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for this service on a sliding scale based on the income of the parents. Broadly speaking
admission of children is restricted to (a) those whose mothers are the sole support
and have to go out to work and (b) those whose health is, or may be affected by adverse
home conditions. On medical recommendation handicapped children may be admitted and in
such cases no charge is made. Anyone who undertakes the daily care of more than two
children must be registered under the Nurseries and Child Minders Regulation Act and at
the end of 1963 there were in the Borough one registered private day nursery and six
registered child minders. It is known that a number of women undertake the daily care
of one or two children They do not require to be registered but where they agree to the
inspection of their home and the children by health visitors and to bring the minded
children at least once a month to see the doctor at the infant welfare clinic, a fee of
1/- per child per day minded is paid.
In 1919 the Borough started a home help service for women at the time of confinement
as part of their maternity and child welfare service. In 1927 the service was
extended to families needing help during influenza outbreaks and in 1945 was further
extended to cover domestic emergencies arising from illness and infirmity. Now the service
is given to households "where such help is required owing to the presence of any
person who is ill lying in an expectant mother mentally defective, aged or a child
not over compulsory school age and a charge is made on a sliding scale. This service
which was designed originally to deal with temporary domestic crises has changed slowly
but steadily and is now largely devoted to the care of the aged and chronic sick. The
growth of the service has been remarkable (average annual number of households assisted
has risen from 54 in 1939 43 to 898 in 1959-63) and demand shows no sign of falling off.
Where formerly help might be needed for two or three weeks to cover a domestic emergency
continuous care of the elderly and infirm is now the order of the day. The records
show a number of current cases who have been receiving help for 20 years. It is not
easy to find women who are prepared to work in any home to which they may be sent and
possibly to tackle problem families, rubbish accumulated over years, incontinence and the
occasional old person who is dirty in person objectionable in habit, obscene and defiant
in speech and resistant to all attempts at improvement. The Borough laundry scheme does
help with the laundry of the incontinent but as it is a weekly service, considerable
washing and laundering still has to be done by the home helps. This is a real problem
especially in regard to drying facilities and in an effort to ease the burden incontinence
pads are now being tried. Some old people can manage with help in lighting fires,
shopping and tucking up in bed at night and where a neighbour is willing to do this regularly
and keep a friendly eye on the case, they are engaged as "neighbourly helps"
and paid for their services. Under the stimulus and example of Mrs Chapman, Home Help
Organiser the service here has gained a high reputation and no case seems too difficult
to be tackled. Many of the home helps view their work as a vocation and not just as a
job and the amount of help given voluntarily by them and often by their husbands, at
weekends and holiday times to the old people and families under their care is very considerable.
In 1962 the County Council started a chiropody service for the elderly physically
handicapped school children and expectant and nursing mothers. Chiropody sessions are
held at clinics and where necessary the chiropodist makes home visits. The shortage of
suitably qualified staff has regarded the growth of this service and contributions continue
to be paid to voluntary organisations running a chiropody service for the aged.
Health education is a difficult subject. Its object can be said to be (a) "to
ensure that health is regarded as a valued community asset and (b) to equip the individual
with knowledge which he can use to recognise and possibly to solve his own health problems".
The educator has to be certain of his facts - our knowledge of the source of and of the
factors influencing diseases is steadily increasing - and has to devise effective ways and
means of spreading the information. This is the real problem and a series of "dont's"
does not get very far. Staff are encouraged to do what they can in the way of health
education in their daily contacts with the public. Use is made of leaflets, posters, talks,
etc. but is is difficult to judge the impact of these. The new medium of television enables
facts about health to be presented with vivid reality and there are signs that this opportunity
is being explored. Democracy is a way of life based on personal responsibility and
health is one of these responsibilities.
Prior to the National Health Service, medical attention to mothers and children was
subject to an individual charge and it was only natural that many sought the services
of local authority clinics where there was no charge for advice or treatment. The impact
of this new service has shown itself in reduced attendances at ante-natal, infant welfare,
school eye orthopaedic clinics, etc, but this has been accompanied by an increased demand
for home nursing, midwifery, health visiting, home help chiropody, etc., - i.e. of the
servies ancillary to medical care It is all to the good that general practitioners should
be taking an increase share in the work formerly left largely to the local authorities.
During the last 25 years, there has been a tendency to consider environmental hygiene infectious
disease control, medical examination of school children etc. as of lessening importance
while pleading for more action in regard to mental health, prevention of maladjustment
and neurosis care of the aged and supporting services for the frail and handicapped.
If we are to hold what we have gained the existing and well tried measure of the past must
not be dropped and this must be borne in mind in planning health and welfare services. The
largest stumbling block to developing the widening the scope of local authority services looks
like being inability to recruit adequate and suitable staff.
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