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59
invaluable voluntary help schemes they are, perhaps, somewhat
better than we have a right to expect considering that we are not
in the first flight of countries in the percentage of national income
we spend on providing such services.
Within its limited budget the N.H.S. struggles, progressively
less successfully, to provide the nation with the highest standards
of medical care but its task is made all the more difficult because it
fails to differentiate between need and demand. Currently, there
is a clamour for greater financial support if existing standards
are to be maintained, much less improved. But with a changing
age structure and a reduction in working population presaged for
the next decade, the future determining factor could well be manpower.
So far, deterioration in the professional situation has been
prevented by the fact that the nett annual loss of over 300 British
doctors, chiefly to "developed" countries, is being over-compensated
by an inflow of 700, unhappily from "under-developed" areas
overseas.
To what extent monies need to be raised and allocated for
National Health purposes and how they may be deployed is a policy
matter for Central Government. Current expenditure on the
National Health Service is running at the rate of approximately
£1,900 millions per annum, an amount equal to 5.4% of the national
income, of which local authority health services are responsible
for about £190 millions. As preventive health measures fall
mainly within the sphere of local government it is obvious that,
compared with resources allocated for curative or relief purposes,
those devoted to prevention are somewhat circumscribed.
It is singularly unfortunate that a number of years or perhaps
a generation or two may be necessary before the efficacy of any
particular preventative measure can be established but experience
shows that, apart from the humane element, any adjustment in
favour of prevention will prove to be sound economics. To appreciate
this point one has only to consider, inter alia, the remarkable
control achieved over infectious disease since the turn of this
century, brought about mainly by the application of preventive
medicine with no small assistance, especially during the last 30
years, from the pharmaceutical industry. In 1900, deaths from
tuberculosis in England and Wales were averaging 61,663 per
annum whilst those arising from measles were at a rate of 12,684
with diphtheria, scarlet fever and whooping cough claiming some
8,000, 5,000 and 11,500 victims respectively each year. Today, the
relative figures are 1,606, 42, 3, nil and 16 and, furthermore,
morbidity rates have been likewise drastically cut.
A reduction in infant and maternal mortality to approximately