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An unsatisfactory grant system
Public Health. THE
JOURNAL
OF
The Society of Medical Officers of Health. No. 11.
AUGUST, 1919.
Subscription price, 2is. per annum, post free in advance. Single cop~e~ is. 8d. post free.
CONTENTS. EDITORIAL---
PAG~
An Unsatisfactory
Grant System
......
i2t
SPECIAL A R T I C ~ (By H. R. Kenwood, C.M.G., M.D., D.P.H., F.R.S.E.) . . . . . .
The Public ~Iilk Supply.
123
NOTES-D.P.H.
R e s u l t s of E x a m i n a t i o n ...... 122 M.O.H. Salaries . . . . . . . . . . . . I27-I28 Panel Doctors' War Bonus . . . . . . . . . I27 Maternity and Infant Welfare . :. . . . . . . I~ 7 iY[ental D e f i c i e n c y & c t , S e c t i o n 4 7 ...... 128 P r e v e n t i o n of V e n e r e a l D i s e a s e .... 1 2 7 61 i 2 8 Lay Controllers for Medical:Work ...... 128
SOCIETY OF MEDICAL OFFICERSDF HEALTH-Proceedings . . . . . . . . . I29, I3 ° , 131,132
g iforiae. AN IYNSATISFACTOR¥
GRANT SYSTEM.
Ministry Of Health has issued a circular T HEdated the I5th July, 1919, with respect to grants in aid of expenditure On Maternity and Child Welfare during the current year. Grant is payable at the rate of one half of the approved expenditure incurred where the services have been provided with the Ministry's sanction and are carried on to their satisfaction. During the present year 4° per cent. of the estimated current expenditure will be paid, together with the sum necessary to make up the grant for the preceding year to half the ascertained expenditure of that year. The grant is available in respect of expenditure on adaptation and equipment of premises if paid out of revenue. Loans for the purchase and erection of premises urgently needed for public health purposes may be sanctioned, but before approving of a loan for the erection of a building the Ministry will require to be satisfied that no existing building or disused military establishment is available and could properly be utilised. Where a loan is sanctioned grant will be paid on the ann~a~ charge~
VOL. XXXII.
The grant is also available in respect of (a) expenditure incurred in the numing of cases of poliomyelitis in young children, (b) in the provision of hospital accommodation for measles and whooping cough occurring in children under five years of age, the accommodation being either permanent or temporary in character, and (c) payments to Registrars for returns of unnotified births. So far as its positive side is concerned, there is little to criticise in the circular, but when we turn to the excluded items, we regret to find that the Ministry has continued the old policy of the Local Government Board in its cheese-paring attempts to whittle down the just claims of Local Authorities. It iS, of course, far too early to expect the new Ministry to overhaul and revise all the unfortunate polici~ of the old Board, but we must confess to some disappointment in respect to the present circular. Among the items which may not be included in applications for grants are (a) payments to the Central Midwives Board, (b) compensation to midwives for abstaining from work after contact with infection, (c) rent of premises in the possession of the Local Authority or of the Education Committee, (d) any part of the salary of the Medical Officer of H e a l t h except an additional salary specially voted for ~aternity and Child Welfare work, (e) clerical and other establishmemt expenses, except additional expenditure specifically necessitafed by the scheme. Apparently the indefensible policy formerly pursued by the Local Government Board is to be continued. It would be interesting to know the reasons of the Ministry for refusing grants in the ease of items (a) and (b) mentioned above, but with regard t o the other three it is not too much to say that it wouid be impossible to give reasons that would satisfy anybody outside a Government Department. As to the rent of premises in the possession of the Local Authority, no one would have believed, but for the issue of circulars of this kind, that even a Government Department would have taken action which amounts to an expression of opinion t h a t no Local Authority when about to erect premises for any particular purpose should have regard to the needs of the future. In the view of the Ministry of Health, buildings should not ~n any circumstances provide accommodation ~ff6~work outside that immediately contemplated,
122
P U B L I C HEALTH~
and L o c a l Authorities which provide for the future wilt be penalised by losing grants which are obtainable by Authorities living from hand to mouth. Fortunately for the public, however, Local Authorities when about to undertake building operations exercise some foresight and, beating ill mind that they are the custodians of public money, they endeavour to a greater or less extent to spend that money in the interests of the public. The attitude of the Local Government Board, and now of the Ministry of Health with regard to the salary of the Medical Officer of Health, is equally indefensible, and the position can perhaps best be explained by an illustration. Suppose, for example, the salary of the Medical Officer is represented by tile figure 8o, and that as the result of the coming into operation of a Tuberculosis Scheme this increased to IOO. T h e Ministry are prepared to pay a grant in respect of the inerease of 20, it being understood that 20 per cent. of the Medical Officer's t i m e is given to Tnberculosis work. At a later date Maternity and Infant Welfare work is introduced, and instead of giving 20 per cent. of his time to ±ubereulosis work the Medical Officer is able to give only Io per cent., an equal amount being devoted to maternity work. No-one outside a Government Office would believe that in such circumstances the Department concerned would refuse a grant in respect of the IO per cent. salary and time devoted to the new work, but such has been the policy of the Local Government Board, and is, as this circular makes clear, to be the policy of the Ministry of Health, the net result being in the ease taken that the Authority concerned is penatised to the extent of five per cent. (half the actual expenditure) of the Medical Officers' salary. The obvious fact that the Medical Officer should have a n additional salary .on account of the increased responsibility, has nothing to do with the just apportionment of his salary in accordance with the relative amounts of time devoted to each part of the Work. The case w i ~ regard to clerical expense is on almost parallel lines. I t is weI1 known that the work of a Public Health D e p a r t m e n t fluctuates to an exceptional degree, and that in a n y weltmanaged office where regard is had to the useful expenditure of public money, there is no attempt to divide the work between the various members of the staff on rigid lines and t o i l e t up a series of water-tight compartme~lt s. In other words, when necessity arises, all the members of the staff are available for the work that needs to be done. The Ministry of H e a l t h , however, apparently contemplate the provision of these water-tight compartments and seem to be unable to appreciate the possibility of a clerk engaged for One purpose being transferred either temporarily or permanently to another. Accordingly, they encourage Local Authorities to set up a b r ~ d ~ew clerical staff
A~..GtIST,
for every additional service placed upon them, just as in the past the Loeal Government Board has encouraged the appointment of special Medical Officers' and nurses for particular subjects, involving serious overlapping and waste. The result is that Imcal Authorities who carry out these duties with_regard to economy as well as to pubtie welfare are very severely penalised by the issue of Regulations such as these. The payment of grants by Government Departments if carried out with ordinary common sense, could be m a d e the means of incalculable benefit to the nation at large; and as a spur to slothful Local Authorities such grants would, under reasonable conditions, be a very powerful lever in the hands of a progressive department. I t is, therefore, all the more to be deplored that the Minister who was responsible for securing authority to make such grants was unable to endow the Officers charged with the administrative work with some of his foresight and imagination, for i t is difficult to conceive anything more absurd and unreasonable and more calculated to exasperate Local Authorities, and even to encourage wasteful expenditure, than the present attitude of the Ministry ill this connection. Presumably, as the Poor Law is d o o m e d , the department concerned has made up its mind to continue the exercise of its powers of control, by which Boards of Guardians were so long held in thraldom, by means of making rules and regulations with regard to the issue of grants. We have every confidence, however, that the Ministry will prove to have a nicer sense of justice and proportion, and a much wider horizon than the old Board, and that when the former grant System comes to be overhauled, it will be drastically altered. There is a very simple remedy, and t h a t is for all expenditure on approved public health work t o be made grant bearing. The work is beyond argument of a national character, and it is too ob~dons to need debate that every encouragement should be given to Local Authorities to carry i t out efficiently. DIPLOMA IN PUBLIC H E A L T H . UN1NrERSIT¥ O F MAx'qCHI~STI~I~. The following gentlemen h a v e obtained the Diploma in Public H e a l t h . o f the University of Manchester :-=A. W. B a k e r , M.B., B.S. (Lond,) ; G . H. T. N . Clarke (M.B., L.R.C.P., L.R.C.S., L.R.F.P., and S. (Edin.) ; G, J. Crawford, M~B., B.Ch., (Belt.) ; C . . C . Hargreaves, M.B., Ch.B. (Aberd.) ; A. Heath, F.R.C.S. (Eng-), M.D. (Loud.), M.B,, M.R.C.S., L.R.C.P. (Loud.) ; J. L. Meynell, M.R.C.S., L.R.C.P. (Loud.), L.S.A., LM.S.S.A. (Loud.) ; E. N. Ramsbottom, M.B~, B.S. (Loud.), M.R.C.S., L.I~.C.P. ( L o u d . ) ; H. F. Sheldon, M.R.C.S., L.R:C.P~(Loud.) ; E. H. Walker, M.B., Ch.B. (Manch).
JOURNAL
OF
The Society of Medical Officers of Health. No. 11.
AUGUST, 1919.
Subscription price, 2is. per annum, post free in advance. Single cop~e~ is. 8d. post free.
CONTENTS. EDITORIAL---
PAG~
An Unsatisfactory
Grant System
......
i2t
SPECIAL A R T I C ~ (By H. R. Kenwood, C.M.G., M.D., D.P.H., F.R.S.E.) . . . . . .
The Public ~Iilk Supply.
123
NOTES-D.P.H.
R e s u l t s of E x a m i n a t i o n ...... 122 M.O.H. Salaries . . . . . . . . . . . . I27-I28 Panel Doctors' War Bonus . . . . . . . . . I27 Maternity and Infant Welfare . :. . . . . . . I~ 7 iY[ental D e f i c i e n c y & c t , S e c t i o n 4 7 ...... 128 P r e v e n t i o n of V e n e r e a l D i s e a s e .... 1 2 7 61 i 2 8 Lay Controllers for Medical:Work ...... 128
SOCIETY OF MEDICAL OFFICERSDF HEALTH-Proceedings . . . . . . . . . I29, I3 ° , 131,132
g iforiae. AN IYNSATISFACTOR¥
GRANT SYSTEM.
Ministry Of Health has issued a circular T HEdated the I5th July, 1919, with respect to grants in aid of expenditure On Maternity and Child Welfare during the current year. Grant is payable at the rate of one half of the approved expenditure incurred where the services have been provided with the Ministry's sanction and are carried on to their satisfaction. During the present year 4° per cent. of the estimated current expenditure will be paid, together with the sum necessary to make up the grant for the preceding year to half the ascertained expenditure of that year. The grant is available in respect of expenditure on adaptation and equipment of premises if paid out of revenue. Loans for the purchase and erection of premises urgently needed for public health purposes may be sanctioned, but before approving of a loan for the erection of a building the Ministry will require to be satisfied that no existing building or disused military establishment is available and could properly be utilised. Where a loan is sanctioned grant will be paid on the ann~a~ charge~
VOL. XXXII.
The grant is also available in respect of (a) expenditure incurred in the numing of cases of poliomyelitis in young children, (b) in the provision of hospital accommodation for measles and whooping cough occurring in children under five years of age, the accommodation being either permanent or temporary in character, and (c) payments to Registrars for returns of unnotified births. So far as its positive side is concerned, there is little to criticise in the circular, but when we turn to the excluded items, we regret to find that the Ministry has continued the old policy of the Local Government Board in its cheese-paring attempts to whittle down the just claims of Local Authorities. It iS, of course, far too early to expect the new Ministry to overhaul and revise all the unfortunate polici~ of the old Board, but we must confess to some disappointment in respect to the present circular. Among the items which may not be included in applications for grants are (a) payments to the Central Midwives Board, (b) compensation to midwives for abstaining from work after contact with infection, (c) rent of premises in the possession of the Local Authority or of the Education Committee, (d) any part of the salary of the Medical Officer of H e a l t h except an additional salary specially voted for ~aternity and Child Welfare work, (e) clerical and other establishmemt expenses, except additional expenditure specifically necessitafed by the scheme. Apparently the indefensible policy formerly pursued by the Local Government Board is to be continued. It would be interesting to know the reasons of the Ministry for refusing grants in the ease of items (a) and (b) mentioned above, but with regard t o the other three it is not too much to say that it wouid be impossible to give reasons that would satisfy anybody outside a Government Department. As to the rent of premises in the possession of the Local Authority, no one would have believed, but for the issue of circulars of this kind, that even a Government Department would have taken action which amounts to an expression of opinion t h a t no Local Authority when about to erect premises for any particular purpose should have regard to the needs of the future. In the view of the Ministry of Health, buildings should not ~n any circumstances provide accommodation ~ff6~work outside that immediately contemplated,
122
P U B L I C HEALTH~
and L o c a l Authorities which provide for the future wilt be penalised by losing grants which are obtainable by Authorities living from hand to mouth. Fortunately for the public, however, Local Authorities when about to undertake building operations exercise some foresight and, beating ill mind that they are the custodians of public money, they endeavour to a greater or less extent to spend that money in the interests of the public. The attitude of the Local Government Board, and now of the Ministry of Health with regard to the salary of the Medical Officer of Health, is equally indefensible, and the position can perhaps best be explained by an illustration. Suppose, for example, the salary of the Medical Officer is represented by tile figure 8o, and that as the result of the coming into operation of a Tuberculosis Scheme this increased to IOO. T h e Ministry are prepared to pay a grant in respect of the inerease of 20, it being understood that 20 per cent. of the Medical Officer's t i m e is given to Tnberculosis work. At a later date Maternity and Infant Welfare work is introduced, and instead of giving 20 per cent. of his time to ±ubereulosis work the Medical Officer is able to give only Io per cent., an equal amount being devoted to maternity work. No-one outside a Government Office would believe that in such circumstances the Department concerned would refuse a grant in respect of the IO per cent. salary and time devoted to the new work, but such has been the policy of the Local Government Board, and is, as this circular makes clear, to be the policy of the Ministry of Health, the net result being in the ease taken that the Authority concerned is penatised to the extent of five per cent. (half the actual expenditure) of the Medical Officers' salary. The obvious fact that the Medical Officer should have a n additional salary .on account of the increased responsibility, has nothing to do with the just apportionment of his salary in accordance with the relative amounts of time devoted to each part of the Work. The case w i ~ regard to clerical expense is on almost parallel lines. I t is weI1 known that the work of a Public Health D e p a r t m e n t fluctuates to an exceptional degree, and that in a n y weltmanaged office where regard is had to the useful expenditure of public money, there is no attempt to divide the work between the various members of the staff on rigid lines and t o i l e t up a series of water-tight compartme~lt s. In other words, when necessity arises, all the members of the staff are available for the work that needs to be done. The Ministry of H e a l t h , however, apparently contemplate the provision of these water-tight compartments and seem to be unable to appreciate the possibility of a clerk engaged for One purpose being transferred either temporarily or permanently to another. Accordingly, they encourage Local Authorities to set up a b r ~ d ~ew clerical staff
A~..GtIST,
for every additional service placed upon them, just as in the past the Loeal Government Board has encouraged the appointment of special Medical Officers' and nurses for particular subjects, involving serious overlapping and waste. The result is that Imcal Authorities who carry out these duties with_regard to economy as well as to pubtie welfare are very severely penalised by the issue of Regulations such as these. The payment of grants by Government Departments if carried out with ordinary common sense, could be m a d e the means of incalculable benefit to the nation at large; and as a spur to slothful Local Authorities such grants would, under reasonable conditions, be a very powerful lever in the hands of a progressive department. I t is, therefore, all the more to be deplored that the Minister who was responsible for securing authority to make such grants was unable to endow the Officers charged with the administrative work with some of his foresight and imagination, for i t is difficult to conceive anything more absurd and unreasonable and more calculated to exasperate Local Authorities, and even to encourage wasteful expenditure, than the present attitude of the Ministry ill this connection. Presumably, as the Poor Law is d o o m e d , the department concerned has made up its mind to continue the exercise of its powers of control, by which Boards of Guardians were so long held in thraldom, by means of making rules and regulations with regard to the issue of grants. We have every confidence, however, that the Ministry will prove to have a nicer sense of justice and proportion, and a much wider horizon than the old Board, and that when the former grant System comes to be overhauled, it will be drastically altered. There is a very simple remedy, and t h a t is for all expenditure on approved public health work t o be made grant bearing. The work is beyond argument of a national character, and it is too ob~dons to need debate that every encouragement should be given to Local Authorities to carry i t out efficiently. DIPLOMA IN PUBLIC H E A L T H . UN1NrERSIT¥ O F MAx'qCHI~STI~I~. The following gentlemen h a v e obtained the Diploma in Public H e a l t h . o f the University of Manchester :-=A. W. B a k e r , M.B., B.S. (Lond,) ; G . H. T. N . Clarke (M.B., L.R.C.P., L.R.C.S., L.R.F.P., and S. (Edin.) ; G, J. Crawford, M~B., B.Ch., (Belt.) ; C . . C . Hargreaves, M.B., Ch.B. (Aberd.) ; A. Heath, F.R.C.S. (Eng-), M.D. (Loud.), M.B,, M.R.C.S., L.R.C.P. (Loud.) ; J. L. Meynell, M.R.C.S., L.R.C.P. (Loud.), L.S.A., LM.S.S.A. (Loud.) ; E. N. Ramsbottom, M.B~, B.S. (Loud.), M.R.C.S., L.I~.C.P. ( L o u d . ) ; H. F. Sheldon, M.R.C.S., L.R:C.P~(Loud.) ; E. H. Walker, M.B., Ch.B. (Manch).