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In this conception of area control I am reminded of the Brontosaurus which became extinct
because it grew so large that its brain was too far from its limbs. Perhaps there is a lesson to be
learned here!
When we come to the environmental services the Green Paper is vague and proposes that
medical advice would be available to local authorities from Medical Officers on the staff of the
Area Boards.
The Green Paper envisages that the functions and powers of the Medical Officer of Health in
respect of personal and environmental services would be transferred to the Area Board, but it
does not say how they are then to be carried out. If a post equivalent to that of Medical Officer of
Health is to be established under the Area Board he is in danger of becoming merely an "adviser"
and spending most of his time on Committees where his special knowledge and experience will be
wasted. The Medical Officer of Health is, or should be, a specialist field worker whose major
interest is the prevention and control of disease and not its treatment. One of the great weaknesses
of the National Health Service is its emphasis on illness and its neglect of prevention and the price
we have had to pay for this is astronomical and will continue to increase.
My view is that already the London Boroughs are too large as far as the Health Departments are
concerned — although I concede that for other services they may be ideal. If a Medical Officer of
Health is to carry out his preventive duties properly he needs to be relieved of those personal
health services which deal with the individual and to concentrate his efforts on the Community
and the prevention of illness. The Area Board proposal would not appear to encourage or permit
this. I have for years advocated the separation of Local Authority Health Services into two
divisions each under a medical officer of equal status. The Medical Officer of Health would continue
in charge of Environmental and Preventive Services, the other Medical Officer in charge of
the Personal Services. They would collaborate closely but each would have time to do his job
properly, and most important of all, the preventive aspects would receive proper attention which
they are not doing at present, to the country's cost.
Communication within a large Local Government organisation seems to deteriorate geometrically
with the size of the organisation and whatever the theorists may imagine, the larger the
set-up the greater the problem of technical and professional control at the perimeter and of
obtaining prompt and accurate information.
From my 30 years experience in Local Government I have no hesitation in stating I made my
most useful contribution to the public welfare and derived the greatest satisfaction from my work,
when I was Medical Officer of Health and Principal School Medical Officer of a Borough of 35,000
and did everything single-handed.
In my view the proposed services under Area Boards could function, but whether the new
arrangement would bring any benefit to the public I very much doubt. The cost would be greater
than at present and the preventive aspects of disease would get pushed further and further into the
background, as the curative sections of medicine would undoubtedly dominate the activities,
interests and finances of the Boards.
I have deliberately kept away from the effects on the Hospital and General Practitioner
Services as these are not spheres of which I have first-hand knowledge, nor have I concerned
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