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An interesting aspect of the work of the district nurses is the paediatric home care unit provided
by St. Mary's Hospital, which is staffed jointly by the hospital and the City Council's Health
Department, which enables many children to be treated in their own homes who would otherwise
have to be admitted to hospital.
With regard to home dialysis, the City Council has fully accepted its responsibility to adapt the
homes of those suffering from renal disease for whom kidney machines are provided, and to help
them by providing nursing assistance or advice as may be necessary.
In the field of family planning, the City Council is constantly expanding its service, and as an
adjunct to this has established a youth counselling service which has already proved valuable and
is being further developed.
So far as screening services are concerned, the City Council already provides a service for women
for the detection of possible malignancy of the cervix and breast and which incidentally is instrumental
in detecting many other unsuspected infections and abnormalities for which treatment is
necessary. A mobile health clinic will shortly come into operation which will be used for a variety of
purposes and, it is hoped, will play a part in extending the screening services to include perhaps such
conditions as diabetes, hypertension, cardiac disease, glaucoma and visual acuity.
A comprehensive plan has been drawn up for the future provision of health centres which will be
one of the principal means of bringing together the general practitioner and other community health
services under one roof and so facilitate their integration.
These, then, are the ways in which it is envisaged the health services will develop over the next
few years. The Health Department was formed in 1965 following a major operation. Minor surgery
was undertaken in 1971 when certain services were amputated. A major transplant is now scheduled
to take place in April, 1974. I am confident that the patient will again not only make a complete
recovery but will continue to prosper—and, indeed, may even in the future be in better health.
To turn now to the body of the Report, the vital statistics are set out on page 11. From these it will
be seen that there has been a continued decline in the number of births, associated with a general
fall in population and perhaps partly due to the extensive family planning service available in
Westminster. An adjusted birth rate of 8.72 compared with 16.0 for England and Wales is significant
and indeed is the lowest in the country.
The illegitimate birth rate (17.43%) is marginally lower than in 1969 (17.63%) but is regrettable
when compared with the national average of 8%. However, the illegitimate infant mortality rate in
1970 was reduced to 26.97 compared with a national average of 26.
The stillbirth rate of 8.96, compared with 13.0 for England and Wales is perhaps a reflection of the
excellent facilities for ante natal care and delivery provided in Westminster, and the fact that over
98% of births take place in fully equipped maternity units. It is unfortunate that as might be expected,
this is counter-balanced to some extent by a relatively high neo-natal death rate, 15.91 compared
with 12 for England and Wales, resulting in a perinatal death rate of 23.30 which is comparable
with the national average.
Out of 58 deaths of infants under one year, 42 were certainly associated with prenatally determined
factors which in the present state of our knowledge are not preventable. There is, however,
no justification for complacency and every death is investigated to discover whether there were
avoidable factors. On page 39 the circumstances surrounding a number of these deaths are
discussed and attention is drawn to the tragic death of a baby who developed eczema vaccinatum
following re-vaccination of the mother.
These matters are dealt with in detail in the Report, and I would direct attention particularly to
the introduction to the Personal Health Services section set out on page 36, and the ensuing section
on the Handicap Register (page 39).