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The second death reported was due to massive haemorrhage from placenta praevia in an eleventh
pregnancy presenting as a breech. The woman, aged 43, had had no ante-natal care until a month previously.
She was admitted in a state of extreme shock and did not respond to resuscitation.
The third death was that of a French woman of 42 who had undergone termination of a third pregnancy
at nine weeks, in a private nursing home, who suffered cardiac arrest and failed to respond to all attempts
at resuscitation.
The fourth death was associated with termination by Caesarian section of an eighth pregnancy of a 33
year old woman because of fulminating pre-eclamptic toxaemia at 35 weeks. She was delivered of a live
child but died seven hours later of subarachnoid haemorrhage.
HANDICAPPED CHILDREN
A register is kept of all children who are handicapped by a developmental defect, by illness or by adverse
environmental conditions. Children are entered on this register as a result of hospital reports, including
those notified at birth as having congenital malformations, those admitted or investigated because of acute
illness, trauma or failure to thrive, or as a result of serial screening when the medical officer finds some
deviation from the normal.
Westminster is fortunate in having 68 special nursery places available for handicapped children and in
addition many of the less severely handicapped are admitted to ordinary day nursery places.
As the value of early assessment of handicap has been so clearly demonstrated in previous years there
are now 4 full-time medical officers specially trained for this work and 3 more are in training at present.
Assessment of Handicapped Children
Assessment is undertaken at two levels. First, special clinics for handicapped children staffed by
specialist medical officers trained in developmental assessment are run by the City of Westminster. Parents
attend by appointment and time is allowed for complete examination with psychometric testing and for
parent counselling. Secondly, at two of the teaching hospitals in the area, assessment clinics are held in the
paediatric departments. At both, a principal medical officer from the Health Department attends to undertake
psychometric testing and co-ordinate further training and parent guidance.
Westminster therefore provides a complete and comprehensive service for handicapped children.
LOCAL AUTHORITY NURSING SERVICES
At the request of the Department of Health and Social Security, the City Council reviewed the Health
Department's nursing services and late in 1971 approved the Medical Officer of Health's recommendations
for a three tier management structure for the City of Westminster's nursing service. The revised management
structure was brought into operation early in 1972 and the necessary nursing appointments were completed
by the Summer.
At top management level the Director of Nursing Services is responsible for policy and co-ordination
of all the nursing services. In the City of Westminster these services are divided into four geographical areas
which correspond as far as possible, taking into account the siting of the maternal and child health and
district nursing centres, with the four geographical areas of the Social Services Department. An upper middle
management nursing officer is in charge of each area, with overall responsibility for all the nursing services
in her area. Two lower middle management nursing officers in each area deal with the day-to-day management
of the field personnel in health visiting and district nursing respectively. The upper middle management
nursing officers also specialize in certain aspects of the nursing services according to their special
qualifications and experience.
Reports from the individual Area Nursing Officers follow; from these reports it is amply evident that
integration of the community services and hospital services is already well under way in Westminster in
advance of the forthcoming reorganisation of the national health service.