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The Worshipful the Mayor, Aldermen and Councillors of the London
Borough of Hillingdon.
Mr. Mayor, Ladies and Gentlemen,
I have the honour to present my second Annual Report which covers the work of the health
department for the year 1971. The Report follows the revised pattern with an emphasis upon the
review of services for which I am responsible within a wider context of the health needs of the
area. Particular prominence has been given to the work of the School Health Service in view of
its crucial importance, yet uncertain future, at the present time. The year under review has been
one of progressive improvement as agreed policies have been implemented and key staff recruited.
Significant advances in staffing levels have been recorded in most areas within the department
and have enabled more appropriate services to be provided, and new ones to be introduced. The
resultant increases in the output of the service are reflected in the improved statistics recorded in
the report and require no further amplification.
The year was also marked by the introduction of management concepts within the health
department and by the application of specific management techniques. In July, management by
objectives was extended to the health department and involved most senior professional officers.
Contrary to expectation it was found that standards of performance could be accurately defined
and could be quantified in over 70% of cases. The technique has already produced a clearer
organisation pattern within the department and has helped to define more accurately the contribution
which each manager is expected to make. At the same time the introduction of the technique
within the management organisation of the department has in no way infringed the essential
clinical freedom which each professional officer is expected to exercise during contact with
individual patients.
In the same month a research team from Birmingham University commenced an operational
research study at the health control unit to determine what changes in existing practice or in
staffing levels were necessary in the light of the changing patterns of aircraft movement at London
(Heathrow) Airport. The present requirement upon the unit to have available at least one clerk/
receptionist at a moment's notice at any time of the day or night militated against any significant
economies but the study did show that a modified shift system which would ensure that more
staff were available when they were most likely to be needed would reduce the additional staff
who would otherwise be necessary to meet the commitments imposed by the new pier.
In November a detailed study of the work of the domiciliary nursing services was undertaken
and each nurse provided details of the work undertaken during a two week period. It has been
recognised that the number of home nurses employed in Hillingdon is less than the recommended
level and, indeed, an interim addition to the establishment was agreed during the year. Nevertheless
it was necessary to determine the current levels of work, the extent of unmet need in the existing
case load and indeed the total need for nursing services within the community. It is certain that
some of these needs can be met by staff other than state registered nurses and the results of this
study will enable realistic decisions to be taken about future staffing levels.
Vital Statistics
The total number of births confirmed the continuing downward trend in birth rate which has
been noted in London generally for some years. The number of deaths was similar to the previous
year, and whilst annual fluctuations and relatively small numbers preclude precise statistical
conclusions the trends of earlier years continued. The steady increase in the number of deaths
from ischaemic heart disease and other cardiovascular manifestations was maintained together
with the upward progression of deaths from malignant disease. Carcinoma of the bronchus remains
the largest single cause of death in this latter group. The urgency of the need to persuade people
to stop smoking is reinforced by the knowledge that 128 Hillingdon residents died from what
may now reasonably be regarded as a potentially preventable disease.
The infant mortality figures are, yet again, disappointing. The interruption in 1970 of the
depressing trend in the mortality rate amongst young babies since the inception of the Borough
has not been maintained, and the figure this year is worse than ever before. A more detailed analysis
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