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MATERNITY SERVICES IN SCOTLAND

Ix parallel with the Cranbrook Committee, whose reportwe reviewed last week, a committee of the ScottishHealth Services Council 1 has been considering maternityservices in Scotland. Its report

11 concludes by sayingthat much of the confusion in these services seems to be

related to the many choices provided and the risk of lackof continuity of medical care. Hence the committee

thinks that a primary requirement is that one personshould be regarded as the coordinator, and it believes thatthis should be the general medical practitioner. Accord-

ingly it makes the following recommendations:1. It should be the responsibility of the general practitioner

to provide or secure the provision of all the facilities requiredby the mother during pregnancy, confinement, and lying-in.No problem should arise where the practitioner is himself to beresponsible for the confinement, but when he is not, we regardit as essential that he should be informed by anyone else whohas accepted the care of the woman.

2. A list of general-practitioner obstetricians should beintroduced in Scotland. The condition of entry for practi-tioners not undertaking maternity medical services at the timeof the introduction of the list would be an initial qualificationof six months’ resident experience in an obstetric unit, and thecondition of retention would be a requirement to undertakerefresher courses at intervals of not more than five years.Practitioners already undertaking maternity medical servicesat the time of the introduction of the list would be includedautomatically and all would be subject to removal if they didnot undertake a refresher course, officially recognised as quali-fying for the purpose, at intervals of not more than five years.

3. A general-practitioner obstetrician undertaking responsi-bility for the confinement, whether at home or in a general-practitioner bed in hospital, should visit during labour and, ifpossible, be present at the delivery: and the fee to be paidshould have regard to this.

4. Local health authorities should instruct midwives directlyor indirectly employed by them to urge women seeking toengage their services to make arrangements with their generalpractitioners: and the midwife should report to the local healthauthority in any case of difficulty.

5. Regional hospital boards should reassess, as a matter ofurgency, their need for maternity hospital accommodation toprovide for antenatal admissions of not less than 8 beds per1000 births per year, together with lying-in beds for 70-75%of the total births.

6. Regional hospital boards should review the systems ofadmission to obstetric units, to ensure that the best use is madeof the available accommodation and that the admission systemin force will secure (subject to quite unforeseen emergency)that bookings are honoured.

7. The facilities of local-health-authority clinic premises andthe services of their staffs should be utilised both by the hos-pital staffs and by general-practitioner obstetricians, whowould be enabled to take advantage for their patients of all thefacilities in these clinics, including those for group teachingof mothercraft or parentcraft and health education, as well aspnority dental services and the provision of welfare foods(including vitamin supplements).

8. The Secretary of State should initiate action to ensurecoordination by a specific requirement of a report from each

1. The members were: Prof. G. L. MONTGOMERY, F.R.F.P.S. (chair-man; Dr. MAY BAWD; Dr. J. T. BALDWIN; Miss M. B. CLYNE,S.C.M.; Mrs. M. S. EWART; Miss M. FRASER, S.C.M.; Mr. C. S.GUMLEY; Dr. C. HARROWER; Prof. J. L. HENDERSON, F.R.C.P.E.;Mr. A. R. HOWIE; Mr. H. R. MACLENNAN, F.R.C.O.G.; Mr. D.MILLER, F.R.C.O.G.; Miss E. RENWICK, S.C.M.; Dr. J. RIDDELL;Sir JOHN STORRAR; Mr. A. A. TEMPLETON; Dr. N. I. WATTIE;Dr. M. E. MITCHELL (medical secretary), and Miss L. C.WATSON (lay secretary).

2. Department of Health for Scotland: Scottish Health Services Council.Maternity Services in Scotland. H.M. Stationery Office. 1959. Pp. 64.3s 6d.

regional hospital board setting out the arrangements in opera-tion and the method of maintaining cooperation; he shouldhave available, for consultation on the reports and on othermatters affecting the organisation and content of the maternityservice, a standing advisory committee under the ægis of theScottish Health Services Council; and the reports shouldcontain provision for the establishment of professional com-mittees, at appropriate levels, as part of the local arrange-ments to ensure the smooth working of the maternity service.

1. Manchester Guardian, Jan. 26, 1959, p. 5.

Points of View

IN THE EYE OF THE BEHOLDER

IT was late when I finished my latest paper describingthe changes we have been introducing into our hospital,and I suddenly realised how sleepy I was. On my way tobed I glanced at a newspaper 1 that was lying on thetable, and my eye was held by the juxtaposition of thetwo pictures of St. George and the Dragon, so muchalike and yet wholly different. On my way upstairs I.thought, if Uccello and his colleague gave such variedaccounts of so comparatively simple an incident as

slaying a dragon, how would a really complex procedurelike running a mental hospital strike different observers ?I have often been scathing about other people’s hospitalsbut how would mine look to them? Its merits surelywould be obvious; and in bed I turned to the first pageof my typescript for reassurance. But somehow it seemedto have changed. Instead of my own well-turned openingsentences I read...We do not often go to other hospitals--our own patients

and our duties as representatives on national and internationalbodies keep us too busy. But we had read so often that this

hospital was good, that we looked forward with pleasure tovisiting it. Everyone longs for progress, and we had a feelingof comradeship for its physician-superintendent which was inno way affected by the fact that in his articles he never seemedto describe any procedure which was not common practiceelsewhere. We had also noticed that he never mentionedother psychiatrists who had used these procedures long beforehe introduced them. A small matter perhaps, but even if thereis not time for intellectual humility it is agreeable to see acertain graciousness between colleagues. For a moment we didwonder why only one person from this hospital wrote articles;for more than one doctor must have made its progress possible.We spent a week there. We could not judge a hospital on

the strength of a four-hour visit. We took a tip from one of thephysician-superintendent’s articles; after he had shown usaround each day, we made a point of going back over our routeand actually spoke to a large number of nurses and someyoung doctors.We have always treated our chronic patients well and have

provided the same careful attention for new admissions. Wewere surprised to find here that the admission wards are left tothe young doctors. Surely the recent and severe illnessesdeserve the best treatment which can be given and this mustmean the attention of the most senior and most skilled doctor?One of our informants voiced a suspicion-which we do notshare-that the consultants found the careful examination of new

patients too time-consuming and were loth to accept the inevit-able responsibility of diagnosis. It was in fact suggested that theypreferred the chronic wards because the work there was easy.Most of it was done by the nurses, and note-writing was at aminimum. Indeed we can see that it is one thing to spend manylong and anxious hours in the admission wards, and another towalk rapidly through the chronic wards which have beenspecially emptied of patients and then to spend the rest of theday in the occupational-therapy departments or strollingthrough the grounds.