Doctors' Revolt

When Laborite Aneurin Bevan set up Britain's "womb-to-tomb" National Health Service a generation ago, he responded to doctors' opposition by declaring, "I shall stop their mouths with money." Their criticisms have never really ceased, however, and in recent months NHS doctors have been objecting with increasing vehemence to a government plan that could severely curtail the lucrative private practices many of the senior specialists maintain on the side. Last week their resentment finally erupted into action. In the first nationwide strike since NHS was founded, the 15,000 junior physicians who provide much of the medical care in the system's hospitals refused to treat anyone but children, pregnant women and emergency cases.

The strike, which has so far affected some 100 institutions, hardly shocked Britons, who in the past two years have lived through major work stoppages by coal miners, engineering and transportation workers. Most physicians remained politely on duty in their hospitals, but they refused to do all routine work. At Middlesex Hospital, one of London's best, 200 striking doctors unveiled a banner made of used operating smocks, each bearing a large handprinted letter. The banner said: END DICTATORSHIP. SACK MRS. CASTLE.

Jumping the Queue. Social Services Minister Barbara Castle, whose department is in charge of the National Health Service, has shown an inflexibility that has worsened the present impasse, but the background of the crisis is complex. Constantly rising demands for care have all but overwhelmed NHS and raised its costs to $8.2 billion. This has forced some people to wait months, or in some cases years, for routine treatments like hernia repair and other elective operations. For years the nation's 15,000 junior hospital doctors have put up with the long hours (more than 80 a week) and low wages (still held to a maximum of -L-6,279 or $12,872 a year) because they have hoped to attain the status of "consultants"--senior specialists who could treat private patients in government hospitals. Now, however, the Labor government is threatening to remove even this incentive. In 1974 it returned to office on a platform that included the eventual banning of all private beds and private medical practice in the National Health Service's hospitals, which in many areas are the only hospitals. The pledge was popular with labor unions, which felt that the so-called pay beds diverted scarce medical resources from patients who depended on NHS; they also attacked the notion that people with money could commit the very un-British offense of "jumping the queue." But Labor's promise was viewed as a betrayal by physicians, who felt the government was placing political considerations before human needs.

What finally brought the quarrel to a head was the government's latest pay proposal for health service doctors below consultant rank, most of whom are full-time employees of the state. Holding to the Labor government's current ceiling on wages--no raises of more than $12 a week--Castle proposed a formula that reduced the physicians' basic work week to 44 hours but at the same time altered the overtime policy so that the doctors who worked the longest hours received the lowest proportional pay. Negotiators for the junior doctors reluctantly accepted the offer, but the doctors themselves did not. "Mrs. Castle is a very inflexible negotiator," explained Dr. John Kirwan. "This shows we mean business."

No Cure. Some officials believe the doctors have a point. Said Dr. David Owen, a Laborite who is Minister of State under Castle and immediately in charge of the health service: "The health service was launched on a fallacy. We were going to finance everything--cure the nation and spending would drop. That fallacy has been exposed. Now we realize that no country, even if prepared to pay the taxes, can supply everything."

A special royal commission, appointed last week by Prime Minister Harold Wilson, may help calm the conflict and get the strikers back to work. But it is not likely to produce a quick cure for the problems now plaguing NHS. Only a comprehensive course of financial and administrative therapy is likely to do that, and such a treatment cannot even begin until the government and its opponents agree on a diagnosis of the problem.

This file is automatically generated by a robot program, so viewer discretion is required.