London's Pulse: Medical Officer of Health reports 1848-1972
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Hints from the Health Department. Leaflet from the archive of the Society of Medical Officers of Health. Credit: Wellcome Collection, London
Willesden 1944
[Report of the Medical Officer of Health for Willesden]
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(b) County and county borough councils will normally provide most of these local services. The exact
allocation of responsibility between the joint authority and the individual county and county borough
councils will be finally settled in each case in the approved area plan ; but the principle will be that
services belonging to the hospital and consultant sphere will fall to the joint authority, while other local
and clinic services will fall to the individual councils.
(c) Child welfare duties will always fall to the authority responsible for child education under the new
Education Bill.
(d) New forms of service, e.g., for general dentistry and care of the eyes, will be considered with the
professional and other interests concerned. In the case of dentistry the report of the Teviot Committee
is awaited.
Finance.
The following table given in the White Paper shows the total cost of the scheme to public funds and the proportion to which that cost might be borne by ratepayers and central funds:—
| Service. | Cost Met from Central Funds. | Cost Falling on Ratepayers. | Total Cost to Public Funds. | ||
|---|---|---|---|---|---|
| (a) By Direct Grants or Payments. | 0b) By Grants in Aid of Rates or Precepts. | Total Cost from Central Funds. | |||
| £m. | £m. | £m. | £m. | £m. | |
| Expenditure of new Joint Authorities | 28.4 | - | 28.4 | 41.6 | 70 |
| Exchequer Grant to Voluntary Hospitals | 10 | — | 10 | — | 10 |
| Expenditure of County and County Borough Councils | 8 | 7.6 | 15.6 | 6.4 | 22 |
| Fees to General Practitioners and Payments to Chemists | 30 | — | 30 | — | 30 |
| All Services | 76.4 | 7.6 | 84.0 | 48.0 | 132.0 |
The White Paper goes on to state how far the central funds will consist of, or be assisted by, sums of money
set aside out of contributions under a social insurance scheme will fall to be considered later. The Beveridge Report
proposed that a sum of £40 millions per annum should be available for the new health service. Of this, £35*7 millions
would be the share appropriate to England and Wales, and if this assistance is assumed, the proportions in which the
total cost of the new service would fall on the social insurance scheme, the taxpayer and the ratepayer would be, on
the foregoing estimates and ignoring the effect of the block grant under the Local Government Act, 1929 :
Social Insurance Scheme ,£35*7 millions, or about 27*0 per cent.
Taxpayer 18'3 millions, or about 36*6 per cent.
Ratepayer 48'0 millions, or about 36'4 per cent.
£132.0 millions.
Again ignoring the effect of the block grant, the corresponding table for the incomplete services in 1938-39 would be approximately :
| £m. | |
|---|---|
| Contributions under N.H.I. Acts | 11.2, or about 20 per cent. |
| Taxpayer | 3.0, or about 6 per cent. |
| Ratepayer | 40.3, or about 74 per cent. |
| 54.5 |
NOTES BY MEDICAL OFFICER OF HEALTH.
The foregoing summary of the proposals is culled from the abridged version of the National Health Service
published by the Government. The following observations, however, are submitted :—
Central Control.—All the medical and health services of Central Government will not be the function of
one Ministry. The following, amongst others, appear to be excepted from the control of the Ministry of Health,
namely, the Industrial Medical Services under the Factory Acts, the Ministry of Labour, the Ministry of Supply,
the Ministry of Fuel and Power and certain features of the School Medical Service under the Board of Education.
Local Control.—Here again a number of authorities are at work in an area. Firstly, the Joint Board which
will itself provide hospitals and certain other forms of treatment and will plan what is to be provided by County
Councils and County Borough Councils. The Welfare and Education Authority will also be involved in the local
provision to be made and presumably their services will be a part of the plan to be devised by the Joint Board.
Medical Personnel.—It should be observed that the employment of the doctor in general medical practice
is under the Central Medical Board of the Ministry of Health and that only where he works in a Health Centre is the
Local Authority a party to the contract. The distribution of doctors will be determined by the Central Medical Board
and what powers of appointment of doctors, if any, the Local Authority concerned may have is not clear.