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securing that comprehensive facilities for free medical treatment are available to its pupils
either under this Act or otherwise'. Guiding principles on the specialist work carried out
at local education authority clinics were laid down in Circular 179 issued by the Minister
of Education and after discussions with the Boards it was agreed that responsibility for
the provision of specialists at rheumatism, ear, nose and throat, vision and orthoptic
clinics lay with the Metropolitan Regional Hospital Boards, while the Council remained
wholly responsible for the minor ailment, audiology, special investigation, nutrition
and dental clinics. Circular 179 suggested that the Regional Hospital Boards should
plan the future organisation and development of services for school-pupils in consultation
and agreement with local education authorities, but, in fact, the final word on any
growth of the specialist side of the school health service would appear to lie with the
Regional Hospital Boards.
In the 1953 report reference was made to the fact that in the area of one of the four
Regional Hospital Boards which serve London, the Council had been endeavouring to
secure extra vision sessions, to meet the increased demands which had arisen as the school
population had increased. For financial reasons, however, the Board had not been able
to accede to these requests, though approving in principle the provision of additional
sessions.
In June, 1954, the Council approved the direct employment by the Council of
ophthalmologists, temporarily, to deal with waiting lists of about 5,000 cases, without
prejudice to the principle that the provision of this service was the responsibility of the
Board. In July, the attention of the Minister of Health was drawn, both by letter and
by deputation, to the unsatisfactory position which had led the Council to make this
decision. In October the Council was informed that, though the Board had agreed in
principle to the need for an increase in this service, the Board felt unable to accept any
additional financial commitments.
In June the Minister of Education had been asked to approve the Council's proposed
expenditure on the employment of ophthalmologists. In December, 1954, the Council
was informed that the Minister of Education had consulted the Minister of Health who
agreed that the arrears might be dealt with under the supplementary ophthalmic services.
This decision of the Ministers implies that the Minister of Health accepts the Council's
contention that the provision of vision treatment for school pupils is the responsibility
of the National Health Service and not of the local education authority. However, the
Minister apparently prefers not to direct a Regional Hospital Board on the details of its
expenditure on specialist services, and accordingly has decided to meet the additional
expenditure through the Supplementary Ophthalmic Services provided under Part IV
of the National Health Service Act, 1946.
From the point of view of the welfare of the school pupils it is immaterial whether
their glasses are obtained under Part II or Part IV of the National Health Service Act,
1946, so long as they can be obtained without delay. However, from the point of view
of the practical implementation of the expedient that the Minister has devised, a
wide range of administrative complexities necessarily arise at the clinics. 'Normal'
sessions remain the responsibility of the Hospital Eye Service, so that the Ophthalmologist
is remunerated by the Regional Hospital Board, prescriptions are on white form H.E.S.I,
and the optician is paid by the local Hospital Management Committee. The 'extra'
sessions (held at the same clinic, with the same staff) come under the supplementary
service, so that the Ophthalmologist is remunerated by the Council, prescriptions are on
green form O.S.C.2, and the optician is paid by the Executive Council. Little wonder
that all concerned, staff, parents, opticians, teachers and care committee workers are
bewildered.
Moreover, it will be noticed that there is, as yet, no final solution of this problem
of obtaining extra sessions for school pupils, though the school roll continues to rise
and will reach its peak in about 1958-59.
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