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PREVENTION OF ILLNESS: CARE AND AFTER-CARE
Chiropody
In 1948 a total of 26 foot clinics were transferred to the Council under the National
Health Service Act, 1946. These had been established by the metropolitan borough councils
under section 227 of the Public Health (London) Act, 1936.
The Council proposed to continue the existing service and to augment it where necessary
in the light of experience. The Minister approved the continuation of the existing facilities
but did not feel able at that time (1948) to agree to any increase; although he said he would
be prepared to consider new proposals for extending the service in the light of any recommendations
which the Executive Council or the regional hospital boards might make.
Cope Committee—In May, 1949 the Minister of Health set up a series of eight committees
under the Chairmanship of Mr. V. Zachary Cope, M.D., M.S., F.R.C.S., to consider the
supply and demand, training and qualifications of certain medical auxiliaries employed in
the National Health Service. I had the honour to be appointed a member of the
committee on chiropodists.
The committees invited evidence from interested parties and in its evidence to the chiropody
committee the Council pointed out that chiropody was essentially a preventive service;
that experience had shown that it had done, and could do, much to prevent the development
of serious foot trouble and ill-health arising therefrom; that since the services of
medical staff were not needed at foot clinics there appeared to be no justification for regarding
them as coming within the province of either the hospital and specialist services or the
general medical service; and moreover, that the hospitals were not always conveniently
situated and that most of them were already overcrowded. For these reasons the Council
expressed the opinion that the provision of foot clinics could properly be held to be a
function of the local health authority which, under section 28 of the National Health
Service Act, 1946, is empowered to make arrangements for the prevention of illness.
In their report (April, 1951) the Committee recommended (inter alia) that:
'Local Authorities should be enabled to provide chiropody in the National Health
Service, possibly in the exercise of their powers under section 28 of the National Health
Service Act, 1946.'
Negotiations for the expansion of the service—In the circumstances then prevailing the
Minister was unable to adopt the recommendations of the Cope Committee, nor did he feel
able to approve the provision of additional facilities for chiropody. The lack of facilities
in certain areas of the county, e.g., in East and South-West London was, however, brought
to the attention of the Minister. He was asked to permit some extension of the existing
facilities with a view to mitigating the hardship experienced in certain parts of London, but
in the financial circumstances at that time he felt unable to authorise any extension of the
service. An expansion by 40 sessions a week for the benefit solely of the priority classes
(expectant and nursing mothers and the elderly) was, however, approved as a result of a
discussion between a deputation from the Council and the Parliamentary Secretary on
28 March, 1952. This small increase allowed an expansion from 425 to 465 chiropody
sessions a week (sessions are calculated on the number of chiropodists working at a clinic,
e.g., two chiropodists working together at one session equal two chiropody sessions).
The pressure on the facilities for foot treatment continued to grow and at the end of
1953 it was estimated that to meet all reasonable needs an increase in the level of the service
of some 112 per cent, would be required.
Further approaches were made to the Minister of Health in 1954 and 1956 for approval
to an expansion in the service, stress being laid on the following points:
(i) The existing service was inadequate to meet the demand.
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