which it is proposed to expend for this purpose should be included in the estimates of the Council for Maternity and Child Welfare purposes under the head "Provision of Midwives."

4. It is intended that the contributions made by County Councils for the provision of midwives should take the place of any contributions which are or have been made by Local Education Authorities towards the cost of the training of midwives, and it should be understood that in future no grants will be available from the Exchequer in aid of payments by Local Authorities towards the cost of the training of midwives.

5. It will be observed that provision is made in the enclosed Memorandum for the payment of Exchequer grants in aid of whole-time courses provided in residential institutions for practising midwives. Where it is necessary for the Local Supervising Authority to pay the travelling expenses of midwives attending such a course, reasonable expenditure for this purpose will be recognised for grant under the Maternity and Child Welfare Regulations. The Minister will also be prepared to consider any proposals of the Local Supervising Authority for assisting in the provision of temporary substitutes in these cases.

The Minister is advised that there is also a need for short local part-time courses for midwives already in practice, and he is prepared to approve of arrangements being made by Local Supervising Authorities for the provision of such courses for the midwives practising in their areas. It is suggested that these courses should ordinarily comprise six or eight weekly lecture demonstra tions, and the Minister is prepared to recognise for Exchequer grant, under the Maternity and Child Welfare Regulations, reasonable expenditure incurred in providing approved courses of this kind, and the travelling expenses of midwives who are not themselves in a position to pay such expenses.

6. In view of the importance of securing an adequate midwifery service in all parts of the country, the Minister would suggest that each Local Supervising Authority should review the position in their area, and in consultation with the County Nurs ing Association make such provision as may be necessary both for covering the areas hitherto unprovided with trained midwives and for improving the efficiency of the service already in existence.

I am, Sir,

Your obedient Servant,

Aly. Shaclacken

Assistant Secretary.

MINISTRY OF HEALTH MEMORANDUM.

147

MATERNITY AND CHILD WELFARE.

SPECIMEN RECORD FORMS.

1. It is generally recognised that the careful and accurate keeping of records is an essential part of a scheme for Maternity and Child Welfare, as it is of any public service which is concerned with the health of individuals. Provision is made in this way for a continuous health record of a child from the time it first comes under observation. irrespective of change in the observer, and for ready access to the facts of any particular case which is under consideration. When the child reaches school age the health record should be transferred from the Maternity and Child Welfare Service to the School Medical Service in order that the knowledge already gained may become available for the guidance of the school doctor. Supervision of Maternity and Child Welfare work as a whole is greatly facilitated, and accuracy and clearness of mind in those responsible for visiting or investigation are fostered, by the habit of writing down briefly what is observed. Although too much stress should not be laid upon the mere numerical recording of visits or attendances, this is in itself a check upon the amount and distribution of the work done. Without some permanent records it is indeed almost impossible correctly to gauge the progress made, either as regards the health of the individual or in the work generally.

2. The experience of the Department shows that the recording of work done under Maternity and Child Welfare schemes has not hitherto been placed upon a systematic basis. While admirable records are kept in many areas, in others either the notes are found to be meagre and lacking in purpose and therefore largely valueless, or the record keeping is unnecessarily diffuse or laborious and valuable time is occupied with duplication, etc., which might be avoided. The forms appended to this Memorandum have accordingly been prepared in the hope that they will be useful as a guide both to the facts which it is desirable to note, and also to the general form in which these facts should be preserved.

3. It is fully recognised that the type of record must vary with the nature of the Maternity and Child Welfare work undertaken and that no uniform system can be applied to all schemes in all districts. Nor is it suggested that any satisfactory system of record keeping already in operation should be altered merely in order to make it conform more closely to the forms set out below. But it is hoped that these forms may prove helpful when existing records require alteration or

addition.

4. The scope of Maternity and Child Welfare records varies with the extent of the scheme undertaken. While the work of health visitors and of infant welfare and maternity centres is common in greater or less degree to practically all schemes, records may also be

needed in connection with visits of special inquiry and the inspection of midwives, and with institutions such as maternity homes, observation wards, children's homes, day nurseries, homes for mothers and babies, etc. It has not been thought necessary, however, to prepare forms applicable to all these different activities, but only to those branches of work where good note-taking is considered to be of special importance, viz. :—

(1) Inquiries by the Health Visitor, child under 1 year:
(2) Inquiries by the Health Visitor, child 1 to 5 years:

(3) Attendances at the Infant Welfare Centre:

(4) Attendances at the Maternity Centre (ante-natal and postnatal):

(5) Home Visiting of the Expectant Mother (Midwife or Health Visitor):

(6) Investigation of Still-births:

(7) Investigation of Infant Deaths:

(8) Inquiry into Ophthalmia Neonatorum:

(9) Inspection of Midwives.

5. The contents of the forms are based on the average practice in different areas, and where the forms are adopted the details may need to be amplified or reduced according to the circumstances and experience of particular districts. The forms are self-explanatory and it seems unnecessary to describe in detail how they should be used. It may be well, however, to observe that record keeping should take up the minimum of time compatible with efficiency, and should not be allowed to encroach unduly on the time which should be devoted to practical work. The facts should be intelligently selected and clearly and consistently stated, and the result should be legible, readily accessible and easy to summarise; but diffuse statements should be avoided, information should not be duplicated, and "fair copies should seldom be made. It should be remembered that important as is the duty of keeping good records, it is a means and not an end and is always secondary to the work itself,

MINISTRY OF HEALTH.

March, 1925,