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77
pay a routine visit to the kitchen in a maintained school in either capacity,
just as he may deal with an outbreak of infection in one of the County
Council day nurseries. At least one person holding the joint appointment
of Medical Officer of Health and Area Medical Officer, feels that he
is allowing the time he devotes to County Council work to be taken away
from that he ought to be spending as the Medical Officer of Health.
To that extent it would seem to point to the allocation being wrong.
The County Council have recently indicated that they wish the proportion
of time to remain as before. They seem, however, to agree to its not
being correct, because they now offer (a thing which previously they were
not anxious to do) to the district council part of the time of the Deputy
Medical Officer, Assistant Medical Officers and clerical staff. Such an
offer could be made only in complete ignorance of the position of the
Medical Officer of Health of the district. When such an officer needs
technical assistance, he needs the help of one who has had some experience
in the administration of the district council's health services. To that
extent the offer of the County Council is of little value. The solution
surely must be found on other lines, namely, for the holder of the joint
appointment to give more time to carrying out his duties as Medical
Officer of Health and to strengthen his hands in administering the County
Council's Part III Services, by increasing the time available to the more
senior County staff in the district to help to maintain the Part III
Services.
If the ratio of time allotted to the Medical Officer of Health of a
smaller district is correct, then it cannot be held that that same ratio
can be correct in a larger district. If the smaller district needs 40 per
cent. of the time of the holder of a joint appointment, a larger district
must need something more, a proportion which in the case of the largest
districts in this county, might rise to 75 per cent. or 80 per cent. This
would leave something very much less than the present 60 per cent. for
county work, but that time available would be spent in supervising
the work of other county medical staff administering the county's
services in the locahty.
The following is an extract from the Annual Report of the Chief
Medical Officer of the Ministry of Health for the year 1949:—
"The appointment of district medical officers of health to do part time
work for the county council has much to recommend it. It enables them to
keep touch with the population of their areas at all ages, and forms a valuable
link with the county medical officer. Where such joint appointments are
made, it should not be forgotten that the primary responsibility of the
district medical officer of health is to his local sanitary authority, because
there is a statutory obligation on all those authorities to appoint medical
officers of health, whose duties to them are laid down by statute. Too much
emphasis on county work might lead to delay and confusion in dealing with
outbreaks of infectious disease."
Here is emphasised the primary responsibility of the district medical
officer of health. What needs to be further emphasised is the importance
of ensuring that medical officers in the public health service are in carrying
out their duties in the posts to which they are appointed put into the
way of gaining the experience necessary to enable them to undertake the