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Ideally, action should precede any significant physical abuse, but in the absence of evidence
to warrant legal action, it is difficult for the health visitor to intervene even when she recognises
stress within the family and suspects that this may lead the parent to harm the child. It is important
to preserve a close and sympathetic relationship with the family, and such children will now be
placed in a special section of the Observation Register to ensure that the risks are not forgotten
even if there is a change of personnel.
Paradoxically one of the greatest safeguards for children at risk of physical abuse is for all
professional workers connected with the family to recognise that the possibility exists. By drawing
attention to the problem the meeting has achieved this objective, and also shown ways of ready
communication between the health and social services likely to be principally concerned with
such families.
WELFARE FOODS AND MEDICAMENTS
The Welfare Foods Service requires Local Health Authorities to ensure the distribution of
National Dried milk for babies, orange juice, cod liver oil for children, and vitamin tablets for
expectant mothers. In addition it is the practice in this area to permit the sale of certain specified
proprietary foods at a cost slightly less than that available in local shops. It has been argued that
the sale of proprietary foods in Child Health Centres encourages mothers to attend, but research
studies do not endorse this opinion.
Distribution is assisted by a valuable group of voluntary workers who attend at the Child
Health Centres. The assistance of these ladies in the promotion of child health within the Borough
is much appreciated, not only because of its financial advantages but because of the community
interest that it so admirably demonstrates.
During the year increasing difficulties were experienced in maintaining a distribution service
at Centres other than Child Health Centres owing to staff shortages. Bearing in mind that individual
needs for these foods can usually be planned from week to week, and that on any day in the
Borough there will always be several Child Health Centres from which supplies can be obtained,
a reduction in the number of distribution centres was considered. This allowed the retirement of
some staff who have assisted with the service for many years, and far beyond the usual retirement
age. To these workers also grateful thanks are recorded.
The list of proprietary foods which are on sale is kept under continuous review, so that
changes in Welfare Foods policy generally may be accurately reflected at the local level.
THE WORK OF THE COMMUNITY NURSING SERVICES
A decision to review the management structure in the Local Authority Nursing Services in
the area was overtaken by the receipt of Circular 13/70 from the Department of Health and Social
Security which requested all Local Authorities to undertake such a review and to report progress
by 31st December, 1970. Although there has been some integration of the domiciliary midwifery
and domiciliary nursing services for some years the health visiting service has been quite separate.
It has been recognised therefore that all nursing services should become the responsibility of a
Chief Nursing Officer who would not only co-ordinate the two existing services but would undertake
responsibility for the professional supervision of any staff employed by the Council on
nursing duties. The creation of a new post of Chief Nursing Officer was agreed during the year,
together with an extensive revision of the management structure consisting of two Principal
Nursing Officers and eight Senior Nursing Officers. These latter officers may be described as
"First line managers". In the Local Authority nursing services in Hillingdon it is not felt appropriate
that field work staff, all of whom have undertaken some duties of a managerial nature in Hospital,
should themselves be supervised in their day to day professional duties. There are certain specialist
duties to be undertaken within the nursing services, and it is appropriate that nursing staff of
appropriate seniority should undertake such responsibilities and receive appropriate recognition
for doing so. Liaison with Hospitals, training of nursing personnel, and the necessary support of
recently qualified health visitors fall appropriately into these areas of responsibility, together with
those undertaken by the three officers currently designated "Deputy Superintendent".
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