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PROPOSALS AS THEY AFFECT WILLESDEN.
It would appear that the Willesden Council will be affected in the following ways :—
1. The Willesden Municipal Hospital and the Willesden Maternity Hospital will pass to the Joint Board.
2. The Midwifery Service will revert to the County Council.
3. The position of Willesden as a Welfare Authority or as an Education Authority will be determined by the
Education Bill. As the Bill now stands it would appear that these services will pass to the County Council and that
there may be delegated powers to Willesden to carry them out in accordance with the County Council plan, or it may
be in accordance with the Joint Board plan.
4. The control of Infectious Diseases is not definite in the White Paper and may or may not remain with
the Willesden Borough Council.
5. Environmental Hygiene as now practised by the Sanitary Section of the Health Department will remain
with the Willesden Borough Council.
CERTAIN GENERAL PRINCIPLES OF A NATIONAL HEALTH SERVICE.
Certain general principles should determine the structure of a National Health Service and guide its
development.
1. There should be only one central Government Department dealing with medical care, personal and
environmental hygiene, whether in the works, the office or the schools or the home, and the various social circumstances,
other than moneys, which affect good health.
2. Locally there should be one authority sufficient in size and adequare in financial resources to deal with
a comprehensive health service in its widest aspects. This authority should be the Local Authority for the area and
the Health Services should be administered with the other services for which it may be responsible, many of which
are necessarily allied to questions of health.
It is stated in the White Paper that proposals for new local government areas have been rejected on the grounds
of urgency, but it does not appear that in the present circumstances this plea holds good for the following reasons :—
(1) Even if there were no war there is not sufficient medical personnel to man a complete service.
(2) Immediately after the war only attenuated Health Services can possibly be available as medical
personnel will not be released at once.
(3) The Comprehensive Health Service as envisaged will probably take ten years at least after the
war is over before it could be considered, as reasonably adequate.
Private Practice.—It will be observed that although the service is comprehensive, private practice may be
carried on by doctors in the service. This will obviously be difficult to arrange and some very clear thinking will
have to be done in order that there is no conflict of opinion between the doctor and his patient as to whether he is
being treated under the Public service or as a private patient. It should further be observed that the service includes
provisions other than medical care, e.g., nursing, ambulance, etc., and it is not clear whether they too would be paid
for privately.
Health Centres.—Health Centres are indicated as subjects for trial, but they cannot be established in any
local area unless the Joint Board include them in their plan after consultation with the Local Health Services Council
and with the approval of the Minister.
The Consultant Service to be provided is to be a part of the Hospital Service and the consultants required
in clinics or at home will,it is presumed,be provided by the Hospitals. This arrangement is good, but it is unsatisfactory
that the Hospital and Consultant Service is under the Joint Board and the Health Centre Service is under the County
Council or County Borough Council or the Welfare and Education Authority, while the Domiciliary Medical Service
appears to be under the Central Medical Board of the Ministry of Health.
HEALTH.
In the White Paper emphasis is put on the Hospital Service and the Treatment of Disease which, in my
opinion, although important, should not be the main considerations of a Local Health Authority, whose aim should
be to maintain and improve the health of the people. The maintenance of health is a complex process. It is the
family doctor who should be in the front line in this matter. The maintenance of health implies not only a knowledge
of the physical and mental state of the individual, but knowledge of the background, the environmental, industrial
and social conditions under which he works and lives. If improvement in national health is to be achieved, the general
practitioner and consultant must know these conditions and assess their influence on health and illness. Many of
these environmental matters and social circumstances are brought to light by Sanitary Inspectors, Health Visitors,
Hospital Almoners and members of Local Authorities themselves, and such information must be pooled with medical
knowledge so that a complete picture may be presented to the authority in order that they may decide as to the best
measures to be taken for the promotion of health. As the White Paper leaves severely alone the questions of
environmental hygiene and social circumstances as they affect health, it does not appear that full use will be made
of knowledge acquired in respect of these matters. The whole tendency of the White Paper is to make not only the
doctor but the public hospital minded rather than health minded.