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welfare sessions. These clinics were provided by the metropolitan borough councils
as part of their general provision for the care of expectant and nursing mothers and
young children ; but, it has now been determined that they are specialist services
not proper to the local health authority under the National Health Service Act.
Maternity and Child Welfare Centres provided by Hospitals
Consultations were held with representatives of the teaching hospitals and of
the metropolitan regional hospital boards on the continuance of the maternity and
child welfare services (ante-natal and post-natal clinics, infant welfare clinics, health
visiting services) provided by some of the hospitals before the " appointed day."
The consultations arose from the need of applying the ruling of the Ministry of Health
that it is not legal for a hospital as such to provide a service for healthy babies or to
employ health visitors. The Ministry suggested, however, that it would be possible
for the committee of the medical school of a teaching hospital to be regarded as a
voluntary body and to act as the Council's agent in providing these services. Also
the Council could continue a clinic on hospital premises, paying a rent for the
accommodation. The Ministry's ruling did not apply to ante-natal and post-natal
clinics as the hospitals may provide these for their own patients. Infant welfare,
however, provided a more complex problem. It was ascertained that ten hospitals
were providing only consultative clinics or clinics for sick children which were within
their powers under Part II of the Act. The Council has no concern with these, and
incidentally no question arose of continuing any grants made for these services by
the metropolitan borough councils before 5th July, 1948. There were three infant
welfare clinics in hospitals of the metropolitan regional hospital boards but, although
the Council was willing to continue these clinics, the hospital management committees
concerned decided to discontinue them. The children attending them were transferred
to the Council's nearby centres.
There remained four teaching hospitals with infant welfare clinics for consideration
under the Ministry's ruling. As a result of consultations and with the agreement
of all parties concerned it was finally decided that at one hospital the Council should
take over the services hitherto provided and run the clinic in the hospital premises
as a municipal centre, paying rent to the hospital authorities. In order to preserve
continuity and to provide teaching facilities, a member of the hospital medical staff
who previously conducted the clinic holds a part-time appointment as a medical
officer in the Council's service and continues his work there. The Council may not
pay specialist rates for work of this nature but pays the non-specialist rate, the
balance being made up by the medical school.
At the other three teaching hospitals the medical schools preferred to run the
services as voluntary bodies grant aided by the Council. This was agreed in consultation
with the medical schools and hospitals. Broadly the arrangement is that the
medical school pay a rent agreed by the Council to the hospital authorities for use of
the clinic premises. The medical school also provide and pay all staff, except health
visitors. The Council reimburses the medical schools at the rate of ninety per cent.
of the approved net expenditure, subject to the payment by the Council of the full
non-specialist rate for the pediatricians. The other ten per cent. of the expenditure,
with the balance of any specialist rates paid to medical staff, is found by the medical
school and is regarded as a fair return for the teaching facilities which they enjoy
at the clinic. The arrangements will be confirmed by agreements between the
Council and the hospital or the medical schools. Subject to safeguarding the interests
of the Council and of the people for whose welfare it is responsible, the special requirements
of the teaching hospital are preserved, e.g., in such matters as the appointment
of medical staff to conduct the clinics attended by medical undergraduates. Any
grants made by the borough councils prior to 5th July, 1948, were paid by the
Council up to the date of operation of the new agreement.