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26
In accordance witn the rules of tne Central Midwives Board, the Council
is also required to provide or arrange refresher courses of instruction for
certified midwives practising in the area.
Close liaison has been maintained between the domiciliary midwives working
in the Borough, the healtn visitors and the district nursing staff, thus
ensuring the continuity of the service in the interest of both mother and child.
HEALTH VISITING
The health visitor has always been a key worker in health departments.
She has had special training in the knowledge and sKills sne will require to
ensure tne well-being of the family, and in particular the health of mothers
and young children. Sne is also a qualified State Registered Nurse and must
nave had some midwifery training.
Over tne years tne detailed content of ner work nas altered, in line witn
rising standards of living and cnanging social conditions. Whereas the health
visitor some years ago would nave oeen primarily concerned with oasic standards
in infant feeding, hygiene and management, today far more of her work concerns
personal relationships between mother and child, surveillance of high risk groups
(sucn as families witn problems and those who nave a mentally or physically
handicapped child), and liaison between the general public (i.e., the families)
and workers of other social agencies and departments. Her basic role remains
that of healtn educator and social adviser to all families with children under
5 and the detector of early signs of stress and strain. It would oe true to
say that amongst all the welfare workers in the community services tne healtn
visitor's duties are unique in their preventive nature and wide scope of service
to tne family. Sne is the only worker wno has a statutory duty to visit every
new born baby in her area as well as all pregnant mothers. She will pay a
most important visit to every new baby following the notification of the birth
and this will inevitably involve her with the whole family, from tne youngest
to the oldest member. She has become generally accepted in the pattern of our
society as a worker with healthy families. She is in effect in "at the ground
floor" in contrast with otner workers who are called in to deal with actual
problems and difficulties.
Health visitors in the Borough work from nine maternal and child health
centres, each of which serves a defined geographical area. The larger centres
all have on the staff a senior health visitor (Centre Superintendent) who is
responsible for the day to day supervision of the health visiting service in
the centre's area, giving guidance to newly qualified staff and assisting in
the practical training of nursing and health visitor students. She is also
responsible for the "housekeeping" of the centre, and for co-ordinating the
services offered there, including giving information and advice to members of
the public. Full details of the centres and their activities are shown in the
summary on pages 3 and 4.
Ideally each health visitor should have a case load of approximately 400
families and should then be able to give time not only to ner statutory duties
under Section 24 of the National Health Service Act, 1946, but to visiting persons
requiring care and after-care, health education (including teaching in secondary
schools and ante-natal classes for expectant mothers), and adequate follow-up
which is particularly vital in families with problems. However, owing to the
shortage of health visitors, which I mentioned in my report last year, health
visitors in this Borough have to carry a case-load almost three times this size
and in fact the hignest for any Inner London Borough. They are therefore having
to limit their work to visiting new oabies, and pregnant mothers (the birth rate
in Hackney is still the highest in London) and to dealing with families with
acute problems and emergencies. It must be remembered, too, that this is an
area with many social problems; there aremany semi-skilled and unskilled workers
who might in any case be regarded as most in need of the help and support of
local services.