Britain Hard Cases, Strong Cure

By Guy D. Garcia

Never let it be said that Margaret Thatcher lacks courage. After confidently taking on the miners, the press and the teachers, the Prime Minister has announced plans to reform two of the country's most prestigious professions, medicine and law. Her proposals, the most sweeping in decades, prove that Thatcher has lost none of her zeal for leading Britain toward a more open, free-market economy.

The most controversial changes involve the National Health Service, the state-financed system that employs about 1 million workers and treats 30 million patients a year. Thatcher's plan, which must still be approved by Parliament, allows the best-managed of the nation's 2,000 state-run hospitals to form self-governing trusts that can hire outside staff, pay higher wages to . doctors and negotiate salaries for nursing personnel. The plan encourage doctors to shop around for the best prices on hospital services, and permits them to refer patients to hospitals outside their district.

Neil Kinnock, the Labor Party leader, pounced on the government, accusing the Tories of "putting cash before care" and "profits before patients." Labor health spokesman Robin Cook said the proposal would "put bureaucrats in the driving seat at the expense of doctors and patients," and denounced it as a "prescription for a health service run by accountants."

Those charges struck a chord among middle-and lower-income Britons, who fear a future of progressively better services for an increasingly wealthy few. The issue goes to the heart of Britain's free-health-care system and moves the country toward medical treatment based largely on the patient's ability to pay. Says Paul Swain, a London hospital consultant: "A majority of people really like the NHS no matter how much they grumble about it."

While the British Medical Association and the Royal College of Nursing opposed the plan, other health professionals reserved final judgment. Otto Chan, a junior doctor at St. Thomas's Hospital, is concerned that the emphasis on efficiency will hurt the elderly and the poor most, since they often require expensive drugs or repeated office visits. Says Chan: "The profit- making system is biased in favor of young patients."

The Conservatives are finding it much easier to rally popular vocal support for deregulation of the legal profession. Thatcher's plan calls for abolishing the traditional division between solicitors, who deal directly with the public, and barristers, who must be "instructed" by solicitors before taking on a case and who have a virtual monopoly on presenting cases in high court. Under the government's proposal, any lawyer would be free to present cases in court after obtaining a "certificate of competence." Many consumer-interest groups and solicitors cheered the plan, while barristers promised to fight it.

In an effort to further broaden access to legal advice, the government also proposed allowing lawyers to accept civil cases on a no-win, no-fee contingency basis, taking their payment out of their client's award. To prevent an explosion of litigation, the government wants to strictly limit the maximum lawyers can collect on contingency.

The Thatcher government, showing its determination to push ahead with the medical-service reforms, will issue eight working papers in the next two weeks. The resulting legislation will be submitted to Parliament, where its chances of passing are considered good. As for the legal reforms, a bill is expected to be ready by this fall. Despite the barristers' all-out campaign to block the changes, there is a widespread feeling that their monopoly is nearing its end.

With reporting by Anne Constable/London