View report page

103
APPENDIX G. 26th January, 1938.
FEES PAYABLE TO DOCTORS CALLED IN TO MIDWIFERY EMERGENCIES
OTHERWISE THAN BY MIDWIVES.
REPORT OF THE MEDICAL OFFICER OF HEALTH.
As instructed by the Hospital Visiting Sub-Committee at its meeting on the 29th December,
1937, I beg to report on the above matter.
Where a doctor is called in to see a woman in pregnancy or during labour or afterwards by a
midwife, fees are paid by the Willesden Borough Council in accordance with the scale of fees prescribed
by the Minister of Health (herewith).
Apart from the cases in which a doctor is called in by a midwife, a doctor would be called in in
the following circumstances:—
(a) Where a pregnant woman or a woman in labour or during the puerperium has made no
arrangements whatsoever for her care and where an emergency arises.
(b) Where a pregnant woman or a woman in labour or during the puerperium has made
arrangements for her care but for some reason or other these arrangements are not
available.
Section 177 (1) of the Public Health Act, 1936, states:—
"A local authority may, with the approval of the Minister, provide a temporary supply
of medicine and medical assistance for the poorer inhabitants of their district."
Section 204 (1) of the Public Health Act, 1936, states:—
"A welfare authority may, subject to the general approval of the Minister, make
arrangements for the care of expectant and nursing mothers and of children who have not
attained the age of five years and are not being educated in schools recognised by the Board
of Education:
Provided that nothing in this section shall authorise the establishment by such an
authority of a general domiciliary service by medical practitioners."
M.C.W.4, page 16, No. (4), states that grants are available for
"The provision, for necessitous women, of a doctor for illness connected with pregnancy
and for aid during the period of confinement for mother and child."
Paragraph 5 of Circular 1072 of the Ministry of Health dated 12th February, 1930, states:—
"The authority for other services commonly provided as part of the arrangements for
Maternity and Child Welfare, such for instance as health visiting, a midwifery service,
maternity nursing and nursing for expectant mothers and young children, home helps, day
nurseries, and the supply of milk or meals, must be found in Section 1 of the Act of 1918,
and the Minister is advised that his sanction will still be necessary to the provision of any
of these services. But in all cases in which any one of these services has already been provided
by a Local Authority with his approval, he hereby sanctions the extension of that service
to such an extent, and in such a manner, as the Authority think desirable."
I would recommend that the scale of fees prescribed by the Minister for medical practitioners
called in by midwives be adopted for the payment of doctors called in as above.
GEORGE F. BUCHAN,
Medical Officer of Health.
Observations of the Town Clerk.
I have considered the matter raised in your memorandum of the 5th January and I append my
observations for incorporation in the report to the Hospital Visiting Sub-Committee:—
"The above quoted Section 204 (1) of the Public Health Act, 1936, undoubtedly confers
wide powers, and such authority as there may be for making provision in the circumstances
contemplated in the report of the Medical Officer of Health seems to me to be contained
therein. I know of no other enactment under which the case could be met.
The Section lays down an important qualification precluding the establishment of a
general domiciliary service by Medical Practitioners but regrettablv no definition is given
either in the Public Health Act or elsewhere as to what constitutes such a service. While
I am of opinion that the Section would cover the payment by the Council of a Doctor's fee
where a woman is unable to take advantage of arrangements made in advance of the confinement,
it would not, in my view, be in accordance with the Act to undertake a similar payment
where the patient has failed to make any arrangements whatsoever. In either event I would
advise that the Minister's approval be sought before the proposed scheme is operated."
E. A. PRATT,
Town Clerk.