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Nursing Services
Miss M. Smith — Director of Nursing Services
Health Visiting
The present establishment of health visitors is 36. This ratio of staff per population is far below the recommenda
tion of the Jameson Report 1956 (an inquiry into Health Visiting). This report accepted by the Ministry of
Health, recommended one health visitor per 4,300 population (50 posts). Circular 13/72 issued by the
Department of Health February 1972 states: —
"While subsequent experience confirms this estimate (1—4,300 population) as reasonable for some areas, a
ratio of one health visitor to 3,000 population may be desirable in others, e.g. those with a highly developed
system of attachment to group practice or those with a high immigrant population" (79 posts).
Attachment of health visitors to group practice is not a practical proposition at the present time, nor will be in
the foreseeable future due to shortage of staff. There were 12.4 unfilled posts at the 31 December, that is one
third of the very low establishment of 36. A considerable inward and outward flow of residents, the complexity
of present day problems, makes it impossible to give the kind of service to the public that is necessary and
desirable with such a limited staff.

Student Health Visitors
Four sponsored student health visitors were successful in obtaining the Health Visitors Certificate and five
commenced the year's training in September 1972. Unfortunately training students in such a limited number
does not result in achieving a full establishment, but it does contribute towards filling some of the gaps
resulting from retirement, staff moving from London and others starting their own families.
Midwifery Service
Domiciliary deliveries continue to show a decrease. 167 patients were delivered in their own home (229—1971).
22 patients who were considered suitable by the consultants for early discharge were delivered by the domiciliary
midwives in hospital. A total of 847 patients were discharged early for nursing by the midwives. Of these 199
were planned early discharges, that is the homes had previously been assessed and considered suitable for early
discharge within 48 hours following confinement. 616 were discharged between three to eight days, and 26 were
self discharge against medical advice for a variety of reasons. Some of whom give cause for concern because of
the poor home facilities.
Student Midwives
District training for students is arranged four times each year in association with the North Middlesex and
Whittington Hospitals. The training lasts for three months, the student being under the supervision of a
domiciliary teaching midwife, having spent nine months prior to this in the training hospital. During 1972 thirty
eight students received district training.
Obstetric Nurse Training
Forty student nurses undergoing three months obstetric training at the City of London and Whittington
hospitals were given an insight into the work of the domiciliary midwife.
Guthrie Tests
Infants born with phenylketonuria appear normal at birth but as they get older the features of untreated
phenylketonuria becomes apparent. Severe mental retardation is seen. If the condition is diagnosed early the
infant can be given a special diet. The prognosis is then excellent. The Guthrie Test detects a raised level of
phenylaline in the blood. This can be due to causes other than phenylketonuria and if the test is repeated after a
few days the raised level will have fallen to normal in most instances.
Two babies required further investigation following the test but ultimately proved to be normal. First and
repeat Guthrie tests carried out by midwives number 1,073 (955-1971), and all were found to be normal.
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