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69
decline in the day nurseries is an increase in child-minding from 103
children minded by 39 minders in 1948 to 329 children minded by
133 minders in 1958.
The home help service has responded to the national policy of using
it as an ancillary to the other medical and hospital services for confinement
cases and for chronic sick persons. The full-time equivalent
number of helps employed has grown from 185 to 380, and the number
of households served from 1,160 to 3,075.
Among the new activities undertaken have been the sale of government
welfare foods at child welfare clinics, B.C.G. and polio vaccination,
the detection of signs of mental ill-heath and physical disabilities in very
young children and priority dental services. Progress has been made
towards the integration of the health visiting and school nursing services
and, whereas in the early days the staff in these grades were divided
almost equally into two self-contained groups, now, half of the fulltime
staff are doing combined duties.
There have been several well-marked trends since 1948. A fall in
attendances at ante-natal and child welfare sessions reflects the fall in
the birth-rate, but may also owe something to the increased activity of
family doctors, especially during the latter part of the period, when the
birth rate has somewhat rallied. In school treatment centres, although
the number of new cases at vision sessions has grown by over a thousand,
the number of attendances has dropped: this may be due to the use of
hyoscine for the refraction of older pupils which reduces the number of
attendances per child. At bathing centres the sharp fall in attendances
is attributable to higher standards of cleanliness and improved cleansing
methods. There has been an appreciable decline in cases and attendances
at minor ailment centres, but the special investigation of pupils referred
from school medical inspections has grown considerably. The most
noticeable fall has been in cases and attendances at rheumatism supervisory
clinics; and, although this may be partly offset by a diversion of
cases to special investigation clinics or to hospital departments, it
undoubtedly reflects a decrease in the overall number of cases, which
in turn may be associated with the greatly increased use of ear, nose
and throat sessions over the same period.
A well-defined pattern of co-operation has evolved with other
branches of the National Health Services, with other local authority
services and public bodies. These efforts have been made to meet the
needs of special classes in the community, in the care of expectant
mothers, of problem families and maladjusted children, of old persons,
in the prevention and control of infectious disease, and in health education
and the avoidance of accidents."
The elderly
The first allusion made by the Medical Officer of Health in his
Annual Report to the question of help for elderly people was in 1948
when he said "The question of help for old people has been coming
more to the fore in recent years. This is because of the gradual realisation
that it is almost inevitable that the proportion of old people in the population
will considerably increase during the next 40 years or so "
In the same report he went on to say