Warnock (1978)

Notes on the text
Preliminary pages Membership, Contents, Introduction
Chapter 1 General approach
Chapter 2 Historical background
Chapter 3 Scope of special education
Chapter 4 Discovery, assessment and recording
Chapter 5 Children under five
Chapter 6 Schoolchildren with special needs: introduction
Chapter 7 Special education in ordinary schools
Chapter 8 Special education in special schools
Chapter 9 Parents as partners
Chapter 10 Transition from school to adult life
Chapter 11 Some curricular considerations
Chapter 12 Teacher education and training
Chapter 13 Advice and support in special education
Chapter 14 Other education service staff
Chapter 15 Health service and social services
Chapter 16 Relations between professionals, confidentiality and coordination of services
Chapter 17 Voluntary organisations
Chapter 18 Research and development
Chapter 19 Priorities and resources
Summary of recommendations

Appendices

Appendix 1 List of contributors
Appendix 2 Categories of handicapped pupils
Appendix 3 Possible grid as basis for statistical returns
Appendix 4 Organisation of health service
Appendix 5 Research project on services for parents of under 5s
Appendix 6 Research project on pre-school education
Appendix 7 Research project on employment experiences of handicapped school leavers
Appendix 8 Survey of teachers' views on special education

Index

Report of the Committee of Enquiry into the education of handicapped children and young people

London: Her Majesty's Stationery Office 1978
© Crown copyright material is reproduced with the permission of the Controller of HMSO and the Queen's Printer for Scotland.

ISBN 0 10 172120 X

Appendix 4: The organisation of the health service
[pages 384 - 387]

1. The new administrative structure for the health services in England, Wales and Scotland became effective on 1 April 1974. It is based on the establishment of health authorities, which are statutory agencies of central government responsible for all health services within defined geographical areas. These services include hospital and specialist services, the primary health care (including general practitioner) services, the community services previously administered in England and Wales by local health authorities and the school health service, which was previously administered by local education authorities in England and Wales and provided on an agency basis by local health authorities in Scotland. The new health authorities also have a general responsibility for preventive health measures. They cooperate with local, port and water authorities, which have certain defined responsibilities and powers in relation to environmental health. The Employment Medical Advisory Service, however, with its limited defined objectives in relation to occupational health, is part of the Health and Safety Executive and remains outside the responsibility of the health authorities.

2. In England there is a three-tier structure for planning and control under the Secretary of State for Social Services. This comprises the Department of Health and Social Security, which has a central strategic planning role and a responsibility for monitoring the working of the service as a whole; the regional health authorities, which are responsible for regional planning, for the allocation of resources to area health authorities and for monitoring their activities; and area health authorities, which are responsible for operational management of health services and for planning within their areas.

3. There are 14 regional health authorities, each with one or more university medical schools within its boundaries. Each region comprises between three and 11 areas. The regional health authorities form part of a chain of responsibility running from the Secretary of State to area authorities, to which they delegate operational functions. They retain some direct executive functions which are more economically organised in this way than by individual area authorities. It is at regional level that the approval of specialist regional centres takes place, although these are then developed by area health authorities by agreement with the regional authority to serve a wider area. The boundaries of the regional health authorities are not coterminous with those of the regional conferences for special education.

4. There are 90 area health authorities in England. Their boundaries generally match those of the new non-metropolitan counties and metropolitan districts of local government. In London the boundaries of the health authorities correspond in four cases to those of individual London boroughs and, in the remaining 12 cases, to those of two or three or in one case four boroughs grouped together. The area health authority is the operational authority in the national health service responsible for assessing health needs in its area and for planning, organising and administering area health services to meet them, including the necessary supportive services. It is responsible for providing school health services to the matching local education authority. These services include the provision of medical staff, nurses and therapists to ordinary and special schools; arrangements for medical examinations, immunisation and the oversight of health care in schools; the provision of advice to parents, teachers and local education authorities on the nature and extent of handicapping conditions or other medical conditions significant for a child's education; participation in health education; and the provision of counselling services for pupils and others.

5. Each area health authority is served by an area team of officers consisting of the Area Administrator, the Area Medical Officer, the Area Nursing Officer and the Area Treasurer. This team carries out the planning and evaluation work for the area health authority. It draws up planning guidelines for each health district and reviews and monitors the performance of districts. The Area Medical Officer reviews the needs of the area for health care and advises the area team of officers and the area health authority on policies for health care. He is responsible for coordinating preventive and other services as well as for the work of Specialists in Community Medicine on the authority's staff. The Specialist in Community Medicine (Child Health) in England and Wales has dual responsibilities to and is appointed with the agreement of both the area health authority and the local education authority. His responsibilities include the organisation of the school health service provided for the local education authority. The Area Nursing Officer provides nursing advice to the area health authority, to the area team of officers and to individual officers at area level; monitors and coordinates the work of District Nursing Officers and manages his or her own staff based at area level including the Area Nurse (Child Health); and participates in the formulation of policies and plans in conjunction with other members of the area team of officers. The Area Nurse (Child Health), who is appointed in agreement with the local education authority, is responsible for the provision of nursing services in schools and provides nursing advice on child health (including school health) to the Area Nursing Officer and similar advice on child health, including health education in schools, to the local authority. The Area Nurse (Child Health) collaborates with District Nursing Officers, who have day to day responsibility for the management of school nursing services, and works closely with the Specialist in Community Medicine (Child Health) to provide a comprehensive school health service.

6. The day to day running of the services for which an area health authority is responsible is based on health districts. These always contain a district general hospital, and each district covers a population of between 100,000 and 400,000. About a quarter of the 90 area health authorities consist of one health district only; they thus fulfil the role of both an area health authority and a health district. The remainder consist of between two and six districts. The execution of health policies in a district is in the charge of the district management team, again consisting of four officers of the area health authority: a District Administrator, a District Finance Officer, a District Nursing Officer and a District Community Physician, together with two doctors elected by the district medical committee which represents doctors working in all parts of the national health service. Hospital staff and general practitioners can thus influence planning and decision making at this local level through the representative system. To assist district management teams area health authorities should establish district planning teams, which can include local authority staff where services are of concern to both health and local authorities. Their purpose is to conduct detailed planning of the health care of particular groups of patients, for example expectant and nursing mothers, children, the elderly, the mentally ill and the mentally and physically handicapped. Under the reorganised national health service the status of general and dental practitioners, ophthalmic medical practitioners, opticians and pharmacists as independent contractors has remained. Each area health authority has set up a Family Practitioner Committee to administer their contracts and this Committee deals with the Department of Health and Social Security on contractual matters.

7. Health services in Wales are established in accordance with the same legislation as in England, with some significant differences to meet the special circumstances and needs of Wales. The Secretary of State for Wales is responsible for health services in Wales, and the eight health authorities, which are coterminous with the new counties, report direct to the Welsh Office, which supplies central guidance.

8. In Scotland the Scottish Home and Health Department is the central authority responsible for providing and allocating resources to 15 health boards, and for monitoring their performance. These health boards broadly combine the responsibilities of the regional and area health authorities in England. The boundaries of 11 health boards coincide exactly with the corresponding regional and island councils. The remaining four health boards relate to subdivisions of the largest region, Strathclyde, and coincide with local authority districts. The formulation of policy on health and the planning of all health services including child and school health are area responsibilities. The health board collaborates with local authority regional councils, which have among their responsibilities social work, education and strategic planning, and district councils, which are concerned with land use planning and environmental health. Each health board is serviced by an Area Executive Group, consisting of the Secretary, the Chief Administrative Medical Officer, the Chief Area Nursing Officer and the Treasurer. Their individual responsibilities in general correspond with those of their counterparts on the area team of officers in England. The day to day running of the services in Scotland, like that in England, is based on health districts. These tend to be smaller than those in England. The five smallest health boards are single district authorities. Otherwise the number of districts in a health board varies between two and five. Health board districts have an executive function and policies are carried out by an executive group consisting of four officers from the main disciplines as in England but without any elected clinicians. As in England and Wales, general and dental practitioners, ophthalmic medical practitioners, opticians and pharmacists have remained independent contractors. However, there are no statutory committees such as the Family Practitioner Committee, the functions of which are undertaken by sub-committees of the health board.

9. In Scotland the responsibilities of the Community Medicine Specialist (Child Health) and the Area Nursing Officer (Child Health) are non-clinical and advisory. These officers are not responsible for the deployment of staff or for clinical management within the service, nor do they undertake clinical duties. Community Medicine Specialists are not employed by the education authority. They do, however, provide links between the education authority and the health board and assist with the determination of needs, the provision required to meet these needs and the formulation of policies and priorities. The clinical medical staff are accountable to the Chief Administrative Medical Officer, the nursing staff to the Chief Area Nursing Officer.