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40
borough councils, by whom they were assisted financially. Two of the Council's former
hospitals provided ante- and post-natal facilities for metropolitan borough councils by
agreement but without payment, and others provided dental services for expectant and
nursing mothers and children under five years of age, payment being made on a case
basis.
Ante- and post-natal clinics may be provided under Part II of the Act of 1946 by
hospitals for their own booked maternity patients, but in view of the ruling that a
service for healthy babies and a health visiting service can be provided only by a local
health authority either directly, or through a voluntary organisation on an agency basis,
consultations took place with representatives of the teaching hospitals and of the Metropolitan
Regional Hospital Boards about these services. It was pointed out during the
course of these consultations that it would be possible for a medical school to be regarded
as a voluntary body and to act as an agent of the Council in providing child welfare
services. It was found that 10 hospitals were providing only consultative clinics or clinics
for schoolchildren which were within their powers under Part II of the Act. Three child
welfare clinics were being held at hospitals under the jurisdiction of the Metropolitan
Regional Hospital Boards, but although the Council was willing to continue these, the
hospital management committees concerned decided to discontinue them and arrangements
were made for the children in attendance to be transferred to nearby Council
welfare centres. Child welfare clinics were being provided at five teaching hospitals,
one by agreement with the City of London on behalf of that authority. It was agreed
that the Council should continue the same arrangements as the City Corporation. At
one of the teaching hospitals it was agreed with the consent of all parties concerned that
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. At the
three remaining hospitals it was agreed that the medical schools would run the service
as voluntary organisations grant-aided by the Council. A similar arrangement was
subsequently made with the Institute of Obstetrics and Gynaecology for the provision
of child welfare services at Queen Charlotte's Hospital. Broadly speaking the arrangements
with these teaching hospitals is for the medical school to pay a rent agreed by
the Council to the hospital authorities for the use of the clinic premises. The medical
school also provide and pay for staff except health visitors. The Council reimburses the
medical school at the rate of 90 per cent. of approved net expenditure subject to the
payment by the Council of the full non-specialist rate for the services of the pædiatrician.
The other ten per cent. of the expenditure with the balance of any specialist rate paid
to medical staff is found by the medical school and is regarded as a fair return for the
teaching facilities which are enjoyed at the clinic. By mutual agreement, at one hospital
one health visitor is employed by the medical school and her salary is allowed to rank
for the purposes of the Council's grant. These arrangements have been working very
satisfactorily since their inception and are shortly to be confirmed by agreements between
the Council and the medical school. The Council's health visitors attend the hospital
child welfare clinics where they work to the paediatrician in charge, but they remain
under the direction of the Council's divisional medical officer for their work outside
the clinic.
All the Council's duties under section 25 of the National Health Service Act, 1946,
are carried out on its behalf by voluntary organisations. There are 24 district nursing
associations, the Ranyard Nurses, the Nursing Sisters of St. John the Divine and the
Catholic Nursing Institute, their work being co-ordinated by another voluntary body,
the Central Council for District Nursing in London. All these organisations are grantaided
by the Council (see page 73), but retain their independent and voluntary status.
The loan of equipment to patients being nursed at home has been undertaken on behalf
of the Council by the district nursing organisations and by the City of London and the
County of London Branches of the British Red Cross Society, which are grant-aided
by the Council (see page 73).