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Bible Encyclopedias
Health Ministry
1911 Encyclopedia Britannica
or "HEALTH MINISTRY. - The Ministry of Health in Great Britain was created by the Act of 1919. This had as its principal object the concentration of the main health services of the country in a single department under a Minister of Health responsible to Parliament. The Act in the form in which it received the royal assent established a Minister of Health for England and Wales with a parliamentary under-secretary. Wales was given a Board of Health separately constituted but responsible directly to the minister. A Scottish Act was subsequently passed, setting up a Scottish Board of Health; this is entirely a separate organization and its chairman and parliamentary head is the Secretary for Scotland, who has a Scottish Under-Secretary for Health. The main Act also designated the Chief Secretary for Ireland as Minister for Health in Ireland. He is assisted by an Irish Public Health Council but its functions are purely advisory and its members are nearly all nominated directly by the Chief Secre tary. It is important therefore to note that the health administrations of England and Wales, Scotland, and Ireland respectively, are quite independent, are under three distinct ministers, and that if any United Kingdom health legislation is desired it must be sanctioned by three distinct Government offices. Nurses' registration, indeed, was carried in 1920 in the passage of three identical Acts; and the Medical Research Committee (a United Kingdom body) had to be withdrawn completely from the sphere of the Health Ministries and placed under a committee of the Privy Council. In practice the Ministry of Health and the Scottish Board of Health perform almost identical functions and have proceeded on similar lines. Conditions in Ireland are so different that no comparison is possible.
The Ministry of Health came into being on July 1 1919 and assumed from that date the whole of the powers and duties of the Local Government Board and of the English and Welsh insurance commissioners, save for their powers over the Medical Research Committee. The powers of the Privy Council relating to midwives were immediately vested in the new ministry. On Oct. I it took over, as provided by the Act, the powers of the Board of Education with respect to the health of mothers and young children, and of the Home Office in relation to infant life protection under the Children Act. On Dec. I the ministry further assumed responsibility for the duties of the Board of Education regarding the medical inspection and treatment of children and young persons. Arrangements had however been made to enable certain of these latter duties to be carried out by the Board of Education on behalf of the Minister of Health.
In May 1920 the ministry took over from the Home Office the administration of the Anatomy Acts and of certain powers and duties in relation to lunacy and mental deficiency. The 1919 Act also prescribes that there shall be transferred to the Ministry of Health " all or any of the powers and duties of the Minister of Pensions with respect to the health of disabled officers and men after they have left the service," and the date was to be not later than three years after the termination of the World War (see Pensions Ministry). Many powers inherited from the Local Government Board, but inappropriate to the new body, have been transferred to other departments, ranging from the Board of Education to the Electricity Commissioners and the Ministry of Transport.
The activities of the new ministry fall into five main sub-divisions: - (I) public health, (2) local administration and taxation, (3) housing and town-planning, (4) administration of the Poor Law and the Old Age Pensions Acts, (5) national health insurance.
It will be seen that these arise naturally by inheritance from the parent bodies. Indeed, Dr. Addison, the then President of the Local Government Board and Minister Designate of Health, was careful to point out when introducing the bill that no new medical treatment was provided for any person by the bill, nor did it affect the functions of any local authority of any kind. There is, however, one interesting innovation in connexion with the actual machinery of the Act itself. Section iv. provides that consultative councils shall be established for the purpose of providing advice and assistance to the minister. They have the power of making recommendations to the minister on their own initiative and their reports are to be published if possible. Already several of these councils have been set up (e.g. medical and allied subjects, insurance, and Welsh affairs), and a report by the first-named, outlining extensive changes in health organization, was published in 1920.
The organization and administration of public health in England on systematic and vigorous principles dates from the Royal Sanitary Commission of 1869. As a result of the commission's report the Local Government Board was set up in 1871. In 1872 the great Public Health Act was passed which for the first time organized all England into sanitary districts, imposed on every sanitary authority the obligation of appointing both a medical officer of health and an inspector of nuisances, and established the principle of a grant-in-aid towards their salaries. Sanitary law was further amended and codified by the Act of 1875 whose 343 sections still determine in many fields the health administration of the country. This vigorous health policy produced almost unhoped for results. The group of typhus, typhoid, scarlet fever, smallpox, cholera, diphtheria, measles and whooping-cough - the " fevers " - caused in the decade 1861-70 713,000 deaths out of a population for England and Wales numbering roughly 22,000,000. In the years 1910-9 the population had risen to some 33,000,000, but the deaths from this group sank to 252,000, and of these measles and whooping-cough accounted for 169,000.
The position was reviewed by a Royal Commission from 1905-9 It was found that confusion had once again crept in and that the numerous groups of Acts which had to be administered by the various local authorities - county councils, district councils, parish councils, boards of guardians - stood in urgent need of simplification. The commissioners presented a majority and a minority report, both urging reorganization, while the minority (Webb) report also proposed the abolition of the boards of guardians. In 1917 the Maclean Committee presented conclusions, subsequently adopted by the Government, practically embodying the minority report.
Meanwhile in the combat with disease progress has continued. New ground has been broken in the case of tuberculosis, venereal disease, and child welfare. Tuberculosis was brought much into public notice during the Insurance Act campaign in 1911, and though the results from sanatorium treatment have not fulfilled the earlier hopes as to cure of actual sufferers, yet the mortality statistics have been most encouraging. The death-rate per 100,000 from tuberculosis (all forms) has diminished from 139.7 in the quinquennium 1910-4 to 125.8 in 1919 and 112.8 in 1920, by far the lowest figure ever recorded in Britain. Though this fall undoubtedly owes something to the effects of the great influenza pandemic of 1918-9 which swept away many cases which would ultimately have swelled the tuberculosis mortality, there are factors which give hope that here we have a proportion of permanent gain.
Venereal disease was the subject of the report of a Royal Commission in 1916 and has since been officially recognized as an infectious disease presenting a community as well as a personal aspect.
A beginning has consequently been made with clinics and propaganda work throughout the country, treatment being free and the cost shared between local and central authorities (75% central, 25% local). Child-welfare grants-in-aid (50% of the total expenditure) increased from £12,000 in 1914-5 to £4,000,000 in 1919-20. Concurrently, though not necessarily because of this expenditure, infant mortality fell from an average of 110 in the years 1911-5 to the unprecedentedly low levels of 89 per 1,000 in 1919 and 80 per 1,000 in 1920. The general death-rate (all causes) in 1920 was 12.4 per 1,000, being the lowest on record.
Local administration and local loans call for little comment. Local finance, heavily strained by the rise in prices, has also had a large burden to bear in the cost of social reform; thus in the year 1920 a sum of £5,266,000 was borrowed for the sole purpose of settling ex-service men on the land. Local finance has also shown an unexpected buoyancy in the raising of large sums for the housing programmes by 6% housing bonds.
Housing, previous to 1918 a very minor province of the Local Government Board, expanded so vastly as to form almost a ministry in itself. House-building, seriously depressed since 1911, had been entirely stopped during the World War. The complete hold-up, during more than five years, of the natural overflow of the population in emigration much more than balanced war losses. The combination of these two factors caused a congestion so great that it was determined at the end of the World War that local authorities should forthwith initiate and carry out large housing schemes, with supervision and financial assistance from the State. These proposals were made law in 1919 [Housing and Town Planning Act, Acquisition of Land Act, Housing (Additional Powers) Act.] These Acts make it obligatory on every local authority to provide for the housing of the working classes within its area, and they guarantee that the exchequer will bear any deficit on a housing scheme over and above the produce of a rate of id. per pound. The Additional Powers Act also provides that a subsidy may be paid to private individuals who have completed a house " suitable for the working classes " to the satisfaction of the ministry before a specified date.
By July 31 1920 10,748 schemes had been submitted by 1,679 local authorities and 149 public utility societies; 5,211 applications had been received for the approval of house plans covering 246,159 houses; tenders had been approved for 135,572 houses and building had commenced on 30,618. Meanwhile a subsidy had been sanctioned for 17,593 houses to be erected by private enterprise, and 1 ,000 more had received the grant on actual completion. A very rough preliminary survey by the local authorities of the number of houses eventually required had given an estimated need of 800,000 houses but this was almost certainly too high. In July 1921 the Cabinet decided that only the 176,000 houses already contracted for could be completed owing to the grave financial position of the country and the enormous cost of the scheme.
A review of the administration of the Poor Law and the Old Age Pensions Act shows a great falling-off in the number of adults in receipt of domiciliary relief and a small decrease in the numbers receiving institutional relief after 1910 (when old age pensions were granted). The war period reveals a further striking decrease in all groups in receipt of relief (726,060 in Jan. 1915; 549, 6 7 2 in July 1919). Old age pensions were raised'from the 5s. per week originally granted in 1910 to Ios. per week by the Act of 1919, which also provides that out-door relief shall no longer disqualify for the receipt of pension. Pensions payable on March 26 1920 numbered 957,915, of whom 620,343 were women. Of these totals about 95% were in receipt of the maximum pension of ios. Unemployed relief, administered by the Local Government Board under the Unemployed Workmen Act of 1905 was transferred to the Ministry of Labour.
The changes in national health insurance in consequence of the amalgamation with the Local Government Board were mainly administrative. The joint committee was reconstituted and in 1921 consisted of the Minister of Health (chairman), the Secretary for Scotland, the Chief Secretary for Ireland and a fourth member having special experience of national health insurance in Wales. The Medical Research Committee constituted under the Insurance Act of 1911 was transferred to a committee of the Privy Council under the name of the Medical Research Council. Its funds are now derived from a direct parliamentary grant instead of from a levy of id. per head per annum for each insured person.
The first full audit of the approved societies took place in 1920. It was anticipated in 1921 that its final completion would show that the surplus of all the approved societies amounted to £7,000,000. Much of this of course was due to the war modifications of approved societies risks, but the increasing health of the nation must also be taken into account.
The Scottish Board of Health is completely independent of the English ministry though proceeding on similar lines. The board derives directly from the board of supervision for relief of the poor, set up in 1845, to which public health was added by the Act of 1867, transformed in 1874 into the Local Government Board for Scotland and so in 1919 by reorganization with the insurance commission into its present form. A feature differing widely from anything in England, however, is the Highlands and Islands Medical Service Board. This was set up by Act of Parliament in 1913 and is subsidized directly by the exchequer. It approximates to a State medical service and was only provided on account of a strong report in 1912 (Dewar Committee) showing that while the various health services in these areas were inadequate no amelioration could be expected from local resources which were completely exhausted. (W. E. EL.)
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Chisholm, Hugh, General Editor. Entry for 'Health Ministry'. 1911 Encyclopedia Britanica. https://www.studylight.org/encyclopedias/eng/bri/h/health-ministry.html. 1910.
