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32
PERSONAL HEALTH SERVICES
There are some special features in the City of Westminster which present a problem and a challenge
so far as the provision of personal health services is concerned. The City Council is well aware of
its special problems and is anxious to meet them.
A large area of the City is devoted to commerce, government and entertainment and here the
resident population is small. There are good residential districts containing large houses with
gardens, and blocks of luxury flats. Many of the residents are elderly, and domestic help is extremely
difficult to obtain. There are "twilight" areas of outworn houses, chiefly in multiple occupation
and in some cases seriously over-occupied. Finally, there are many hotels and bed-and-breakfast
houses accommodating chiefly single business and professional residents and students. Westminster
contains excellent parks and open spaces, but these are at some distance from the more
densely populated residential areas.
Work of all kinds, clerical, distributive, light industrial, building, domestic and catering, is easy to
obtain and therefore the City attracts immigrants from all parts of Great Britain and overseas. This
in turn produces a rapidly changing residential population, a serious housing shortage and very
high rents.
In spite of—or because of—this housing problem and the high cost of living and working in
central London, the work in the Health Department, offering as it does excellent experience and
interest, attracts professional staff who are willing and able to accept the challenge. It is, however,
increasingly difficult to recruit manual and domestic staff and the shortfall is reflected in the home
help and day nursery services.
There are six general hospitals in the City, five of them teaching hospitals. Mental hospitals
and hospitals for the mentally subnormal are at a considerable distance, but there are good psychiatric
out-patient and child guidance facilities within the City.
The large number of hospitals presents certain difficulties in liaison, but as mentioned later in this
report, every effort is made to secure the maximum co-operation and co-ordination between these
two branches of the health service.
Approximately 400 general practitioners practice wholly or partly in the City, chiefly single-handed
or in partnerships of two doctors. It has therefore been difficult to arrange health visitor, domiciliary
midwife or district nurse attachments, but reference is made elsewhere in the report to schemes that
are in operation in two group practices. Family doctors who are interested in and have time for
preventive medicine are employed by the City Council in child welfare and the school health service,
and receive some post-graduate training from the Council's staff, (see page 33).
As is mentioned on page 33, the City is well supplied with maternal and child welfare centres,
and the work undertaken in them is being planned according to current trends. A particular
problem in Westminster is the high number of illegitimate births and the number of inadequately
supported mothers who are bringing up families.
The eight day nurseries are inadequate to meet the demand for the day care of children. Not only
are there mothers who must work for economic reasons, but there are also many children who need
day nursery care because of adverse environmental conditions or because of physical or mental
handicaps.
Day care is provided by some excellent private day nurseries; often, however, the fees are high
and the nurseries open only in the mornings. Play groups are run by voluntary organisations,
financially supported by the Council. They provide opportunities for children to play for limited
periods under trained supervision and with modern equipment. But the majority of children under
the age of five are being cared for by "daily minders". Some of these provide an excellent service
and are registered by the Council. The majority are unregistered and "illegal". The care provided
falls far short of what is required, and these unregistered minders present a great social problem
here as in many other areas.
In order to cater for the needs of working mothers, evening sessions are held for ante-natal care,
family planning and child welfare. Facilities for the care of children under the age of five are being
increased and the formation of more play groups is being encouraged. Health visitors and social
workers are finding it increasingly necessary to provide support to families and to lone mothers in
the evenings and at week-ends.
Westminster has a large number of elderly residents. Many of them live on their own without
family support. There is a shortage of Part III accommodation within the City, and geriatric beds
are very limited. This means that old people must be supported in their own homes, which imposes a
great burden on the home help, chiropody and meals-on-wheels services. In this sphere the Council
is assisted by voluntary organisations such as the City of Westminster Old People's Welfare