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officers of the Council in deputation. The reasons for the Council's concern were put to
the Minister, who accepted that he had direct responsibility to produce measures which
would improve the maternity bed situation. Following this meeting, on the instruction of
the Ministry of Health, the metropolitan regional hospital boards prepared schemes for
catchment areas for maternity beds. These were still under discussion at the end of the year.
Representative bodies will be set up to co-ordinate administrative and executive action; to
agree and to keep under review the procedure needed to secure that maternity beds serving
these areas meet their needs both for ante-natal treatment and confinement and, possibly,
to suggest minor expedients that could improve the availability of beds. It was agreed that
the Council should be represented by the appropriate divisional medical officers and the
non-medical supervisor of the midwives (supported where necessary by the divisional
nursing officer).
Schemes for early discharge of mothers from maternity hospitals
As a means of making greater use of hospital maternity beds, the Council continued to
co-operate with the hospitals in arranging early discharge schemes for maternity patients
discharged 48 hours after confinement. During 1963 a further seven schemes were agreed
with hospitals, six of them in south London. At the end of the year 16 schemes were in
operation. In addition, some hospitals having their own district practice discharged
patients delivered in hospital to the care of their district midwives. Following early
discharge, 2,810 patients who were delivered in hospital were nursed at home by
domiciliary midwives. This was an increase of about 28 percent on the previous year
(2,187 cases).
Co-operation with hospital and general practitioner services
Since 1950 there has been a working arrangement in London for hospital almoners to
contact divisional staff about the needs of patients before discharge from hospital. Generally
the liaison so established has proved most effective but in view of the length of time since
inception, a review was undertaken in March of all the arrangements for the provision of
personal health services for persons needing them on discharge from hospital. Teaching
hospital authorities and the four metropolitan regional hospital boards indicated that the
existing arrangements were satisfactory. There has been no rigid pattern for securing local
health services for discharged patients and hospital authorities were told that there was no
wish to impose one, but steps had been taken to foster a good relationship by disseminating
information about the Council's services and by holding local meetings between almoners,
the Council's officers and those of other services concerned. The opportunity was taken,
through the London Local Medical Committee, to ask again for the continued assistance
of general practitioners in alerting divisional services in any case which might come to their
knowledge in which it appears that a local health authority service needed by the patient
is not being provided.
This review coincided with the receipt of Ministry of Health Circular 3/63 and indicated
that the suggestions made in the circular and memorandum which accompanied it were
now being fully met. No action was taken, however, on the suggestion in the Circular that
officers should be designated by the Council for mobilising the community services; it was
considered preferable for almoners to continue to approach their well-known contacts
when services were required for a patient about to be discharged. Hospital authorities, and
through them the almoners, have been told that whoever they approach in the Council's
health service will arrange for all local health services needed to be provided.
Prevention of break up of families
The work in this field continued to expand. In October authority was given to increase
the establishment of family case-workers by six to 21; this enabled every division to have a
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