1. The hospital is the power source for patient care, for teaching, for supervision and research. But if it loses sight of the home situation and of other agencies, the treatment and the teaching become inadequate, the research unrealistic; it is spinning its wheels and failing to maintain any progress.
2. Maternal and child health in advanced countries has adopted a pattern of "preventive but little or no curative" care. It is only when there is a properly integrated service that care of the sick, teaching and research will be effective. Service must be comprehensive in content and extent. This type of integrated service is the most suitable for developing areas.
3. There has been an artificial separation between preventive and curative medicine. Public health services provide preventive medicine in its major operations and with the mass approach. But personal or individual medicine must be both preventive and curative. In treating a minor disorder we are preventing a major catastrophe. It would be preferable if the division came not between curative and preventive, but between individual and mass medicine. Then hospitals, health centers, and homes could provide rational settings for continuity of care.
4. Continuity of care is essential. The public health nurse, health visitor, community nurse, midwife, district nurse, and their aides are the most essential workers. Their numbers should be increased and their training improved. The first diagnosis is made by the mother when she decides to take the child to the doctor, the hospital, or the clinic. The second diagnosis is made by the nurse when she decides to refer the child to the doctor. Without continuity in this chain of diagnosis, the whole system is inefficient.
5. Training of personnel needs to be revised with these objects in view.
Enhancing assertiveness in district nurse specialist practice