[from "The Birth of a Service", 2008]

CHAPTER 2

There was to be a National Health Service, and it was to come into operation on 5th. July, 1948. The reason for both decisions was the same, as explained to an exasperated member of the Legislature during one of the later debates as to why they were being rushed, that the Board of Social Services, to ensure reciprocity with the United Kingdom, would be collecting National Health Insurance contributions from that date, and that "people would object if they were not getting something that they were paying for".

One of the factors which had impeded progress, and continued to do so, was the long-running saga of the proposed appointment of an all-Island Medical Officer of Health, and, when appointed, what his duties and powers should be. In 1936, Dr. Jubb of the English Ministry of Health had visited the Island, and had submitted a report recommending such an appointment. No action was taken, and the outbreak of war put such considerations aside. In 1945, the then Governor constituted a Public Health Commission, whose report, dated 13th. March, 1946, made the same suggestion, he or she to be on the staff of the LocalGovernment Board, and with sweeping powers and responsibilities to supervise or advise on all services which government or local authorities did or should provide, except the Mental Hospital. There seems little doubt that the Local Government Board had long had aspirations to extend their remit into the health services field, and indeed, during the consideration by the Legislative Council, on 30th. April, 1946, of the Local Government (Amendment) Bill, it transpired that, as submitted, it would have given the M.O.H., when appointed, powers of inspection over not only nursing homes, but the voluntary hospitals. Fortunately, the Council decided that this was too controversial, and deleted the relevant clauses. Even so, at that session, the Council had before them the Board of Health Bill, which was the intended new name of the L.G.B. The Council did not like that either, and the plea was put forward that the Board would like the alternative "Public Health and Local Government Board". In the end, it was agreed that it should be the Isle of Man Local Government Board.

(It might be mentioned at this point that, in those days, legislation was introduced by the Council, hence the name, and then was passed to the Keys for approval, rather than the reverse, as now. The reason is that it was seen as stemming from the Governor, as the "Governor in Council")

It had taken the L.G.B. more than a year to submit their views, asked for in June 1946, and this may be an indication of some internal dissension. Their Memorandum was put before the meeting in December 1947, but they had also taken the rather unusual, and some might think strange, step of submitting a Memorandum of Advice prepared for them by the Board's Secretary, expressing his diametrically opposed views. The Board thought that there should be a new Health Board, but delayed until the M.O.H. was appointed, and able to advise. They did not agree that the new Board should be a reconstituted Mental Hospital Board. The new Board was to take over certain responsibilities from the L.G.B., along with the M.O.H. For his part, however, the Secretary did not see any necessity for a new Board, and saw the L.G.B. as running all the health schemes through the M.O.H., with a committee of the Board to supervise the hospitals.

The three voluntary hospitals had views much in common. They could see the advantages of the service, but wished to preserve their independence while being co-operative. They appeared to accept that there must be some measure of Government representation in return for financial assistance, but wished to retain their property and endowments.

The Mental Hospital Board thought that the proposals put forward by other bodies were too elaborate. They thought that they should be reconstituted as the Isle of Man Hospitals Board, taking over Cronk Ruagh, and White Hoe, and supervising the voluntary hospitals. There should be a Board of Health, whose members would be members of Tynwald, anybody else acting in an advisory capacity only, but whilst the Board would be ultimately responsible to Tynwald, its duties would be performed by the Hospitals Board on their behalf.

The dentists wanted a scheme, not the English but a Manx one, but how different this would have been is not clear. They saw a controlling Insular body, with dental representation, and dental services to continue from their surgeries, not in Health Centres.

Some of the doctors' proposals were in accordance with what eventually transpired; some were not. In the main, apart from organisational details, the doctors (in this context, General Practitioners) were concerned in maintaining the traditional relationship with patients, and not becoming paid servants of the State. A matter of grave concern was the question of whether or not they were to retain the right to sell their practices, which was still the subject of a long and bitter dispute between the doctors in England and the Minister of Health, and upon the settlement of which depended events in the Island. If a doctor lost the right, he suffered a considerable loss of capital investment, unless there was adequate compensation (a sale at that time could realise up to £3000; for the 31 doctors who it was thought would be taking part, the figure of £66,000 had been quoted). A qualified doctor was entitled to start up without buying a practice, but he would be starting from scratch, and could experience severe financial hardship until his practice became viable. If, on the other hand, the doctors were to retain the right, and a doctor came to the Island from England and set up independently, and received a basic remuneration from the State, he could survive while absorbing patients from established practices, when this would have the effect of reducing the established doctors' lists of patients, and therefore reducing their income from the other main source, the "capitation fee" to be paid for each patient on his list. The value of their practices would diminish accordingly.

In the end, the course which was followed agreed very closely to the proposals put forward by the Board of Social Services, who had obviously studied all the proposals in great depth, weeding out those which were cumbersome or unconstitutional, and adopting those which were more in keeping with the Island's situation whilst conforming to the spirit of the English Act.

Any comments, errors or omissions gratefully received The Editor HTML Transcription © F.Coakley , 2008