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107
effective organisation of the work of the Dispensaries, the convenience of
different classes of patients resorting to them, and the avoidance of long
periods of waiting.
RECOMMENDATIONS FOR THE IMPROVEMENT OF THE
DISPENSARY SERVICE.
In their letter, the Ministry of Health made certain suggestions for the
improvement of the existing service. These were briefly discussed in a
report submitted by the Medical Officer of Health to the Health Committee
on the 12th January last, but as the question of the future of the Battersea
Dispensary for the Prevention of Tuberculosis in relation to the Borough
Council's Tuberculosis Scheme was still in suspense, the question of action
in relation to their recommendations was postponed pending the result of
the changes which were foreshadowed in the administrative arrangements
for dealing with Tuberculosis under the Order made by the National Health
Insurance Committee under Section 21 of the National Health Insurance
Act, 1920.
In considering a revised Dispensary Scheme for the Borough, regard
must necessarily be had to the recommendations, and it will be convenient
to deal with them in detail and separately, with observations as to how
these suggestions are being applied in regard to the revised Dispensary
Scheme in Battersea.
Recommendation 1.—Arrangements should be made for the complete
co-ordination of the work of the Dispensary with that of the Public Health
Department of the Council, and the Ministry are of opinion that if this is
to be secured it will be necessary for the Tuberculosis Officer to be appointed
as assistant to the Medical Officer of Health of the Borough for Tuberculosis
work, and be given a responsible share of the control under the administrative
direction of the Medical Officer of Health of the Tuberculosis work in
the portion of the Borough served by his Dispensary. Such an appointment,
in the case of a voluntary dispensary, would not, of course, affect the right
of the Tuberculosis Officer to report direct to the managing body of the
Dispensary.
The taking over of the Dispensary from the Voluntary Organisation
hitherto in control of the institution has simplified this arrangement for
carrying into effect this recommendation. The Tuberculosis Officer now
acts as an assistant to the Medical Officer of Health, and is under his
administrative control in regard to preventive matters, but is independent
of the Medical Officer of Health in respect of clinical work.
Under this arrangement the Tuberculosis Officer now has become an
Officer of the Public Health Department of the Borough Council, and all
information relating to the incidence and mortality from Tuberculosis in
the Borough is at his disposal, thus enabling him to obtain a comprehensive
survey of the problem of Tuberculosis as it affects his area.
Recommendation 2.—The working week of a whole-time Tuberculosis
Officer rot to be less than 36 hours per week; and it is suggested that on
a normal basis there should be one whole-time Tuberculosis Officer to about
every 160 deaths from Tuberculosis per annum. When the needs of a district
require, on this basis, the services of more than one whole-time Officer, but
less than two, a part-time Assistant Tuberculosis Officer might be appointed,
and there should be at least one Dispensary Nurse for each whole-time or
part-time Tuberculosis Officer. These Nurses should work under the direct
control of the Tuberculosis Officer, and their work properly co-ordinated
with the work of the Dispensary.
The working week of the Tuberculosis Officer is at present not less
than 36 hours. It is probable that the needs of the Borough, on the basis
suggested, require the services of a part-time Tuberculosis Officer. The
consideration of this addition to the Dispensary Medical Staff, without
being lost sight of, may be conveniently deferred pending the development