View report page

40
and the Surrey County Councils during the year. The number of tickets issued to
midwives for attendance at the lectures was 535 and 60 for attendance at the demonstrations.
Nine of the Council's domiciliary midwives attended summer schools
arranged by the Royal College of Midwives.
Payment of
medical fees
Fees paid under the Midwives Act, 1918, to medical practitioners called in by
midwives in emergency amounted to £15,594 and the number of claims was 6,354 in
1948, compared with £12,509 and 7,995, respectively, for 1947. The rise in the amount
of fees paid is due to the increased scale of fees introduced from 18th April, 1948, by
the Medical Practitioners (Fees) Regulations, 1948. The fall in the number of claims
received is attributed mainly to the fall of approximately 13 per cent. in the birth
rate for London and also to a lesser degree to the introduction of the general practitioner
obstetrician scheme under the National Health Service Act, 1946, as from
5th July, 1948. It is estimated that the full effect of the latter scheme on the number
of claims received will not be felt until after March, 1949.
Under Part IV of the National Health Service Act, 1946, a pregnant woman
can obtain the services of a medical practitioner with obstetrical experience who,
for a comprehensive fee paid by the Local Executive Council, will provide her with
maternity medical services which include:—
(i) examination at time of booking;
(ii) examination about the 36th week of pregnancy ;
(iii) a post-natal examination about six weeks after confinement;
(iv) any medical attention additional to the above, either if he thinks it
necessary, or in response to a call from the midwife.
The medical practitioner on the medical list is not required to undertake the
more frequent routine ante-natal supervision that is essential, nor to attend the
labour unless such attendance is considered necessary by himself or by the midwife.
The doctor may, of course, provide additional services if he so desires, but his
remuneration is not thereby affected.
Historical
sketches
For statement on origin and development of this service see page 106.
HEALTH VISITING
The day-to-day administration of the health visiting service has been on a
divisional basis since the "appointed day" and has followed the lines existing before
that date. As anticipated in the proposals submitted to the Minister of Health under
the National Health Service Act, it has not been possible to expand the service and
the main efforts of the personnel continue to be in the maternity and child welfare
field. The over-riding problem has been a shortage of qualified staff.
Voluntary
organisations
Health visitors employed by voluntary bodies have been given the opportunity
to transfer to the Council's service in order to provide for that close integration of
services which is desirable, but no pressure has been brought to bear on any individual
who did not desire so to transfer. The appointment of new health visitors to serve with
these organisations should replacements be necessary will be undertaken by the
Council, but the voluntary committees will be asked to send one or more representatives
to the committee of the Council which is interviewing candidates for appointment.
Few of the hospitals have employed health visitors as such, but where these
officers have been employed negotiations are proceeding for the integration of their
services with those provided by the Council.
Child life
protection
Until 5th July, the authorities for administering the child life protection powers
under the Public Health (London) Act, 1936, were the Common Council of the
City of London and the metropolitan borough councils. Under these provisions,
any person who proposed to undertake for reward the nursing and maintenance
of a child under the age of nine years (a "foster child") was required to notify the fact
to the Local Authority. It was also the duty of the Local Authority to make enquiries
from time to time to ascertain whether there was any person residing in its area