View report page

36
PERSONAL HEALTH SERVICES
Deputy Medical Officer of Health
MARY T. PATERSON, M.B., B.S., D.P.H.
As this is the last year in which the Health Department was entirely responsible for the personal
health services, it is an appropriate time to review these services, analysing both the achievements
and the shortcomings.
Since 1918 Health Departments have been empowered to provide a service for mothers and
young children, and over the years this has been expanded to meet all needs, ante and post natal
care, health education, child health, day care, and support for families with special problems.
Many of the problems which confront the Health Department stem from families living in
unsatisfactory or inadequate housing conditions. Much progress has been made over the years in
improving housing and many new or converted dwellings have been provided by the local authority,
housing associations and private landlords. Indeed, during 1970 a total of 765 families were provided
with housing accommodation by the City Council (331), the Greater London Council (246) and by
nomination to housing associations (188), irrespective of the number who obtained accommodation
through private landlords. None the less, much still remains to be done until every family is adequately
and satisfactorily housed and the imaginative scheme now being actively undertaken in connection
with the North Westminster Project (referred to earlier in this Report) will help to alleviate some of
the problems which families face at the present time.
During the past 5 years, there has been a steady decline in the number of births and consequently
in the child population (1966, total births 3,651; 1970, total births 2,790).
Notification of births ensures that the health visitor service is available and offered to all regardless
of social need; but those who are in need are identified early and given special attention. Because the
numbers are small, personal contact can be achieved with every mother. The mobility of the population,
however, means that case loads are constantly changing, and personal communication with
field workers both within the City and in other boroughs is vital.
Ante-natal care is still provided on a tripartite basis—by hospitals, general medical practitioners
and the local health authority. The important thing is to ensure that every mother receives adequate
medical and social care and that health education is available to all.
The illegitimacy rate in Westminster is still regrettably high (17 per cent, compared with 8 per cent,
for England and Wales); in addition there are mothers unsupported for a variety of reasons who
require special help.
The City Council has fully implemented the National Health Service (Family Planning) Act, 1967,
and provides free advice to residents with free supplies to all in medical and social need. Residents
may attend sessions run by the Council itself, of which there are 7 weekly (including 3 evening
sessions) or those run by the Family Planning Association in Council premises. Increasingly the
hospitals are providing this service for both in and out patients who desire it. For the young, two
weekly special youth advisory clinics are available, where counselling on personal problems is given
as well as family planning advice.
One important advance in preventive medicine has been the introduction of the Guthrie test for
phenylketonuria. Blood samples are taken by hospital and domiciliary midwivesfrom every baby shortly
after birth and examined in two hospital centres. It is the duty of the Health Department to check
the results, both positive and negative, and to ensure that the necessary follow up is achieved. This
has thrown an extra burden on the staff which they have accepted willingly, and for this I must pay
tribute to their diligence and efficiency.
With the decrease in the child population, it is inevitable that the number of attendances at Child
Health clinics should also fall. In many ways this is an advantage. The quality of service provided
has been improved. Fewer attendances mean that more attention can be given to each individual
mother and child. Developmental screening and parent counselling is readily available, and the
facilities for child minding during sessions, with play under expert supervision and observation, have
been improved. The health visitors have provided stimulating social and educational sessions for
mothers, and in many cases the mothers themselves undertake the management of their "clubs".
One important aspect of the Child Health service is the early identification and care of handicapped
children. This subject is considered in detail elsewhere in this Report, but here it may be stressed that
because the numbers are small, a full and expert service can be provided of which the City may well
be proud.