View report page

Circular 11/59—On 21 April, 1959 the Minister issued a circular (11/59), stating that he
was prepared to approve proposals by local health authorities who wished to establish or
extend a chiropody service and reminding them that under the Local Government Act,
1958 his approval was no longer required to contributions by local health authorities to
the funds of voluntary organisations providing chiropody services.
The following addition to the Council's proposals under the National Health Service
Act was then submitted to the Minister and received his approval:
' The Council proposes to extend its chiropody service as may be necessary, priority
being given to the needs of old people, of the physically handicapped and of expectant
mothers. The service will be provided at foot clinics established by the Council and/or
at surgeries of private chiropodists, by means of a domiciliary service and/or by utilising
on a grant-aided basis the services of approved voluntary organisations.'
In recommending the adoption of this proposal the Health Committee stated that it
was not then proposed to start a domiciliary service or to use the surgeries of private
chiropodists, but that they thought it desirable that the amended proposal should provide
for the Council to be able to do so.
Detailed enquiries disclosed that it was not possible to estimate the total number of
persons in the priority groups who were likely to require chiropody treatment, but as a
first step the Council decided in July, 1959 to authorise an additional 100 sessions a week.
So far as old people were concerned, a survey carried out by the National Corporation for
the Care of Old People indicated that 20 per cent. of those over retirement age required
an average of six treatments a year. On this basis some 94,000 old people in the county
would require 564,000 treatments a year. Additional facilities would be needed to serve
expectant mothers and the physically handicapped; no estimate of the numbers in these
two groups was available but it was thought to be relatively small. With the 100 additional
sessions approved in July, approximately 213,000 treatments a year were available at the
Council's clinics for all classes (134,000 for old people and 79,000 for other age groups).
In addition, voluntary organisations provided some 82,000 treatments a year, mainly for
old people.
To meet in full the estimate of 564,000 treatments a year for old people would have meant
that the combined facilities provided by the Council and by the voluntary organisations
would have had to be more than doubled. Apart from the difficulty of obtaining sufficient
chiropodists, an expansion to this level was impracticable on financial grounds. It was
therefore decided that the Council's service should be extended by another 100 sessions a
week from 1 April, 1960 and the position reviewed at the end of a year's working.
Voluntary organisations—The voluntary associations providing a chiropody service are
(with the exception of the Deptford Central Mission which provides a service for the physically
handicapped) concerned solely with the welfare of old people. Their funds are derived
from a variety of sources but (until March, 1960) came mainly from grants made by the
metropolitan borough councils under section 31 of the National Assistance Act, 1948.
Some of the organisations received a grant during the three years ended 31 March, 1959
from the National Corporation for the Care of Old People, in order that they could extend
their chiropody services. It was agreed with the Metropolitan Boroughs' Standing Joint
Committee that the Council should accept responsibility, as from 1 April, 1960, for grants
to the voluntary organisations in respect of their chiropody services and that consideration
would be given to the need to make grants for 1959/60 in lieu of any lost income (e.g. from
National Corporation for the Care of Old People) which was used to cover expenditure
on chiropody. After consideration of the accounts of the voluntary organisations the
Council made grants totalling £1,300 to seven organisations in respect of the year 1959/60.
On the basis of estimates submitted by the voluntary organisations it was calculated that to
maintain the service at its existing level grants totalling some £12,000 would be necessary
for the year 1960/61. The payment of grants was made subject to the conditions that:
80