AUGUST 01, 1956 by GEORGE SCHWARTZ
Filed Under : Health Care
Mr. Schwartz is deputy financial editor and economic adviser to The Sunday Times, London.
One of the tasks imposed on the Committee of Inquiry into the cost of the National Health Service was to advise how, in view of the burdens on the Exchequer, a rising charge upon it could be avoided while providing for the maintenance of an adequate service.
The term adequate is a boss word in the draft of any legislation setting up a public service. It is stipulated not only that the particular service should be economic, efficient, and properly co-ordinated, but also that it should be adequate.
In the report of the committee referred to above, consideration is given to the term “adequate service,” and after a few hums and haws and a doubt whether it was possible to attach any specific meaning to the term, the committee proceeded on the assumption that it had to work without any objective and attainable standard of adequacy as a criterion.
I think I can save the time of subsequent committees or commissions by pointing out that in the popular sense of the term—and it has no other sense—no service is adequate or ever will be.
Thus in this sense I can confidently assert that the Armed Services of this country are inadequate, the educational facilities are inadequate, the bus services are inadequate, the roads are inadequate, housing is inadequate, the Library of the British Museum is inadequate, and the rewards to professional writers on economic topics grossly inadequate. If a plebiscite were taken, it would be revealed by a 99.8 per cent vote that the standard of living in this country is inadequate.
What is an adequate bus service? As far as I am concerned and who has a better right to speak in the matter?—it is one that pulls up outside my door just when I want it. No, cancel that. Pulls up two doors away so that discarded tickets and other rubbish do not litter my pavement. The bus would then proceed to my destination without stopping to pick up old ladies and other people who ought to stop indoors. In short, I ought to have the private-car chauffeur service for which, absurdly enough, my income is inadequate. At the present time the traveling public in London is getting more service than it is paying for, but it is unanimous in agreeing that the service is inadequate.
With forty children in many classes the educational facilities of this country are clearly inadequate. But if you are an enthusiast for education, you would say the same about thirty in a class, twenty, even ten. If you were rich enough, you would have a couple of private tutors for a family of four and then think you were only just doing the right thing for your offspring.
If the Navy, Army, and Air Force were doubled in strength, we should be nearer to adequacy in defense. There seem to be a lot of homes in this country without a separate nursery and playroom for the children, a study for father, and an exclusive withdrawal room for mother where she can get away from it all for half an hour. Sheer inadequacy.
My knowledgeable friends tell me that the collections at the National Gallery and the Tare are inadequate. I understand there is not a duplicate for every book in the Library of the British Museum, an elementary precaution on any test of adequacy. One or two people I met last week tried to persuade me that the plumbing of this country is inadequate, and I hear talk that the supply of one shilling articles selling at sixpence is universally inadequate. And so I could go on if the space at my disposal were not inadequate.
The remarkable thing is that an observer from India would pronounce our Health Service, educational facilities, and bus services as fabulously lavish. Many inhabitants of China would regard our housing as palatial, and indeed the bulk of Asia now thinks grimly and sourly of the West as a fund of surplus on which it is entitled to draw. It’s no good pleading inadequacy at home to those fellows.
The Committee on the Health Service wisely concluded that the aim must be to provide the best service possible within the limits of the available resources. Well, whether you aim at that or not, that’s all you can get in the matter of health, education, defense, and all things taken in the lump. True, at this juncture the country is getting 2 or 3 per cent more than it is providing out of its available resources of effort, but that is why the gold and dollar reserves have been running down and why there is all this talk of a crisis. Adequacy is not a lofty ideal but the reality you earn and pay for. 
Reprinted by permission, The Sunday Times (London). February 5, 1956.