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6
the authority any additional powers in administering the health services
of the district. The new Borough will then have just as little direct responsibility
for providing the health services as had the Council of the
Urban District. There are no signs of the County Council being any
more ready to hand over, to what extent they are able, the administration
of these services, services which should be managed locally. For
this desirable state to come about it would seem the next stage in the
elevation of the civic status of the authority must be attained. At one
time the minimum size of a County Borough was fixed because of the
needs of such a district to provide institutions of different kinds each
with its own optimum minimum size, though even then the disadvantages
of some small districts were got over by agreement between bodies to
provide and maintain institutions. Now that the hospitals have passed
to the Ministry, there are not these objections in connection with the
administration of the health services to smaller districts being County
Boroughs. On the education side there may be a case for some special
schools meeting the needs of districts of even more than 200,000 population
; but that and similar aspects which might be held to be points in
favour of the present arrangement of local government administration
in the County of Middlesex are far outweighed by the very real disadvantages
of the many services which should be administered locally, and
by those who have local knowledge and interest in the various districts
being managed centrally, being anything but locally administered, and
being almost not even local government services. While then the promotion
in status does nothing at the moment to improve the health services
of the district, it may perhaps be looked on as a necessary step of progress
to the next stage when the district becomes wholly and directly responsible
for the administration of the personal health services of the Area.
I have the honour to be,
Your obedient servant,
CARYL THOMAS,
Medical Officer of Health.
Council Offices,
Kynaston Court,
Harrow Weald.
23rd April, 1954.