View report page

THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF WALTHAM
FOREST
Madam Mayor, Ladies and Gentlemen,
I have the honour to present my report for the year 1971, the first since Health was split
off from Welfare, a split soon to be consolidated by the removal of Personal Health Services from
Local Government.
At the end of this report are pages of statistics setting out the work of the department as
far as statistics can.
The contributions in the earlier pages set out the same subject from a different standpoint.
We have in recent years been wooed by a number of "Management" concepts - all of value
as far as they go, but nearly all appearing to claim more for themselves than is justified by their
results. This is often because management techniques come from industry and commerce where
quantifiable results are essential, and so defined objectives have a great appeal. The danger in
the Health and Social Services - a danger often avoided because of the obstinate refusal of a
democracy to "see sense" - is that these techniques when applied to human affairs can
systematically distort thinking and undue priority is given to those developments which are
quantifiable, to the detriment of those, often more important, which are not.
An emotive example of this is Family Planning.
"Contraception is better than abortion" - universally agreed, and how satisfying to state
because both are largely quantifiable. "Mature responsibility for oneself and for others is better
still". This is also true whether one's opinion is that it is rarely, sometimes or always an
alternative in the first statement. My point is that the second statement, being vague and
unquantifiable, lacks appeal to those who are attracted to the simplicity of concepts like
"management by objectives" and priorities in the distribution of resources are distorted
accordingly.
The documents about reorganisation of the Health Services lay stress on the high costs
incurred by our sophisticated National Service - nothing is so quantifiable as finance!- and conclude
that therefore it needs good management. Of course it needs good management; any big enterprise
does. But it is a cause for watchful anxiety that this conclusion derives from a preoccupation with
finance, with the unfortunate bias to quantification that that implies. Fortunately it would appear
that more recent thinking has been much more broadly based.
In any service quality is important as well as quantity but in personal services with
indefinable objectives like "health" the importance of quality can mean that quantitative figures
mean very little. For instance, the number of visits made by Health Visitors or of Health Education
talks given are a very secondary consideration compared to what actually happens at the visits or
talks.
In assessing how good a personal health service is attention should always be directed
first to these qualitative aspects. One is morale, another the quality of staff, another the amount
and aptness of training, and another the degree of initiative shown by individuals. The feature to
which I would draw attention is that of communication which at all levels vitally affects the
quality of service.
Does the nurse treat her patient within a human relationship or just as an object receiving
technical attention?
- 4 -