British Medical Journal. Supplement : A general medical service for the nation
1938-04-30 1938 1930s 14 pages APRIL 30, 1938 GENERAL MEDICAL SERVICE FOR THE NATION SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 261 the minds of these women, which would render them more prone to follow the doctor's advice should the labour prove to be prolonged or otherwise abnorma...
| Institution: | MCR - The Modern Records Centre, University of Warwick |
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| Language: | English English |
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[London : British Medical Association]
30 April 1938
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| Subjects: | |
| Online Access: | http://hdl.handle.net/10796/72D39B95-F00B-4E6E-8AC7-5268AD1D6416 http://hdl.handle.net/10796/80959835-E371-4389-8741-D025BB3E0043 |
| Summary: | 1938-04-30
1938
1930s
14 pages
APRIL 30, 1938 GENERAL MEDICAL SERVICE FOR THE NATION SUPPLEMENT TO THE BRITISH MEDICAL JOURNAL 261 the minds of these women, which would render them more prone to follow the doctor's advice should the labour prove to be prolonged or otherwise abnormal. Were a competent midwife present in every doctor's case he would be saved much anxiety and many unnecessary and tiring calls. Were he able to remove a patient to hospital and continue in attendance, if necessary with the co-operation of the specialist, he would be enabled to undertake certain operations in more suitable surroundings, and the patient would be less likely to object to removal. These few examples show how materially the clinical work of general practitioners in conducting domiciliary midwifery can be bettered. There are also opportunities by means of improved midwives' service, and by the provision of "home helps," etc., to ameliorate the home conditions and so retard, if not reverse, the quite recent tendency of women to seek admission to hospital for their confinements for purely social reasons or merely because of financial inducement. 71. The Association accordingly has come to the conclusion that continuity of medical care should be secured by the provision in any national maternity service of a general practitioner and a certified midwife for every maternity case. If the training of the medical practitioner in this branch of practice can be shown to be still defective the remedy lies in its reorganization and improvement. All available evidence suggests that the institution is not safer than the home, and, in the view of the Association, the remedy for the existing situation lies, not in a more complete separation of the general practitioner from midwifery, but in a full recognition of his position as the person responsible for the continuous care of the mother. General practitioners should be sufficiently equipped to know how to deal with obstetric emergencies, and this can only be achieved if they remain in effective and practical touch with midwifery; this means that steps should be taken to increase the number of maternity cases which the general practitioner will attend rather than to encourage the present tendency to diminish it. 72. An efficient maternity service should include: (1) Ante-natal care by, or under the responsibility of, a medical practitioner chosen by the patient throughout pregnancy in every case; (2) Attendance in every case by a certified midwife during the ante-natal period, labour, and the puerperal period; (3) Attendance by the practitioner chosen by the patient during pregnancy, labour, and the puerperal period, when as a result of his ante-natal examination the practitioner has declared his personal attendance to be necessary, or when his attendance is requested by the midwife; (4) The provision in every case of at least one post-natal consultation between the patient and the practitioner (including, if necessary, examination); (5) The services when necessary of a second practitioner — for example, to administer anaesthetic; (6) The services of a consultant when considered necessary by the practitioner; (7) The provision of laboratory services; (8) The provision of beds for such cases as in the opinion of the practitioner require institutional treatment, treatment in the institution being as far as possible continued by the same practitioner; (9) Supply of sterilized obstetric dressings in every case; (10) Provision of ambulance facilities for patients requiring to be removed to institutions (11) The provision of "home helps" — that is, women trained in domestic work — who would relieve the mother of the worries of domestic management during the lying-in period. 73. The Maternity Services (Scotland) Act, 1937, provides an example of legislative provision for a maternity service of a national character. A national scheme based on the principles adumbrated in earlier paragraphs is urgently necessary in England, Wales, and Northern Ireland. Its establishment need not await the other health service developments which are here recommended, but can be proceeded with immediately. When the fuller service is provided under a unified administration it will not be difficult to link up the national maternity service with the general medical service. 74. It is urged that in the meantime any development which takes place under the existing law should be based on the provision for every mother, in her home, of a general practitioner, a midwife, and, where necessary, a consultant, her care during pregnancy, labour, and the puerperium being under the continuous supervision of her general practitioner. The recent step of the preparation by local supervisory authorities of lists of practitioners to be available to afford medical aid to midwives when necessary provides a basis for the construction of local schemes, in which the ante-natal and post-natal care is conducted by the general practitioner, who is to remain liable to be called in at the actual confinement. A number of such schemes are working satisfactorily in both urban and rural areas. But such local and unrelated developments should not delay the establishment of a full maternity service on a national basis. (b) Hospital Problems 75. Now that there exist two types of hospital in which provision is made for the treatment and nursing of the sick, questions of co-operation and co-ordination are of exceptional importance. The closest co-operation is essential in order that there shall be no unnecessary duplication of accommodation or wasteful competition between individual hospitals, voluntary or municipal, or between the two hospital systems. It should be secured that any development of additional accommodation should be related to existing hospital accommodation, whatever the agency providing it. There are three aspects of the problem of co-operation — that relating to co-operation between voluntary hospitals and local authority hospitals, that relating to co-operation between the voluntary hospitals themselves, and that relating to co-operation between contiguous local authorities managing hospitals. 76. For many years the Association has envisaged the evolution of a hospital system on a regional basis. In each region all the hospitals would be grouped around a central or base hospital, which would be one of the larger voluntary or council hospitals, either associated with a medical school or possessing outstanding advantages in regard to staff and equipment for undertaking the more specialized methods of treatment. Around such a base hospital or hospitals would be grouped all other hospitals in the area. These, which would include both special and cottage hospitals, would provide such services as were within their competence, patients being passed on where necessary to the central or base hospital. 77. The services of such a region or area would be developed as an integrated whole, and a patient would be directed to one or other of the institutions according to the conditions from which he suffers and not because of individual prejudice or preference. It is probable that such a development would render necessary the absorption of some hospitals, particularly special hospitals, and the establishment of others in order that the regional institutional service may be economical and efficient as well as complete. 78. Such an ideal will remain unattainable until more authoritative and comprehensive machinery of co-operation and consultation has been created. All too often voluntary hospitals have grown up in isolation without contact or co-operation with neighbouring institutions of the same kind. In order to remedy this situation the Voluntary Hospitals Commission recommended in 1937 the division of the country into hospital regions and the establishment of a regional council in each region, representative of the voluntary hospitals of the area, and a
292/847/1/60 |
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