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facilities which the Council now offered for such pupils and the purpose of those
facilities, so that, with the parents' understanding assured, the chances of readjustment
of the children might be improved. At the same time there was set up in each education
division what became known as the 'Problem Case Conference' to co-ordinate the
Council's resources in the sphere of child psychology and to consider the treatment and
education of schoolchildren presenting special behaviour problems in relation to their
home circumstances and environment, and the care committee organisation was ideally
situated to play an important part in this new development.
Integration
of services
it had always been an advantage to the council that as the school health authority,
it was the local education authority with wide powers relating to both elementary
and secondary schools. In the ascertainment, diagnosis and treatment of the physical
and mental defects of schoolchildren it was unnecessary for the Council to decide
whether education or health, or both together, or the one to a greater extent than the
other, necessitated the making of different administrative arrangements. The National
Health Service Act, 1946, gave the Council the opportunity to integrate the work
being done with families through the school health service with the important
work with mothers and young children that had been developed and expanded over
the years by the maternity and child welfare authorities in London. Within a short
time after 5th July, 1948, plans had been made to merge the school nursing and health
visiting services and to bring about a closer association of the health visitor with the
voluntary school care committee workers in the care of schoolchildren. These measures,
the fact that the health visitor has now a new responsibility to be concerned with the
care and welfare of all members of the family no matter what their age or sex, and
the increasing co-operation and consultation taking place between the health visitor,
general medical practitioner and the voluntary and statutory agencies serving the
family, together with the expanded personal health services referred to below have
provided the means in London whereby family problems could be tackled more
effectively than had previously been possible. One result of this integration has been
that all workers in the health and welfare services found that from dealing with individuals
with problems they were increasingly being concerned with the problems of
families. Health visitors, for example, who are particularly well-placed to recognise
early symptoms of family break-down and likely neglect or ill-treatment of children,
found that they were spending more and more time with the difficult families and it
became important that this extra demand on their time should not divert them from
their main duties, which are to support the work done in the field of maternal and
infant mortality and child morbidity. By employing clinic nurses the health visitors
were relieved of some of the less specialised work in the maternity and child welfare
centres and in the schools, and the introduction of selective visiting allowed discretion
in the frequency of visits so that more time could be given to the families who needed
support by reducing the number of routine visits to those families whose standards
were satisfactory. Further redeployment of staff was combined with measures for
securing greater co-operation and co-ordination between departments of the Council
and the statutory and voluntary organisations concerned, and attention was paid to
the economic use of staff and the avoidance of overlapping and multiplicity of visiting.
Multiple
visiting
Until a few years ago the general picture of the services available to meet the needs
of all families, and of problem families in particular, was one of considerable diversity
and specialisation, with nearly as many types of worker as there are different aspects of
individual and family welfare. This situation arose out of the separate origins and
character of each of the services and of their piecemeal evolution. There grew up a
tradition of separately trained specialist workers (and organisations) owing allegiance
to professional or quasi-professional bodies exacting a high standard of ethical conduct
and qualifications and, whilst the need for specialist officers must be readily conceded,
there was an understandable tendency for the workers concerned to regard themselves
as separate groups. The boundaries of their activities however were not always clearly
defined and, in some cases, overlapped. In this general situation, overlapping duties
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