1317

IDENTIFICATION OF A BODY

THE Hampshire Constabulary (Incident Room, PoliceStation, Whitchurch, Hampshire) seeks help with the identifi-cation of a White female, aged 18-25, whose body was foundat Ecchinswell, Hampshire on Sept. 29, 1975. The followingdetails may strike a chord in the memory of a doctor who hastreated this woman. Height 62 in, weight about 120 Ib,appendicectomy scar of long standing, scar in shape of hori-zontal V on front of right leg, below the knee, small mole onouter aspect of left calf. There was an extensively pigmentedarea 2 in wide running down from above the right hip andtapering to a point towards the spine. It might have beenvisible after immersion in cold water, but cannot strictly beconstrued as a birthmark though it might have appeared assuch after swimming or showering. Hard calluses at the baseof the 3rd and 4th fingers of the right hand, right thumbnailshorter than normal, maybe representing new growth. Foren-sic examination revealed the following: blood-group A; tracesof diazepam; remains of an enteric-coated bisacodyl tablet

(’Dulcolax’) and mushroom, root vegetable, and uncooked,small-grained, cut wheat in stomach; small, pedunculatedfibroid extruding from posterior surface of uterus.

Commentary from Westminster

Phasing-out of Pay-bedsFROM A CORRESPONDENT

THE Government compromise to end the dispute overpay-beds has left both sides of Parliament feelingslightly uneasy. Conservatives are unhappy because theGovernment refused to send the whole issue to the RoyalCommission and because the commitment to phase-outpay-beds remains. Labour M.P.s are muttering angrilyabout a sell-out to the consultants and, seeing the fami-liar hand of Lord Goodman in the compromise, they areeven more suspicious. But both sides privately agreedthat Lord Goodman appeared to have got Mrs BarbaraCastle, Secretary of State for Social Services, off anawkward hook. Twelve days after Lord Goodman’s sur-prise intervention in the dispute at the Prime Minister’sexpress invitation, Mrs Castle was able to unveil to M.p.sa detailed compromise which bore all the hallmarks ofhis mediation.

At the heart of the proposals is the creation of an in-dependent board which would be given the remit ofphasing-out pay-beds from N.H.S. hospitals. The five-man board, appointed by the Government, would havean independent chairman, two members from the medi-cal profession and acceptable to it, and two membersappointed after consultation with other N.H.S. staff andother interested parties. The board would have two spe-cific commitments: one to separate private beds and faci-lities from the N.H.S.; the other to maintain privatemedical and dental practice through the renewal of theprovision in the N.H.S. Amendment Act 1949 whichmaintains the right to private practice by entitling doc-tors and dentists to work both privately and in N.H.S.establishments. Initially the board’s main task would bethe phasing-out of more than 4000 pay-beds. Althoughpay-beds last year totalled 4574, the average daily occu-pancy by paying patients was only 2245.

As Mrs Castle explained in the Commons, the criteria

under which pay-beds and facilities would be phased-outwould be the availability of alternative facilities for pri-vate practice within a reasonable geographical distance.On this basis the Government calculates that there are1000 pay-beds which could be phased-out without delay,and the Bill, when it is published, will specify these."Without delay" in this context means within sixmonths of the Bill’s Royal Assent, which in effect meansearly in 1977. Clearly the immediate phase-out would bein the big cities, and, with 1550 pay-beds in the fourThames Regional Health Authorities alone, the bulkwould be in London and the south-east. The time scalefor phasing-out the remaining 3000-plus pay-beds wouldbe determined by the new board-and it is here thatLabour M.p.s begin to get suspicious. For no indicationis being given as to when the last pay-bed would disap-pear. Specific criteria would be written into the legisla-tion to guide the board. It would state that there shouldbe a reasonable demand for private medicine in the areaof the country served by a particular hospital, that suffi-cient accommodation or facilities existed in the area forthe reasonable operation of private medicine, and thatall reasonable steps had been or were being taken to pro-vide those alternative beds and facilities. In addition,where all reasonable steps were not being taken, thatwould be grounds in itself, after due warning, for with-drawing pay-beds and facilities in the hospitals con-

cerned.

One of the factors the board would bear in mind in

deciding whether private facilities for specialised opera-tions, treatments, and investigations should be phased-out would be the willingness of the N.H.S. to makesuch facilities reasonably available on an occasionalbasis in specified circumstances and at an appropriatecharge. The Bill would allow health authorities to pro-vide and charge for such services for patients, providedthat they could satisfy the Secretary of State that therewould be no disadvantage to N.H.S. patients and thatsuch patients were admitted on the same basis of medi-cal priority as an N.H.S. patient. Charges would bemade to these patients and there would be no subsidy bythe N.H.S. No professional fees would be received bywhole-time N.H.S. staff for their personal benefit, butan appropriate element of the total charge would beretained by the health authority. Staff on a part-timecontract would be entitled to receive fees from these pa-tients and the amount would be determined in the usual

way by agreement between the parties concerned.Conservative opposition to the Government’s inten-

tions is perhaps strongest on the proposals to regulatethe private sector. Mrs Castle repeated in the Commonsthat her licensing scheme was still subject to further con-sultation with the professions, in particular on how toachieve by voluntary means a situation in which devel-opments in the private sector did not significantlyendanger the service the N.H.S. gave to its patients. Shealso disclosed that she is considering whether to vest inthe Board reserve powers to regulate the private sector.So the Conservative opposition, already highly sus-

picious of Mrs Castle’s intentions towards the privatesector, is now viewing the whole concept of the newboard with considerable doubt.

Labour t.P.s might have been less unhappy about theproposed package had Mrs Castle secured agreement on