693

law, under which, TREVELYAN tells us, " the personalliberty of the poor was not a thing of which muchaccount was taken "; and the only influences broughtto bear on the idler, the unemployable, or the drunkardwere the house of correction or the stocks.Some of the most interesting provisions relate to

the care of old people. The county and county-borough councils in England and Wales, and the

county councils and large burghs in Scotland, are toprovide board, lodging, and attendance, and suchamenities as hot and cold water and laundry services,for all who cannot wholly look after themselves.Those who can afford it will pay a fixed standardcharge for such residential care, and others will payat least 21s. a week. Those with retirement pensionsof 26s. a week will thus be able to meet the minimumcharge with 5s. pocket-money in hand, and thosewith less will have their income made up to 26s.

by the National Assistance Board. The principle ofpaying for residential care is important, for experienceat the Hill Homes and elsewhere 13 has shown that

payment makes all the difference to the self-respectof the residents. Local authorities will also be

empowered to extend to the deaf and the crippledthe same welfare services as they now provide forthe blind, arranging, if they wish, for voluntarybodies to act as their agents for these purposes.The numbers needing assistance are at present

smaller than might be supposed. Since 1946, whenpensions became payable at rates provided in theNational Insurance Act, the number of applicantsfor assistance has fallen from 1,500,000 to 500,000.National assistance in its new form will take the

place of unemployment assistance and the grantingof supplementary pensions to widows and old people(now paid by the Assistance Board), domiciliaryassistance to the blind, and outdoor relief underthe poor-law (now paid by local authorities), andtuberculosis treatment allowances (now paid by localauthorities at the cost of the Exchequer). It isestimated that the numbers transferred to the NationalAssistance Board would be 430,000 people on outdoorrelief, 72,000 blind people receiving domiciliary assis-

‘

tance, some 500,000 widows and old people receivingsupplementary pensions, and 30,000 people receivingunemployment or other allowances. The NationalHealth Service will take over the 50,000 sick peoplenow in poor-law institutions, and the 18,000 patientsin mental hospitals ; while the 30,000 children

deprived of a normal home life will come under thechild-care services of the Home Office. The healthyold people in the residential homes provided by localauthorities will number some 40,000. Under thislast heading it is thought that about 20,000 additionalbeds in residential homes will have to be provided,in the course of the next five years, for old peoplein England and Wales, and a further 3000 in Scotland.Some 60 % of these beds will have to be in new buildingsput up with the help of an Exchequer subsidy. Asis pointed out in the financial memorandum attachedto the Bill, " the rate at which it will be possibleto provide these beds in new buildings cannot beforeseen," and it is unfortunate that the presentationof this Bill should coincide with an embargo on thebuilding of houses and institutions of the kind itwill require. If much of the fulfilment therefore lies

13. See Lancet, 1947, i, 800.

in the rather distant future we may nevertheless

rejoice in a reform which will do much to remove theindignities of poverty. Its realisation will make iteasier, without hypocrisy, to see our nation as " ahuge team of all sorts and kinds of people." 14

Annotations

THE PANEL CONFERENCE

THE atmosphere of last week’s Panel Conference wasvery different from that of a year ago. Then, negotiationsfor the increase in the capitation fee in consonancewith the findings of the Spens Committee, had brokendown, and war with the Minister of Health seemedimminent. The fiery cross had gone round, and resigna-tions from N.H.I. service had been gathered in everycounty from almost all panel practitioners. The con-ference met in a mood of frustration and defiance.

Fortunately a last-minute message from the Ministerprovided grounds for reopening discussions, and a

compromise was eventually reached. Satisfaction withthis achievement was naturally the keynote of this

year’s conference; and little criticism arose on thematters reported by the Insurance Acts Committee.As was to be expected, the delegates demanded up-to-

date information about the progress of the negotiationson the National Health Service ; and Dr. Guy Dainresponded with a statement. Between February andJuly, he said, detailed discussions had taken place betweenthe Ministry’s officers and five subcommittees appointedby the Negotiating Committee ; the whole field of

controversy had been covered, and no subject excludedfrom debate. The Negotiating Committee was to meeton Nov. 5 finally to agree on a summarised statementof all the arguments put forward during the discussions.This document was next to be presented to the Minister,who had already agreed to meet the committee onNov. 11 and 12. The committee’s document and theMinister’s reply would later be printed and circulated toeach member of the profession, and would be the subject ofdiscussion in the British Medical Association’s divisionspreparatory to the calling of a special representativemeeting of the B.M.A. Immediately after this meeting,doctors would be asked by plebiscite whether or not theywere willing to take part in the new service.Having accepted this statement, the conference passed

on to discuss points of difficulty already arising in theestablishment of the administrative machinery for thenew service, in particular the failure of many healthauthorities to agree to coopt medical men to the healthcommittees to be set up under the 4th schedule of theAct. It agreed to the suggestion of Sheffield thatthe profession’s representatives should press for an

amendment of the Act which would make such cooptionobligatory rather than permissive. Finally, it asked thechairman of the Insurance Acts Committee, Dr. E. A.Gregg, to speak on the probable future of the LA.C.,the National Insurance Defence Trust, and the PanelConference itself. Dr. Gregg announced with confidencethat though there is no statutory provision for a com-mittee or a conference analogous to the ones that haveso long represented doctors under National HealthInsurance, the need for them will remain. It will be

impossible, he holds, for the new service to be built ormaintained without the help of such bodies, and he hasno doubt that under one name or another new bodieswill arise surprisingly like the old in function and perhapseven in personnel. The conference accepted this pro-phecy, and proceeded unanimously to elect its presentchairman, Dr. J. A. Brown, to be chairman of the firstconference to be called after the appointed day.

14. Sir Stafford Cripps. Broadcast of Nov. 2.