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47
PERSONAL HEALTH SERVICES
The quality of the personal health services depends on the number and calibre of the staff.
Westminster is in many ways fortunate. Because of its central position and the great variety of
field work available and the excellent opportunity for experience, many newly trained health visitors'
district nurses and social workers are anxious to apply for posts in the City; and although the
turnover is regrettably high it is possible to fill junior posts. It is much more difficult to obtain
experienced professional field workers, especially psychiatric social workers. It is therefore essential
to use the existing senior staff so as to put their special skills to full advantage and to delegate
the less exacting duties to junior and less highly qualified workers. The need for in-service training
is obvious and this takes much of the time of the senior supervisory staff. Regular courses and
seminars are arranged and when possible promising members are sent on full time courses.
During the year, a new post of Senior Medical Officer was created. The holder is responsible
for reorganising the observation and handicapped registers, for supervising the clinical work in
the child welfare centres, for the training of medical staff in developmental paediatrics and for
developing co-operation with the hospital paediatric departments particularly in a new district
assessment centre. An appointment system has been introduced in the child welfare clinics, and
although it cannot be rigidly enforced, it does mean that every child can have a full developmental
examination at the appropriate times. It is on this aspect of the work that the medical officers
are mainly engaged, while advice on feeding, management and family problems is undertaken
by the health visitors.
With a large number of working mothers and many over-occupied and unsuitable homes, the
day care of pre-school children presents great problems. The Council's day nurseries are fully
used and have long waiting lists, there are not enough private registered day nurseries and child
minders to meet the heavy demand. There are a number of unsatisfactory child minders: as a
result many socially deprived children require stimulation and training before they are fit to attend
school. It is hoped that the new powers under the Health Services and Public Health Act 1968
will enable the Council to improve the situation. Facilities for part-time care have improved as a
result of an increased number of play groups and creches.
The decline in the number of births continues and the birth rate for 1968 was 13.03, compared
with 13.71 in 1967 and 13.89 in 1966. One effect is that there is no pressure on hospital beds and
that every woman who wishes to or needs to have a hospital delivery can do so. It also means
that there is very little demand for the Domicilliary Midwifery Service; only 57 cases were undertaken
during the year. Fewer births also result in smaller case loads for the health visitors. They are, therefore,
able to devote more time to families in need and to undertake a variety of other duties for
families, for old people, for adolescents, and in health education.
An increasing demand is made on the services of the social workers, and further specialised
work is being developed to deal with drug abuse, unsupported mothers and young people who
need advice and counselling. Although the number of mentally disordered patients in community
care has not increased much the complexity of their problems has, chiefly owing to difficulties in
obtaining hospital beds and in finding suitable accommodation and employment. The number
of compulsory hospital admissions was 20 per cent, higher than in 1967. There is a need to expand
this overburdened section of the Department which it is hoped to meet in 1969.

The causes of infant deaths in 1968 as set out by the Registrar General are shown in detail in
Table 2, page 79. Seventeen deaths were due to prematurity or causes associated with prematurity
whilst a further 18 were due to congenital malformations.