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Is the intention of the doctor being achieved by the nurse or just an approximation of it?
Does the doctor (or patient? or administrator?) make decisions with the benefit of all
information, including the influences of and repercussions on related people as well as quantifiable
data?
Is the whole Health Service system in constant touch with the community it serves, giving
leadership where appropriate, but equally receptive of that community's views? The new Community
Health Councils proposed for the Health Service are designed to achieve this and the greatest
vigilance and care must go into ensuring that they attract into their membership those most able to
voice true community views and voice them vigorously. The Councils themselves must be
constantly self-aware in representing the "man in the street" rather than unrealistic and noisy
sectional interests. It is a challenging and potentially rewarding concept — if it works.
In 1971 Waltham Forest made a number of advances concerning communications in the
Health system.
Undoubtedly the great leap forward the Council has taken in starting work on three major
Health Centres is progress indeed. These buildings do not change people, either doctors or
patients, and to expect them to do so is misguided. It is sad that the fact that they have not done
so is at times given as evidence against their value. What they do do, besides often providing
better facilities, is enormously to shorten the lines of communication between all who work there.
Experience teaches that sooner or later the new links are used, found to be of great assistance,
and used again. So success breeds confidence and confidence between colleagues musters all the
skills available in the service of the patients, in a new quality of care.
In Waltham Forest we have in respect of the building of further health centres not only an
incentive but a goad. Young doctors qualifying now have a new concept of what Family Doctoring
is all about, derived from the new techniques advance has made available to us, and there is
really no prospect of them coming to some of the practices in the south of the borough in particular,
when vacancies are occurring in so many places which are in more attractive areas to live. In these
circumstances every effort must be made to get modern health centres built as soon as possible;
the Authority should in my view bend to the limit to meet the fears and anxieties of doctors in the
area in this respect. Many of the objections they have to taking this step are neither fantasy nor
old fashioned reaction to change (though some are!) but honest reasoning based on distances of
travel and money spent on their present premises. The danger of family Health Services spiralling
downward in quality in these parts of the borough may not be imminent for a few years, but neither
can all the Health Centres be built overnight, and action now is necessary to protect the
population and doctors of this area from crisis in the foreseeable future.
These are other aspects of communication which give satisfaction.
The big advance in attachment of Health Visitors and District Nurses to group practices has
been an achievement, greatly reducing the number of professional relationships each has to make
with consequent increase in quality and use of those remaining. All is not gain, for the good in a
Health Visitor feeling responsible for a district is lost, but the gain in quantity of work done is
easy to measure while the work is altogether vitalised by the rapport between doctor and nurse and
by each with their colleagues. She gains a sense of responsibility for the patients on that doctor's
list as well as keeping an eye on some not registered with a doctor locally.
The new links with hospitals referred to in Miss Pittom's report and refashioning of the old
ones are other evidence of progress and all these things are steps in the process of unifying the
Health Services which has been going on for years but which is soon to be accelerated by the
administrative reorganisation.
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