Education And Debate

Local government and health care: the historical perspective

BMJ 1995; 310 doi: (Published 17 June 1995) Cite this as: BMJ 1995;310:1584
  1. Charles Webster, senior research fellowa
  1. a All Souls College, Oxford OX1 4AL

    Local government administration of health services is prevalent in Scandinavia, and the tradition was equally deepseated in Britain, brought to an end only in 1948. It is generally thought that the local government alternative was decisively and permanently rejected when the NHS was started, but the local government option was not so readily or completely discarded. In particular, the return of the health services to local government was a possibility at the time of the 1974 reorganisation. Both the longer term perspective and the arguments surrounding the illfated 1974 reorganisation need to be kept in mind in the course of current discussions concerning the future of the NHS.

    Administrative tradition

    In the course of the century from 1848 to 1948 it was increasingly accepted that public provision of health care should be the responsibility of local government rather than the poor law authorities.1 Health care was recognised as the analogue of education; both services came to be administered predominantly by county councils and county boroughs; the various committees of these authorities concerned with health and education were the best endowed and most prestigious areas of local government administration. Over the course of a century, the suitability of local government for administrating personal and environmental health services became so widely accepted that it achieved the status of almost an unquestioned constitutional principle.

    At first the departments of the medical officers of health were predominantly concerned with public health, but by the first world war local authorities also controlled a vast institutional service connected with infectious disease, destitute sick people, and longterm confinement. It was therefore entirely understandable that such advanced thinkers as the Fabian society should advocate the extension of local government activity into the acute hospital sector. As early as 1900 the Fabians declared, “We must municipalise all our hospitals”.2 …

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