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It may be felt that the MOH has finally achieved his aim-to make his own office redundant.
His successor, the Community Physician, will be concerned with these more complex ecological
and social problems, with influencing mental attitudes as well as monitoring the total health care
available to individuals and groups within the community. The Community Physicians will be
members of the Health Management Teams from District (equivalent in size to existing London
Boroughs) through Area to Region and the Department of Health and Social Security. The concepts
of critical management and cost/benefit analysis are at first sight repugnant to most doctors, but
if tomorrow's problems are to be contained radical change is necessary. Only a few years ago,
when the statutory lying-in periods after childbirth was 14 days, we were desperately short of beds
in maternity hospitals. Co-ordination and the provision of an efficient home care maternity service
enables most mothers and babies to be discharged after only 48 hours, theoretically increasing the
bed usage by a factor of 7. Of course, in practice, not all are fit for early discharge, nor are all
homes suitable for maternity and neo-natal nursing but, without putting up a single extra bed,
3,079 or 85% of our total 3,629 live births this year took place in hospital and still there were
beds available. Some similar radical approach is needed to contain the growing demand for mental
and geriatric beds. Since the Community Physician will have a locus in the hospitals as well as
in the community he is better placed to deal with problems of this nature. Hopefully he will
continue a close collaboration with the members and officers of the former Local Health Authorities
especially the Public Health Inspectorate, in the field of Social Services and that of housing policy
where a background of local authority health and welfare work is invaluable. He is not really a new
medical animal - there have been Community Physicians since the priest physicians of Ancient
Egypt - Moses wrote the first textbook on Public Health with food and personal hygiene regulations
(Leviticus Old Testament) over 4,000 years ago.
CHILD HEALTH SERVICE
Dr.Gwyneth Richards, Principal Medical Officer, writes:-
With the advent of re-organisation of the National Health Service and the formation of new
Health Authorities in 1974, I cannot resist the temptation to look back and see what progress has
been made under the present National Health Service, especially in the field of Child Health. This
has been considerable and children have never been so healthy, well fed, well clothed, and given
such good facilities for equipping them for the future than at present. Yet still there are discussions
and reports concerning the "disadvantaged child", showing how children are affected physically,
mentally and educationally by an adverse background - an adverse background which is still a
great improvement on the slum conditions where we worked in pre-National Health Service days.
Then, much of the medical and social help provided was in the hands of charitable organisations
and their supervised students, and a more rudimentary school health and clinic services provided
locally. Memories of work in a slum in student days - filth and smells; gross overcrowding; poor
lighting; inadequate heating; inadequate water supply; lack of cleanliness and ventilation; poor
quality of clothing and food; large families with children with heads and faces covered with
impetigo and the rest of the body covered with scabies; lice of various types on body and head;
fleas and bugs in flats where the well-kept was the unexpected and not the rule; confinements at
home in grossly unsuitable conditions with the mother an equally unsuitable patient for a birth at
home or even in hospital; a drawer used for the baby instead of a cot and none of the sterile packs
used nowadays.
Increasing pay packets, increasing standards, and help available for the poor and handicapped
has made such a difference that deprivation has taken on a different aspect and is seen
now more as an emotional rather than a physical deprivation - inadequate income and inadequate
accommodation not necessarily the important factors.
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