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3
REPORT OF THE MEDICAL OFFICER OF HEALTH FOR 1952
Report, since at the time of writing the system has been operating for
barely 18 months. I think, however, that the members of the
Council should have a short interim statement about a method of
public health administration which has given rise to a good deal of
interest and comment.
In order that the new arrangements may be seen in their proper
perspective, it is important that the principles on which they are
based should be recognized. Everyone is agreed that 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, responsibility for which was divided amongst a
number of statutory bodies by the National Health Service Act, 1946.
The main branches resulting from that Act are the local 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. There is no difference of opinion on the need
for the closest co-ordination of the work of these three statutory
bodies and of the officers of all grades who serve under them. It is
harder to achieve this object, however, where there is dual responsibility
within the local authority health services, and the difficulty is
probably most acute within the County of London. The reason
for this is that many of the metropolitan boroughs (Wandsworth,
of course, is an example), which are responsible only for the
environmental health services, are larger in population and acreage
than many important provincial cities and counties, some of 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 also for other services closely
linked with them, namely, the education and welfare services. It is,
I think, a testimony to the efficiency of the officers engaged in the
local public health service in London that the standard of public
health practice and administration under these conditions is so high,
both in the environmental and the personal health spheres. Nevertheless,
it must be obvious that this dual responsibility is a serious
weakness in the administration and that great advantage would
result from effecting a blending of the two sections of the preventive
health service.
There are a number of ways, no doubt of varying degrees of
practicability, by which this can be attempted, and one is the
method which has been adopted in this area, where the Medical
Officer of Health for two adjoining metropolitan boroughs and the
Divisional Medical Officer is the one person ultimately responsible
to the three committees concerned with the administration of the
two sections of the public health services. It should be possible
by this means for the two branches of the public health and preventive
medical services to be very closely combined and co-ordinated.