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37
Conferences are held periodically at officer level to ensure co-ordination and cooperation
in the administration of the services with the senior administrative medical
officers of the four Metropolitan Regional Hospital Boards, the medical officers of health
of the Home Counties, representative house governors of teaching hospitals, and representative
metropolitan borough medical officers of health.
Each of the nine divisional medical officers is a member of at least one hospital
management committee in the area. Senior divisional staff also serve on many voluntary
committees concerned with health (e.g. nursing associations, tuberculosis care, care of
old people).
From the inception of the National Health Service Act, 1946, the Council, through
its divisional staff, fostered close co-operation between the almoners of hospitals and
the divisional organisation in view of the fact that the two services are interdependent
for a full knowledge of the patient, his background and his needs, and that the two
services have a common concern in the well-being of the patient and the maintenance
of his health. In view of Ministry of Health circular 160/48, negotiations took place
with the hospital authorities and the Institute of Almoners on the after-care arrangements
for persons discharged from hospitals. A scheme was introduced early in 1951 whereby
the Council undertook through its divisional organisation to carry out home visiting
and provide after-care for patients referred by hospital almoners. Under this scheme,
the direct approach of almoners to the Council's fieldworkers for mutual discussion and
exchange of information is encouraged, but all correspondence on arrangements for
home visiting and after-care is conducted through the divisional medical officers.
There was a good record of co-operation between hospital maternity and pediatric
departments and the ante-natal and child welfare clinics at welfare centres before the
National Health Service, and this has been maintained and developed since 1948. So far
as the discharge of maternity patients from hospital is concerned, the Council introduced,
with the co-operation of hospital authorities, a form which hospitals could use when
notifying the Council's divisional medical officers of such discharges which has worked
well.
On the receipt of Ministry of Health circular LHAL 1/51 enclosing a copy of the
memorandum RHB (51)74, divisional medical officers offered to co-operate with local
hospitals by advising on admissions on social grounds. This is closely allied to the problem
of the number of home confinements and the work of the domiliciary midwife. Detailed
reference to the origin of the circular and its first results is made in the section on the
domiciliary midwifery service. Reference may be made here to the approach which has
been made to the secretaries of the Metropolitan Regional Hospital Boards and of
hospital management committees and boards of governors of all hospitals with maternity
beds, suggesting that the time has arrived for a review of the progress made in co-operation
in this and allied matters, relating to the maternity services, under the following heads:
(a) Selection of maternity patients for admission to hospital.
(b) Co-operation between hospital maternity departments and the Council's antenatal
clinics.
(c) Notification to the Council of the discharge of maternity patients from hospital.
(d) Provision of care and after-care for maternity patients as part of the scheme
for provision of care and after-care at the request of hospital almoners.
Reference is made in the section on the domiciliary midwifery service to the
liaison between ante-natal clinics and the general practitioner. Arrangements have
been in force for a long time for exchanging information between the Council's
domiciliary midwife and the booked general practitioner obstetrician on the ante-natal
examination of their patients. There is in existence also a form for notifying the general
practitioner, subject to the patient's consent, that one of his patients is pregnant.
General practitioners are notified when any of their patients (mothers or children)
are referred from maternity and child welfare clinics to hospital out-patient departments
for further advice and treatment. Co-operation is encouraged between general practitioners
and the Council's health visitors and in some divisions arrangements have been