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In my report for 1957 reference was made to the link with the hospital service which had
already been established at the Bexley and Cane Hill hospitals, and to the intention to
try to extend this to other distant mental hospitals which serve London. There have
as yet been no formal arrangements through joint committees with the hospital and general
practitioner services, but preliminary meetings have established a general understanding of
the lines along which it is hoped to develop liaison between all three branches of the health
service. As hospital schemes for the provision of day hospitals are gradually extended,
consideration will be given by the Council to provision of the services of psychiatric social
workers and occupational therapists at these hospitals.
Relationship with the health visiting service—In some spheres of public health, such as
the tuberculosis service, the social worker/health visitor relationship has long been firmly
established. Although the functions of the tuberculosis care organiser and the health visitor
are not clearly demarcated and at times inevitably must overlap, recognition of the place
of each in a common service to the tuberculous patient and his family is understood and
accepted by social worker and health visitor alike.
In other spheres (such as the mental health service, which has been almost exclusively
the province of the social worker) new relationships must be developed. Already, through
the case conference groups set up since 1954, psychiatric social workers and health visitors
meet regularly for discussions, and consultants in child psychiatry now call with confidence
for reports from visitors who have been members of such a group. The health
visitor is frequently the first to know of the subnormal baby in a family and therefore
introduce the mental welfare worker into the home, or bring mother and baby to the
special clinic where she and the mental welfare officer meet. The school nurse must be
increasingly alive to the ill effects on young children which may arise from the presence in
the home of a mentally ill parent. Both health visitor and school nurse must be alert to
detect early signs, such as behaviour disturbances in children, which might indicate a
failure of adjustment of the parent or mental cruelty to the child. In such a case she would
discuss the situation with the psychiatric social worker or mental welfare officer. It is
likely that the changes in organisation proposed in the mental health services in London
will provide further scope for integration.
The health visiting service is not of course directly concerned in the control of venereal
disease and takes no part in London in tracing contacts of these diseases, except in those
cases where the patient, as an expectant mother, is already visited by the health visitor.
In April, 1959 the Minister informed local authorities of his concern at the increasing
incidence of gonorrhoea and reference was made in Circular 6/59 to the value of publicity
and health education. The health visitor may be called upon in London to give talks on
venereal diseases to mothercraft classes and parent associations. Opportunities can be
taken to answer questions on this subject in discussion groups on sex education in schools.
It must be remembered too that with the cessation of National Service in the near future,
a valuable opportunity for health education of young men may be lost and ways should
be found to fill this gap.
The social worker has not been introduced into the general field of public health in
London during the last few years in order to replace the health visitor, who is and must
remain the key figure in the care of mothers and children, but to give a complementary
service. It is the health visitor who is best placed to recognise the medical and social needs
of the families and to initiate action when necessary. No single worker or single service
can however take over all aspects of the more difficult problem family, for personnel
from both statutory and voluntary services may necessarily be involved. One of the functions
of the co-ordinating committees is to prevent avoidable overlapping in such cases
and, when a family requires extra help for their profound social need, to bring in a social
worker to give support to the family and to relieve the health visitor of some of her burden.
It is clear that in London in the public health field the foundations for partnership
between health visitors and social workers have already been laid and that we can look
forward to the future with confidence.
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