HC Deb 03 July 1947 vol 439 cc169-71W
6. Mr. M. Lindsay

asked the Minister of Health whether he intends to make use of his powers under Section 22 (4) of the National Health Service Act, 1946, in so far as the setting up of divisional executives is concerned, or what alternative administrative arrangement he contemplates.

Mr. Bevan

No. Following is a statement describing the alternative arrangements proposed:

Section 22 (4) of the National Health Service Act, 1946, enables me to make regulations requiring local health authorities of counties in which schemes of divisional administration are in force under the Education Act, 1944, to make corresponding schemes of divisional administration with respect to the care of children under five. My object in seeking that power from Parliament was to safeguard continuity in the health services for children. On careful re-examination I have come to the conclusion that the making of regulations would entail disadvantages and that continuity in the health services for children can be secured, and secured more adequately and efficiently, in another way.

There would be disadvantages for two reasons. In the first place many of the areas of divisional administration, which have naturally been selected by reference to educational considerations, are not so well adapted to the administration of health services. Secondly, the arrangements for infant care under Section 22 cannot, without loss of efficiency, be separately administered from the arrangements for the care of expectant and nursing mothers or from those concerned with infant health, like health visiting and vaccination and immunisation.

I believe that continuity and the maintenance, which is so desirable, of local interest, can best be secured by subdividing all counties (except those where, either on account of the small size of the county or of other local considerations, de-centralised administration for the whole or part of the county would be inappropriate) according to local health requirements. In each sub-division, the County Health Committee would use its powers under the Act to appoint a subcommittee on which the Councils of County Districts comprising the subdivision would be represented, and to which would be delegated the day-to-day administration in the division, not only of the child care services specified in Section 22 (4), but also of other services under Part III of the Act. Under the County Medical Officer, executive charge of those services in the division will normally be taken either by an existing Assistant County Medical Officer, preferably one who is also Medical Officer of Health of one or more of the districts constituting the division, or by the Medical Officer of Health of one of those districts who would be appointed to the staff of the County Medical Officer.

There is, moreover, a limited number of non-county boroughs and large urban districts which, besides being "excepted districts" under the Education Act, house an unusually high proportion of the total population of the county, and possess exceptionally well developed public health (including school health) services. Such a borough or urban district would ordinarily become an area of health administration separate from the surrounding districts and the County Health Committee would in these cases appoint, for that borough or urban district, a sub-committee of which half or more of the members would be members of the borough or urban district council, and to which day-to-day administration would similarly be delegated. The Medical Officer of Health of the borough or urban district would then be appointed, by agreement with the borough or urban district council, in a part-time capacity to the County Medical Officer's staff. Both in these areas and in the sub-divisions which I mentioned earlier the County Council as local health authority would retain, unimpaired, its responsibility for policy and finance.

I have consulted the Associations of local authorities on this proposal, and they have informed me that they are in agreement with the principle on which it is based. I do not, therefore, intend to exercise my powers to make regulations under Section 22 (4) of the Act.