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The type of patient to be nursed is also changing. The patient who remains at home longer
is now likely to be more incapacitated and therefore requires additional nursing time, so that a
single nurse cannot treat as many patients during the working day. A further addition to the home
nurse's work has arisen from attachment to the family doctor. By relieving him of a number of
essentially nursing duties, she adds to her own. The reorganisation of present services to permit
a greater number, and possibly greater variety, of nursing staff to visit patients in their own homes
is anxiously awaited.
The routine week-day liaison with Hillingdon Hospital has continued daily and has proved
highly successful. Details of patients to be discharged within the next 24 hours are passed to the
home nurses, and continuity of care is now assured. Negotiations are in progress to extend this
system to Mount Vernon Hospital.
The liaison scheme between one district nurse and the consultant geriatrician continues
with meetings at Hillingdon Hospital on two afternoons per week. This close contact allows
individual cases to be assessed, and ensures that the suitability of Hospital in-patients for discharge
can be assessed, together with the need for admission to Hospital amongst patients who are
being nursed on the district.

PROBLEMS OF DISPOSAL
The popularity of labour-saving heating methods in the home brings its own problems.
Modern housing development is automatically designed with central heating, but no provision
is made for the disposal of medical waste. There are now more and more people in the Borough
with collections of soiled dressings from wounds, colostomies, etc., but with no easy means of
disposal. The coal or coke fire has gone and the use of a bonfire discouraged. Communal incinerators
are subject to vandalism, whilst the normal refuse disposal methods are inappropriate.
It has become increasingly common for home nurses to transport such waste in their own
cars, but this is clearly unacceptable. During the year discussions were commenced with the
Director of Engineering concerning the introduction of alternative disposal schemes in appropriate
cases. The helpful co-operation shown by members of the Director's staff in the resolution of this
problem was much appreciated.
HYPOTHERMIA
Recently public attention has been drawn to the problem of hypothermia. Doctors and nurses
working outside Hospitals have been aware for some time that the old and the very young can
suffer irreparable physical damage simply by being in cold conditions long enough for the body
temperature to fall below normal levels. The Department's home nurses have carried special
thermometers capable of registering low temperature readings for some years. At the beginning
of the Winter these were checked and the domiciliary staff were reminded of the dangers of
hypothermia. In spite of these preventive measures two cases were reported to the Department
during the year.
HEALTH VISITING SERVICE
The health visiting services have been maintained as in previous years, but the responsibilities
have tended to increase on account of the shortage of medical officers. Health visitors have been
required to report on the progress of children when a medical report, if available, would have
been sought. Unfortunately the shortage of qualified health visitors has continued, and by the
middle of 1970, it was evident that major changes were necessary if the level of recruitment was
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