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presents serious problems for the future development of midwifery services. In Hillingdon a scheme
has been developed by arrangement with Hillingdon Hospital and local family doctors, in which
the domiciliary midwife supervising the case accompanies the mother to hospital at an appropriate
stage in labour. In hospital the mother is attended by the domiciliary midwife and medical assistance
is provided by the family doctor. Hospital midwives and specialist medical staff are readily available,
but do not intervene unless specifically requested. The mother returns home from hospital in the
care of the domiciliary midwife as soon as she is fit to do so. This scheme provides many of the
advantages of institutional delivery whilst allowing the domiciliary midwife to maintain her clinical
responsibility for the health of the mother and the safe delivery of her child.
Drug Abuse
The current attention directed at the experimentation with drugs by young people together
with the appearance at Uxbridge Court of persons well known in the entertainment industry has
naturally raised the possibility that drug abuse in Hillingdon may be a serious problem. Careful
evaluation during the year suggested that whilst the Borough is certainly not exempt from what
appears to be a national trend there is no evidence of a specific local problem demanding urgent
attention. The situation in this field is, however, a constantly changing one, and it was thought
prudent to create a review panel with representatives from various social agencies who would
monitor continuously the available evidence. It is clear that in any situation with legal implications
adequate statistical evidence will be difficult to obtain. Complacency must be avoided but extravagant
conclusions from the small minority of cases which ever come to light are equally
dangerous and may be self-fulfilling.
Environmental Health
The increasing recognition of the need to control modern forms of environmental pollution
was welcomed and has enabled the Department to investigate less obvious problems. The Chief
Public Health Inspector comments on these matters in his report. The shortage of smokeless fuel
which necessitated a further setback in the clean air policy for the Borough was regretted, and
vigorous action seems necessary at a national level if the advantages of a smoke control policy
which are already apparent, are to be fully realised.
New Legislation
The passage of the Local Authority Social Services Act 1970 foreshadowed the artificial
separation of health and social service functions. It remains to be seen how long this organisational
separation will be permitted and what implications it will have for the patient who needs both
health care and social support. Certainly the division is hardly likely to overcome those difficulties
at present existing between residential care in hospital and residential care outside it. Nevertheless,
the integration of most social workers employed by Local Authorities within a single organisational
structure is welcome. Mental illness is not infrequently associated with matrimonial problems and
both are potentially damaging to the child. Physical handicap equally has an effect upon the
family unit, and the provision of a social casework service based upon the whole family rather
than upon specialist problems seems self-evident. During the year the Council commenced
preparations for the creation of a new Social Services Department, and thus emphasised its
recognition of the value of this important unifying concept, together with its determination to
implement it.
The passage of the Chronically Sick and Disabled Persons Act was heralded as a charter for
the disabled, but concern was soon expressed by voluntary societies that its welcome concepts
might not find practical expression in proposals by statutory bodies. The most important role of
voluntary societies as stimulators and innovators in the field of social care sometimes brings
conflict when new services by statutory agencies seem slow in development. In these situations
there must be respect for the differing roles of the two participants together with a recognition
that both have the same ultimate objective. The Chronically Sick and Disabled Persons Act
provides more for the handicapped than individual aids and adaptations important though these
are. The educational provisions under the new Act should not be overlooked, and reference to
these is made in the report on the School Health Service.
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