View report page

The Worshipful the Mayor, Aldermen and Councillors of the London
Borough of Hilling don.
Mr. Mayor, Ladies and Gentlemen,
I have the honour to present my third Annual Report which covers the work of the health
department for the year 1972. Progress towards previously agreed standards of performance continued
and the higher levels of output achieved by the service in the previous year were, in general,
maintained. The year under review has been one of continuing improvement as the additional
numbers of staff required to bring the community services to an appropriate level have been recruited
and assimilated into the general work of the department. The strengthening of the administrative
support necessary to enable field workers effectively to discharge their responsibilities was particularly
welcome.
The year was marked by an emphasis upon the reorganisation of the National Health Service.
The need to integrate the three separate branches into a unified whole has been recognised for many
years, and the first suggestions concerning a possible reorganisation were introduced in May 1968.
Since that time a succession of documents has steadily modified the original concept as the final
proposals presented in the White Paper in August 1972 and the National Health Service Reorganisation
Bill published in November made clear. Preparation for this major reform involved considerable
time and effort by individual members of the department usually at the most senior levels. Certain
officers in the department were asked to participate in a local field trial of management hypotheses
which have been developed for the new service. A Committee, established by the Secretary of State
and advised by Messrs. McKinsey and by the Brunei Institute of Organisation and Social Studies,
had formulated certain proposals concerning the management arrangements which might be appropriate
at each level in the new organisation. Senior staff from all branches of the health services in
Hillingdon were invited to study these proposals in depth, and to suggest how they might be applied
on a theoretical basis in the Borough. It was pleasing to note that the final document "Management
Arrangements in a Reorganised National Health Service" published later in the year included many
of the amendments which had been suggested during the course of the field trial in Hillingdon.
The arrangement of area health authority boundaries in London caused problems throughout
the year since not all Boroughs could be considered self-sufficient as far as health services provided
within their boundaries were concerned. Thus the general principle of co-terminous boundaries
between health services (administered by the new area health authorities) and social services
(administered by the new local authorities) could not be applied universally in London. Many
combinations of Boroughs were suggested and a number of reports were produced justifying the
views of particular groups. One such report showed that over 81 % of Hillingdon residents receive
their in-patient hospital care within the Borough boundaries, and the announcement by the Secretary
of State in November that Hillingdon would form an area health authority on its own was, therefore,
particularly welcome.
Vital Statistics
The total number of births showed a 2% reduction compared with the previous year and was
the lowest yet recorded since the inception of the Borough. The number of deaths confirmed the
trends identified in previous years. There continues to be a steady increase in the number of deaths
from lung cancer (166), whilst cardiovascular manifestations continue to account for the largest
number of deaths. It is upon these diseases processes that preventive action must be concentrated
although it should be remembered that these diseases characteristically occur in older people.
The proportion of births delivered at home decreased slightly to 19% but it is clear that an
excessive number of mothers for whom it is now recommended that a hospital confinement should
invariably take place are, in fact, accepted for home delivery. Some 28% of such mothers in Hillingdon
are subsequently rushed into hospital either late in pregnancy or early in labour and this fact suggests
that better selection of cases for home confinement is urgently necessary. During the year arrangements
were completed to ensure that all "high risk" mothers were encouraged to accept hospital
delivery.
3