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4
created local health authority) are widened. Just as they are the
education authority for the entire County they now become responsible
for the administration of the maternity and child welfare services
throughout the area. They will maintain the ambulance service
transferred from local authorities. They will be responsible for the
new home nursing service and also for the domestic help service. The
duties of the health visitors are to be broadened, and the County
Council becomes responsible for making arrangements for the immunising
of the population against diphtheria and its vaccination against
smallpox. The County Council is the authority responsible for providing,
equipping and maintaining the new health centres which are to figure so
largely in the new sickness service and which will in most areas presumably
in time replace the surgeries of the general medical practitioners,
while at the same time at them will be provided certain health services
for which the local health authority is responsible. The County Council
though while acquiring much, is losing much. It is losing its hospitals, not
only the general, medical and surgical hospitals, institutions for the
administration of which they were made responsible by the Local
Government Act, 1929, but special hospitals such as those for maternity
cases, those for the tuberculous and for the mentally afflicted. They
lose, too, services related to clinics and hospitals, including the entire
tuberculosis service with its chest clinics and institutions for pulmonary
and for non-pulmonary cases and the social services now based on these
centres. All these pass into the hands of the regional board. The
country is being divided into fourteen regions, each based on a university
area, each being administered by a board appointed by the Minister of
Health. Each board will operate through hospital management committees—bodies
appointed by the board and having on them representatives
of local health authorities, executive councils, and medical and
dental staffs. The last of the bodies concerned in the administration
of this new health scheme is the executive council. These are bodies
each representing an area corresponding to a county or a county borough
on which will be representatives of the Minister, of the local health
authority and of the local medical, dental and pharmaceutical committees.
The doctors who will be responsible for the general medical service will
contract with the executive council.
The direction of activities of a welfare authority is changing.
Health visitors have gradually extended their range of duties embracing
the entire family and not now merely the small child or the mother.
This extension is to be given official recognition in the definition of the
functions of the health visitor in the new Health Service Act. Her
outlook is more sociological than clinical. Authorities provide day
nurseries. The administration of these nurseries falls to the welfare
committee in that it is the committee which has to be responsible for
the arrangements for ensuring the health and well-being of the children
but this is more the concern of the staff, whereas what concerns the
committee more is the justification for the nurseries which leads to the
discussion of such problems as the employment of married women and
the country's drive for export. Again the domestic help service is not
so very far removed from a domestic service agency, and while the service