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Secondary and Tertiary Prevention
Secondary prevention aims to reduce the duration of existing illness, and tertiary prevention to limit the severity
of any existing disease or defect which cannot be eliminated. In undertaking these aspects of the care of older
people the Health Department works in close co-operation with general practitioners, hospitals and social
services.
The Department is represented on the North West Metropolitan Regional Geriatric Liaison Committee in which
the above meet to discuss the care of the elderly.
The Liaison Committee's first annual report, which was issued during the year, makes some interesting
comparisons between the domiciliary services provided by the three local authorities represented on the
committee: Camden, Islington and Haringey. The two former have greater financial resources than this
borough and this is generally reflected in the figures. While Haringey had in June, 1970, 0.60 home helps per
1,000 population, Islington had 0.68 and Camden 0.80. Haringey, however, had a target of 0.85 for 1975 while
Islington's was 0.80; but Camden aimed for 1.36. Where home nurses were concerned, Haringey had 0.14 per
1,000 population compared with 0.18 in Islington and 0.19 in Camden. Neither Haringey nor Islington is
proposing to alter the ratio of home nurses, but Camden intends to increase it to 0.25 by 1975. As for
health visitors, Haringey had 0.11 per 1,000 population in May, 1970, while Islington had 0.16 and Camden
0.17. Haringey plans to increase its ratio to 0.17 in 1975 and Camden to 0.19, but Islington's will reduce
slightly to 0.15.
The most striking difference between the boroughs is with regard to geriatric visitors. Islington had 8 in September
1969, and Camden 21. Haringey had none, a situation which still exists.
There is an urgent need for geriatric visitors in Haringey. A very high proportion of the problems of the elderly
are concerned with their health. Social workers do not have the background and training to deal with many of
these, while the skills of the state registered nurse are eminently suited to them. It is to be hoped that it will
become possible to make appointments of this kind in the near future as the need is considerable.
Not to be confused with the Geriatric Liaison Committee is the Geriatric Co-ordinating Committee, which is a
small group of specialised officers in the Health and Social Services Departments formed to exercise surveillance
and a degree of control over elderly people in the borough who are in a state of crisis or are likely to become so.
Although compulsory removal to a hospital or an old people's home was considered in a number of cases it
fortunately did not prove necessary, and the Committee was able to co-ordinate the services so that the old
people retained the maximum freedom of action while receiving as much support as was acceptable to them.
The Co-ordinating Committee has with time developed a good deal of experience in this field. It meets monthly
and has been deliberately kept small in number to facilitate prompt action. After long deliberation it was
decided this year to enlarge it by one, giving a total of six, by including a Medical Social Worker from St.
Ann's Hospital who has since made a valuable contribution to its work.
The principal quality required of a member of the Co-ordinating Committee is expertise. Geographical factors
are of no importance. Any worker in the field may inform a member of a problem, which is then dealt with
by the whole committee.
The Chairman is the Deputy Medical Officer of Health, who takes responsibility for compulsory removal under
Section 47 of the National Assistance Act, 1948. A senior Mental Welfare Officer advises on mental health
questions, and the remaining four are the Deputy Superintendent Health Visitor, the Supervisor of Home
Nurses, a Senior Welfare Officer with considerable knowledge of old people in the community and also of the
residential and other services available to them, plus the Medical Social Worker.
Thirty new cases were referred during the year and 28 old cases were kept under review. Nine went into old
people's homes, 7 died and 18 were removed from the list with the proviso that they could be returned at any
time.
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