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that when the time came it should be possible for the Council to offer facilities for screening
women attending the Council's ante and post-natal clinics and family planning clinics.
In addition, the Council could start ad hoc screening clinics if the numbers justified it.
The screening could be carried out by the Council's full-time and sessional medical officers
but this would be done only at the request or with the agreement of the patient's general
practitioner. General practitioners could also be offered facilities for holding ad hoc clinics
in the Council's premises. At certain centres patients attending the ante-natal clinic are
seen by their booked general practitioner obstetrician and he, too, with the agreement of
the patient's own doctor, could carry out screening tests at the centre.
Whatever arrangements were made for the taking of smears in the Council's centres,
the Council would need to provide supporting nursing and clerical staff to assist the doctor,
keep the appropriate records, send specimens to the laboratory and distribute reports
from the laboratory on the test results. The Council's staff (health visitors and others)
would have an important part to play in educating women to accept screening (particularly
women in Social Classes IV and V). The actual arrangements would be agreed locally in
the light of local needs and circumstances, but subject always to observance of the principle
that smears should be taken only with the agreement of the patient's general practitioner,
who would be given every opportunity, if he so wished, to convey the results of the test
to the patient and who would always do this if the result were positive or showed the need
for further investigation. The Local Medical Committee approved of these proposals,
suggesting that when facilities for cytological examinations became available there should
be local discussion between the local health authority, the hospital laboratory and the
general practitioners in the area.
So far in London four small pilot schemes are in operation (one started early in 1963
and three during 1964). In division 1 smears are taken from women attending a family
planning clinic aged 35 and over, selected women aged 30 and over and some women who
are taking oral contraceptives. In division 4 smears are taken from women attending a
family planning clinic and who have been recommended to use oral contraceptives; in
division 6 from all post-natal cases attending three clinics regardless of age and in division 9
from women referred to one clinic by general practitioners who have been advised that this
facility is available.
Maternity beds
Although in London over 80 per cent. of births take place in hospital, the maternity
bed situation has been a source of continual anxiety for many years. Maternity liaison
committees have tried to improve local arrangements to ensure a planned selection of
mothers for hospital confinement, but in the north-west parts of the county in particular
for some years it has not been possible to book a hospital maternity bed for all the women
who need hospital delivery on grounds of age, parity or social conditions, if such women
attend for ante-natal care for the first time during the second half of pregnancy. Many
such women are older multipare or immigrants, temporary residents or unmarried mothers
with accommodation more often than not in lodgings or boarding houses. To help them,
a general practitioner is asked to undertake the ante-natal care and, if no bed can be found
during the pregnancy, to visit, when labour starts, to arrange for hospital admission through
the Emergency Bed Service.
In June 1963, a deputation from the Council informed the Minister of Health that
three per cent. of women in London who need maternity beds had to be admitted in labour
through the Emergency Bed Service. Most of these women were not emergency cases,
for it was known during pregnancy that a hospital bed would be needed but one could not
be booked. Nor was it a case of shortage of beds, because when the women went into
labour a bed was found for them. The Minister said the problem in London appeared to
be one of maldistribution of beds and he undertook to try to improve the situation. The
result was the issue of a circular (780) by the Chief Medical Officer proposing:
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