A MEMORANDUM PREPARED BY THE WANDSWORTH BRANCH OF THE SOCIALIST MEDICAL ASSOCIATION

Hon.Secretary: Miss C.Markland, SEN., 12, Veronica Rd. SW.17 December, 1943.

Price 6d.

Wandsworth Health Services 1943

INTRODUCTION

One of the most important – one might almost say the most important – factor in post-war planning is Health. To be an A1 nation the people must be 100% fit. To achieve this it is necessary to study our local health services in order to remedy any deficiencies.

1. What is Health?

Health is not obtained from bottles of medicine or panel doctors’ certificates. It is the result of healthy living in a healthy environment. Every worker individually can live, within limits, wisely or unwisely e.g. he may take insufficient sleep, may drink too much, or expose himself unnecessarily to infection. But he cannot make the best of a bad job. If he has to live in an insanitary house, is unable to get the right food at the canteen, work in unventilated shops or waits in the rain for inadequate transport, his health is likely to suffer through no fault of his own.

The basis for sound health is therefore good living and working conditions, proper food and rest, and freedom from want. But this is unobtainable without social security – e.g. a job and adequate wage when well and adequate sick pay when ill. That is why every worker should concern himself with the efficient running and proper provision of all those services to .the community of which he and his family are members.

2. What are Health Services?

Health services include:-

a) Environmental or preventive services, and

[b) Curative or treatment services,

The latter provide the services of doctors, nurses, hospitals, etc., for individual patients once the damage is done.

The present system of curative medicine leaves much to be desired. Assumption B of the Beveridge Report for a “comprehensive national health service” is sorely needed if full use is to be made of the medical services. The “Panel” is not enough; it does not provide for dependents of the insured person, or for specialist or hospital treatment. To extend the “panel” to cover this would merely be a compromise;  “a modern Health Service should be based on group practice„ organised through health centres, should make all types of specialist advice readily available so that an early diagnosis is possible, should provide an adequate hospital service and should be available for the whole population”.  (Statement by Health Workers Council),

The environmental services on the other hand are provided to help the community and the individual to keep healthy and avoid disease. They include such varied things as well-built houses, pure food and water, immunisation against disease, recreational facilities in the open air, proper disposal of sewage, scavenging, and isolation of cases of infection.

These services are provided in this area mainly by the London County Council (L.C.C.) and the Wandsworth and Battersea Borough Councils.  Members of these Councils are elected by the rate-payers of the district concerned and are responsible to the local citizens for the proper carrying out of the duties imposed on them.

3. What is Wandsworth?

Wandsworth is the largest borough in London. It extends from Putney in the West to Clapham North and Streatham Common in the East. It is V shaped and its two halves are separated by the Borough of Battersea.  Consequently any adequate consideration of the health services of the district must include both boroughs.

Population:  (census 1931) Wandsworth 353,0002 Battersea 159,000, In 1941 the population was reduced by 30% owing to evacuation, but is now almost back to normal. The region therefore caters for half a million people.

Type of District; Wandsworth is mainly a dormitory area. For every 2 inhabitants who work in the borough, there are 3 who leave it daily to work elsewhere; while 1 person living outside the borough enters it daily to work. There is an industrial belt by the Wandle and since the war small factories have sprung up in other areas.  In 1941 there were 1317 factories employing 30,000 people, while 500 people received work to be done in their own homes. Planned industrial expansion is desirable to absorb some of the big labour pool which at present leaves the Borough.

Housings Most of the houses are two-storey dwellings, but there are-some L.C.C. and W.B.C. flats. All blitzed families have been re-housed. In 1941, 1,648 houses were unfit for human habitation.  (282 of these were made habitable without the service of a notice).  111 cases of overcrowding (690 persons) were abated, 105 still remaining on the books at the end of the year.  (Report of Medical Officer of Health for Wandsworth).

Open Spaces;  Compared with most other boroughs, Wandsworth is fortunate in having nearly 4 acres of open space per 1000 of the pop­ulation – the proportion laid down as desirable in the County of London Plan.  The main public spaces are King George’s and Wandsworth Parks and the commons at Clapham, Putney Heath, Streatham, Tooting Bec and Wandsworth.  These provide recreational facilities and sports grounds, and there are open air baths at King George’s Park, Roehampton and Tooting Bec.

Cemeteries:  Large open spaces are taken up by the Lambeth, Putney Vale, Streatham and Wandsworth cemeteries.  If the public were educated to the benefits of cremation, which is healthier for the community and takes up less grave space, more land would be available for playing fields for the new generation.

PREVENTIVE SERVICES

4. Food Inspection is a most important public health measure which most people now take for granted. But until this was instituted quantities of impure and adulterated food were sold to the public with serious effects on health.  There are 4 inspectors in Wandsworth making 24,000 inspections a year at 2,500 separate food premises.  There are 162 registered dairies and samples of the milk sold in the Borough are analysed.

The Slaughterhouse, meat depot and the 44 licensed piggeries are visited regularly by Sanitary Inspectors.

Sanitary Inspectors made over 56,000 visits to houses and air­raid shelters in 1941 and 2,855 defects were found. 5000 baits were laid by the Council’s rat-catcher.

5. The Water Supply is no longer a local affair, but is provided by the Metropolitan Water Board from filtered and tested supplies outside the London area.  Sewerage is organised on a large scale by the L.C.C.

It should be remembered that local authorities in England and Wales each year spend on waterworks and sewerage more than twice as much as they spend on Hospitals.  This sum of 33 million pounds for pure water and clean drains is the same amount as is spent yearly on the whole of National Health Insurance, but it is probably a greater contribution to public health.  Thousands used to die in London from cholera epidemics due to bad water supplies. Now the disease has disappeared from England altogether.

6. Refuse Disposal and street cleaning is the responsibility of the Borough Council. An average of one ton of refuse per house is collected each year and taken to land in the Thames Estuary and covered by layers of soil.

7. Infectious Diseases.  Most infectious diseases are notifiable to the Medical Officer of Health, and to protect the community facilities for the segregation of those suffering from the more serious diseases are provided by the L.C.C. Of the dozen or so such hospitals serving the London area, one, The Grove with 600 beds is situated in Wandsworth. The Borough Council has arranged with various nursing associa­tions for patients suffering from infectious diseases to be nursed (if suitable) at home.  Over 5,000 visits were made in 1941.

Scabies has increased greatly since the war. As many persons suffering from “itch” do not receive medical treatment the condition is more prevalent than the official figures suggest. Treatment and disinfection of clothing etc., is provided at the Cleansing Station at the Disinfecting Station, Blackshaw Rd. Tooting.

Vaccination against smallpox is provided in each district by a medical practitioner appointed to vaccinate persons free of charge.

Immunisation against diphtheria.

There are now 8 weekly clinics in operation. The addresses are:  the Municipal Buildings, Fairfield Street, Congregational Church Hall, Earlsfield Road, Wandsworth; Clapham Dispensary, 42, Clapham Manor Street, S.W.4.; 91, Bedford Hill-, Balham;  Baptist Church Hall, New Park Rd., S.W.2.; St.Peter’s Church Hall, Beechcroft Road, Tooting; Baptist Church Hall, Longley Road, Tooting; and at No.6., First Aid Post, Streatham Baths, S.W.16.     The total attending these clinics in 1942 was 7,272.

Children may also be immunised at School and Day Nurseries. Serum for this purpose is supplied free to general practitioners. The total number of children attending all clinics during 1941 was 5,862. Although, as a result of propaganda, more and more parents are taking advantage of immunisation, numbers of children each year, who could have been protected, still contract this deadly disease.

8. V.D. Publicity Campaign,

Ignorance of the nature of these diseases (syphilis and gonorrhoea) and of the way in which infection is acquired has lead to a grave increase in the number of cases in recent years. The Ministry of Health is conducting a widespread campaign to enlighten people as to the risks involved in promiscuous intercourse, and urging those infected to seek treatment at once.

There is only one clinic (for women) in the Borough (South London Hospital) and other patients have to travel to hospital clinics out­side the region.  More local clinics should be provided.

9. Tuberculosis.

The rise in the incidence of tuberculosis since the war began is causing considerable alarm. In 1942, 646 new cases were added to the Notification Register in the Borough, This disease is a social evil, attacking mainly young people and interfering with their earning capacity for long periods. The figures show a gradual rise in adolescence until, in females, a maximum incidence is reached about 25 years of age; while in males a secondary peak arises about 55 years.

Tuberculosis attacks most people during their lifetime, but healthy ones are able to resist the infection. Predisposing causes are over-crowding, worry, malnutrition and fatigue due to overwork. Tuberculosis of bones and glands is found mainly in children and often caused by infected milk. Boiling or pasteurisation of milk is the only safeguard against this mode of infection.

Although great advances in diagnosis and treatment have been made, there will be little substantial reduction in the cases of tuberculosis until we are free from such evils as bad housing, unemployment and financial insecurity during treatment. We must insist also, on adequate facilities for convalescence and rehabilitation.

The Tuberculosis Officer is responsible for holding clinics at dispensaries, visiting homes, examining contacts, and making recom­mendations for institutional treatment and financial allowances. The Tuberculosis Health Visitors, of whom there are 5 in the Borough, visit patients’ homes and “round up” contacts.

Tuberculosis Dispensaries, where the work of examining and diagnosing is performed, are situated at the Municipal Buildings, and 114, Gosberton Road, Balham. There is no compulsion, but patients are advised to attend the clinics which are held four times weekly at each dispensary, two being in the evening to enable patients who are working to attend. Patients are advised to attend every 3 months for routine examination.

In 1941 there were 2,154 cases on the Register and 5,272 attendances at dispensaries. Out of these 547 X-ray examinations were made and 2,428 artificial pneumothorax refills given in 142 cases. As there is no X-ray apparatus available in Wandsworth these people had to attend either Brompton or St.Thomas’ Hospitals for treatment. This is an unsatisfactory position and a full size X-ray plant should be made available in the Borough for TB patients. In 1942 there were 2213 cases on the Register and 4425 attendances at the Dispensaries.  1043 X-ray examinations were made and 2780 artificial pneumothorax refills were given in 170 cases

10. Mass Radiography,

In January 1944 a mass radiography apparatus (taking miniature X-rays of people’s chests at the rate of about one a minute) will be available in No.2 First Aid Post, which adjoins the Municipal Buildings All local citizens, especially factory workers, should take advantage of this opportunity to make sure that they are free from tuberculosis of the lungs – or, should suspicious signs be discovered, of seeking treatment while the condition is in its early and curable stage.

1l. Financial Allowances.

The new scheme for financial allowances, although a great improve­ment in some ways, leaves much to be desired. It applies, for example, only to a fraction of the people on the register, either because it is not considered that they will be able to return to work in a reasonable time (this may cause great mental distress) or because they have tuber­culosis of some part of the body other than the lungs. Nor do patients in sanatoria get an allowance if they have no dependents or home.

The allowances should be extended to cover all cases, not only for the individuals concerned, but because chronic cases much more than early cases are a danger to their fellow workers if untreated.

MATERNITY SERVICES

12. Ante-natal Clinics.

Ante-natal clinics do valuable work and have been instrumental in the reduction of maternal mortality during the last few years, (The figures for 1941 were 1.98 per 1,000) Maternal mortality figures for 1942: Wandsworth 2.67 England & Wales 2.01. Here the mother-to-be is examined and given advice and in cases of distress may be provided with extra food. The issue of milk has, however, been largely suppla­nted by the Ministry of Food scheme for cheap milk for pregnant women and young children.

The Clinics are mainly to protect the health of normal women in pregnancy and not to treat abnormalities.By early detection and transferring to the “family doctor” or hospital, these are often treated and brought to a successful conclusion.  There are 10 ante­natal ( and Infant Welfare) clinics in the Borough. Ante-natal clinics are also held at the Maternity Homes.

The alternative to these clinics is the private doctor and it would appear in Wandsworth that a number of women either consult their own doctor or receive no advice during pregnancy, as for the 2,938 live births in 1941 only 2,969 attendances were made at ante-natal clinics.

13  Maternity facilities

Wandsworth Borough Council War Memorial Maternity Home “books” 26 cases per month.  St. James Hospital Maternity Block has 60 beds. Plans have been submitted to the Minister of Health whereby a unit of 24 beds at the South London Hospital can be converted into a maternity ward. Wandsworth Borough Council Maternity Home has 20 beds.

Hospital accommodation for confinement is very limited and even after allowing for mothers whose babies are born outside the borough either in other hospitals or under the L.C.C. evacuation scheme, it may be deduced that large numbers are confined at home.

Midwives.  The services of the L.C.C. midwives are available for those confined at home.  The midwife is a trained person who is competent to deal with normal childbirth but who, in the event of any abnormality, will call a doctor.

Home Helps. The demand for home helps is in excess of the supply, but if a home help is available, or the mother knows some suitable person, there is a scheme whereby the whole or part of the payment (according to income) is made by the Borough Council.

Dental Treatment There is a clinic at the Municipal Buildings for expectant and nursing mothers and children under 5 years, for dental treatment. The charge is 1/- per visit. If dentures are necessary patients are assessed on their incomes.

Unmarried Mothers. The same facilities are available to unmarried mothers, but in view of their special circumstances grants are made by the Borough Council to various charity organisations such as the Southwark Diocesan Society for Moral Welfare, and accommodation is found in special homes.  If necessary the Relieving Officer of the L.C.C. Social Welfare makes financial allowances until the mother is fit for work.

Post-natal Treatment.

Mothers are given post-natal examinations at St. James’ Hospital or the Maternity Home or at the Ante-Natal Clinics held throughout the Borough, Massage can be arranged for those mothers needing it at the Municipal Centre, twice weekly at a charge of 2/- per visit.

INFANT WELFARE

14. Health Visitors visit the homes of mothers in the Borough. 80% of births were visited in 1941, and the health visitors by seeing the child’s home conditions, are in an excellent position to instruct the mothers on matters pertaining to infant hygiene. The Health Visitors also supervise foster-mothers of children under nine years and are allowed by law to examine the child and the premises in which it is kept. Health visitors. visited 86% of the births in 1942. Infant Welfare Clinics may be attended by children up to 5 years of age. 46,578 visits were made to these clinics in 1942.

Infant Welfare Clinics, Children up to 2 years of age may be taken to the Infant Welfare Centre which is staffed by a doctor and health visitors. At these clinics the baby is weighed, the mother given advice on feeding, etc., and if necessary extra nourishment is provided. Only minor ailments are treated, all others being referred to the private doctor or hospital. In 1941, 30,922 visits were made to these centres.

Ultra Violet Light and Massage, There is one small clinic held twice weekly at the Municipal Buildings, for ultra-violet light and massage. Children are sent for treatment from the Infant Welfare Centres and Day Nurseries.

15. Day Nurseries

Before the outbreak of war, children between 2 and 5 years of age were often overlooked; their younger brothers and sisters visited the Infant Welfare clinics, and the older ones came under the supervision of the School Medical Service, but there was little provision for toddlers. There were only two nurseries and 1 Nursery School in the Borough, and it would appear somewhat ironical that the need for women in industry, and not the health of the children, was the primary reason for opening other nurseries.

There are now 10 day nurseries in Wandsworth run by the W.B.C., under the Ministry of Health, each taking from 35 to 80 children from 1 month to five years of age. Priority is given to children whose fathers are in the forces and whose mothers are engaged in vital war industry.  The charge is 1/- per day, or part of a day, and each child is well fed and cared for.

Once a month each nursery is visited by a doctor, who examines every child. He may, if necessary, suggest but is not allowed to carry out treatment. Children in need of medical attention are referred to their own doctor, e.g. a child needing removal of tonsils is advised to see his own doctor who will give him a letter to take to hospital, thus involving the services of at least 3 doctors before the child can be treated.

Residential Nurseries.  In  cases of sudden necessity, e.g. sickness of mother, the L.C.C. will    evacuate children into residential nurseries either in London or in the  country.  In other cases, the W.V.S. make all arrangements,

16. School Medical Services.

This service is run by the L.C.C. under the Board of Education, the ruling being a compulsory medical examination at least 4 times during the child’s school life, and weighing and measuring every 6 six months by the school nurse.  Dental treatment and treatment of minor ailments is provided but, as in the nurseries, the child is referred to his own doctor for all further treatment.

TREATMENT SERVICES

17. Chemists Shops,  Many people when ill go first to the local chemist to get a bottle of something which they believe will cure them without seeking medical advice. The reasons for this are mainly economic.  Firstly, they cannot afford to go sick.  If they are insured they may be put on the ‘panel’ and their income will drop to 18/- and if they are not on the N.H.I. doctor’s bills are expensive,. Secondly, chemists are always available, except at night, and there is no waiting. Doctors can only be seen between certain hours and the visit may involve the loss of a good deal of time. This will probably mean taking time off from work with a consequent decrease in the pay packet.

The mass advertising of “cures” in the press is another power­ful factor in promoting the sale of proprietary medicines.  Each year the public spends thirty million pounds on medicines the value of which, whether judged by results or cost of ingredients, is only a fraction of this sum.

When every member of the community is entitled to free medical advice and treatment, the public will be less inclined to spend their money on magic ointments and wonder cures, and the patent medicine trade will be reduced.  Properly qualified pharmacists will however be needed in health centres, and will there be able to use their special skill, instead of spending their time as counter hands as so often happens at present,

18. General Practitioners are the first line of defence in the battle against disease, and should therefore be consulted early in any illness. Doctors would then be given the opportunity of treating diseases in their earliest stages, No economic barrier should prevent any person needing medical advice from receiving it, and doctors should not have to consider whether the patient can afford the treatment needed. Doctors have to live, and they cannot avoid keeping an eye on their incomes. The rich patient able to pay large fees is bound to get more of the doctor’s time under the present system, even though his needs compared with the other members of the community are not so great or urgent.  Under the panel system, where a doctor gets 9/9d a head per year for each patient on his list, he must “build up his practice” and is therefore in competition with his colleague round the corner.

The general practitioner in the present service is too isolated. Doctors are in competition with each other; they cannot easily obtain consultant advice for their patients; their work is not integrated with the hospital service and they tend to lose contact when their patients are admitted to hospital.  There are inadequate facilities for laboratory tests, X-rays and special treatments.  Thus the service supplied to the public is a patch-work in which the wasteful overlaps do not compensate for the gaps.

19. District Nurses give valuable service but are at present overworked and underpaid. Patients who are ill at home need skilful nursing as well as medical treatment. The former can often be carried out only by a trained nurse, and in some illnesses it is the nurse rather than the doctor who contributes most to the patient’s recovery.

HOSPITALS.

20.Hospitals in this country are of two types –

1. Municipal: paid for out of the rates and by patient’s payments.
2. Voluntary: which are supported partly by legacies and donations (including flag days) partly by insurance contributions from people who are well (Hospital Savings Association, etc,) and partly by payments from and on behalf of patients using the hospital.

Hospitals can also be classified as general (medical and surgical) and special (maternity, fever, mental, etc.,).

Until the war there was very little coordination between the individual voluntary hospitals, and there was virtually no connection between them and the municipal hospitals. The Emergency Hospital Service inaugurated by the Minister of Health at the beginning of the war provided an organised hospital service for casualties, but this is only partially available to the ordinary patient requiring hospital treatment.

The distribution of hospitals is very uneven. Central London with relatively few inhabitants has many large hospitals, while the outer districts have a totally inadequate hospital service. Conse­quently many patients have to obtain their hospital treatment outside the area in which they live.

Municipal Hospitals were formerly administered by the Boroughs in London under ther poor law, and these “infirmaries” were intended for the sick poor. In 1929 the L.C.C. took over these hospitals (as well as the fever and other hospitals then under the Metropolitan Asylums Board) and in 14 years has greatly improved and developed them as a complete up to date hospital service which already bears comparison with the voluntary hospitals. This service could be made one of the best in the world provided it is coordinated with other services.

Hospitals in Wandsworth and Battersea are listed below, and the map shows the situation of existing Hospitals. There is only one municipal general hospital, St.James (D) and 4 small voluntary hospitals, Putney (E) Battersea (1) Bolingbroke (3) and Weir (5) for the two boroughs. Together these provide 1 bed for each 400 of the population, but four times as many beds are needed according to present estimates.

21. Accident Service. L.C.C. ambulances are provided free for all accident cases whether at home, at work or in the street, and for maternity cases. At present accident cases are treated in the casualty department of general hospitals, but owing to shortage of staff, undue delay sometimes occurs.

Modern treatment of accidents depends on the case being seen as promptly as possible and a specially equipped department should be provided at one of the hospitals in the region where all serious accidents can be treated immediately. Treatment for shock, blood transfusion, special treatment of wounds and fractures must be avail­able day and night, from specially trained personnel, if casualties are to be made as fit as possible with the minimum time off work.

Rehabilitation centres are an important part of a modern accident service.

MENTAL HEALTH

22. Mental Health Services comprise two branches, which overlap to a certain extent, namely, the care and treatment of the mentally ill, and the care of the mentally deficient.

The facilities available for the mentally unstable patient are roughly of three kinds depending primarily on the severity of the illness. Firstly, there are out-patient departments in some general hospitals and the Maudsley Hospital. Occasionally in-patient treatment is also provided as at the Maudsley.  Secondly, for the more seriously ill there are Observation Wards at some of the municipal hospitals. Here the patient can be watched for a short period and information obtained which will enable those in charge of him to decide what is the best treatment for him.  Thirdly, there are the mental hospitals, maintained by the L.C.C.

The special facilities available for the care of the mentally deficient are of recent origin. They are of two kinds, institutional and non-institutional, the latter consisting of a boarding-out system. Special schools are provided for backward children.

In Wandsworth there is an observation ward at St John’s Hospital (A); two mental hospitals: one, Springfield (J) with 2000 beds, taking all types of mental disorder; the other, Tooting Bec (H) with 2,300 beds, catering for senile patients.  In addition, there is one mental deficiency institution, the Fountain (G) with 800 beds.

The mental hospitals of today are too isolated from general hospitals, and both the public and medical workers need considerable education in an enlightened understanding of mental illness.

Mental Health Services should provide (1) diagnostic and treat­ment facilities for nervous cases and early mental disorders, as out-patients at special clinics at the health centre,  (2) Observation and early treatment units for those requiring in-patient treatment at the central hospital,  (3) Special treatment in mental hospitals for more serious or chronic cases,  (4) After-care facilities

A unified health service would contribute greatly to the improved treatment of many patients who now too often become chronic mental cases.

PROPOSALS

23. The Medical Service that we Need

1. The nation needs a medical service which is planned as a whole.
2. The service should be preventive as well as curative.
3. The service should be complete, covering all kinds of treatment required.
4. The service must be open to all, so that poverty shall be no bar to health.
5. The service must be efficient and up-to-date, providing for “team-work” and for convenient concentration of medical resources.
6. The service must be accessible to the public at home and at work.

24. How would the proposals apply to Wandsworth?

Unification.If the country’s Health Services are to be planned as a whole, a central plan must be drawn up by the Ministry of Health indicating in outline the general and administrative structure of the service, and the financing of the service would be by allocations from a National Health Fund built up from taxation, rates and insurance contributions.

25. Regionalisation.  In order that the new health service should not become inelastic and over-centralised,. the country should be divided into regions of from half to two million population. Each region would be responsible for developing its health services according to local needs in relation to the national plan. Local government would thus be strengthened.  The London area owing to its very large population is a special problem. It will probably be best to organise it as one special region administered by the L.C.C., but divided locally into subsidiary regions or units,  The existing boroughs of Battersea and Wandsworth would together make a suitable sub-region having 500,000 inhabitants an area containing a number of hospitals and an existing local government administration The actual boundary might  need some adjustment so as to conform with existing lines of communi­cation and population distribution

26. Coordination  In each region all the present health services and resources would be pooled and developed in the most effective way. The community should have the easiest access to the hospitals, clinics and other facilities it requires and not have to travel to points outside the region owing to local government boundaries which have become unrelated to present communications or population changes.

For example, today, owing to lack of local special facilities some tuberculosis patients in Wandsworth attend St.Thomas’s and Brompton Hospitals, several miles away.  Similarly, a mental patient whose home is next to Springfield Hospital might owing to his “London settlement” be admitted to St. Bernards (LCC.) Hospital at Hanwell, while a Hanwell resident might journey in the opposite direction to be admitted to Springfield (M.C.C.) Hospital, having been resident in Middlesex,,  A lot of unnecessary travelling would be saved by patient’s relatives if the hospital services of a community were open to all irrespective of county or borough, A coordinated service would make this possible.

27  Hospitals. The requirements of the region would best be met by using St.James (D), and developing and enlarging St.Johns (A), South London (B), and St.Benedicts (C); and by building a new 1,000 bed hospital on a suitable site on West Hill to serve the Western section of the region. These hospitals would be only for in-patients and would not provide for out-patients, as these would be attended at health centres.

The chronic sick should not be separated in special hospitals where they may lose hope and receive inadequate investigation. Large voluntary hospitals today tend to admit only acute and “interesting” cases, while the municipal hospitals cannot refuse any­one who needs a bed.  If all the general hospitals in the region took their share of the acute and chronic cases, patients, doctors and nurses would all benefit.

HEALTH CENTRES

28. Health Centres are essential if adequate modern treatment is to be provided by general practitioners. Each person would choose his doctor from the 10-12 working at the centre, and his full medical record would be kept there. If he became ill he would ‘phone the centre and his doctor would visit him in his home and a visiting nurse would be available from the centre to carry out the treatment, If the patient were well enough he would ask for an appointment at the centre, and would not have to spend tine waiting in a crowded surgery or hospital out-patient department. Only at night or in special emergencies would he receive treatment from a doctor other than his regular doctor. Patients and doctors who were not suited would have the right to change. At the centre specialists would be available to give expert advice on difficult cases and a full laboratory and X-ray investigation would be available for those needing it.  If hospital treatment were required, the health centre would arrange for the patient’s admission and the full medical notes would be sent to the hospital with the patient to ensure continuity of treatment.

The local health centres would provide the home doctor service and also the various clinics such as immunisation, dental, and maternity and child welfare, so necessary for the preventive side of the health services.

A region with 500,000 people would be divided into 5 divisional health units, as 100,000 people is the most efficient size to be given a complete medical service. Each unit would have its 1,000 bed hospital for in-patient treatment, and these hospitals would also provide at the Divisional Health Centre the consultants and the special diagnostic facilities not available at local health centres.

No health centres exist at present in the region and their provision must be a priority in the new health programme.  In the transition period, Battersea (l), Bolingbroke (3) and Weir (5) Hospitals could rapidly be transformed into health centres, but new buildings would be required for the remaining localities. Health centres should be situated at the most accessible points in each community, so that people have the shortest and easiest journey to reach them.  If placed as in the plan, most of the population would be within 5 minutes walk to a centre, and few people would be more than 10-15 minutes walk from one.

This memorandum is intended to explain the general principles of the proposed scheme in relation to health centres.  The details must be worked out by the authorities having all the necessary information.  The map has been simplified and only the main health centres are shown.  In practice about 20-24 such centres would be necessary each with about ten doctors, giving one doctor to about 2,500 patients.  health centres giving full medical facilities would in fact be more accessible than appears from the map.

29. Industrial Medical Services.  A comprehensive industrial medical service is of the utmost importance.  The health of the factory

worker is of vital concern to the community as a whole, as bad working conditions may lead to a general lowering of the standard of health.

In each factory medical and welfare officers should be responsible for supervising the health and working conditions of all workers.  They should act in close cooperation with health centres and hospitals, who would provide additional specialist services.

In the case of the smaller factories the medical officer could be part time and attached to the local health centre as well as to the factory.  In large factories it might be better to have Health Protection Stations with a whole-time staff. The feasibility of this would really depend on the necessary personnel being available.

HEALTH EDUCATION

30. Health Education.  The aim of the health services should be the achievement of optimum health, which can only be achieved if the people are educated in the principles of healthy living.  It should be part of the work of the staff of the hospitals and health centres to educate the public in health matters.  The whole work of the health centre should help in this, and in addition there should be demonstrations, lectures, films, posters, etc., giving information in a clear and simple way.  Only when the medical services are free from financial barriers between the patient and the service can the doctor really give his time and thought to teaching his patients to be healthy.

But there is another aspect of health education. Not only must we teach people to be healthy, we must also encourage them to get the most out of the health services.  This involves active participation in local government.

“The health of the people is the concern of the people themselves”.  The health services are therefore yourservices. They are for your benefit and are ultimately your responsibility.

REFERENCES

Beveridge Report.  H.M.Stationary Office. 1942.

P.E.P. Report on British Health Services. 1937.

County of London Plan. 1943

Reports of Medical Officers of Health.

Voluntary Hospital Reports

Reform of the Public Health Services. McNalty. 1943.

Medical Planning Commission, Draft Interim Report. 1942.

L.C.C, Handbook of General and Special Hospitals.

L.C.C. Administration of Relief.

Articles in British Medical Journal, Nov.20.1943. p.633. and Lancet, Nov.13.1943. p.612.

1. Medicine Today and Tomorrow. Quarterly.   6d
2. Future of Medicine. Murray. Penguin. 9d
3. Health of the Future. Bourne. Penguin.9d
4. National Service for Health. Labour Party, 2d
5. National Medical Service. C.P. Memo.  1/-
6. Socialist Programme for Health. S.M.A. 4d
7. Britain’s Health Services. C.P. Memo. 6d
8. Hospital Services.    Hastings. Fabian. 6d
9. Socialised Dental Service. S.M.A.3d
10. Pharmaceutical Service in Wartime. S.M.A. 3d
11. War, T.B. and the Workers.S.M.A. 4d
12. Health of the War Worker. SMA. & LRD. 6d
13. New Weapons against T.B. SMA. & LRD. 3d
14. Milk: The Need for Pasteurisation. SMA 4d
15. Public Health Protection in USSR.    Moscow. 3d
16. SMA. memoranda on; Health Centres, Administration, Industrial Health Services, Rushcliffe Report, etc. each 1d.

Pamphlets numbered 1-16 may be obtained from the Secretary, S.M.A., 59, New Oxford St. W.C.1.

Note; The figures and facts stated in this memorandum are believed to be correct. Changes due to war-time develop­ments and the delay in the publication of some official reports, however, have made it difficult to obtain the most recent information.

The Secretary would be glad to be notified of any corrections and to receive constructive comments on the opinions and proposals put forward.

PRESENT HOSPITALS IN THE REGION

Group	Key (see map)	Hospital	Beds	Type.	Class
1.	A	St. Johns	600	LCC.	Chronic Sick
	B	South London	160	Vol.	Women
	C	St. Benedict	320	LCC.	Chronic Sick & Convalescent
	D	St . James	900	LCC.	General
1a	E	Putney	100	Vol.	General
2.	1	Battersea	85	Vol.	General
	3	Bolingbroke	135	Vol.	General
	5	Weir	30	Vol.	General
3.	F	Grove	616	LCC.	Fever & E.M.S
	G	Fountain	800	LCC.	Mental Deficiency
	H	Tooting Bec	2300	LCC.	Senile dementia
	J	Springfield	2000	MCC	Mental
4.	K	Hostel of God	55	Vol.	Incurables
	L	Jewish Home of Rest	45	Vol.
	M	Streatham Babies	21	Vol.	Children, (evacuated)

PROPOSALS

Group

• 1. To be developed immediately as Health Unit Hospitals,
• 1a To be temporarily developed until a new Health Unit Hospital is built on West Hill, Wandsworth.
• 2. To be transformed immediately into Health Centres.
• 3. To continue as special hospitals for the Region,
• 4. Not required to be included’in the coordinated scheme.

NEW ORGANISATION

Region;  County of London.

Sub-Region: Battersea and Wandsworth Boroughs.  Population 500,000.

Health Unit Hospitals; A. B, C., etc., each serving about 100,000.

Health Centres;  1, 2. 3. etc., as required, situated at accessible points in each community,

Community Centres; are based on the County of London Plan.

NOTE:-  Map shows only the main health centres as follows;-

1. Battersea 2. Fairfield 3. Bolingbroke, 4. Clapham N. 5. Clapham S 6. Streatham     6a. Streatham Hill   7. Tooting. 8. Balham 9. Springfield, 10. Southfield 11. Putney,

x – New Hospital on West Hill as proposed in Plan,