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In general, the scheme is intended to facilitate simple, short-term nursing care in the patient's home.
Certain items of catheterisation equipment may be provided as a personal issue to paraplegic patients to enable
them to care for themselves in their own homes. Other items of equipment may be purchased in special cases.
TUBERCULOSIS
(Tables 13—16)
Mortality and Morbidity
There were nine deaths from respiratory tuberculosis among men and two among women, compared
with eight and four respectively last year. All the deaths were in the older age groups (45 years +). Three of
the men and one of the women were previously unknown to the health authorities. This indicates that in spite
of the improvement in case-finding methods, there is still a reservoir of infection among older people in the
community which holds special hazards for the young and unprotected. In view of this "hard core" of tuberculous
infection, B.C.G. vaccination is an important preventive measure offered to all school leavers to raise
their resistance to the disease. (For details of B.C.G. vaccination of school leavers see Report of Principal
School Medical Officer, page 67).
Care and After Care
Provisions for care and after-care of patients have continued throughout the year. The focal point of
these arrangements is the Chest Clinic, Pound Lane, Willesden. The physician-in-charge, who is employed by
the Regional Hospital Board, is a consultant in diseases of the chest. Although, therefore, his prime function
is that of clinician concerned with diagnosis and treatment, he is also fully aware that the prevention of
disease on the one hand and the after-care of patients on the other cannot be divorced from actual treatment
itself. Because of this, the physician has responsibility for the general supervision of the local health
authority's scheme for promoting the after-care of patients, and experience over the years has confirmed the
desirability and effectiveness of this arrangement at the Clinic. For the furtherance of the same aims, it is also
arranged that Council staff employed at the Clinic are under the direct control of the physician-in-charge for
day-to-day administration and management of all duties relating to after-care of patients.
Home Visiting
Four tuberculosis visitors were on the staff at the end of the year. Besides home visits to patients,
they undertake duties at the Clinic, including that of clinic sister during diagnosis and treatment sessions.
In the course of home visiting, the tuberculosis visitors advise on methods to prevent the spread of infection,
explain provisions for care and after-care and keep all known contacts under close supervision. Home visits
made during the year totalled 1,442, 267 of which were to households proving to be non-tuberculous.
Occupational Therapy
A full-time occupational therapist, as the first stage in the rehabilitation of patients, gives guidance
and training in many handicrafts to selected patients in their own homes. As the therapist spends part of his
time visiting the homes of physically handicapped persons on behalf of the Welfare Division, it was deemed
suitable, although their therapy needs had originated as referrals from the Chest Clinic, to have tuberculous
patients also registered with the Welfare Division, so that the occupational therapist now deals with all his cases
as part of the same general case-load. The arrangement whereby the same officer provides service to patients
in the London Boroughs of Ealing and Hounslow continued in operation, but the numbers of such patients
in each of these Boroughs has reduced gradually over the years since the joint arrangement was instituted in
1965. The occupational therapist's visits to the Hostel for Tuberculous Men run by the London Borough of
Richmond at Twickenham, ceased in December with the dealth of the one resident there for whom this
authority had responsibility.
One hundred and thirty-three successful visits were made to patients' homes in Brent.
Vaccination against Tuberculosis
Vaccination with B.C.G. is provided for persons who are tuberculosis contacts, school children aged 13
and over, and students attending universities, teachers' training colleges, technical colleges and other further
education establishments.
The number of persons vaccinated during the year was 2,146.
The report of the Principal School Medical Officer, page 67, gives details of tuberculosis testing of
schoolchildren and school leavers and of B.C.G. vaccination of school leavers.
In July, 1968, there was published a report of an ad hoc sub-committee (chaired by Professor D. G.
Scadding, M.D., F.R.C.P.) of the Standing Medical Advisory Committee of the Central Health Services Council,
entitled "The Future of the Chest Services". This report reiterated the main recommendations of the
1960 Standing Tuberculosis Advisory Committee, before proceeding to its terms of reference "to consider the
general organisation of chest clinics in relation to the rest of the hospital services and to make recommendations."
Comment was made on the development, as recommended in 1960, of chest units being incorporated
within out-patients departments of general hospitals as against the continuance of provision of facilities in
chest clinics separated from the hospitals. Particularly with regard to the former, the sub-committee made
recommendations on the future of speciality in chest diseases, siting, staffing and training, special facilities required
including radiological and respiratory function laboratories. The role of the local health authority and
its responsibility for preventive and after-care services was clearly re-stated. The report also records what has
in fact been local experience, that with the decline in the incidence of tuberculosis, the increase in bronchial
carcinoma and the increasing recognition of other forms of chronic respiratory disease as causes of morbidity
and mortality, the work undertaken in the chest clinic has become more varied.