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6
could not have retained autonomy. At the time they were first designated,
it was appreciated that there should be some minimum figure for a
district to be a county borough. Later legislation imposed a limit
which was, in its turn, raised. One of the main reasons making this
desirable was that, to provide an economical and efficient institution
such as a hospital, it was necessary that it should have a minimum
number of beds; that in turn, meant that the hospital should serve a
minimum sized population. With the erection of institutions to serve
more than one area such a point carried less weight; still less is that the
case to-day, when such institutions are not provided even by county
boroughs. If then it should appear that areas such as this have, in fact,
lost something tangible because they are classed as minor authorities,
this might be all the greater argument for their being upgraded and
being made major authorities.
Of the administration of the hospital services, the medical officer of
health learns little. In some districts, he has been appointed on the
Hospital Management Committee. His knowledge of local conditions
and all that might be arranged through the local services is probably
of real benefit to the other members of the committee. This district is
served by hospitals in two groups; the Edgware General Hospital in
the Hendon group is just outside the district; on the other hand the
Harrow Hospital is administered by the Charing Cross Hospital Board
of Governors. It happens then, that there is no member of the District
Council on either of the local Hospital Committees providing services
in this area. When the local Council made grants to some of the voluntary
hospitals, it was customary for the authority to receive reports on
the workings of the hospitals. Nothing of that sort is now being presented
to the Council. However small a case can be made out for the
importance of the hospital services in the general scheme of the health
services of an area, it would seem that there should still, with advantage,
be room for close association between those on the local Council providing
the health services, and those administering the hospitals. These health
authorities were the natural bodies on which were imposed the earlier
of the personal health services. The same interest which made them
the natural repositors of those trusts at that time, would seem to make
them again the bodies from whom should be drawn some, at least, of
those who are responsible for the local administration of the hospital
and clinic services. All these bodies surely would gain if there were
some members who were on the Public Health Committee of the District
Council, on the Sub-Committee of the County Council responsible for
the Part III Services, and on the committees responsible for the management
of the hospitals and clinics in those areas.
1949 was the first complete year of the working of the services
provided under the National Health Service Act. It is understandable
that those in health departments learn more of the difficulties arising
from the operation of the Act because they are approached for help,
help which so often cannot be given. Whether this is a matter which
has arisen out of the changes brought about by the Act or whether, if
no change had been made, matters would have been much the same,
there does seem to be a very real difficulty in finding accommodation