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through its domiciliary midwifery service. The majority of pupils reside with the
midwife during district training, but a few remain resident at their Part II training home.
Non-medical supervisors of midwifery attend, in turn, refresher courses for teachers
arranged by the Royal College of Midwives and the Association of non-medical
supervisors. Midwives have attended residential courses arranged by the College since
1948. In addition until 1957, the Council in conjunction with the County Councils of
Middlesex and Surrey held annual courses at the County Hall for all midwives who
notified their intention to practise. The Council has continued these lecture
demonstration courses for midwives in its own area.
The general shortage of midwives has not seriously affected the staffing of the
domiciliary service. Since 1948 accommodation has been offered to midwives and more
encouragement has been given them in the past few years to accept such accommodation
in order to give more elasticity to the service, as areas have now more frequently to be
changed owing to the decline in home confinements. A small district home was opened
in 1954 in North Islington in Council property staffed by a superintendent midwife
and four midwives with four pupil midwives. This has proved a most useful venture as it
gives newly qualified midwives experience in running district practice under supervision
before taking over an area of their own. A mileage allowance has always been paid to
midwives using their own cars. Some form of motorised transport for all midwives is
becoming more necessary because of the increasing load of equipment which midwives
must carry. The Council is helping to meet this need by the introduction in 1958 of a
loan scheme.
Dental services
The coming into force or the National Health Service Act in 1948 brought about
the transference of the Council's quite substantial maternity and child welfare dental
service (in hospitals) to the regional hospital boards. By the same Act the Council
absorbed the various dental services formerly run by the metropolitan borough councils
a proportion of which was for maternity and child welfare patients. The equivalent of
six whole-time dental officers on maternity and child welfare work was taken over.
The service given was about one eleventh of the then total dental effort (school
service and maternity and child welfare service) and, on the advice and with the agreement
of the two Ministries concerned, this proportion has been maintained to date.
Direct demand to the Council for treatment is met and it is known that, in addition, a
number of mothers seek treatment from general dental service sources, or elsewhere.
Health visiting
It has been the Council's policy to expand the functions of health visitors to cover the
whole range of duties envisaged in section 24 of the Act. Apart from the national
shortage of health visitors, development was handicapped by the statutory separation
in London, until 5 July, 1948, of the health visiting and school nursing services. This
resulted in the Council having in the service a large number of school nursing sisters,
who, lacking the qualification specified in the National Health Service (Qualification
of Health Visitors and Tuberculosis Visitors) Regulations, 1948, could not play their
part in the health visiting service. Since the Handicapped Pupils and School Health
Service Regulations, 1945, which required school nursing sisters to possess the health
visitor's certificate, came into force, efforts have been made to encourage existing school
nursing sisters to secure the qualification. Special intensive courses were arranged with
the approval of the Ministry and leave without pay granted in approved cases to those
wishing to take other courses of training to qualify as health visitors. The majority of
the school nursing sisters, however, were unable to secure the qualification as they are
not accepted, because of age, for the normal training courses.
Considerable progress has, nevertheless, been made in integrating the health visiting
and school nursing services and in extending the function of health visitors to cover the
care and welfare of the family as a whole and the process continues. Shortage of staff has
been met by redeployment, to ensure that the health visitor is able to use her special skills
to the greatest advantage, while selective visiting has enabled her to allocate more time