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have her confinement at home, attended either by a midwife working on her own,
or by a midwife and family doctor acting together; if her family doctor does not do
midwifery he should refer her to a colleague who does; or if her circumstances
demand it to refer her to a hospital for her ante-natal care and confinement. It
the patient reports in the first instance to some other place like the ante-natal
clinic or a hospital, she should be referred to her family doctor.
It was clear that the ante-natal clinic can provide many services not very
easily provided in a doctor's surgery, as, for example, group teaching about the
mother's health; teaching by special aids, such as projector, models and apparatus;
by midwives and health visitors devoting special sessions to the teaching of health;
and by supplementing these by talks with the clinic medical officer. The clinics
can also provide vitamins and food supplements of various kinds; and education
on infant welfare.
So at the conference it was agreed that when a family doctor refers a patient
to a local authority clinic he should indicate whether he has booked the case;
whether he wishes the patient to receive the facilities provided by the local authority;
and whether he wishes the clinic to provide the medical ante-natal care in addition.
We also made up a list of medical items which should be carried out when
doing the ante-natal routine of expectant mothers wherever held. We tried to make
it clear as to the work which has to be done by the hospital ante-natal clinics, the
local authority ante-natal clinics, the family doctor, and the midwife, so that each
would know what was expected of them.
Each branch of the maternity service had to make arrangements for its own
follow-up. We hoped that if everybody understood these principles it would get
rid of overlapping and confusion and make far smoother and less costlier working
and save time for the patients and everybody else. For instance, women patients
were constantly grumbling about being compelled to go long distances for hospital
ante-natal examinations which they could get just as well and under more comfortable
circumstances in their local clinics. We managed to fix up an ante-natal
session at Ashford clinic done by the hospital doctors, so saving the women from
Ashford the long journey to the West Middlesex hospital.
These liaison arrangements are a long way off working perfectly yet. But
slowly the doctors are realising they have everything to gain for themselves and
their patients by co-operation. But we shall never have the perfect scheme until
the three branches of the health service are united.
HEALTH VISITING TOPICS
By Miss G. M. Francis, Area Superintendent Health Visitor
Making the Best Use of Resources
The report of a working party enquiring into Health visiting published during
the year, emphasised the acute shortage of health visitors and the increasing scope
of their work. It said that if they are to make the fullest use of their opportunities
to prevent mental and physical ill-health their case-load must be reduced. Since
1948 the National Health Service Act has placed additional functions and responsibilities
on health visitors, such as care and after-care for the adult population,
especially the elderly. In 1956 there was a real shortage of health visitors even when
reckoned according to requirements before the new Act came into operation.
In an effort to overcome this and leave health visitors as much time as possible
to do work which requires their special training and experience, state registered
nurses have been engaged, and now form a valuable section of the health
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