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138
Present plans for this eventual divorcing of health from local
government, however, demand the establishment of two organisations
covering identical areas and entrusted with tasks that
experience shows to be indivisible but which will be administered
by entirely different authorities. In such circumstances we cannot
but view this further upheaval with apprehension.
In a climate of rapid social change we need to keep abreast of
new ideas and to take advantage of opportunities which become
available but, in all persons no matter of what class or status and
whether young or old, change inevitably causes anxiety. In the
sphere of community care we have certainly had a surfeit of change
with the promise of more to come.
Consider the Reports of Maud, Skefhngton and Seebohm, the
two Green Papers on Integrated Health Services, the transfer of
responsibility for the E.S.N, from Health to Education, the Children
and Young Persons Act, 1969, the Local Authority Social
Services Act and the Chronically Sick and Disabled Persons Act,
both of 1970, not to mention the series of internal investigations
and re-organisations and one can begin to understand the widespread
anxieties thereby generated and to realise the almost impossible
task of maintaining an efficient Community Care Service
under such circumstances. If to all this one adds the ever-present
necessity for financial stringency, our efforts merely to hold the
existing position seem to have been little short of heroic.
Compared with the £3,562 millions for Social Security Benefits
and the £2,328 millions for Education, that for the National Health
Services during 1969 amounted to £1,813 millions (5.39% of the
total national income) of which only £223 millions were allocated
to local authority Health and Welfare Services. It is small wonder,
therefore, that the latter authorities were constrained to become
somewhat parsimonious and attracted to policies of expediency.
Some 10 years ago, Councils reacted to this type of fiscal
restriction by looking at efficiency and evaluating costing systems,
organisation and methods control, management by objectives,
design of forms, etc., and in a plethora of "efficiency" operations
the main and most important objective, that of effectiveness, has
become obscured. If present facilities to the public are to be improved
we must move away from the pure efficiency approach to
one of assessing and increasing their effectiveness, particularly with
regard to the personal services. Clearly, the efficient implementation
of a wrong decision merely compounds inefficiency and,
despite all modern innovations, there is no substitute for sound
judgement based on wide experience. Planning is essential and
budgeting almost equally so. But, of necessity, budgetings focus