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Officer for the London County Council Health Division 9, while the
Deputy Medical Officer of Health of Battersea is also Assistant
Divisional Medical Officer for Health Division 9.
I do not wish to make more than a brief reference to this important
subject in this Report since at the time of writing the arrangements
have been operating for only about eighteen months. It is, however,
proper that members of the Council should have a short interim statement on a method of public health administration which I know has
aroused a good deal of interest and comment.
One of the major problems in the administration of the health
services is to effect the closest liaison between the various branches of
the health and medical services. The main branches are the public
health and preventive medical services, the responsibility of various
types of local authorities; the hospital and specialist services, the responsibility of the Regional Hospital Boards, Boards of Governors and the
Hospital Management Committees; and the general medical or general
Practitioner services, the responsibility of the Local Executive Councils.
Everyone is agreed on the need for the closest integration of the work of
these three statutory bodies and of the officers of all grades who serve
under them. The problem, however, is even more marked where there is
a dual responsibility within the local authority health services, and
Probably is most acute within the County of London. Many of the
Metropolitan Boroughs (Battersea is an example) which are responsible
only for the environmental health services are larger than many of the
important provincial County Boroughs which are all-purpose authorities,
whereas the London County Council (the largest public health authority
in the country) is responsible for the personal health services and is
also the education and the welfare authority. It is, I think, a testimony
to the efficiency and skill of the officers engaged in the local public
health service in London that, under the circumstances, the
standard of public health practice and administration in both spheres
is so high. Nevertheless, it must be obvious that this dual
responsibility is a very serious weakness in the administration, and there
is everything to be said for effecting an integration and blending of the
two sections of the preventive health services. There are a number
of ways, no doubt of varying degrees of practicability, by which this
Ca n be attempted, and one way is the method which has been adopted
in this area, where the Medical Officer of Health for the adjacent
Boroughs and the Divisional Medical Officer is ultimately responsible to
t he Committees concerned for the administration of the two
sections of the public health services, and it should be possible, at least
m theory, for the two branches of the public health and preventive
medical services to be very closely combined and co-ordinated.
I am happy to be able to state that up to the time of writing, no
difficulty whatsoever has been experienced. I have not met
a my unduly serious administrative problems and lam unaware that
a ny commitment or responsibility has gone undischarged. Apart from
the feasibility and practicability of the arrangements as a purely
administrative problem, there are many other advantages. For instance,
the area and population concerned is such that it forms a convenient
a nd economic unit for the purpose of planning the public health services
a nd this means that over a reasonably sized area unified methods of