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6
child-minders given in the Health Services and Public Health Act,
1968, will improve the supervision and, in the longer term, increase
the facilities for the day-time care of children under five. The
effects of the registration provisions of the Health Services and
Public Health Act, 1968, became more apparent in 1969 and
necessitated the appointment of an Assistant Nursing Officer with
ancillary clerical staff to meet the extra work which this Act had
imposed. It has meant an increase not only in the time which the
district health visitors are called upon to give to these questions
but also in the demands on the senior medical staff who may be
called in to advise on some of the problems. Nevertheless, the
fact that registration is now required, no matter how few children
are to be minded for profit, enables a more consistent approach to
be made to this important aspect of child care which in an area
like Wandsworth poses many difficulties both of size and type.
I referred in my Annual Reports for 1966, 1967 and again last
year to the highly current question of attachment/liaison schemes
or, as we in Wandsworth prefer to call it, "linkage " of our community
health staff with general practitioners and other health
services. My only reason for returning to the subject yet again is
a specific request from the Department of Health and Social
Security that Medical Officers of Health should do so in their
Reports for 1969.
There is no dispute that there must be the closest links, cooperation,
liaison (call it what you will) between the general practioner,
as the domiciliary doctor responsible for his patients' care
in the community and these ancillary services, the responsibility of
health visitors, home nurses and midwives, who also care for the
health and welfare of people, whether patients or not, living in the
community. Where opinion is divided is how these links are best
forged.
Ideally, but certainly a long way in the future, most if not all
family doctors will be practising in groups either from purposebuilt
health centres erected by the local health authorities (or their
successors), or from premises built and owned by the group of
doctors itself. To each such group or team of doctors should be
attached similar teams or groups of health visitors, home nurses
and midwives. This ideal is not likely to be achieved on any
extensive scale for many years to come but it seems sensible in the
meantime to approach as near as possible to this ideal. This is
particularly the case in a highly urbanised area like Wandsworth
where the number of health visitors, home nurses or midwives is
small in relation to the number of family doctors and where it is
difficult to arrange for the full-time attachment of a health visitor,
home nurse or midwife to any one particular practice unless it is
a group practice of reasonable size.
In Wandsworth, as I have explained in previous years, the health
visiting service is decentralised and all the health visitors work in