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92
SECTION IV
PERSONAL HEALTH AND RELATED SERVICES
General
Evolution towards community medicine continues and the value
of closer ties between general practitioners, health visitors, nurses
and midwives is becoming ever more comprehensible. This logical
advance, unfortunately, is not matched by the decisions to divorce
health from welfare and then to take health out of the local
authority sphere of control.
For the efficient conduct of community medicine, co-ordination
is essential and this is best achieved 'by integration but, with
health and welfare serving separate masters and community health
shortly to be placed in the hands of area health boards success, I
fear, will depend over-much on co-operation which can be as
good or as bad as the participants allow. It would seem that
"bridges" linking these services need to be on firmer foundations.
Ominously we hear constantly of the chronic shortage of social
workers, both qualified and unqualified, and reiteration by their
representatives for the personal health professions to become more
knowledgeable of community and social matters—as if these
qualities were not already part of the extensive armoury of health
visitors and nurses. This modern penchant for change should not
obscure the fact that, despite a dated appellation, our health visitors
are highly skilled professional women. Besides being state
registered nurses and midwives their additional training covers
subjects ranging from sociology and psychology to teaching techniques
and preventive medicine. Rather should the cry be that
social workers ought to have a minimum of medical or nursing
background in order that, as generic visitors, they may more
efficiently execute their duties which are indissolubly bound up
with health aspects and nursing needs. That this point has some
validity is exemplified by the efforts being made to introduce a
modicum of medical knowledge into the social worker's training
curriculum. Indeed, this is a tacit acceptance of the dictum that
health and welfare are largely indivisible, a truism well understood
by Seebohm but ignored in his summation and recommendations.
However, even before the present climate of uncertainty precipitated
by Seebohm et al supervened, the role of the health visitor
over the past two decades had been changing and her duties
becoming more diversified. From being primarily responsible for
the expectant and nursing mother and the pre-school child, her