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(a) that groups of beds should be assigned to the service of areas defined by the
Metropolitan Regional Hospital Boards in consultation with Boards of Governors of
Teaching Hospitals, Local Health Authorities, Executive Councils and Local Medical
Committees concerned;
(b) that in each area so defined the Hospital Board should take the initiative in setting
up a body representative of those authorities to agree and keep under review the procedures
needed to secure that maternity beds serving the area meet its needs;
(c) that it should be the responsibility of the hospital to which any expectant mother
from the area served by its group applies, or is referred, to make a firm booking (if a
hospital delivery is indicated on medical or social grounds) either in its own hospital
or another hospital in the group or in another group.
In response to the Ministry's circular, the four metropolitan regional hospital boards
set up area committees (on which serve the Council's divisional medical officers and nonmedical
supervisors of midwives) to agree and keep under review the prodecures and to
secure that maternity beds serving the area meet its needs. These committees made recommendations
to the Boards on proposed schemes for maternity catchment areas and the
Council's officers were active in seeking improvements to the draft schemes where necessary.
The four Boards subsequently provided details of the catchment area schemes which the
individual hospitals had been asked to introduce from 1 May 1964, with the object that as
bookings proceeded in the natural course of events the schemes would become fully
operative by 1 October 1964.
For its part and as a means of making greater use of hospital maternity beds, the Council
has taken the initiative and offered to every hospital early discharge schemes for maternity
patients discharged 48 hours after confinement. At present (December 1964) there are
22 schemes in operation. The number in each metropolitan regional hospital board
area and the maximum number of patients agreed for maternity nursing at home per
month are:
No. of schemes Maximum discharges per month
M.R.H.B.
North West 6 68
North East 1 12
South West 5 52
South East 10 119
The early-discharged patients are nursed at home either by a part-time midwife specially
employed for the purpose, or by the whole-time midwife for the area, as may be arranged.
In addition to the schemes arranged by the Council, some hospitals having their own district
practice discharge patients delivered in their hospital to the care of their district midwives.
A considerable number of mothers return home early, other than under the agreed early
discharge schemes. Some are mothers whose babies were stillborn or died shortly after
birth; some, mothers who take their own discharge (often for domestic reasons) and other
mothers who return home under an arrangement made by their general practitioner with
the hospital. Until 1964 all these were nursed at home by a general nurse from the local
district nursing association. However, the view is now taken that every mother requiring
post-natal nursing should in her interests, and particularly in the interests of the neo-nate,
be attended by a practising midwife within the definition of Rule E.3 of the Central Midwives
Board. Accordingly, arrangements were made during the year to encourage sufficient
general nurses who were state certified midwives to notify their intention to practise as
midwives under Rule E.4 of the Board and to arrange for them to nurse any woman
returning home early other than under an agreed early discharge scheme. These nurses
receive an allowance of £10 a year.
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