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

CHAPTER 6

Throughout its existence, the Health Services Board, and later the Health Services Division, like any other arm of Government, has had its, possibly over-optimistic, estimates of the expenditure it would like to have granted to it by Tynwald for the coming year severely pruned by the Finance Board. However, whereas any department would strive for the ideal, more than any other the Board had to resist cuts, because its expenditure was conditioned by the demand on its services; it might be justifiable to postpone a road-widening scheme by a year, but not operations or other urgent treatments. Nor could the Board be expected to generate revenue; even when there was income, from the use of private beds, for example, the charges were deliberately kept to a minimum, and considerably below those corresponding in England. It is also possibly true to say that in no other field, apart from electronics, have there been such rapid and accelerating technical advances, with which the Health Service has had to keep abreast. A glance at the National Formulary of 1948, and that of 2008, shows very little comparison. From the introduction in the war years of M&B 693, and penicillin, there has been a veritable explosion of, some very expensive, preparations. The Royal Colleges do not just award qualifications to their respective professionals. They expect them to keep up to date with developments in their fields, and, furthermore, to be able to offer the benefits to their patients, with the resultant calls for evermore sophisticated equipment. In financial terms, the Health Service is a consumer, at the mercy of trends and demands which cannot be predicted. All of this goes to explain the consternation of Tynwald to learn that in the financial year ended 31st. March 1954, there was a deficit in the Island's revenues of 500,000, of which a goodly proportion was attributable to the Health Service, and the passing of a resolution that the Board's expenditure in the next year was to be strictly limited to 400,000, a reduction of 20% of what had been seen as required. It is to be observed that the total revenue of the Island in the year before the war had been only 452,000! The Board was to make a report to Tynwald which would justify why it could not function at this level, before any further funding would be forthcoming.

The Board responded by pointing out the steps it had already taken to reduce spending, the drastic actions which would be needed to bring about the reductions, and further, as it was carrying out a scheme which it had been the will of Tynwald to introduce, it was in effect up to Tynwald to say what alterations should be made. A Commission was appointed, and duly reported its findings that the Island's experience was similar to that of the United Kingdom, and upheld the Board's views that no reductions in the Service could be effected on its part, and that if there were to be any reductions they would have to be determined by Government. However reluctantly, Tynwald had to concede the issue.

The steps which the Board had already taken had included, initially, reducing the payment to chemists for supplying containers from 2d. to 1d. per prescription, and in October 1950 this allowance was discontinued, the patient being expected either to provide his own, or pay the chemist. The introduction of the National Health Service Act 1950, widened the Board's powers to introduce charges, and it might be a surprise to some to learn that in this respect the Isle of Man was in advance of England. In November 1950 a charge of 6d. per prescription form was introduced, a measure not introduced in the United Kingdom until June 1952, where it was 1s.0d. (5p.) a form.

(It might be helpful here to explain that a prescription is not the piece of paper; that is the "prescription form", or "script". A "prescription" is the written entry on the form for each individual preparation prescribed, and it has been known for a single form to contain as many as seven prescriptions for different preparations.)

The introduction of this charge was the cause of a dispute with the chemists, and the so-called "chemists' strike", all but six of them withdrawing their services. An emergency service was set up, involving collection points, and the use of the police as couriers to and from the chemists still continuing, whilst urgent discussions were held. The nub of the matter was not that the chemists objected to the principle, but that there had not been sufficient consultation, and also that the regulations did not apply to dispensing doctors. Although the doctors were under notice that they were to cease dispensing, this would not be until 18th. January, 1951, and the chemists were prepared to continue the strike until then. In the end, the dispute lasted little more than a fortnight, settlement being reached on the Board promising to introduce categories of exemptions from charges, and to withdraw the requirement for patients to pay for containers, which had concerned the chemists in view of the summer visitors who, not having experience of this, would object. It would also appear that, by this time, there was only one doctor who was still dispensing.

In December 1950 the Board granted exemption to children, "persons of straitened means", and those suffering from long-continuing illness, at that time totalling roughly 29% of the population. (By 1998, with the inclusion of further categories, this had risen to over 80%)

Also, in 1950, the Board introduced charges for dental treatment, again ahead of the United Kingdom, who introduced theirs in May, 1951, together with charges for spectacles. In the Island, charges for spectacles were not brought in until August, 1952.

A recent study has put forward the view that, in real terms, expenditure on the NHS in the United Kingdom really did diminish in the first few years, as had been forecast. Whether or not this was the Island's experience might be an interesting exercise for an economist. Certainly it applied in dentistry, as in the first full year, 1949-50, there were 16,802 cases, at a cost of 68,104, reducing to 12,200, at 20,911, in 1954-55. Also in ophthalmics, from 7,818 sight tests to 4,324, and a cost of 25,144 down to 7,550 in the same period.

The Health Service had survived, and there was much of which to be proud, but, inevitably, to some extent the dream had faded. It was no longer free.


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