1-6 years).Although none of the others have been shown to have macro-scopic neuroblastoma they are all sensitised to antigenic deter-minants expressed on neuroblastoma cells. Since necropsy stu-dies on infants have shown a high incidence of in-situ neuro-blastoma,12 we suggest that these other four children have hadtumours contained at a microscopic level. If so, the dancingeyes syndrome is an important model for the study of naturaltumour regression.Fraser of Allander Assessment Unit and

University Department of Child Health,Royal Hospital for Sick Children,Glasgow G3 8SJ

J. B. P. STEPHENSONJ. GRAHAM-POLE

University Department of Pathology,Western Infirmary, Glasgow

L. OGG

A. J. COCHRAN

12. Beckwith, J. B., Perrin, E. V. Am. J. Path. 1963, 43, 1089.

Parliament

More Disagreement on Pay Beds

SOME of the unfinished arguments in the House of Com-mons debate on the Government’s proposed legislation to sep-arate private practice from the National Health Service werecontinued in the House of Lords on Oct. 21 when the HealthServices Bill, despite much opposition, received its second

reading. Introducing the debate, Lord WELLS-PESTELL saidthat the National Health Service existed to provide a compre-hensive health service for all citizens, irrespective of theirmeans. It was not, therefore, in business to meet the specialneeds of private patients. The fact that it had continued to setaside some of its resources for the benefit of private patientswas regarded by many of the most ardent supporters of theHealth Service as morally objectionable, socially unjust, and apotential source of abuse. The Goodman compromise pro-posals, embodied in the present Bill, allowed for the immediatephasing out of 1000 pay beds (which were very little used), andthereafter for the phasing out of the remainder to be deter-mined by a Health Services Board which would be quite inde-pendent of the Secretary of State; for the setting up of a newsystem of control of some forms of hospital building in the pri-vate sector; for access by private patients to N.H.S. facilitiesfor highly specialised treatment on an occasional basis; and fora legislative guarantee of the continued existence of privatepractice. One improvement to the Bill which had been madein an amendment in the House of Commons was the proposalto include the Health Services Board and its committees

among the bodies in respect of which the Health Service Com-mission was empowered to conduct investigations. TheGovernment sincerely hoped by the Bill to remove a long-standing source of bitterness, anger, frustration, and disrup-tion, and to get back to the most important thing-the careof patients.

Baroness YOUNG began her attack on the Bill by saying thatalthough it was entitled the "Health Services Bill", it did abso-lutely nothing to help the N.H.S. patient or his doctor. Manydoctors saw the Bill as a step in the direction of a full-timesalaried service, or a service in which there would not be thefreedom to practise medicine after fulfilling their work in theN.H.S. Much had been made of the guarantee of the right toprivate practice which had been written into the Bill, but allsorts of guarantees had been given in 1948. Legislation couldnot guarantee because it was not possible to bind one’s succes-sors. What was needed, above all, was trust, and that seemedto be one of the most important things that was missing at thistime. However, the main point was that patients would suffer

as a result of the legislation. As the Bill stood there was -._guarantee that all those beds phased out would be used b) pa-tients in the N.H.S., and if this guarantee was not given, ther:could be no shortening of the N.H.S. queue-if that was theaim of the Bill-and the position would remain precisely as was now.

Lord GOODMAN agreed that the Bill would not do anythingto assist the patient. It was important, however, to see theproblem in perspective: there were something like 400 000 hos-pital beds in the United Kingdom, and the Bill dealt with

4000-1%. It should be a source of shame to all doctors thatthe practice of their profession was nearly brought to a stand-still by a relative trifle of this kind. For it was a relative triflein relation to the number of beds involved, and their utility tothe population at large, and to the fact that the most had beenmade of the difficulties, not because of the real issues butbecause the medical profession suspected, and suspected withjustification if not with cause, that an attempt was being madeto phase out private practice. If the Government continued asthey had begun by enacting the proposals in a decent andhonourable form, subject to some amendments, if they main-tained that spirit, and if, again and again, they would assurethe profession that they had no intention whatever of attack-ing the continued existence of private medicine, but intendedto allow it to continue to exist side by side with the N.H.S.,then it might be found in the end that something rather goodhad come out of the whole unfortunate matter.

Lord WINSTANLEY said that Nye Bevan had looked forwardto a day when the N.H.S. would be so constructed and soworking that private practice would disappear because of lackof need. Unfortunately there seemed to be nothing in the Billto improve the standards of the N.H.S. or to bring the serviceeverywhere up to the ideal standard that existed in certain

areas. Deliberately to build up two separate services was, it

seemed, inviting resources to go to the private service, and theresult of this apartheid system would be that the private sectorwould bleed the N.H.S. white.

Lord HUNT OF FAWLEY said that it was now the convictionof many thousand members of his profession that collective

professional action might be justified, in certain circumstances,for the benefit of British medicine in the future. These circum-stances might arise when there was a serious risk of erosion ofprofessional freedoms by Party-political moves-for example,by the forcing through of a Bill such as that being debated,and when no conciliatory mechanism existed which would ensurethat both sides would listen to reasonable arguments and

respond to them. Lord PLATT could not accept this advocaoof industrial action, and said that an alternative, in his

opinion, was real collaboration between the Department andthe profession, which it seemed had never happend since thebeginning of the N.H.S. In order to facilitate collaboration.some kind of conciliatory body, which did not belong to tbeGovernment or any Party and was not overloaded by membersof the medical profession, should meet to try to solve problem,before the stage of confrontation was reached. Summing urthe debate, Lord SANDYS said that many of the people he ha;spoken to, including members of the medical profession, hareached the conclusion that the Government had made c

totally fundamental mistake in introducing legislation toMbefore that point in time at which it was either desirable or

necessary. Lord WELLS-PESTELL said, in his concludingremarks, that on the contrary the matter had been under con-sideration for years, not months. The best thing he could was to sit down, because it was quite clear that those who hs.spoken in the debate were still thoroughly and deepentrenched in the views which they had held when theentered the Chamber. The present Government felt that :t.ehad a responsibility to provide for the people in a rera.’number of defined ways. One of them was the N.H.S. If peopwanted to buy health, the Government did not mind, but :’:said that there must be no misunderstanding, no confusion.overlapping ; the thing must be kept absolutely separate