The White Paper - An Analysis
1944-03 1944 1940s 12 pages 12 experimental efforts running simultaneously in different parts of the country, there is not likely to be a genuine experimental period. 52. The Paper gives the impression that the health centre being regarded as the ideal basis of general practice, provides the opport...
| 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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| Online Access: | http://hdl.handle.net/10796/B477D789-A507-4F9D-A975-9C736DE605DC http://hdl.handle.net/10796/5FC3E3C9-D85C-4B33-84C0-6E0F82811A42 |
| Summary: | 1944-03
1944
1940s
12 pages
12 experimental efforts running simultaneously in different parts of the country, there is not likely to be a genuine experimental period. 52. The Paper gives the impression that the health centre being regarded as the ideal basis of general practice, provides the opportunity for introducing, not merely a form of clinical practice, but a certain type of administrative arrangement, viz., the salary arrangement. If the health centre is intended primarily as a means of introducing a whole-time salaried service, the principles set out early in the White Paper are denied by the White Paper itself. 53. There are three main types of centre for which a good case could be made out. The first is a centre with beds of the cottage hospital type, the Dawson centre. The second is a diagnostic centre for special investigation. The third is a centre in which the practitioner provides complete general practitioner service, both preventive and curative, and undertakes together with his existing work much of the work now undertaken by the local authority Maternity and Child Welfare and School Medical Service. 54. What the Government proposes is merely communal consulting and waiting rooms. Maternity and Child Welfare and School Medical Services are to be administered by authorities which may or may not be the County or the County Borough Councils. In many cases they will not be. The Maternity and Child Welfare work is, it appears, to go on as at present. There is a general suggestion that medical treatment provided under the new Education Act will be undertaken as part of the comprehensive medical service when the new health service is "fully developed." A scrutiny of the White Paper conception of health centres strengthens the case for a period of genuine experimentation, centrally controlled, before any type or types of centre become standard. SCOTLAND. 55. The general principles of this analysis apply to Scotland. There are, however, certain differences in organisation: Joint Health Authorities. 56. In Scotland these bodies will be known as joint hospital boards ; they will administer the hospital and consultant services in their areas and will have no planning functions outside the hospital and consultant sphere. Local authority clinic services allied to that sphere will be the responsibility of the joint boards (e.g., tuberculosis and cancer clinics), but it is proposed to leave the remainder of the clinic services (including the maternity and child welfare, ante-natal, venereal disease, and scabies clinics) where they are now, in the hands of the major local health authorities. 57. The new joint boards will be composed entirely of representatives of the constituent county councils and town councils of the large burghs. Regional Hospitals Advisory Councils. 58. The areas which will be necessary for the planning and co-ordination of a comprehensive hospital and consultant service in Scotland will be too large to serve as administrative units. It is accordingly proposed to set up Regional Hospitals Advisory Councils in each of the five hospital regions which have been defined by successive committees on hospital problems — four based on the teaching centres of Glasgow, Edinburgh, Dundee and Aberdeen, and the fifth based for geographical considerations on Inverness. These councils will be consultative and advisory bodies, and will consist of members nominated in equal numbers by the joint hospitals boards and by the voluntary hospitals in the region, with an independent chairman appointed by the Secretary of State. It will be observed that in this respect the Scottish plan shows important differences from that proposed for England. Local Medical Services Committees. 59. In lieu of the local health services councils to be set up in England and Wales, there will be created in Scotland a local medical services committee for every joint health board area. It will be the duty of these committees both to advise the Secretary of State on the development of the general practitioner service — including the need for health centres — and to act as a means of liaison between the general practitioner service and the other parts of the health service. The committees will consist of representatives of all the major local authorities in their areas, of the local medical, dental, pharmaceutical and nursing professions, and of other interests closely concerned with the health services. The committees will be able to send representatives to sit with the Regional Hospitals Advisory Councils, and will be able to appoint sub-committees, professional or general, as they find desirable. 60. Health centres in Scotland will be provided and maintained by the Secretary of State, who will have power to delegate his functions in this respect to a local authority where, after the initial experimentation period, this is shown to be desirable. March, 1944. (V1792/F1200)
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