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for the family doctor and local health authority
nursing service than for continued expensive
hospital care.
To get back to community care. Firstly the
school health service covers the years 5-15 and
beyond if necessary. In Hounslow it follows the
usual pattern of four routine medical inspections,
but the question of selective examinations is under
active consideration though our departmental
medical officers appear to prefer the former well
tried method of case finding.
In this context the advantage for the
handicapped child of locally based medical
assessment units appears now to have been
widely realised and the problems of how, where
and when to set up such units are now actively
exercising the minds of doctors and others at
many levels in this country and in the committees
of the World Health Organisation. In Hounslow
two such local authority assessment units have
flourished for over ten years and have attracted
a stream of visitors from all parts of the world.
The teams at the purpose-built medical
assessment unit for all types of paediatric
handicapping conditions at Martindale and at the
purpose-built audiology unit at Heston are truly
multi-disciplinary. Here are shown the great
benefits which can accrue from the combination
in one team of hospital consultants, local
authority medical and paramedical staff and the
teaching staff of the immediately adjacent special
schools and satellite special classes.
Here assessment of every function from infancy
onwards can be carried out without causing
apprehension to the child. Vital follow-up is
continuous as the child attends school daily.
Wheelchairs, calipers, plasters, hearing aids,
physiotherapy, speech therapy, orthoptic
exercises and a host of other therapies can be
obtained without stepping outside the schools
with its attendant loss of vital time and energy for
both child and parent. Physiotherapy and
hydrotherapy are viewed by these children in
much the same way as physical education and
games are viewed by ordinary children. To these
children in a school setting the speech therapists,
orthoptists and nurses are people no different
from their class teachers or teachers of the hard
of hearing. There is every advantage for such local
assessment units to be attached where possible to
large comprehensive special schools within the
community rather than to district hospitals.
Continuous observation and close liaison with the
teachers, psychologists and other school staff is
inevitably so much better in school surroundings
and the atmosphere of a hospital is also avoided.
After all such children rarely need pathological,
radiological or other investigation at a moment's
notice and if they do require such an investigation
as an EEG it can usually be arranged at leisure
with the same consultant paediatrician who
attends the hospital and the medical assessment
unit—in fact he himself usually refers the child
to his own unit at the hospital.
The advantage of the combination of pre-school
out-patient diagnostic and therapeutic facilities
within the medical services for the school child at
these units was further augmented in 1961 by
the setting up of a risk/observation register
aimed at earlier detection. (2 and 3) In 1965 a
closer integration was achieved with the
consultant obstetricians at the local district
hospitals and this has resulted in the formation of
a programme on the subject for the borough's
computer. The first part of the programme is now
almost complete after considerable early
difficulties due to the complexity of the subject.
Student Health Service and Occupational Staff
Health Service
As an extension to the school health service the
borough has formed a student health service for
students attending its Polytechnics and Colleges
of Further Education.
In this context the Department of Health has
been fortunate in the appointment of Dr A R
Broadbent, senior medical officer, who is qualified
and experienced in occupational health. Reports
on the London Borough of Hounslow's new
student health service and on its proposed
occupational staff health service are to be found
in the body of the report but it is pleasing to have
these new policies confirmed at a later date by the
following extracts from papers read by doctors at
the Health Congress in Eastbourne—
'Almost all occupational activities provide health
hazards of some kind which vary only in degree
or complexity. The suitability of these many
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