Decoding the Queen's Speech
Authors: W. Russell
Journal: BMJ (1981)

The in-phrase  politics at the moment is to say that something has been delivered in code. It has replaced such favourites of former times as pragmatic, consensus, or getting the balance of payments right, although Disraeli's famous  nation has still to be overtaken  the longevity stakes. If ever there was an example of something written  code it was the Queen's Speech at the opening of the new session of Parliament. The speech always is  code, and the art of working out just how many legislative promises are concealed by the time-honoured jargon  which it is written is not easily mastered. Indeed, I am always taken aback at the end of the day by just how many Bills are found to have been lurking among the verbiage. This year it is said to be 15, though I could trace only 13 plus two that were certainly not mentioned. That it is the Queen's Speech is, of course, a fiction. All she does is deliver it. The text is a party political affair through and through. So far as health is concerned there were no surprises, though two disappointments for doctors. The two Bills everyone has been forecasting were there?the one to reform the sickness benefit system and the one to update the mental health law. Not everything one has been led to expect, however, is  the sickness benefit Bill, which places a duty on employers to provide sick pay for their employees during the first eight weeks of sickness. It is an early runner  this year's programme, but it is, after all, really only a revamped version of the one abandoned  February, so that is to be expected. In the event it does not, as I suggested it might, tackle the question of sick pay for doctors suspended on health grounds. That is one disappointment for an expectant profession. The idea was considered by ministers, since the reform is desirable, but they came to the conclusion that it would be stretching the long title of the Bill?the defi? nition of its contents?too far to try to include these proposals. The Bill is also highly contentious, with Labour firmly pledged to oppose it, and there seemed good reasons for not giving any more ammunition to the enemy than was strictly necessary. The Bill proposes that as compensation for taking on the new liability employers will be able to deduct their payments of sickness benefit from their National Insurance contributions, which are handed over to the Treasury. But the question about what happens over self-certification, the proposal designed to divest doctors of the task of issuing short-term sickness notes, has not been resolved and is not mentioned  the Bill, which will greatly disappoint GPs. They want self-certification to operate from next spring, and the principle has been pretty well considered by the DHSS. Treasury ministers, however, are unconvinced. The objection stems from the fear that employers, now that they can pass on the cost of sickness benefit directly to the Government, will be anything but rigorous  checking up on the first week of sickness. That could lead to an increase  the claims for short-term benefit, especially as the present safeguard of having to obtain the statutory sick note from a general practitioner would have gone. Claims for sickness benefit have been falling recently, after years of having risen steadily?a change explained by the fact that people may be more concerned than before about protecting their jobs  this time of mass unemployment. The Bill is going ahead, but clearly ministers will want the issue settled by the time it comes up for its second reading  the Commons. One way out is a plan for DHSS officials to make checks on claims for the first week, but the objection to that is their lack of medical knowledge, coupled with the bureaucratic effort involved. The staff savings from the scheme proposed  the Bill are put at around 3000, and Mr Norman Fowler, the Social Services Secretary, would object to any scheme that prevented that goal being achieved. The whole problem is currently before a Cabinet committee, and further talks with the Confederation of British Industry and the medical profession are to take place.