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real and effective ones ; in practice almost every decision is subject to the
over.riding decisions of other County Council committees, which causes great
delay in the settlement of outstanding items. Thus the local interest and
initiative have not had the same stimulus as in the past. 1 have felt the sense
of frustration inevitable through being absorbed into a vast administrative
machine, and I have missed the flexibility of action which hitherto I always
enjoyed under an understanding and sympathetic Borough Council.
The population of Area 10 is 211,450, far larger than many a provincial
county borough. It is probable that greater progress could be made and more
efficient administration carried out in the health services if the area were to
become a county borough. Under the new arrangement it is sometimes a
problem to remember which things belong to the Borough Council and which
to the County Council. As Medical Officer of Health of Twickenham I deal
with the same families, the same personal and environmental influences as
I used to deal with before the transfer, the responsibility being shared between
the Area Committee and the Borough Council ; in Sunbury, Staines and
Feltham districts I deal with the personal health services through the Area
Committee, but not the environmental, which are dealt with by the medical
officers of health of three separate district councils; for the school health service
I serve two different divisional executives; and for some services, such as the
supervision of nursing homes, I am assistant county medical officer.
The remainder of this report deals with the separate services in more
detail. For over twelve months following the transfer to the County Council,
the staff of the Twickenham Public Health Department carried most of the
burden for the work of the enlarged area and worked very hard indeed. I
would specially like to mention Mr. H. J. Pugh, on whom the administrative
load fell with extreme severity.
I beg to acknowledge my indebtedness to the Chairman and members of
the Public Health Committee and the former Maternity and Child Welfare
Committee for their helpfulness and support, which were always of the greatest
encouragement. I desire also to acknowledge with thanks the friendly co.
operation and help which I have always received from my colleagues in the
other departments of the Corporation and the other members of the Council.
I am,
Mr. Mayor, Ladies and Gentlemen,
Your obedient servant,
JOHN MADDISON,
Medical Officer oj Health.