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7
be so high. For many of such districts the changes brought about by
the Act would have resulted in a raising of the standard and therefore in
an improved service. It is one of the weaknesses of the Act, that the
position of such authorities as this, of larger population and greater
financial resources than many a county borough, was not recognised.
Unless something is done to recognise this position, then the populations
of many of those larger districts are not likely to have the standard of
service which otherwise they might have. The responsibility for providing
a satisfactory environmental service remains with the local authority.
Many of the personal services can best be administered by those with
knowledge of local conditions. These, then, should be provided by local
councils who should themselves employ the staff providing them. Those
providing these services need to work in such close association that
there is every advantage in their being members of the one staff. Since
the first Medical Officer of Health was appointed over 100 years ago,
the position of the Medical Officer of Health in the administration of the
health services of a district has been recognised. Transference of powers
from the district councils to the county councils led to a change in the
status of the Medical Officer of Health in many districts, a change which
might have serious effects on the recruitment of health officers. This
subject is dealt with in a separate chapter at the end of the report.
As to what might be done to improve what are now County Council
services but which are supposed to be managed by local Area Committees,
some see no hope of improvement except by legislation which will grant
autonomy to the larger of these districts, or legislation which will permit
full delegation of authority to be granted to local bodies. But such a
conclusion can be arrived at only if it is accepted that the present arrangements
cannot succeed. Such conclusions cannot really be reached until
everything has been done to give the present arrangement a real opportunity
of succeeding. For this to come about, it is not necessary to
resort to formal agreements or to written formulae. All that is needed
is a recognition by some that others who have had just as much experience
as they have and who are, to say the least, not less interested than they
are in their districts, can be trusted to administer delegated services.
While this is all that is needed, this much at least is essential, because
without that the Local Area Committees cannot possibly feel that they
are responsible bodies and unless they can feel that, they cannot be
expected to have the essential interest in the work of the body, with inevitable
consequences.
I have the honour to be,
Your obedient servant,
CARYL THOMAS,
Medical Officer of Health.
Council Offices,
" Cottesmore,"
Uxbridge Road,
Stanmore, Middx.
May 28th. 1952.