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42
HEALTH SERVICE PREMISES
the continued shortages of certain building materials, especially steel, and the national
policy of restricting capital expenditure has not permitted the provision of specially
designed clinic buildings and day nurseries at the rate necessary to overcome the difficulties
inherent in maintaining some of the services in improvised accommodation in church
halls, rented and requisitioned premises. Attention was drawn to this difficulty in the
Annual Report of the medical officer of health for the year 1948, but since then steps
have been taken in many instances, as opportunity has arisen, to secure a more permanent
basis of tenure by acquiring leasehold or freehold interests or more satisfactory rental
arrangements. Nevertheless, the continuance of the service still has to depend to a
considerable extent on the continued availability of premises which provide only improvised
accommodation, often held on insecure tenancies.
The maintenance of the day nursery service presents the greatest difficulty in this
respect, and the tendency has been that nursery premises have to be relinquished faster
than replacements can be provided. The continuation of requisitioning powers to
December, 1955, and the strict application of a priority system for admission to day
nurseries has so far postponed a serious crisis in this service, but the occupation of day
nursery premises under requisitioning powers remains a serious potential danger to the
future of this service unless requisitioning powers are to be further extended in time, or
considerable capital expenditure is to be incurred in the near future on the acquisition
of premises or the building of replacement nurseries.
It appears likely that the building of comprehensive health centres will not take place
for many years in sufficient numbers to provide the much needed improvements to the
standards of the maternity and child welfare clinic accommodation, especially by the
replacement of church halls, or to provide new clinics on housing estates. Although
these improvements should not be deferred until health centres can be built, it would
be inappropriate to build maternity and child welfare clinics on the old pattern which
could not be incorporated into health centres in due course. Accordingly, where there
is an urgent need for a new clinic and a suitable site can be obtained for a health centre,
plans will be prepared to erect a maternity and child welfare centre as a first instalment
of a health centre. In suitable cases opportunity will be taken of incorporating some, or
all, of the school health services required for the area in the new clinic, so that fuller
integration of the two services can be achieved. The design of maternity and child welfare
centres, and combined maternity and child welfare and school health centres, is now on
the basis of multiple use of rooms for various purposes at various times. This effects
substantial economies in the space required and consequently the land and capital
expenditure needed.
The areas served by the various centres are now more clearly defined and are adjusted
if necessary when new centres are established to meet local demands due to increased
population, erection of housing estates, etc. Every endeavour is made to ensure that no
mother has to travel more than one mile to her nearest child welfare centre. It is to the
advantage of mothers and children to attend the appropriate centre so that contact with
the health visitor of the area can be maintained, but complete freedom of choice is given
to mothers in this matter.
Building programmes
Further progress was made in the planning and building of new clinics and day nurseries
and the adaptation and improvement of existing premises. Restrictions on expenditure
and on the use of steel made it necessary, however, to modify some schemes and to
postpone others. Early in the year advice was received from the Minister of Health that
it was unlikely that it would be possible for steel authorisations to be given during the
year for schemes which had not already received a starting date. He also requested that
various schemes in hand should be revised with a view to avoiding the use of steel or
reducing the amount and spreading requirements over more than one quarterly period.