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

CHAPTER 4

The Health Services Board's seven members were duly elected by Tynwald on 6th. July, 1948, following which they had their first meeting, in the absence of premises of their own, at the House of Keys. Apart from the appointment of a Secretary and Finance Officer, the main item at a short meeting was confirmation that their office was to be at 32, Circular Road, Douglas. Tynwald had already voted £3,000 for the purchase of the premises, which were to be sold by auction, and a bid of £2,800 had been successful. Plans were to be prepared for the necessary conversion

The meeting was adjourned to 15th. July, at the Mental Hospital, when they settled down to business in their dual capacity as the former Mental Hospital Board. It is enlightening and recommendable to see the detailed interest and knowledge the members displayed in the functioning of the Hospital in those times. It is obvious that they knew the patients individually, and were familiar with their cases, or were briefed on them by the Medical Superintendent as required, extending to the Board interviewing patients recommended for discharge, and receiving reports of new admissions. It was not just the Hospital, of course; they also had the extensive farms and gardens operations to run.

After the routine business of the Hospital, and noting that they were no longer responsible for the management of the Infirmary, which had become vested in the Board of Social Services from 1st. July, the Board proceeded to general Health Service matters, notably making a start on the setting up of the multifarious committees called for by the Act. The sheer number of statutory committees may have been unique to the Board: in the later years, such was the diversity of services and professions, that, apart from the Advisory Council, which to most practical purpose was autonomous, there were seventeen standing committees, and the number at one time may have been in the twenties as the Advisory Council was empowered to appoint its own committees.

Thoroughly familiar though they were with the workings of the Mental Hospital, they were to be confronted with taking on the Cronk Ruagh and White Hoe Hospitals, the latter to be purchased from the Corporation of Douglas at a valuation of £7,645 for the buildings, and £2,927/17/6d. for furnishing and effects, making a total of £10,572/17/6d. It was decided that four members should constitute a Mental Hospital Committee, and that there should be a Hospitals Committee of four members to manage the new acquisitions.

Reading the early minutes, the almost complete lack of preparation becomes very evident, with the Board being asked for individual decisions on the supply, for example, of an artificial hand, or the entitlement of certain persons to treatment which they had undergone without prior N.H.S. arrangements. It is also probable that they thought that they would continue as they had started, dealing with matters as they had when they just had the Mental Hospital to run, though in fairness they could not at that stage have had any real conception of the enormous scope of the services they were expected to supervise, as there are items such as the approval of the purchase of a second-hand bookcase for £19/10/-d., and the Chairman and Secretary had made a visit to Liverpool to select other items of furniture!

In the meantime, there was confusion outside: as previously noted, some practitioners were not accepting registrations because they were waiting to see how things developed, nobody was sure how they were to be paid, and in any case, officially the Board had no money! At the outset it had appeared to be quite simple: establish how payments were made in England, and adopt the same conditions. To take the case of general practitioners, however, it transpired that in England there were different schemes according to the nature of the practice area. Douglas could hardly be classed as rural, but could not be compared to London or Birmingham, while Ballaugh and Sulby (and one might be surprised to learn that at that time there were two doctors in practice there) were not really rural compared to some areas such as in Norfolk. This problem, which affected the Mileage Fund, part of the doctors' remuneration, developed into a long-running source of discontent.

As in England, the public had not been slow to respond to the advantages offered. Popular cartoons of the time featured scenes where everybody in sight had glasses and sparkling dentures. Tynwald was told of an old man whose toothless gums had hardened over the years to the extent that he could chew turnips. He had visited a dentist and been fitted with a complete set of upper and lower dentures, which were now proudly displayed on the mantelpiece! There is the well established story of the man who, immediately on the scheme starting, had visited five doctors, and being given a prescription by each, had requested the chemist to dispense the best one!

When the eventual question of financing the Service arose, it gave rise to considerable disquiet. Tynwald voted, on 10th. August, an interim payment of £20,000; then, on 20th. October, it was asked for a further £88,000. At this stage, it was pointed out by the members that they had been told the cost would be about £100,000 a year, whereas now they were faced with a total of £108,000 for nine months. This was as nothing to the consternation in Tynwald on 16th. February, 1949, when the Board had to request a further £89,200, to cover the nine months of operation to 31st. March, making a total of £197,200, which would seem to indicate that the cost for a full year could have been £263,000. The figures given were revealing as to the unforeseen extent to which the public had taken the Service to their hearts. In the first six months to 31st. December, 1948, 116,294 prescriptions, mainly issued by the 32 doctors, had been dispensed by the 40 chemists at a cost of £19,249/18/6d., an average of 3/4d. The 16, shortly increased to 17, dentists had completed 7,190 cases, costing £29,436/15/6d., averaging £4/5/4d. a case, and the 10 opticians had dealt with 2,783 cases at a cost of £6,229/10/6d., an average of £2/4/9d.

The members had to console themselves with the fact that now the Service was in operation, much heralded as its undoubted virtues had been, they had no option but to go forward in hope that, as had been foretold, the cost would start to diminish. This hardly prepared them for the revelation, at their Estimates Meeting on 26th. April, 1949, that the cost for the first full year to 31st. March, 1950, was estimated to be £454,668!

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