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AMBULANCE SERVICE
Reading through the first Annual Report of my predecessor I
was interested to read that " a motor ambulance is now provided for
the removal of infectious cases to the Isolation Hospital, Upney Lane."
(Italics are mine.) This led me to turn up the report of the Medical
Officer of Health for 1926 in which it is recorded that a horse ambulance
was provided for the removal of such cases to the Isolation Hospital !
At that time accident and non-infectious cases were dealt with by
ambulances coming under the control of the Chief Fire Officer.
A fleet of modern motor ambulances was gradually built up, and
in 1943 the service was made available to the public without charge.
In 1948 the ambulance service was transferred to the County Council
and the control of this service was not decentralised to Health Area
Sub-Committees. This is a matter which personally causes me no
regrets since I feel that to achieve maximum efficiency and economy
the service must be based on as wide an area as possible. Ambulances
are used almost exclusively for the transport of patients to and from
hospital, and local health authorities have virtually no control over
the demands for this service. Bearing in mind that it absorbs 28%
of the authorities' expenditure, and that the service can in no way be
called preventive, it is my feeling that it would more properly have been
made the responsibility of Regional Hospital Boards.
PREVENTION OF ILLNESS, CARE AND AFTER-CARE
Prevention. The National Health Service was set up "to secure
improvement in the physical and mental health of the people," and for
"the prevention, diagnosis and treatment of illness." Prevention is,
or should be, the main function of the local health authorities, and
although the word " prevention " does not appear again until Section
28 of the Act, it will be obvious that many of the services such as
provision for the care of mothers and young children, health visiting
and vaccination and immunisation have a strong preventive bias.
It is interesting to compare the money spent on the hospital
general practitioner, and local health authority services and as will be
seen from Figure 11 the lion's share goes to the Regional Hospital
Boards leaving only 8 per cent. to the local health authorities. The
breakdown of local health authority expenditure (Figure 12) shows
that no less than 28 per cent. goes on the provision of ambulances—
a service which I have already referred to as being one which would
more properly fall to the Regional Hospital Boards. Provision of
midwives, home nurses and domestic helps together account for a
further 28 per cent. which amount might be more properly grouped
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