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to consider the general organisation of chest
clinics in relation to the rest of the hospital
services and to make recommendation
The Ministry of Health in a circular 27 68
forwarded a copy of the sub-committee s report
which had been endorsed by the Standing
Medical Advisory Committee and the Central
Health Services Council The report is commended
by the Minister of Health to hospital and local
health authorities and to general medical
practitioners
Among other things the report gives an
account of how the organisation responsible
for the treatment and prevention of tuberculosis
has evolved over many years and how the
facilities have been extended to cover the
whole field of respiratory disease including
bronchial carcinoma leading to patients with
a wide range of diseases attending at the chest
clinics it follows that the chest physician at
the clinic should have a wide knowledge of
medicine supported by resources of a general
hospital but it is recognised that some chest
clinics have certain valuable features which
are less well developed in most general
hospitals These include an active interest
and collaboration with the local health authority
in preventive and social aspects of disease
facilities through health visitors for the
effective supervision of patients in their own
homes and a sense of responsibility for a
community service The medical staff at the
clinics also readily co-operate in a wide range
of epidemiological and community problems.
The sub-committee considers however that
as new hospitals are built and old ones redeveloped
the work of chest clinics at present
separate from hospitals should be incorporated
into the activities of the general hospital It
is important that the valuable characteristics
of the more or less separate chest clinics should
not be lost in any re-organisation called for
by the developments noted above
The following should be the main responsi
bilities of the local health authority 3 C 3
vaccination of children of school age and of any
other group found to be at risk epidemiology
the tracing of contacts and the provision of
health visitors or in some cases social workers
to help in the arrangements for patients
suffering from either tuberculosis or other
chronic incapacitating chest conditions at home
The physician to the chest department
should continue to carry the responsibility for
32
the personal aspects of preventive work such as
examination of contacts and the provision of
advice to them and their families It will continue
to be important for the Medical Officer of Health
and the physician to the chest department to work
closely together in their area and to make their own
arrangements according to local needs These
responsibilities should be recognised in the
physician s contract but in the Sub Committee s
view do not constitute a valid reason for pavment
of part of his salary by the local health authority
as is still customary in some areas
Arrangements for the use of the health visiting
service must vary according to local circumstances
and special notice must be taken of the rapid
development in attachments of health visitors to
general practices More closelv integrated schemes
are usually possible in urban than in rural areas
An integrated service requires liaison between
hospital local authority and famiIv doctor in manv
urban areas this is facilitated bv the whole or part
time attachment to the chest department of a health
visitor This provides valuable continuity and the
Sub Committee would wish such attachments to
continue where they are working well with their
scope widened to embrace all chest diseases In
other areas the work must be done bv general duty
health visitors in which case one of their number
should be given special responsibility for main
taining liaison with the chest department
The report concluded bv hoping that the evolution
of chest clinics into chest departments of general
hospitals will provide a basis for the best standards
of service to the community by improving facilities
for clinical work especially in non-tuberculous
broncho pulmonary disease while retaining the
advantages which have come from the especially
close association which has arisen between the
hospital and the local authority service in this
specialty
Most of the Standing Tuberculosis Advisory
Committee s recommendations as to the role of the
local health authority have already been implemented
in this borough and arrangements are in hand for the
amalgamation of the health and tuberculosis visitors
staffing establishments
Loan of Nursing Equipment
The British Red Cross Society continues to operate
a scheme for the loan of nursing equipment on behalf
of the council Charges for this service are nominal
but in certain circumstances are abated or waived
Monies received from loan charges enabled the