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The Council has introduced a change in procedure to meet the requests from hospital
obstetricians and general practitioners for social reports on women who seek a hospital
bed but have no medical priority for admission. The visit to assess the suitability or otherwise
of the home for domiciliary confinement is now carried out by domiciliary midwives
and not health visiting staff, where this was not already the practice, although of
course there is close consultation between the midwife and the health visitor who knows
the home. The midwives thus have the opportunity to encourage suitable women to accept
home confinement and this makes a further contribution to relieving the pressure on
hospital maternity units. A very much simplified form of request has been introduced for
a home assessment visit for early discharge schemes and where a maternity bed is sought
on social grounds, incorporating the domiciliary midwife's report. This new form, by
the use of carbon copies, reduces to a minimum the clerical work involved in requesting
and providing these reports.
It is as yet too early to make any assessment of the likely success of the steps that are
being taken to implement the Ministry's proposals. They are being watched very closely
and adjustments made as necessary in the light of experience. However the number of
maternity cases referred to the Emergency Bed Service has been very considerably reduced:
Emergency Bed Service monthly totals
Month 1963 1964
January 156 189
February 186 137
March 318 186
April 230 156
May 234 189
June 294 164
July 200 190
August 225 116
September 179 130
October 138 98
November 153 63
December 133 74
Total 2,446 1,662
Co-operation with hospital and general practitioner services
The Council has placed particular emphasis on co-operation with the other branches
of the health service; a strong link has been forged between the maternity and child
welfare service and the hospital maternity and paediatric departments, with interchange
of staff in some areas, and with the general practitioner service. One unique partnership
is with the Institute of Child Health of the University of London at the Province of Natal
centre. This centre, opened in 1955, provides a wide range of maternity and child welfare
and school health services for the neighbourhood and also provides facilities under the
direction of the Institute for post-graduate medical teaching and research. The cost of
the centre site, the building and its initial equipment was met out of moneys given during
the war by the people of Natal, South Africa to the Gift to Britain scheme, supplemented
(for the purposes of the Institute's reference library and laboratory) by the University
Grants Committee.
Co-operation with general practitioners—Representatives of the Local Medical Committee
and of the London Executive Council serve on the Council's central Health Committee
and the Local Medical Committee is represented also on each of the nine divisional
Health Committees. The Council nominates eight members of the London Executive
Council and the County Medical Officer of Health is a member of the London Medical
Committee. At field level, co-operation is seen as a matter of mutual understanding and
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