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As early an exchange of information as possible is eminently desirable so as to ensure that
handicapped children have the best possible opportunity for care, education and development,
without overlapping or gaps in the services provided.
Circular 7/66, issued jointly by the Department of Education and Science and the Ministry of
Health showed a clear appreciation of these problems and urged the local authority health departments
to take a lead in initiating discussions with representatives of hospitals and other interested
bodies. The Medical Officer of Health held three meetings, two between representatives of hospitals
in the area and representatives of the Health, Welfare and Children's Departments of the City, and
the third meeting was between the same City Council staff and representatives of voluntary societies
active in the care of children. Opportunity was taken at the same meetings to discuss the "Battered
Baby" syndrome and to evolve an agreed procedure for dealing with this problem.
With regard to the Circular 7/66, which concerned the co-ordination of efforts for the care of
handicapped children, some measure of agreement was reached on broad principles, and the
Medical Committees of the local hospitals were asked to disseminate among the medical staff
the conclusions reached at the meetings.
Assessment Clinics for Pre-school Handicapped Children
As foreshadowed in the previous Annual Report, assessment clinics for physically handicapped
children have been instituted comparable with those for the mentally handicapped. After
consultation with the hospital specialists involved, the child is seen, either at a clinic or at
home, for full physical examination and mental assessment. The social circumstances are also
taken into account. Based on the findings, recommendations are made for any of the community
services which are likely to benefit the child or alleviate the family situation, and educational needs
are estimated. A copy of the report is sent to the general practitioner and the hospital consultant,
and it is worth recording that most of the consultants have expressed appreciation of, and agreement
with, these reports. None has disagreed.
The clinics are conducted by an experienced paediatrician on the City's medical staff; this officer
also has responsibility for the observation register and therefore usually has knowledge of the
handicapped children from a very early age.
Observation Register
The work continues of registering children "at risk" by reason of adverse genetic factors or
adverse factors in the maternal or obstetric history or the perinatal or postnatal period. To this
register are added the names of children suffering serious accident or illness in early infancy or
those where known social factors predispose to risk. There were, at December 1966, some 1,140
names on the register, 486 of them being of children born in 1966 and the rest in preceding years.
Ofthechildrenbomin1966,8 havesincedied, 71 moved out oftheareaand 23 were removed from the
register as being no longer at risk. It is impossible to assess yet how many of these 1966-born
children will have some permanent degree of handicap. Some few will, of course be known since
they were born with congenital malformations obvious at birth—these total 42 (see table of
Congenital Defects, Table 40, page 83) but other handicaps, such as those of hearing and
vision, cannot be detected so early in life.
The process of adding or deleting names, accepting transfers into the area and transferring
records for those who move out of the area, is a continuing one, and therefore the number of children
"at risk" is never static. The amount of work involved in registering the children, dealing with
transfer of records, sending reminders of examinations due and dealing with correspondence is
very considerable. The volume of work entailed in the clinical examination of the children is even
more so. The Medical Officer of Health fully accepts that if by this means all children who are
born with, or who develop, handicaps become known to the Health Department, the work involved
is well justified; nevertheless he will have close regard to the proportion of handicapped children
becoming know via the observation register, the total number of handicapped children becoming
known by any means and the total number of children on the observation register in each year. If,
on analysis, it is demonstrated that the number of handicapped children brought to light by the
observation register is only a small proportion of the handicapped in that same year of birth, he
will seek to modify the criteria for the observation register.
THE WORK OF THE HEALTH VISITORS
(Miss E. A. Evans, H.V., S.R.N., S.C.M., Chief Nursing Officer)
The pattern of health visiting work carried out in the City continues. Home visiting and follow up,
organisation of welfare clinics, ante-natal clinics and special clinics for handicapped children,
and an active part in the School Health Service, continued throughout the year. It is inevitable
that a City of this size and character with varying degrees of social need provides work on the home
visiting aspect which is extremely varied and worthwhile.