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Training Scheme
Increasing numbers of students of various categories are coming into the community for
training and although this adds interest to the community nurses' work and is gladly undertaken,
it is a heavy commitment when staff are under pressure. In addition to the student nurses' training
described above student midwives spend three months on what is now a community care course
rather than domiciliary midwifery experience. Newly approved by the Central Midwives Board
this course aims to give the student a broad picture of community services as a whole and involves
time spent with the health visitor and district nurse as well as with the district midwife and visits
to various local authority establishments. Other students are those doing health visitor and district
nurse training and students taking integrated nurse training. In addition, student midwife teachers
and student tutors come for community experience, as do foreign visitors on scholarship study
tours. The chief nursing officer was herself on a Florence Nightingale Memorial Committee
scholarship to Scandinavia for the months of September/October and is therefore well aware of
the needs of these visitors. The community nursing staff also need in-service training which is
given in the form of lectures and study days and use is also made of study days arranged by other
organisations such as the Queen's Institute of District Nursing. During 1971 special courses were
given in hearing testing of babies and in ante-natal psycho-prophylaxis instruction. A comprehensive
plan of training is being prepared for 1972.
Domiciliary Midwifery Service
There has been a marked change in the pattern of midwifery work during 1971 reflecting
the national trend. Fewer women have had their babies at home—560 as against 796 in 1970,
while the number of early discharges after hospital confinement has increased from 148 to 313,
the most noticeable increase being in the last quarter of the year. The number of mothers delivered
by domiciliary midwives in the unit at the Duchess of Kent Maternity Wing has increased from
68 in 1970 to 98 in 1971. For some years the actual number of midwives in post has been less
than the establishment and the establishment has therefore been changed to a rather more realistic
figure of 19 having taken into account the factors described above. It is, however, difficult to maintain
this establishment at the desired level and the recruitment of suitably qualified midwives remains
a problem.
Domiciliary Nursing Service
The number of patients nursed throughout the year has again risen and the district nurses
have been working at a continuously high pressure. In order to assess the exact nursing staff needs
a work study was carried out in November and the results should be known early in 1972. It is
thought that much of the work at present done by state registered nurses could be done by less
qualified staff thus leaving the state registered nurse free to do the highly skilled tasks which only
she can do. For example, bed baths of chronically ill patients could well be delegated to a well
trained nursing auxiliary with a state registered nurse giving supervision and guidance. An assessment
has also been made of the nurses' equipment and sterilisation methods. Boiling as a method
of sterilisation is no longer considered to be bacteriologically safe and therefore an increased use
of pre-sterilised disposable equipment is planned. Preliminary negotiations have taken place with
Hillingdon Hospital into the possibility of using central sterile supply department equipment for
domiciliary nursing and midwifery services. The nursing establishment has been increased during
1971 and on 31st December it was 43 (including staffing of the night service).
Health Visiting Service
The difficulty in recruiting qualified health visitors has continued and increasing use has
been made of clinic nurses and health assistants so that health visitors can concentrate on essential
health visiting duties. The outlook for future staffing is, however, improving—nine students
commenced training in September 1971 and will come onto the staff in 1972. Health visitors
have been greatly helped in their work by the appointment during 1971 of the Principal Health
Education Officer. Health visiting statistics are on page 124.
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