A Ministry of Health for Northern Ireland

A Ministry of Health for Northern Ireland By LEONARD KIDD, M.D. A4 paper read before the Ulster Branch of the British Medical Association, Belfast, March, 1938 REVIEWING the numerous enactment§ passed during the gradual evolution of our present system of public health administration, one is struck by the multiplicity of authorities, both central and local. (a) Central.-The Minister of Labour is responsible for the health of about 417,000 "insured persons" between 16 and 65 years of age, rather more than onethird of the total population. The Minister of Education is responsible for the medical inspection and care of school children. The Minister of Home Affairs is responsible for the remaining public health matters, hospitals, Poor Law medical services, etc., and apparently something like one-sixth of the total population comes within these services. (b) Local.-In addition to the two Borough Councils of Belfast and Londonderry, there are thirty-one Urban and thirty-two Rural Council, Public Health, and Sanitary authorities; a total of sixty-five authorities for a population of a million and a quarter, which is less than the population of the City of Glasgow. Another impressive character of our public health administration is the permissive character of all the old Public Health Acts, e.g., The Infectious Diseases Notification Act of 1889 has been adopted by all the authorities except one; it costs nothing to notify. On the other hand, the Infectious Diseases Act of 1890 has been adopted only by nineteen of the thirty-two rural and thirteen of the thirty-one urban councils; the adoption of this act costs money to provide preventive measures. The overlapping of the various acts is another strange anomaly:(a) In domiciliary treatment of disease, it is possible under existing circumstances for three or more doctors, in the employment of the local authorities, to be in attendance at the same time on patients living in the same house. 229