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5
With the turn of the century the health activities of local authorities
were deflected to other channels which produced less spectacular results.
The major blots had been removed and up and down the country the
environmental state of the community was being markedly improved.
The main interests in the health services then passed from the general
impersonal environmental services to the personal services, namely,
those provided for the benefit of individuals of a certain group or section
of the community, or those suffering from some specific disease or disability.
The first of these was the school medical service which was
imposed on those bodies who on the abolition of the school boards were
made education authorities. These were boroughs of 10,000 or urban
districts of not less than 20,000 population—elsewhere in the county, the
county council. The next was the maternity and child welfare service.
The authorities made responsible to provide this were the larger of the
county districts, including rural districts, but elsewhere in the county the
county council. This, though, was almost the limit to which the provision
of personal services was made the responsibility of county districts.
Thereafter the duty of providing all the new personal services was laid
on the county council (and for its area the county borough council) ;
so that they were responsible in turn for the tuberculosis service, the
schemes for the treatment and control of venereal disease, the care
of the mentally afflicted and the mentally defective, the care of the blind
and, in due course, on the abolition of the Boards of Guardians, under
the Local Government Act, 1929, they were the authorities responsible
for the provision of general medical and surgical hospital accommodation.
Up to recently then, in a county district of any size, the local
council was responsible for the environmental services, as an education
authority for much of the school medical service, and as a welfare authority
for the maternity and child welfare service, with, in some cases, the
domiciliary midwifery service as well. The responsibility for providing
the other personal services in the area of the county district rested on
the county council.
During the recent war, the local government system was put in the
melting pot. The first indication of a pattern for the future was given
in the Education Act, 1944. This resulted in the withdrawal of powers
from the councils of those county districts which had been Part III
Education Authorities, with the transference to the county councils, only
the major authorities—the county councils and the county borough
councils—in future being the education authorities. There was, however,
provision for the exercise of delegated powers in regard to the day-to-day
functions by the county council to the larger of the county districts as
excepted districts. Included in the delegated functions was much of the
school health service. The divisional executive, then—that is very
largely the local council—is responsible for much of the school health service
in the district. The National Health Service Act brings about a
similar transfer of powers and responsibilities in connection with the
maternity and child welfare service. This is to be lost to the county
districts, passing into the hands of the county councils. The Act made
provision for the use of the knowledge and experience of the councils of
county districts in administering these services. It provided that certain
of the services could actually have been delegated to some of the district