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County Borough Group
P U B L I C H E A L T H , June, 1944
104 may be approved by the Minister, and in such cases to be joined in the doctor's contract with the Central Medical Board." There was no d o u b t that G.P.s viewed with alarm this wedding of local authorities to health centres and general practice. T h e y feared that this was a forerunner of a larger system of employment under such bodies. As regards " losses " to the counties, Dr. Wood Wilson thought that there would have to be opening up of hospitals to a large area of population, without consideration of place of residence within limited boundaries. This would involve bringing into the scheme all special hospitals as well as general hospitals. T h e co-operation of voluntary hospitals would be required, although these hospitals were vociferous in their condemnation of the terms offered by the White Paper. T h e deflection of institutional provision for maternity cases from welfare authorities to the Joint Authorities, followed the broad principle of thi~ Report, and would leave county councils with the environmental services relating to ante- and post-natal clinics, domiciliary midwifery, and the health visiting service. One big change ,which affected county councils as distinct from county boroughs concerned the responsibility of those environmental services under the area plan. T h e smaller welfare authorities would automatically cease to exist under the proposals, their functions being taken over by the county council ; and the larger welfare authorities such as municipal boroughs and large urban districts, unless designated an " exempted authority " under the new Education Bill would also be required to cede their functions to the county council. Two other deflections concerning county councils as a whole were the transfer of isolation hospitals and mental hospitals to the Joint Authorities. T h e loss of isolation hospitals would be a grievous one to many district authorities which had prided themselves on the efficiency of their local arrangements, and usually had whole-hearted support from the ratepayers in their endeavours to keep children suffering from infectious diseases near their homes. Dr. J. A. Fraser, who was unable to be present, made some comments in a letter. He considered that the main idea running through the White Paper should be supported and would be a tremendous step forward. He thought, however, that the principle of an ad hoc joint authority was most regrettable, but apparently unavoidable until local government reform took place. I t seemed to him unfortunate that the fate of maternity and child welfare services depended on the present Education Bill. It was regrettable that certain medical services would still remain outside the Ministry of Health, for example, the Home Office and Ministry of Supply. T h e r e was a tendency to make doctors think too much in terms of hospitals and not sufficiently in terms of health. Dr. Fraser noted that medical officers of health had a mere paragraph in the Report, and that public assistance was barely mentioned. T h e r e would be a great reduction in the work of the Public Health Department of most county councils. T h e y would lose control of all hospitals (general, special, fever, maternity, mental) and sanatoria, including laboratories in such institutions, tuberculosis dispensaries with their staffs, cancer diagnostic centres, mental out-patient clinics, and possibly a d hoc venereal diseases clinics. Infirmaries and sick wards in mixed public assistance institutions would have to be separated from the parts of the institution for the non-sick. Difficulties might arise where existing officers (medical, nursing and others) carried out duties for services which would pass to the new Joint Authority--e.g., tuberculosis officers doing other medical duties, tuberculosis nurses who were also health visitors and/or school nurses. Dr. J. J. Jervis referred to the unsatisfactory position of the M.O.H., as outlined in the White Paper. He considered that the proposals would, if carried out, result in a duplication of staff which would be wasteful. Dr. J. F. Galloway said that the White Paper was desirable in principle and should not be opposed even though it might mean some degree of sacrifice on the part of medical officers of health. COUNTY
BOROUGH GROUP
President: Dr. J. A. Charles (M.O.H., Newcastle-on-Tyne). Hon. ,Secretary : Dr. Gordon Lilico (M.O.H., Derby). A special meeting of the County Borough G r o u p of the Society was held at Tavistock Square, London, on M a r c h 31st, to discuss the White Paper on a national health service. T h e President was in the chair, and 30 members were present. Dr. Charles took the meeting through the summary, paragraph by paragraph, and the secretary was instructed to send the following resolutions for the consideration of the Society : (1) T h a t this meeting is of opinion that the Central Health Services Council should be constituted by election from the medical and allied professions, with a minority of members nominated by the Minister of Health. (2) T h a t this meeting is of opinion that the Central Medical Board should be constituted by nomination by the Minister of Health, with a substantial minority of its members elected from the medical profession.
(~) T h a t the Central and Local Health Services Committees and other advisory bodies should contain members who have had practical experience in the Public Health Service. (4) T h a t the practical work of joint authorities and their constituent authorities should be integrated through the medical staff serving both bodies. (5) T h a t the chief executive officer of the Joint Authority should be a medical officer with administrative experience and qualifications. (6) T h a t in the formulation of any comprehensive scheme f o r a National Health Service, the personal health service of the local authority, the hospital service, and the environmental health services should be closely integrated. (7). T h a t in the legislation resulting from the consideration of the White Paper provision should be made for adequate compensation to be payable to any m e m b e r of the existing Public Health Services who may suffer loss of remuneration consequent on alteration of his duties, and that such provision should include for superannuation purposes the addition of years of service in respect of the student period. TUBERCULOSIS GROUP COMMITTEE President: Dr. W. B. Christopherson (Tuberculosis Officer, Norfolk C.C.) Hon. Secretary: Dr. R. L. Midgley (Medical Superintendent, Devon C.C.). Meetings were held on February 18th and March 24th. T h e President occupied the chair at both meetings. A motion that Dr. Lissant Cox be congratulated on his recent honour was carried with acclamation. T h e minutes of the previous meeting were read a n d signed. Council had sent the following resolution to the Ministry of Health : " T h a t ultimate fitness for work should not be the criterion for eligibility for financial allowances on the scale laid down in Memo. 266/T. but that all cases of pulmonary tuberculosis who conform with the instructions of the Tuberculosis Officer should be eligible to receive allowances." A reply had been received from the Ministry stating that this scheme was a war-time emergency one, and that cases outside it would ultimately be provided for in general social security developments. T h e Committee felt this to be an unsatisfactory answer in that it failed to take into account that, unless the chronic open cases could be better controlled, the preventive side of tuberculosis work was largely vitiated. Dr. Lissant Cox presented a draft scheme of training for tuberculosis medical officers. This was discussed at length, many useful alterations and additions being made. T h e Committee debated the White Paper on a National Health Service. T h e following resolutions were formulated : 1. We note that the tuberculosis service is to be transferred from the administration of the local authorities to that of the new Joint Boards. In so far as closer co-operation with the hospitals will tend to improve the service we welcome the change, but we are anxious that the special features of tuberculosis as a disease, which make it essentially a public health problem, shall not be overlooked. In particular we refer to those general environmental and domiciliary measures, social care work and financial matters, which are essential parts of a good tuberculosis scheme, and which either remain under the local authorities or are relegated in the White Paper to some future general security scheme. 2. We urge that tuberculosis specialists should be employed to organise and administer the tuberculosis scheme of the new Joint Boards. 3. We hope that the Joint Boards in administering both the hospital and the tuberculosis services will regard sanatoria as integral parts of the latter and not merely a part of the former. 4. As the Joint Boards are to control the consultant and tuberculosis services we presume that tuberculosis officers and sanatorium superintendents will be classed as consultants as regards conditions of service and remuneration. SCHOOL MEDICAL SERVICE GROUP Acting President: Dr. J. D. Kershaw (M.O.H. and S.M.O., Accrington). Hon. Secretary: Dr. A. A. E. Newth (S.M.O., Nottingham). A meeting of the G r o u p was held at Tavistock House, London, on M a r c h 3rd, preceded by a meeting of the Temporary Committee. T h e chair was taken in the first instance by Dr. R. H. H. Jolly, President of the Society; 31 members were present. T h e Hon. Secretary reported on the interest aroused by the revival of the Group, and said that there were already 216 members. He appealed to those present to make the movement known to those who had not yet joined. T h e meeting unanimously nominated Dr. J. D. Kershaw, of Accrington, for election as President of the Group at the annual general meeting to be held in June or July. Until then he was invited to be Acting President. Dr. Jolly then vacated the chair in hi~ favour.
104 may be approved by the Minister, and in such cases to be joined in the doctor's contract with the Central Medical Board." There was no d o u b t that G.P.s viewed with alarm this wedding of local authorities to health centres and general practice. T h e y feared that this was a forerunner of a larger system of employment under such bodies. As regards " losses " to the counties, Dr. Wood Wilson thought that there would have to be opening up of hospitals to a large area of population, without consideration of place of residence within limited boundaries. This would involve bringing into the scheme all special hospitals as well as general hospitals. T h e co-operation of voluntary hospitals would be required, although these hospitals were vociferous in their condemnation of the terms offered by the White Paper. T h e deflection of institutional provision for maternity cases from welfare authorities to the Joint Authorities, followed the broad principle of thi~ Report, and would leave county councils with the environmental services relating to ante- and post-natal clinics, domiciliary midwifery, and the health visiting service. One big change ,which affected county councils as distinct from county boroughs concerned the responsibility of those environmental services under the area plan. T h e smaller welfare authorities would automatically cease to exist under the proposals, their functions being taken over by the county council ; and the larger welfare authorities such as municipal boroughs and large urban districts, unless designated an " exempted authority " under the new Education Bill would also be required to cede their functions to the county council. Two other deflections concerning county councils as a whole were the transfer of isolation hospitals and mental hospitals to the Joint Authorities. T h e loss of isolation hospitals would be a grievous one to many district authorities which had prided themselves on the efficiency of their local arrangements, and usually had whole-hearted support from the ratepayers in their endeavours to keep children suffering from infectious diseases near their homes. Dr. J. A. Fraser, who was unable to be present, made some comments in a letter. He considered that the main idea running through the White Paper should be supported and would be a tremendous step forward. He thought, however, that the principle of an ad hoc joint authority was most regrettable, but apparently unavoidable until local government reform took place. I t seemed to him unfortunate that the fate of maternity and child welfare services depended on the present Education Bill. It was regrettable that certain medical services would still remain outside the Ministry of Health, for example, the Home Office and Ministry of Supply. T h e r e was a tendency to make doctors think too much in terms of hospitals and not sufficiently in terms of health. Dr. Fraser noted that medical officers of health had a mere paragraph in the Report, and that public assistance was barely mentioned. T h e r e would be a great reduction in the work of the Public Health Department of most county councils. T h e y would lose control of all hospitals (general, special, fever, maternity, mental) and sanatoria, including laboratories in such institutions, tuberculosis dispensaries with their staffs, cancer diagnostic centres, mental out-patient clinics, and possibly a d hoc venereal diseases clinics. Infirmaries and sick wards in mixed public assistance institutions would have to be separated from the parts of the institution for the non-sick. Difficulties might arise where existing officers (medical, nursing and others) carried out duties for services which would pass to the new Joint Authority--e.g., tuberculosis officers doing other medical duties, tuberculosis nurses who were also health visitors and/or school nurses. Dr. J. J. Jervis referred to the unsatisfactory position of the M.O.H., as outlined in the White Paper. He considered that the proposals would, if carried out, result in a duplication of staff which would be wasteful. Dr. J. F. Galloway said that the White Paper was desirable in principle and should not be opposed even though it might mean some degree of sacrifice on the part of medical officers of health. COUNTY
BOROUGH GROUP
President: Dr. J. A. Charles (M.O.H., Newcastle-on-Tyne). Hon. ,Secretary : Dr. Gordon Lilico (M.O.H., Derby). A special meeting of the County Borough G r o u p of the Society was held at Tavistock Square, London, on M a r c h 31st, to discuss the White Paper on a national health service. T h e President was in the chair, and 30 members were present. Dr. Charles took the meeting through the summary, paragraph by paragraph, and the secretary was instructed to send the following resolutions for the consideration of the Society : (1) T h a t this meeting is of opinion that the Central Health Services Council should be constituted by election from the medical and allied professions, with a minority of members nominated by the Minister of Health. (2) T h a t this meeting is of opinion that the Central Medical Board should be constituted by nomination by the Minister of Health, with a substantial minority of its members elected from the medical profession.
(~) T h a t the Central and Local Health Services Committees and other advisory bodies should contain members who have had practical experience in the Public Health Service. (4) T h a t the practical work of joint authorities and their constituent authorities should be integrated through the medical staff serving both bodies. (5) T h a t the chief executive officer of the Joint Authority should be a medical officer with administrative experience and qualifications. (6) T h a t in the formulation of any comprehensive scheme f o r a National Health Service, the personal health service of the local authority, the hospital service, and the environmental health services should be closely integrated. (7). T h a t in the legislation resulting from the consideration of the White Paper provision should be made for adequate compensation to be payable to any m e m b e r of the existing Public Health Services who may suffer loss of remuneration consequent on alteration of his duties, and that such provision should include for superannuation purposes the addition of years of service in respect of the student period. TUBERCULOSIS GROUP COMMITTEE President: Dr. W. B. Christopherson (Tuberculosis Officer, Norfolk C.C.) Hon. Secretary: Dr. R. L. Midgley (Medical Superintendent, Devon C.C.). Meetings were held on February 18th and March 24th. T h e President occupied the chair at both meetings. A motion that Dr. Lissant Cox be congratulated on his recent honour was carried with acclamation. T h e minutes of the previous meeting were read a n d signed. Council had sent the following resolution to the Ministry of Health : " T h a t ultimate fitness for work should not be the criterion for eligibility for financial allowances on the scale laid down in Memo. 266/T. but that all cases of pulmonary tuberculosis who conform with the instructions of the Tuberculosis Officer should be eligible to receive allowances." A reply had been received from the Ministry stating that this scheme was a war-time emergency one, and that cases outside it would ultimately be provided for in general social security developments. T h e Committee felt this to be an unsatisfactory answer in that it failed to take into account that, unless the chronic open cases could be better controlled, the preventive side of tuberculosis work was largely vitiated. Dr. Lissant Cox presented a draft scheme of training for tuberculosis medical officers. This was discussed at length, many useful alterations and additions being made. T h e Committee debated the White Paper on a National Health Service. T h e following resolutions were formulated : 1. We note that the tuberculosis service is to be transferred from the administration of the local authorities to that of the new Joint Boards. In so far as closer co-operation with the hospitals will tend to improve the service we welcome the change, but we are anxious that the special features of tuberculosis as a disease, which make it essentially a public health problem, shall not be overlooked. In particular we refer to those general environmental and domiciliary measures, social care work and financial matters, which are essential parts of a good tuberculosis scheme, and which either remain under the local authorities or are relegated in the White Paper to some future general security scheme. 2. We urge that tuberculosis specialists should be employed to organise and administer the tuberculosis scheme of the new Joint Boards. 3. We hope that the Joint Boards in administering both the hospital and the tuberculosis services will regard sanatoria as integral parts of the latter and not merely a part of the former. 4. As the Joint Boards are to control the consultant and tuberculosis services we presume that tuberculosis officers and sanatorium superintendents will be classed as consultants as regards conditions of service and remuneration. SCHOOL MEDICAL SERVICE GROUP Acting President: Dr. J. D. Kershaw (M.O.H. and S.M.O., Accrington). Hon. Secretary: Dr. A. A. E. Newth (S.M.O., Nottingham). A meeting of the G r o u p was held at Tavistock House, London, on M a r c h 3rd, preceded by a meeting of the Temporary Committee. T h e chair was taken in the first instance by Dr. R. H. H. Jolly, President of the Society; 31 members were present. T h e Hon. Secretary reported on the interest aroused by the revival of the Group, and said that there were already 216 members. He appealed to those present to make the movement known to those who had not yet joined. T h e meeting unanimously nominated Dr. J. D. Kershaw, of Accrington, for election as President of the Group at the annual general meeting to be held in June or July. Until then he was invited to be Acting President. Dr. Jolly then vacated the chair in hi~ favour.