The White Paper - An Analysis
1944-03 1944 1940s 12 pages 10 presumably his report — in his Annual Report. It is suggested that it should provide expert advice on many questions, both medical and allied ; that it should consist of 30 or 40 members representing the main medical organisations (specialist and general), t...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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March 1944
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| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/02C7A15F-4E08-4C39-BFF5-DCB995AC01AE http://hdl.handle.net/10796/7A2109C0-52A6-46FF-B90E-6BA55C3516D2 |
| Summary: | 1944-03
1944
1940s
12 pages
10 presumably his report — in his Annual Report. It is suggested that it should provide expert advice on many questions, both medical and allied ; that it should consist of 30 or 40 members representing the main medical organisations (specialist and general), the voluntary and municipal hospitals (with medical and other representation), medical teaching, "and professions like dentistry, pharmacy, nursing and midwifery." The body will select its own Chairman, regulate its own procedure and its expenses will be met from public funds. The Minister "will be prepared" to "provide a Secretariat." Local Administration. 39. The Government proposes to use county and county borough councils, individually or jointly, for the local administration of the service. New and larger area authorities will be created by the combination of the existing county and county borough councils in joint boards, to which will be transferred the existing powers and duties of the present local authorities in regard to hospital and associated services, together with the existing institutions. The joint health authorities will become the owners of existing local authority hospitals. The associated services will normally include tuberculosis, venereal disease, mental and cancer services. Child welfare will go with education, whether it be to county and county borough councils, or lesser authorities. 40. In addition to administering hospital and associated services the joint health authorities will, after consultation with the Local Health Services Council and others affected, plan the comprehensive service for its area as a whole. When the plan is approved this service will be administered by the several county and county borough councils, other than the parts of it set aside for administration by the joint health authority itself. 41. The joint health authority and county and county borough councils will consist of elected persons only. There is no provision for the inclusion of non-elected members and no provision for the establishment of any committees of the joint health authority in which could be included non-elected membership. It is recognised that there is no suggestion of abolishing the powers of co-option at present enjoyed by the public health committees of county and county borough councils, but in effect these are rarely exercised. In this respect the plan falls short of the Education Bill, which provides that where joint education boards are established they shall be under the general obligation to appoint Education Committees which shall include non-elected members. 42. At the periphery, as at the centre, the advisory body is to be comprehensive in character and to include medical and non-medical members. It is to be representative of all professional interests. There is proposed an advisory committee, the local health services council, to the joint board, but not advisory committees to the county and county borough councils which will, in accordance with the approved plan, administer many non-institutional services, including the Health Centres. True, the local health services council is free to advise county and county borough councils, but the structure does not encourage the hope that such consultation will be effective. 43. Insurance committees disappear, their functions being taken over partly by the central medical board and partly by an area or local committee of the central medical board. The area to be covered by the local committees of the central medical board is not defined. The committees will include local authority members. General considerations. 44. There are other general considerations :— (1) The administrative structure, viewed as a whole, means the division of medical services broadly into the hospital and allied services and non-hospital medical services ; despite the administrative devices for co-ordinating their work, one set of services will be administered by the joint health authority, the other by individual county and county borough councils. There is no sufficient link either between these services themselves or between them and general medical practice and the hospitals. An illustration of this division is the failure in the Paper to deal with the important question of associating general practitioners more closely with hospital work. There is a danger too, that despite the efforts of the planning authority, health centres, owned and administered separately, may not be intimately associated with parent hospitals. (2) The joint health authority will the local authority hospitals and enter into contract with voluntary hospitals. Voluntary hospitals entering into contract and observing certain conditions will receive various service payments from both central and local funds, but these payments must, in total, be less than the cost incurred by the voluntary hospital. There must be a balance for the voluntary hospitals to find, but at the same time the voluntary hospitals lose their right to collect from public service funds money on an insurance or services rendered or to be rendered basis. In short, the motive for the contributory scheme disappears. Voluntary hospitals will be thrown back on the old methods of charitable collection. Add to this position a lack of any special representation on the local health authority or its committees and the lack of any separate advisory machinery, either central or local, and it will be appreciated that the voluntary hospitals are placed in a precarious position. The question of capital monies is not dealt with. Under the plan as it stands it appears likely that in the majority of cases new buildings and new extensions will be provided in the form of local authority hospitals or extensions. PRINCIPLE K. All branches of medical practice should be regarded as a single service, and it is undesirable that a detailed scheme for general practitioners should be framed and put into operation without corresponding arrangements for other branches of practice.
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