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7
satisfactory arrangement for group teaching would need to be made.
One alternative to the continuation of a local authority clinic is something
on the same lines provided by the family doctors who could be
helped by the health visitors. Even though the time comes that the
family doctor has sufficient time to be able to do this, it is unlikely that
all would wish to. In that case it would be necessary for some organisation
to arrange the sessions on the lines of to-day's clinics to meet the
needs of the mothers who attend those doctors, that is, until there are
sufficient health visitors to enable full home visiting once more to be
undertaken. It would seem then that just as the school health service can
be shorn of many of the treatment arrangements, many of the existing
maternity and child welfare arrangements can come to an end; but, just as
the periodic observation of school children is essential, so are the services
of the health visitors to the mothers. So far then from the position being
that once an authority establishes a service it should continue to provide
it, it is rather that authorities should constantly have in mind,
particularly in times of change, the possibility that the objectives of the
service have been achieved, and that so far as the authority is concerned,
these services can then be curtailed. If this were done, it would leave
the authorities free to undertake fresh responsibilities in other fields,
undertakings which they might be able to take on without increased cost
and without the necessity of recruiting additional staff because they have
reduced their commitments in other fields.
The preventive services are being reproached for having done so
little against the very important groups of diseases, the cardio-vascular
complaints, cancer and peptic ulcer. There is now so very much less
need than formerly to concentrate on the teaching of mothercraft and
on the control of infectious diseases—but, a steadily growing need to
study the conditions leading to psychotic disorders and to helping the
unwanted and the neglected. From the time that local authorities were
virtually forced into the field of curative medicine, the boundaries between
preventive and curative medicine have become blurred. Local authorities
are responsible not only for environmental but also for personal services.
These cannot tidily be allocated to the various types of authority, environmental
to the minor and the personal to the major, if only because of
the extent to which the health of a family is bound up with its housing.
Perhaps the most urgent step is for an appreciation by those in each of
the branches dealing with patients of the services of the others and for
an understanding between those of the public health service, general
practitioners and hospital staffs. Only by the closest working of those
in these various branches can patients be helped to obtain full benefit
of the services available to them.
The question of what further powers might be delegated to district
councils by the County Council was at the end of the year to be discussed
by representatives of the County Council and of the district councils. In
connection with the arrangements for carrying out those of the Part III
services which the County Council could delegate to district councils, the
following report was submitted to the Public Health Committee: