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6
cases even rural districts), being administered by the County Councils
only in those parts of the counties not falling into one of these larger
areas. Later developments were made the responsibility of the County
Councils, the only exception being the domiciliary midwifery service.
Many of these personal services are administered best by those with
intimate local knowledge of their districts. Nevertheless such considerations
were pushed to one side by those who framed the National Health
Service Act which transferred the responsibilities for administering these
services to the major authorities. Even before the change came about, there
was uneasiness at this decision. With knowledge of the actual operation,
expressions of this uneasiness grew and many bodies have discussed what
might be done to remove some of the disadvantages and weaknesses of
the present arrangements. The aspect most affecting this Council
perhaps is the administration of the Part III services of the National
Health Service Act which include the maternity and child welfare service
including the clinics and health visiting service, the midwifery service,
the home nursing and the home help service. From 1948 the Council
has not been directly responsible for these services, most of which they
had built up for the whole district since 1934. While the transfer of
responsibility to the County Council has quite possibly resulted in a
raising of the standard of service provided in the areas of some of the
smaller authorities, it is widely felt that the change did not benefit those
in some of the larger districts just round London.
Many of these districts have populations far larger than a number
of the major authorities, and are sufficiently large and possess sufficient
financial resources to enable them to provide health services of the highest
standard. Many of these areas are large enough and wealthy enough
to be created County Boroughs, and to be made responsible for the
administration of many of the local services, including those relating to
health. This development in Middlesex would lead virtually to the
extinction of the County Council. But to grant to these minor authorities
the responsibility for providing these as of right and not by the unsatisfactory
method of delegation would involve new legislation. In July the
Government White Paper on local government was issued. This recognises
the special problems of Middlesex, but rules out the question of the
promotion of any district to County Borough status, and considers that
the two-tier structure should be retained. It does, however, add that—
"the desirability of some further delegation or transfer of functions
within the county of Middlesex should be considered." The Council at
their meeting in November accepted the following recommendation of
the General Purposes Committee:—
"1. That the Council are not convinced that the retention of the
two-tier system of local government in the County of Middlesex,
as envisaged by the Government's White Paper, is
necessarily the best solution to the local government prob e
of the county, as the Council are of the opinion that certain
of the functions at present administered by the County Council
can, with efficiency and economy and in the best intereste of
the Burgesses of Harrow, be exercised at local level by
Council of the Borough.