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71
health (including care, after-care and family case-work) could the
maximum benefits to society be realised.
As early as 1920, this logical extension into a "one-tier"
system was the subject of a Report by Lord Dawson of Penn
and it should occasion no surprise, therefore, that the Government's
decision to implement a separate Social Services Act was received
with some dismay in the ranks of the supporters of "unification"
and with the feeling that a great opportunity has been lost to set
the nation's health services on the right road. Apprehension has
also been expressed about the fact that full success will now
be dependent not upon integration but upon co-operation with all
its inherent disadvantages. However, it would be a serious error to
pre-judge such an issue and, assuredly, time will prove an
adequate arbiter.
Although the merits of a single agency will be argued ad
nauseum, nevertheless, the Secretary of State has insisted that
inauguration of the Area Health Boards in April, 1974, will usher
in an entirely new structure, the purpose of which is to eliminate
artificial barriers and, by combining the hospital and primary care
or practitioner services with those of community health, to
promote a service which will be a source of pride to public
and staff alike. This impending and unique re-organisation will
give, for the first time ever, an opportunity for all medical,
paramedical and administrative services to work in unison for
the common good, untrammelled by sectional interests. Watched
by a critical world-wide audience we must not fail.
It would be unrealistic not to acknowledge that a re-organisation
of this magnitude will inevitably precipitate some problems
which will not fit neatly into pre-selected niches. Among these
will be the allocation of responsibility for epidemiological investigations
and preventive actions involved in the control of serious
infectious diseases as exemplified by the diphtheria outbreak at
Manchester and the tuberculosis affair at Plymouth during the
current year.
At present the Medical Officer of Health, with the skilled assistance
of the Public Health Inspectors, has the statutory powers
to bring all resources into play and to deploy them with the
utmost expediency, an arrangement which has proved to be
outstandingly successful. However, the coming re-organisation
will leave these officers within the jurisdiction of dissimilar authorities.
Speed of action in the application of "expertise" is so
vital in such circumstances that the future line of responsibility
needs to be clear and defined and, if continuity is not to be lost,
warrants urgent consideration and an early decision.
As stated in the previous Report the extent to which monies