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This was found to be a question difficult of solution, albeit an important problem,
as the salaries of the staff concerned account for about half the total pay bill of the
department. Professional and auxiliary staff must be free to work according to the
highest standards of their professions and cannot be tied to any hard and fast rules
governing output a session. Yet to look for some evaluation of work performance
measured in terms of cases dealt with is the only rational way of approaching the
problem. From the little research so far done, either nationally or otherwise, it is
apparent that conceptions of the standards on which calculations might be based vary
remarkably. The problem is complicated in London, too, by the divergence, sometimes
wide, in demand or level of service provided, between one division and another.
Nevertheless, certain useful criteria for establishing staffing ratios were suggested ;
their application to each grade of staff concerned will necessarily take time. The deputy
medical officer of health and the establishment officer have been given the joint responsibility
for the continued scrutiny and the giving of advice on it.
The view was that, subject to general conformity with centrally directed policy,
it was reasonable to leave divisional medical officers to run their divisions in their own
way, provided that local variations were not carried too far; on the whole the proper
balance had been struck, though in certain respects there was a need for greater
uniformity as regards procedures and forms.
It was felt that the decentralisation of the services handled in divisions should be
continued but there appeared to be little scope at present for its extension to the mental
health, ambulance and midwifery services. For the ambulance service central control
is essential. In the mental health service, it was agreed that the centralisation of work
under the Lunacy and Mental Treatment Acts should be continued permanently, but
it is proposed to decentralise the mental deficiency inspectorate and combine its work
with the supervision work now undertaken from four district offices. There is no
practical alternative at present to central control of midwifery, but some future
decentralisation is not precluded.
A considerable volume of work, mainly case work, is handled centrally either as a
service to other departments, e.g., medical examination of staff, or as part of a mainly
decentralised service, e.g., the scrutiny of divisional recommendations for the ascertainment
of educationally sub-normal children. In view of the need to maintain uniform
professional standards, to ensure fair judgment in applying priorities dictated by
restricted facilities, to deploy specialist services quickly and economically, and to secure
liaison between staff handling complex cases and for administrative convenience, no
change is proposed in those arrangements.
London ambulance service—Two types of work are dealt with, accident or emergency
removals and general removals (usually to and from hospitals). The service operates
from a headquarters station with a central control room, from six large general ambulance
stations and from 19 accident ambulance stations.
Organisation
and staffing
of centrally
administered
services
As organisation and methods staff in 1952 investigated traffic control and the procedures
and staffing at ambulance stations, the present review was restricted to the
headquarters organisation. Greater decentralisation since 1952 has enabled a 28 per cent.
increase of work to be absorbed without increasing the control room staff, but a slight
strengthening of headquarters staff has now been agreed for this and other purposes.
Mental health services. (a) Mental deficiency—Six social workers (inspectors), based
on the County Hall, make reports as part of the ascertainment procedure and are
responsible for defectives living under their guardianship in lodgings or hostels and for
the supervision of defectives under the guardianship of other persons (including
relatives and friends). This work is to be decentralised and merged with the work,
based on four district offices, of the local organisers and their assistants responsible for
supervision of mental defectives living at home. Inspectors will gradually be replaced
by assistant local organisers.
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