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41
PERSONAL HEALTH SERVICES
MARY T. PATERSON, M.B., B.S., D.P.H.
Deputy Medical Officer of Health
Community health services as we know them today have grown up during the past 120 years or so to
meet the needs of the population. In the last century the most obvious needs were for the control of
infectious disease, for the relief of poverty and malnutrition, for the provision of adequate housing, for
improvement in working conditions especially for women and young children. Local authorities were
gradually empowered to provide services to meet many of these needs, which are now included in the
environmental health services.
Personal health as the name suggests is the promotion of health of the individual, the prevention of
disease and the relief of suffering. Most of these personal services were pioneered by philanthropists and
voluntary bodies, and once established taken over by local authorities empowered to do so by Acts of
Parliament. Home nursing, health visiting and maternal and child welfare are important examples: provision
for destitute or neglected children, for unmarried mothers, for the elderly and chronic sick are others.
Post-war legislation, the National Health Service Act, the National Assistance Act and the Children Act
set up a new method of organising the services and divided responsibilities between different bodies and
departments. The larger local authorities were designated health authorities, but had powers to delegate
some functions to sanitary authorities. Those hospitals previously administered by local health authorities
were transferred to Regional Hospital Boards. The care of children deprived of a normal home life became
the responsibility of the new children's departments of local authorities.
As a result of these changes the health services previously provided by local authorities were to some
extent fragmented and those services remaining the responsibility of the health department were divided
into environmental and personal. There is no doubt that there was a great improvement in all the services.
Part III of the National Health Service Act included the personal health services already provided by the
local authorities such as care of mothers and young children, health visiting, domiciliary nursing and
midwifery; it also empowered them to provide home helps and day nurseries. Section 28 under the heading
"Care and After Care" enabled the health departments to provide a wide variety of new services such as the
care of infirm old people, care after illness, recuperative holidays, and social work with unmarried mothers
and problem families. The Mental Health Act 1959 added community care of the mentally ill and mentally
handicapped to the personal health services.
When in 1965 the City of Westminster took over the personal health services from the London County
Council, they were well-established and flourishing. But to keep pace with current developments
considerable expansion was necessary. During the ensuing six years 1965-1971 day nursery facilities for
handicapped children were provided, mostly by voluntary effort with financial support from the Council; a
hostel for mentally subnormal men, a day centre for mentally ill adults, and a training school and special
care unit for mentally subnormal children were all opened; social work associated with V.D. clinics was
expanded; a special youth advisory service was set up and a social service for unmarried mothers and their
children was instituted.
The Local Authority Social Services Act 1970 which came into operation in April 1971 was designed to
unify the social services. It did have the inevitable effect of again fragmenting the personal health services.
Although the health department still has responsibilities for the health and welfare of the community it no
longer directly controls the means of providing that care. Child health is an important responsibility of a
health department but day care of children and social work for families is undertaken by the social services
department. The detection and assessment of need of old people and the care and nursing of the infirm is
still undertaken by the health department, but residential care, social visiting, clubs and day centres and
home helps are the responsibility of the social services department. All social work connected with the
mentally ill and mentally handicapped is provided by the social services department with medical officers
acting as advisers when required. In the chest clinics, which had previously been an example of co-operation
between local health authority and hospital services, the social workers have been transferred to the social
services department, although the health visitors undertaking contact tracing remain part of the health
department.