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22
The main, and all important conclusion, is that there is a continuing
need for a preventive service to safeguard the health of children, in which
family doctors will play an increasing part in the future. The Council,
without delay, implemented the recommendation that the service should for the
future be described as the "Child Health Service". The service in Hackney to
mothers and children is now therefore a Maternal & Child Health Service and
the Council's premises where it is carried on are now described as Maternal
& Child Health Centres. The service to mothers is a wide one, including
ante-natal care, family planning advice and screening for cervical cancer by
cytology. These services are discussed in full elsewhere.
The report stressed the need for liaison and exchange of information
between all those involved with the preventive and curative services to children
in the National Health Service and the voluntary services in this field.
Health education should be developed as an integral part of the Child
Health Service, and health education officers are mentioned as having an
important part to play, particularly in co-ordinating all health education
activities in one area. It is, and always has been the view in Hackney, that
health education is part of the normal work of all workers with mothers and
children. The personal approach is of the greatest value and needs to be
supported and strengthened by other means such as publicity and periodic
emphasis on some special aspect.
The Sheldon Committee viewed the distribution of National Dried Milk as
being still necessary, the sale of other proprietory foods to be a matter for
individual authorities. The sale of these foods and vitamin supplements is on
a limited scale in this Borough, and is kept under review. One reason is that
the composition of foods on the market alters from time to time and some may
have harmful effects through containing a large amount of sugar. Others have
vitamin supplements added and if a child is given these from more than one
source an overdose is possible.
The Sheldon Committee also considered that one of the aims for the future
should be the provision of health centres with adequate accommodation for the
local authority services including interview rooms for health visitors and
facilities for family doctors to practice there too.
The Committee recommended the Medical Officer of Health to keep registers
of children under four headings, a procedure that had already'been adopted in
this Borough:
(1) Healthy infants and children up to 5 years. These registers are
maintained at the Child Health Centres where they are referred to by
medical officers and health visitors working with the children.
(2) Children "at risk" of developing a handicap. This register is known
in this Borough as the Observation Register and is described on
page 23.
(3) Children with congenital malformation observable at birth. This
register is required by the Registrar General, to whom returns are
made monthly. The number of congenital malformations recorded
during 1968 was 106 (see page 23).
(4) Children with handicapping conditions. A new form of register on a
punch card system has been introduced and is described on page 23.
Children who are handicapped may require more comprehensive assessment
of their defects and potential abilities than is the function of a preventive
service, and referral to assessment centres is recommended with the agreement
of the family doctor. The development of these assessment centres,
some of which are already set up in hospitals, was examined by a small group
of advisers at the request of the Minister of Health. It was considered that
the early years of the assessment centres would be experimental and during
this period the shape of the future service could be determined.