The Transition to a State Medical Service
1942-08 1942 1940s 8 pages that he has so much the less to spend upon mastering the needs of the personal services. A new Department should be constituted and should take over central direction of all matters not immediately related to health. These should include most of the environmental health se...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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August 1942
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| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/0504DB6C-5F99-4E54-92D3-443018C73868 http://hdl.handle.net/10796/3A5A425E-A080-4FA4-AEB1-21C23B052887 |
| Summary: | 1942-08
1942
1940s
8 pages
that he has so much the less to spend upon mastering the needs of the personal services. A new Department should be constituted and should take over central direction of all matters not immediately related to health. These should include most of the environmental health services, such as sanitation, water-supply, destruction of rats, food control, etc., until such time as the Ministry of Health has organised the personal health services, when the distribution of duties can be reconsidered. (5) The new specialised Ministry of Health should have control of all personal health services, for example, General Practitioner and Hospital or Institutional Treatment, the Clinic Services, the Auxiliary Medical Services (Dental, Nursing, Electro-therapeutic, Massage, etc.) and Health Publicity. The farming out by the Ministry of its responsibilities (as in the case of the existing School Medical Services) should no longer be permitted. It would also administer certain new health activities requiring central direction, such as: (a) Control of food and drug preparations claimed to have medical value. (b) Systematic health planning, essential for the proper distribution of block grants as well as for new extensions of the health services. These plans would necessarily be of long-term application, for example, five- or seven-year plans. (c) Veterinary medicine (which would probably not be taken over in the earlier plans). (d) The study of national dietetic needs in relation to the planning of food production and importation. (e) Tuberculosis, and possibly other infectious diseases for which central control is needed. (6) There should be added to the new Ministry of Health the medical activities of the Ministry of Labour (the Industrial Medical Services in particular), of the Board of Education (already nominally in its hands) and of the Privy Council (Medical Education and Registration), as well as sundry other functions now exercised in respect of research, etc., by smaller statutory bodies. The Union is aware that the Industrial Medical Service is likely to claim its right to be independent of the National Service, but is not convinced that this claim, reasonable enough in present circumstances, would be for the advantage of the industrial patient under a fully developed State Service. The Union admits, of course, that specially trained factory inspectors, both medical and lay, will be needed in any case. (7) The line between personal and environmental health services cannot be drawn with exactitude. The environmental services can be held to include almost every function of local government, and many which are centralised. We are not concerned to draw this line or to attempt any clear definition. But we believe that the new Ministry of Health should at first confine itself to the direct promotion of health and to the cure of disease, having only advisory functions with regard to environmental services. (8) There exists a very general feeling that the post of Minister of Health is regarded as a stepping-stone to higher office or as a position suitable for someone whose claims are political rather than special. It has undoubtedly been held by many individuals who were content to act as no more than the mouthpieces of their subordinates, and by others who were never known to have had any interest in health matters, and were too short a time in office to exert any influence. Everything possible should be done to eradicate this inherent fault of our political system. The Minister should have a status sufficient to attract the best brains and real enthusiasm. Nor is it only at the centre that political influence has stood in the way of proper discussion of health questions and extension of health services. Some local authorities are notorious for the manner in which the recommendations of committees are regarded, primarily from the point of view of their political origin and only secondarily from that of the public welfare. In this, as in other cases, the Party in power often seems to oppose on principle any suggestion, however good, which emanates from an opposition Party which might at a later date make political capital out of it. (9) The personnel of the Central Ministry, and of such branch offices as may be required, should be selected as to 50 per cent. at least from the ranks of those whose main qualification is neither educational nor social but a record of good service in health matters in direct contact with local problems. Ineptitude and delay can only be countered by the continual infusion of new blood into Government offices. This must come from outside, from those who have suffered under bureaucratic obstruction. There is no reason why Departmental posts in the Ministry should not be advertised, and competed for by those who have already made their mark in the provinces. (C) THE EXISTING REGIONAL ADMINISTRATION (10) The demand for regional administration has been much popularised of late, and 12 regions of the Ministry have, in fact, been set up. It is, therefore, necessary to give some attention to this curious modem development. We understand that regional administration was intended to include the actual delegation to the regional chiefs of individual initiative and decision within defined limits. It is thus distinct from administration through branch offices which are merely offshoots of the central administration requiring central authority for all their operations. It also tends to supersede local authorities by nominated bodies or persons in no direct manner responsible to Parliament or to local electors. (11) We find no worth in regional administration thus defined, except where local patriotism, as in Scotland and Wales, makes this inevitable. (12) Regions with independent powers in defined spheres inevitably create conflicts of policy and new opportunities for friction, jealousy and delay, together with increased expenses. (13) Nor can we discover that the existing regions are so constituted and demarcated that they form suitable centres for independent action or for self-contained health services. Those which are suitable in one respect are not convenient in others. Epidemics, and endemic prevalences, do not respect regional boundaries, while movements of population, industrial and residential developments, etc., cannot be made to conform to the convenience of regional offices of the Ministry of Health. Exceptional personal skill (e.g., in some particular form of surgery) cannot be confined in its operation to a single region, nor should research be hampered by the need for drawing its material from a limited 2
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| Physical Description: | TEXT |