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8
particularly the higher proportion of the population reaching the
advanced years of 80 and over, a caseload of the order of 800/900
per geriatric health visitor is the rule. Clearly a formal casework
approach, with caseloads of some 50, is neither relevant nor practicable
and, for the foreseeable future, the bulk of the regular
domiciliary supervision will fall on the health services. It is more
or less the same with the under-fives where the preventive health
services have the predominant interest and refer to other specialised
agencies as required. The very weight of these problems demands
a preventive approach and this is why the domiciliary and day
care facilities are essential in a balanced health and social care
system for the various vulnerable groups. These factors must be
kept uppermost in mind when the new Management Structure for
the health services is being determined.
An analysis of vital statistics appears as usual in the body of
the report. The population continues to decline despite the new
Kidbrooke development and this trend will not be reversed until
Thamesmead is well established. Since the 1961 census, the
Registrar-General has consistently over-estimated the population
in this area and the recorded drop of 8,340 does not reflect
accurately the changes since 1970. All our infant mortality rates
show decreases and there are also decreases in deaths from heart
disease, cancer of the lung and bronchus, pneumonia, bronchitis
and emphysema: but deaths from malignancy of breast, uterus and
cervix, congenital anomalies and road accidents have increased.
These matters are discussed in more detail in the main report.
During the year, there was a fall in infectious disease notification,
again, mainly attributable to a reduction in measles infections.
An outbreak of dysentery at a local hospital accounts for the
sharp rise in dysentery notifications. However, the total number of
cases of food poisoning was halved although two deaths were
notified to us posthumously, one due to Salmonella mendoza and
the other CI. welchii.
Turning to the personal health services, the decline in home
confinements continued and hospital deliveries accounted for 88
per cent of all births. Arrangements were finalised with the Greenwich
District Hospital for a midwives' liaison scheme whereby
domiciliary midwives can come to the obstetric unit and deliver
their mothers who book for a planned early discharge at 48 hours,
a scheme which it is hoped will be extended to the British Hospital
for Mothers and Babies. The aim is to encourage the majority of
mothers to be delivered in hospital and, consistent with obstetric
and paediatric considerations, for them to be allowed home as
early as possible.
Despite efforts to encourage women to have the cervical cytology