Health and Finance
The finance of the National Health Service is alarming. To say that is not to condemn the scheme or to suggest that now that it is in operation it can be to any material extent amended. Specific benefits have been promised to all who register under the scheme, which means potentially the whole population, and the pledges must be honoured ; but it may well be doubted whether Parliament would ever have passed the National Health Service Bill if it had had before it at the time such figures as the Select Committee on Estimates has just presented. The disparity between official fore- casts and actuality is staggering. The total cost for nine months in 1948-9 was k208,000,000 against an estimate of under L15o,000,000. The case of the dental and ophthalmic services is particularly flagrant, the cost of the latter being estimated at L2,330,000 and amounting in the event to L54,970,000. When every allowance is made for lack of data and elements of uncertainty it is obvious that the original estimate was no better than mere speculation. To contend that the public must have nothing but the best—dentures, spectacles, appliances and foods of one kind and another regardless of cost— may be magnificent, but it is not practical economics. The public pays, and there comes a point at which the public's back can carry the burden no longer. The Select Committee calls for economies, and no doubt some economies are possible. Mr. Bevan has been requiring Regional Hospital Boards to pare their estimates drastically. But in fact the greater part of their expenditure consists of items statutorily fixed, like fees, salaries and wages, leaving no field for curtailment except by closing beds or saving on food or upkeep. The Minister has now intimated that he does not desire the closing of beds or the reduction of necessary services That means inevit- ably supplementary estimates. But the Chancellor of the Exchequer has announced that he will permit no supplementary estimates except wgere necessitated by some major departure in policy. There may be only one way out—to levy, as the Chancellor suggested might be necessary, a small direct contribution from everyone registered under the Health Scheme.
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