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Links with hospitals exist but closer co-operation is essential. Health
visitors and social workers attend at hospital clinics to discuss cases, in
addition to the constant interchange of knowledge at field level.The particularly
close relationship with St. Clement's Hospital for mentally ill patients is
commented on elsewhere. The hope is to extend this further to achieve a fully
comprehensive mental health service for the Borough providing continuity of care
and help both in and out of hospital.
Joint appointments of staff at all levels may be the best way to reach
this goal. If it were possible to overcome the financial dichotomy between
hospital and local authority expenditure on capital schemes, rapid progress
would ensue.There can be little difference between day hospital care under the
hospital service, and day centre care provided by the local authority. With
mental hospital nurses working in the community as at present for part of their
training, and our staff attending at the hospital, the distinctions are even
now becoming blurred.
Another fruitful field of co-operation with other branches of the health
services is in the care of the handicapped. At present, rehabilitation,
resettlement,after-care and the welfare services for these groups are fragmented.
It would be beneficial for example with the physically handicapped for a
unified approach to be made by all interested agencies. Hospital resettlement
clinics have been tried in other areas, following the recommendations of the
Ministry of Health, and the findings of the Piercy Committee 1956. Many
authorities utilise the case conference approach and co-ordinating committee
procedure in the field of child welfare. A similar method could be applied to
other groups in need; for instance, attendance at hospital case conferences
by local authority officers, and vice-versa, with the co-operation and advice
of family doctors, would assist in this field. To base a resettlement clinic
entirely on a hospital,in my view would be to over-emphasize the roleof hospitals
in the rehabilitation and resettlement back into the community where life is
lived, for the most part, by most of us for most of our days.
With the continuing good health of infants and children is there not
opportunity for a shift of emphasis to helping the more vulnerable older age
groups, not forgetting that constant vigilance is required to maintain all
health standards? Geriatric assessment clinics, in an analagous role to that
of infant welfare clinics, ought to be given a pilot trial. The domiciliary
services for the aged in this area are first class, fulfilling indirectly an
important preventive health function. To enlarge "club" facilities to include
periodic medical assessment, and preventive advice, seems a logical extension.
The family general practitioner would be kept fully informed, as with other
welfare clinics, about his patient. Once more, the new charter for general
practice with its proposal for extra capitation fee for aged persons in a list
will give further encouragement to aid schemes for the elderly.
9.