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65
CO-ORDINATION OF SERVICES.
The necessary co-ordination of services was insured in 1928
by an arrangement which worked well. The Medical Officer
of Health for the District was one of two School Medical
Inspectors in the area. In February the arrangements of the
nursing services were altered. Up to that time the school
work for the Essex County Council was performed by the school
nurses, while the nurses' duties under the Maternity and Child
Welfare Act were performed by the Health Visitors of the Local
Council. This arrangement was changed to one by which the
same nurses acted both as school and child welfare nurses for
a smaller area, an important consideration when dealing with
a district growing as rapidly as this, and one in which changes
are frequent. It was therefore with regret that it was learned
that the Essex Education Committee proposed, from April
1st, 1929, to resume the previous arrangement, appointing their
own staff for the school work, while the Local Authority
employed whole time their own officers.
The following is an extract from a report submitted at
the end of 1928 to the County School Medical Officer:
" Since February the four Dagenham Urban District
Health Visitors have given three sessions per week to
school work for the County Council, being in total just
over the services of one full time school nurse.
Understaffing in this connection is apparent when it
is realized that since July in the schools of the district
there has been more time given by doctors than by nurses.
It is most regrettable that this combined arrangement of
the nursing services is shortly to be terminated, more
particularly in a district of this nature, one growing so
rapidly and in which is occurring to a certain degree, transfers
on the Estate and returns to London. One nurse dealing
with all the services for a small area would be long enough
in getting to know the inhabitants. To have separate nurses
for the School, Tuberculosis and Child Welfare services
with consequently larger areas for each individual nurse
will certainly prevent any one of them acquiring a thorough
knowledge of the people for some considerable time. In this
district too, the children at present are of such an age that
in practically every house there are some of pre-school age
and children attending school. The duplication of visits
to these houses is a cause of irritation to the householders