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855 NEW ZEALAND MEDICAL SCHEME AMENDED FROM OUR NEW ZEALAND CORRESPONDENT October, 1949, has seen the passing of two important amendment Acts relating to medicine under social security. Both were hurried through in the last weeks of the session, and aroused little discussion. Members of Parliament have all eyes and ears on the general election to be held at the end of November this year. On the outcome of this there is little confident prediction. The Labour Party have held power in this Parliament by a very thin margin, and their handling of the con- scription issue, waterfront disputes, and other questions has alienated some support. THE MEDICAL PRACTITIONERS AMENDMENT ACT, 1949 The first of the two Acts deals with disciplinary matters in medical practice under social security. In the eight years since general medical services were begun there has been no mechanism for dealing with errors and abuses. The new Act remedies this by constituting a Medical Practitioners’ Disciplinary Com- mittee and divisional disciplinary committees (of 6 members in the case of the four main centres, and 3 in smaller centres). That the. responsibility for discipline has been entrusted to the medical profession is shown by the facts that all members of all the committees are medical men, and in all cases are appointed by the council of the British Medical Association, except 1 member of the 5 constituting the central committee, who is to be appointed by the minister of health. The disciplinary committees are to deal with all charges against practitioners-anyone may make the charges-which fall short of grave impropriety or infamous -conduct. In the latter case, the existing Medical Council remains the appropriate body, and it is also now constituted a " higher court " to which appeals from the disciplinary committees go. Above the Medical Council remains, as at present, the Supreme Court. The disciplinary committee may fine up to ;E100, censure, or order payment of costs of inquiry. The fines, queerly, are to be paid to the B.M.A. ; but this appears to be part of a plan to secure maintenance funds for the conduct of these inquiries, though government responsi- bility for such funds is in part acknowledged. The committees are to regulate their own procedure subject to any rules made by the Governor-General by Order in Council. The Medical Council remains much as before. It may now fine up to E100 (formerly :<E50) and move the Supreme Court to remove a name from the register as before. These provisions are necessary and long overdue, and on the whole have been fairly planned. How far they will be able to cope with the admitted abuses of a scheme which in some of its essential features is prone to error, remains to be seen. THE SOCIAL SECURITY AMENDMENT ACT, 1949 Part 1 of the second new Act deals with the rates of the following monetary benefits : superannuation, age, widows’, orphans’, invalids’, sickness, unemployment, and miners’. In general these are all raised by about 10% from June 1, 1949. Part 3 deals with medical services, and is to come into force on a day to be appointed by the minister of health. The chief provisions are : 1. There is to be a prohibition of simultaneous practice under capitation and fee-for-service. 2. The refund system hitherto approved by the B.M.A. is not to apply unless specially authorised by the association after consultation with the minister. 3. Power is taken to establish the specialist services under regulations with a recognised scale of fees and a list of recognised specialists, and provision for determining what constitutes a specialist service. 4. The right of medical practitioners to recover fees at law is restored. The disciplinary committees may be used as referees by the courts in such disputes. It will thus be seen that some attempt has been made to implement the recommendations of the Joint Com- mittee on Medical Services.1 The major issue - specialist services-is left to regulations. Medicine and the Law Royal Cancer Hospital Reprieved THE Court of Appeal has reversed the decision of Mr. Justice Harman respecting Mrs. Kellner’s bequest to the Royal Cancer Hospital of one-eighth of the residue of her estate. The learned judge had ruled that the operation of the National Health Service Act, 1946, had brought to an end this charity which Mrs. Kellner had intended to benefit. Voicing some vigorous comments oii the work of the Parliamentary draftsman, he held that the Act omitted to provide for the destination of such a legacy and that the gift must be deemed a valid charitable bequest and must be administered by the Crown under the Sign Manual.2 The Court of Appeal considers that the hospital, which was incorporated by royal charter in 1910, has not been dissolved by section 78 (1) (c) of the Act. That section enacted that " governing bodies of voluntary hospitals transferred to the Minister by virtue of this Act, whose functions wholly cease in consequence of this Act " should be dissolved as from July 5, 1948, when the Act was brought into force. This did not dissolve the Royal Cancer Hospital, but merely abolished its old committee of management. The draftsman, said the Master of the Rolls, had not been so negligent as the trial court had suggested. The case was precisely covered by section 60 (1) (a) of the Act whereby trustees can make payments " in the case of a hospital designated as a teaching hospital ... to the Board of Governors of that teaching hospital." The Court of Appeal decided that Mrs. Kellner’s executors must apply the appropriate fraction of her residuary estate for the purpose of making payments to the board of governors of the hospital in accordance with the terms of section 60. Thus the Royal Cancer Hospital, over which Mr. Justice Harman had pronounced sentence of death, is reprieved. Section 77 (1) of the 1946 Act empowered the Minister to amend or repeal any charter which might appear to him inconsistent with the new Act or redundant in consequence of its operation. The Minister has not exercised that power ; consequently the corporate body remains undissolved. 1. See Lancet, 1948, ii, 735. 2. See Ibid, 1949, i, 882. 11... We know that poverty and hardship, danger and pain, are more favourable to character than riches, ease, safety and unfailing health : and, what is less well recognised, often more favourable to happiness too. Circumstances stick a pin into a human being, sometimes a very big one ; then if his reaction is sound he is the better for the experience. Physical illness, financial catastrophe, national disaster, by such things as these men and women are probed.... Such men and women are strengthened and find happiness by the gallant exercise of faith and resolution in the face of great disappointment. They are ’’ making good " ; and that can be making good spirit in a real creative sense, with an effect on the balance of good and evil in circulation."-A SuRGEON, at a Conference of Hospital Chaplains, 1949.

Medicine and the Law

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855

NEW ZEALAND MEDICAL SCHEME AMENDED

FROM OUR NEW ZEALAND CORRESPONDENT

October, 1949, has seen the passing of two importantamendment Acts relating to medicine under social

security. Both were hurried through in the last weeksof the session, and aroused little discussion. Members ofParliament have all eyes and ears on the general electionto be held at the end of November this year. On theoutcome of this there is little confident prediction.The Labour Party have held power in this Parliamentby a very thin margin, and their handling of the con-scription issue, waterfront disputes, and other questionshas alienated some support.

THE MEDICAL PRACTITIONERS AMENDMENT

ACT, 1949The first of the two Acts deals with disciplinary

matters in medical practice under social security. Inthe eight years since general medical services were

begun there has been no mechanism for dealing witherrors and abuses. The new Act remedies this byconstituting a Medical Practitioners’ Disciplinary Com-mittee and divisional disciplinary committees (of 6members in the case of the four main centres, and 3 insmaller centres). That the. responsibility for disciplinehas been entrusted to the medical profession is shownby the facts that all members of all the committees aremedical men, and in all cases are appointed by thecouncil of the British Medical Association, except 1member of the 5 constituting the central committee,who is to be appointed by the minister of health.The disciplinary committees are to deal with all

charges against practitioners-anyone may make thecharges-which fall short of grave impropriety or

infamous -conduct. In the latter case, the existingMedical Council remains the appropriate body, and it isalso now constituted a " higher court " to which appealsfrom the disciplinary committees go. Above the MedicalCouncil remains, as at present, the Supreme Court.The disciplinary committee may fine up to ;E100, censure,or order payment of costs of inquiry. The fines, queerly,are to be paid to the B.M.A. ; but this appears to be

part of a plan to secure maintenance funds for theconduct of these inquiries, though government responsi-bility for such funds is in part acknowledged. Thecommittees are to regulate their own procedure subjectto any rules made by the Governor-General by Order inCouncil. The Medical Council remains much as before.It may now fine up to E100 (formerly :<E50) and move the

Supreme Court to remove a name from the register asbefore.These provisions are necessary and long overdue, and

on the whole have been fairly planned. How far theywill be able to cope with the admitted abuses of ascheme which in some of its essential features is proneto error, remains to be seen.

THE SOCIAL SECURITY AMENDMENT ACT, 1949

Part 1 of the second new Act deals with the rates ofthe following monetary benefits : superannuation, age,widows’, orphans’, invalids’, sickness, unemployment,and miners’. In general these are all raised by about10% from June 1, 1949.Part 3 deals with medical services, and is to come into

force on a day to be appointed by the minister of health.The chief provisions are :

1. There is to be a prohibition of simultaneous practiceunder capitation and fee-for-service.

2. The refund system hitherto approved by the B.M.A. isnot to apply unless specially authorised by the associationafter consultation with the minister.

3. Power is taken to establish the specialist services underregulations with a recognised scale of fees and a list of

recognised specialists, and provision for determining whatconstitutes a specialist service.

4. The right of medical practitioners to recover fees at lawis restored. The disciplinary committees may be used asreferees by the courts in such disputes.

It will thus be seen that some attempt has been madeto implement the recommendations of the Joint Com-mittee on Medical Services.1 The major issue -

specialist services-is left to regulations.

Medicine and the Law

Royal Cancer Hospital ReprievedTHE Court of Appeal has reversed the decision of

Mr. Justice Harman respecting Mrs. Kellner’s bequestto the Royal Cancer Hospital of one-eighth of the residueof her estate. The learned judge had ruled that theoperation of the National Health Service Act, 1946, hadbrought to an end this charity which Mrs. Kellner hadintended to benefit. Voicing some vigorous commentsoii the work of the Parliamentary draftsman, he heldthat the Act omitted to provide for the destinationof such a legacy and that the gift must be deemed a validcharitable bequest and must be administered by theCrown under the Sign Manual.2The Court of Appeal considers that the hospital,

which was incorporated by royal charter in 1910, hasnot been dissolved by section 78 (1) (c) of the Act. Thatsection enacted that " governing bodies of voluntaryhospitals transferred to the Minister by virtue of thisAct, whose functions wholly cease in consequence of thisAct " should be dissolved as from July 5, 1948, whenthe Act was brought into force. This did not dissolvethe Royal Cancer Hospital, but merely abolished its oldcommittee of management. The draftsman, said theMaster of the Rolls, had not been so negligent as thetrial court had suggested. The case was precisely coveredby section 60 (1) (a) of the Act whereby trustees canmake payments " in the case of a hospital designatedas a teaching hospital ... to the Board of Governors ofthat teaching hospital." The Court of Appeal decidedthat Mrs. Kellner’s executors must apply the appropriatefraction of her residuary estate for the purpose of makingpayments to the board of governors of the hospital inaccordance with the terms of section 60.

Thus the Royal Cancer Hospital, over which Mr.Justice Harman had pronounced sentence of death,is reprieved. Section 77 (1) of the 1946 Act empoweredthe Minister to amend or repeal any charter which

might appear to him inconsistent with the new Act orredundant in consequence of its operation. The Ministerhas not exercised that power ; consequently the corporatebody remains undissolved.

1. See Lancet, 1948, ii, 735.2. See Ibid, 1949, i, 882.

11... We know that poverty and hardship, danger andpain, are more favourable to character than riches, ease,

safety and unfailing health : and, what is less well recognised,often more favourable to happiness too. Circumstances sticka pin into a human being, sometimes a very big one ; then ifhis reaction is sound he is the better for the experience.Physical illness, financial catastrophe, national disaster, bysuch things as these men and women are probed.... Suchmen and women are strengthened and find happiness by thegallant exercise of faith and resolution in the face of greatdisappointment. They are

’’

making good " ; and that canbe making good spirit in a real creative sense, with an effecton the balance of good and evil in circulation."-A SuRGEON,at a Conference of Hospital Chaplains, 1949.