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96
Relatione
with the
National
Health
Service
Transfer of
specialist
clinics
Clinics situated in hospitals had been taken over by the hospitals themselves
on 5th July, 1948. During 1951 negotiations were continued with each of the four
metropolitan regional hospital boards for the take-over of rheumatism, ear, nose and
throat, vision and orthoptic clinics not in hospitals. The boards took over responsibility
for provision and payment of the specialists at these clinics, and for provision
of spectacles. The clinics for which the Council remains completely responsible are
the minor ailmeDts, audiology, consultative, nutrition and dental clinics, and the
bathing centres. The Council and the appropriate board divide the responsibility for
those child guidance units which are conducted in Council premises.
While assumption of responsibilities by hospital authorities relieves the ratepayer
of certain burdens and enables the school health service to concentrate on the
preventive and positive health aspects of the work, it may not always be easy to
ensure that the school children receive as effective care as before the change. The
school health services were specially designed for the children (and their parents).
Under the National Health Service, there will be competing claims from other
sections of the community. To economise, hospital management committees may
feel it necessary to move, integrate with adult clinics or even close certain clinics.
The regional hospital boards, however, appreciate fully the needs of the children and
such steps would be taken only after full consultation. To maintain effective liaison
with the schools, medical social workers ("treatment organisers") from the school
health service attend clinics, arrange appointments (see page 95), ensure that recommended
treatment is carried out and generally develop social care work arising from
the clinic visit.
Minor
ailment
clinics
During 1950 the attendances at these clinics rose slightly, but during 1951 there
was a slight decrease. A further reduction in the hours of opening was made releasing
nurses and doctors for other work.
Consultative
and reference
clinics
One of the difficulties always to be faced by the assistant medical officer is that
in the school he so frequently has neither sufficient time nor suitable accommodation
to examine some children as thoroughly as he would wish. The minor ailment clinic,
serving as it does a group of schools, could, like the infant welfare clinic with which
it should be associated in a health centre, become the centre of school health work in
the area, but the historic development of the school health service in London has
hitherto precluded this useful development. During the year several of the divisions
have been able to move a step towards the grouping of these services by arranging for
assistant medical officers to have a session in the minor ailment clinics where they can
more thoroughly examine children previously seen in schools. Other divisions have
special "consultative" clinics to which the medical officer may refer a child. By the
end of 1951 there were eight such consultative clinics functioning. Too much attention
should not be paid to the name of any clinic, for "enuresis" and "nutrition"
clinics have also been used for this purpose. There is clearly a need for a service of
this kind; in the new schools with their medical suites the work can be done, where
it should be, in the school. In our older schools something else is required and experiment
may give the most satisfactory answer.
Audiology
clinics
During the year these clinics have been increased and there is now one clinic
in each division. Older children are referred after failing two gramophone and
one pure-tone audiometer tests carried out by a school nursing sister, for investigation
of suspected deafness not obviously due to conditions requiring treatment, while
younger children may be sent direct from any doctor. Advice is given on the need
for special educational treatment and the provision of hearing aids. As the clinics are
advisory in function, the specialists are employed by the Council.
Special
investigation,
Vitamin B.12
After a pilot experiment in boarding open-air schools in 1950, a further investigation
was carried out in the day open-air schools. The children were divided into
two groups, one group receiving 10 mg. of vitamin B.12 daily and the other a similar
tablet containing only sugar. It is sufficient to say that after eight weeks no difference
of any kind could be observed by any method of analysis between the progress of