This process of illegalization sometimes becomes more vicious when the efforts of the poor to survive and cope are treated as criminal acts. Progressive change in these industrial areas depends first of all on two things, which must go hand in hand: Collings said:.
Class gradients in mortality are an obvious obstacle to this view. Even when the content of medicine was overwhelmingly palliative or magical -say, up to the 1914-18 war- the public could not face the intolerable facts any more than doctors could, and both had as great a sense of priorities as we have; matters of life and death arouse the same passions when hope is illusory as when it is real, as the palatial Swiss tuberculosis sanatoria testify.
It is particularly regrettable that the revolutionary conception of a National Health Service, which has transformed the hospitals of the United Kingdom to the great benefit of the community, should not have brought about an equally radical change in general practice. The backlog of untreated disease dealt with in the first years of the service was immense, particularly in surgery and gynecology.
The common experience was described by Titmuss in 1968: The study concluded:. In any large organisation management requires quantitative information if it is to be able to analyse a situation, make a decision, and know whether its actions have achieved the desired result.
We tend to be more interested in the people who have diseases than in the diseases themselves, and that is the first requirement of reasonable economy and a humane scale of priorities. All these trends of argument are gathered together in the report of the B.
Life and happiness most certainly can hang on a readiness to listen, to dig beneath the presenting symptom, and to encourage a return when something appears to have been left unsaid. Chapter 5: Tell us your thoughts in a comment.
Given the large social inequalities of mortality and morbidity that undoubtedly existed before the 1939-45 war and the equally large differences in the quality and accessibility of medical resources to deal with them, it was clearly not enough simply to improve care for everyone: The upgrading of provincial hospitals in the first few years after the Act certainly had a geographical redistributive effect, and, because some of the wealthiest areas of the country are concentrated in and around London, it also had a socially redistributive effect.
By using the simple, convenient and measurable criterion of profit as both objective and product, management has a yardstick for assessing the quality of the organisation and the effectiveness of its own decisions. Political and Economic Planning London 1961.
As we enter an era of scarcity in medical staffing and austerity in Treasury control, this gap will widen, and any social redistribution that has taken place is likely to be reversed.