British Medical Journal. Supplement : A general medical service for the nation
1938-04-30 1938 1930s 14 pages 266 APRIL 30, 1938 REPORT OF COUNCIL SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL a corresponding degree of local unification in counties and county boroughs it appears desirable to modify the position of insurance committees (see para. 119). 114. It is clear, ho...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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[London : British Medical Association]
30 April 1938
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| Online Access: | http://hdl.handle.net/10796/609FD9B4-381D-46CA-8DE8-7C0B7A676F8E http://hdl.handle.net/10796/7799D0F9-847F-47E2-8606-CBEF785C3E8F |
| Summary: | 1938-04-30
1938
1930s
14 pages
266 APRIL 30, 1938 REPORT OF COUNCIL SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL a corresponding degree of local unification in counties and county boroughs it appears desirable to modify the position of insurance committees (see para. 119). 114. It is clear, however, that the proposals advanced by the Association, or any other schemes with a similar object, will fall short of their aim if planned within the present framework of local government. Many authorities administering medical services control areas which are too small in population, and of too low a rateable value, to provide an adequate service of institutions and professional personnel. Moreover, the duality of responsibility of county and county district councils in common areas of England and Wales militates against coherency of policy and objectives. The Act of 1929 was only a first and short step toward unification of local administration. 115. Long and careful consideration has been given to this subject. In particular, proposals have been discussed which involve greatly enlarged areas, to be administered by ad hoc bodies, for hospital and general medical services. These areas would not necessarily have any relation to existing boundaries of local government but would follow those which experience has shown to delimit areas which centre on a voluntary hospital or group of such hospitals. While such delimitation of areas would simplify that relationship between medical practitioners and hospitals and between hospitals of different kinds and sizes which is recommended in Section IV of this report, it would probably tend to detract from public interest in the service and to leave essential public health provision of a preventive character outside the scheme. So great a departure from past and recent policy in relation to local government is, in any case, outside the realm of practical politics. It is noted that the Committee on Scottish Health Services has come to the following conclusion: "While the whole local government system may require to be overhauled in the near future, the questions involved should not be settled in advance by reference to the health services alone." 116. The Association considers, however, that changes in local government, so far as the medical and public health services are concerned, are urgently necessary and are practicable, however great the opposition to them may be. The objects to be aimed at in England and Wales* should be: (a) The creation of a system of complete and all-embracing units for local public health administration by the removal of such functions from county district councils below a certain size, the county councils and those county district councils serving large enough areas being given all the public health and medical responsibilities which county borough councils now enjoy. (b) Limitation of these functions to the councils of areas with a population of not less than 75,000 to 100,000 according to the predominantly rural or urban character of the area. (c) The treatment of hospital services and related medical services as regional problems. 117. In practice the alterations involved would be simple, however controversial they may be. Most county boroughs would be unaffected. A few large county district councils might acquire public health responsibilities now exercised by the county councils, but in densely populated counties the exact population limit to be applied would need careful consideration. The health affairs of counties outside these two types of area would be directly administered by the county councils without intervention by any other body. In the smaller counties all public health administration within their geographical areas would be the function of the county council; indeed, a few in England and several in Wales are below the minimum population which is desirable for efficiency. For hospital administration and related medical services ample power of combination is provided in the Local Government and Public Health Acts to permit of regional arrangements. These are not widely used, but if there is to be any such co-ordination of statutory and voluntary provision as the Act of 1929 envisages, the areas suitable for joint action and the best means of attaining it should receive the earnest consideration of the Ministry, of the associations of local authorities, and of the Provisional Central Council which has been set up by the British Hospitals Association. 118. A desirable administrative development would be the establishment, by each local authority to which health functions are assigned, of a statutory committee to which would stand referred all questions relating to the medical and allied services — that is, to personal as distinct from environmental health services. The services administered by this new statutory committee (the Medical Services and Hospitals Committee or other committee) would include all matters relating to personal health services, institutional and non-institutional, not within the reference of other committees of the council. All committees and subcommittees with functions relating to personal health should include medical practitioners, and the machinery of co-option should in all cases be utilized to appoint, inter alios, medical practitioners to the committee or sub-committee. 119. The national health insurance medical service would, however, require special treatment. It is of vital importance that the central management of that service should be retained by the Ministry of Health. The local administration should provide for adequate representation on the appropriate committee and subcommittee of the bodies now represented on insurance committees, and for the establishment of a professional committee which might be the statutory local medical advisory committee referred to in the following paragraph. 120. It is necessary to refer here to the urgent need, now and in the future, for a closer co-operation, facilitated by statutory provision, between authorities, central and local, and the medical profession. This can be secured by the recognition of a central consultative medical body, representative of the medical profession as a whole and of a local medical consultative or advisory body, representative of the medical profession of the area, with direct access to the local authority. 121. The medical officer of health of the administrative area concerned would be the administrative head of those parts of the scheme under local administration. He would be the liaison officer between the local profession and the local authority. He would be, as now, the chief adviser of the local authority on health matters. The medical officer of health would be responsible to the authority for the proper administration of the various medical institutions provided by, or financed in whole or in part by, the local authority. He would be the director of the local health propaganda. The medical officer of health would not be a member of the statutory local medical advisory committee, but it should be the duty of its secretary to invite the medical officer of health to attend all meetings, to send all agenda, minutes, and other notices to him, and to transmit to him, giving reasonable notice, a copy of any representations to be made to the local authority with enough informative detail to enable him to study the proposals. 122. This problem of local government has been dealt with at some length because it has become increasingly obvious to the Association that the widening range of State medicine during the present century has been accompanied by a lack of reasonable uniformity in the nature and quality of services given in different areas. The rapid development of hospital provision by local authorities and the lack of joint deliberation and agreement between different authorities, and also between these authorities, insurance committees, and voluntary hospital managers, are increasing the urgency of the problem. Its urgency would be still further accentuated by the adoption of a comprehensive medical service for the nation. * These proposals would require special adaptation to meet the different administrative system of Scotland and the views of the medical profession of Scotland in relation thereto.
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