in months of assuming office as Minister he had to pass judgment on a comprehensive plan of capital investment extending 5, 10 and 15 years into the future. He thought it absurd that anyone, possibly least of all a politician, should have the power to decide where and when and what services will be provided so far into the future. The nub of the problem in any state scheme was the inevitable centralization of decision-making. "The politician becomes responsible for every private and public act of judgment." This he felt was both unavoidable and absurd. Clearly he favors substantial expansion in the private sector of health care. He described with scorn the recent and protracted debates on reform of the NHS. "You will have encountered the Green Papers," he said with heavy sarcasm. His criticism of state medicine was vehement and voluble. "I apologise," he concluded, "I have been carried away by my unenthusiasm.' BIBLIOGRAPHY 1. Baldwin, J. A. The Mental Hospital in the Psychiatric Service. London: The Oxford University Press, 1971. 2. Bierman, Pearl; Connors, Edward J.; Flook, Evelyn; Huntley. Robert R.; McCarthy, Thomas; Sanazaro, Paul J. "Health Services Research in Great Britain". Milbank Memorial Fund Quarterly, January 1968; Vol. XLIV, No. 1. 3. Brotherston, John H. F. "Change and The National Health Serv ice". Scottish Medical Journal 14: 130, 1969. 4. Department of Health and Social Security, Annual Report 1970. London: Her Majesty's Stationery Office, July 1971. 5. Department of Health and Social Security, Digest of Health Statistics for England and Wales (with summary tables for Great Britain). London: Her Majesty's Stationery Office, 1971. 6. Department of Health and Social Security Welsh Office, National Health Service Hospital Advisory Service, Annual Report for 1969-70. London: Her Majesty's Stationery Office, March, 1971. 7. Higher Education and the Nation's Health, Policies for Medical and Dental Education. A Special Report and Recommendations by The Carnegie Commission on Higher Education. New York: McGraw-Hill Book Company, October, 1970. 8. Lee, Michael. Opting Out Of The NHS. London: George Berridge & Co., June, 1971. 9. McNerney, Walter J. Financing and Delivery of Health Services In Britain, Impressions and Questions. Reprinted From: Prob lems and Progress in Medical Care, Fifth Series. London: The Oxford University Press, 1971. 10. Loudon, I. S. The Demand For Hospital Care, In-Patient Care: Alternatives and Delays. Berkshire, England: Burgess and Son, Ltd., July, 1971. 11. McLachlan, Gordon and Shegog, Richard (Editors). In The Beginning. London: The Oxford University Press, 1970. 12. McLachlan, Gordon (Editor). Problems and Progress in Medical Care. London: The Oxford University Press, 1971. 13. McLachlan, Gordon (Editor). Portfolio for Health. London: The Oxford University Press, 1971. 14. Powell, Enoch. Medicine and Politics. London: Pitman Medical Publishing Co., Ltd., 1966. 15. Revans, John and McLachlan, Gordon. Postgraduate Medical Ed ucation, Retrospect and Prospect. The Nuffield Provincial Hos pitals Trust, 1967. 16. Sanazaro, Paul. "Assessing Effectiveness of Health Care Delivery". Annals of The Royal College of Physicians and Surgeons of Canada, April 1971, p. 123. 17. Scottish Home and Health Department. Doctors in an Integrated Health Service. Edinburgh: Her Majesty's Stationery Office, 1971. 18. Simpson, J.; Mair, A.; Thomas, R. G.; Willard, N. H.; Bakst, H. J. Custom and Practice in Medical Care. London: The Oxford University Press, 1968. 71-413 O 73-6 APPENDIX I MEMORANDUM PREPARED BY THE DEPARTMENT OF HEALTH AND SOCIAL SECURITY. REGIONAL HOSPITAL ADMINISTRATION IN ENGLAND AND WALES. Regional Hospital Boards. The situation For the administration of the 2,600 non-teaching hospitals and their It was an essential 480,000 beds, fourteen Regional Hospital Boards have been created. feature of the national plan that the hospital services in each Region should be associated with at least one Medical School and Teaching Hospital (and therefore one Board of Governors) as a focal point. This principle determined the number of provincial regions at ten, since there were only ten provincial Boards of Governors. in London was more complicated owing to the concentration of twenty-six Teaching Hospital groups in the metropolitan area. It was finally decided to have four Regions all centred on London, each covering a part of the metropolis, but each, owing to the lack of medical schools outside London, extending over a much wider area. extension of territory is especially notable in the case of the SW Metropolitan Region, which reached as far west as Weymouth. The final pattern, however, remains complicated enough: for example, the NW Metropolitan Regional Board has within its territory no less than five undergraduate and nine postgraduate Teaching Hospital Groups. This As a result of these arrangements the size of the Regions varies considerably: the largest serving populations of more than 4 million, control about three hundred hospitals and over 60,000 beds. The two smallest, the Oxford and East Anglian Regions, serving a population of less than 14 million, are each responsible for about one hundred hospitals and less than 15,000 beds. The two largest boards, the South West Metropolitan, and the Newcastle, have set up special area committees for the administration of a part of their territory. Planning the Regions on this basis has meant ignoring local government areas. The boundaries of Regional Hospital Board areas cut across those of local government As a consequence, Regional Boards may have to deal with a number of local authorities and local authorities with a number of Regional Boards. areas; As the Report by the Central Health Services Council on Co-operation between Hospital, Local Authority and General Practitioner Services puts it: "In London, to take the extreme example, the London County Council area |