9. County Council Services
NATIONAL HEALTH SERVICE ACT, 1946
BEFORE the great National Health Service Act of 1946 came into operation in July 1948, one of the most outstanding features of the County Council’s work in the field of health was the provision of a general hospital service throughout the County, and also certain special institutional treatment, such as that given in sanatoria for tuberculosis and in mental hospitals. The effect of the National Health Service Act was to transfer all these establishments to the control of one or other of the new regional hospital boards, and the County Council ceased to be responsible for a service which it had built up to a notably high standard of efficiency.
On the other hand, the County Council was given the task of organizing a whole range of new services vitally affecting the health of the people of Middlesex. Before July 1948 it had been responsible for maternity and child health services in only nine out of the twenty-six boroughs and urban districts of Middlesex; in the remaining seventeen the district council was the responsible authority. Under the new Act the administration of these services throughout the whole of the County became the responsibility of the Middlesex County Council in its capacity as the Local Health Authority, together with all the other powers and functions conferred under Part III of the National Health Service Act (which is referred to in detail in Part Two of this book), relating to the health of the citizens of the County. In the interests of efficient and economical administration the school health service is also administered, as far as practicable, as part of the National Health Service provided by the County Council.
The work now carried out by the County Health Department includes maternity and child health services; care and aftercare of persons in the community who have been ill; prevention of illness; health education; the school health services; the mental health services and health control services at airports.
These services are generally directed and controlled by the Health Committee, which carries out the bulk of its work through twelve main sub-committees which are
(1) A General Sub-Committee for all services which are centrally administered, with the exception of the mental health service, and for the co-ordination of services the day-to-day administration of which is in the hands of the local Area Committees;
(2) A Mental Health Sub-Committee for the administration of the mental health service;
(3) Ten local Area Committees which deal with the day-to-day administration of most of the personal health services in operation in the ten health areas of the County which are as follows:-
Area 1. Enfield and Edmonton.
Area 2. Southgate, Potters Bar, Wood Green and Friern Barnet.
Area 3. Hornsey and Tottenham.
Area 4. Finchley and Hendon.
Area 5. Harrow.
Area 6. Wembley and Willesden.
Area 7. Ealing and Acton.
Area 8. Ruislip—Northwood, Uxbridge, Hayes & Harlington and Yiewsley & West Drayton.
Area 9. Brentford & Chiswick, Heston & Isleworth and Southall.
Area 10. Staines, Feitham, Twickenham and Sunbury.
The County Health Department has both central offices and offices in each health area and there is a large staff of doctors, dentists, nurses and other technical staff, in addition to administrative and clerical staff, under the direction of the County Medical Officer of Health.
CARE OF MOTHERS AND YOUNG CHILDREN
Since the future welfare of a nation depends very largely on the health of its children, let us first consider what the County Council does in a number of ways to help the children of Middlesex to be as healthy as possible. One of the most important services is the provision and maintenance of Maternity and Child Health Clinics. These are set up in convenient places throughout the County; some have been specially built as clinics and others are held in hired premises, such as church halls. Infant health sessions are held on one or more days every week. At any of these sessions mothers can attend and obtain skilled advice from doctors and health visitors on the best ways of feeding, clothing and generally caring for their babies. Milk foods and vitamin preparations are available at the clinics. The illustration on this page shows the health visitor at an infant health session weighing a baby whilst its mother looks on. Special “toddlers’ “sessions are held for the older children.
The health of the mothers also is the concern of the County Council, which employs a staff of health visitors who visit both mothers and young children and, in fact, all members of the household in their homes to advise on the ways in which to maintain good health and to put them in touch with other social services when necessary. Special clinic sessions are held, where mothers can attend for medical advice both before and after their babies are born. Dental treatment is also available, free of charge, for mothers referred from these clinics. The County Council employs a staff of midwives to attend maternity cases where the babies are born at home.
THE SCHOOL HEALTH SERVICE
Every child attending a school maintained by the County Council is seen by the school doctor at least three times during its school life. First on admission at the age of five. The doctor, when seeing the child for the first time, has the child’s* medical records from the infant health clinic. At about the age of ten the child is again medically examined and once more just before leaving school. If at these examinations any defects are found, the child is placed under observation or sent to a specialist and, if appropriate, arrangements are made for treatment. An important feature is a careful “follow-up” system concerning the child’s health.
The County Council arranges for a considerable range of simple medical treatment for ailments such as cuts, abrasions or skin troubles, which receive treatment at minor ailment clinics. Through these clinics arrangements are also made for treatment of defective vision or squint, ear, nose or throat trouble, orthopaedic defects and speech defects—at specialist clinics if necessary. There are also child guidance clinics for children with emotional problems and so forth. Handicapped children—blind, deaf; epileptic, delicate and otherwise physically defective children—and educationally subnormal children also receive treatment, supervision and special education—where necessary in special residential or day schools.
The care of the teeth of school children is a very important matter. A school dental surgeon endeavours to visit every school in his district once a year to inspect the children and give appropriate advice. Dental treatment is carried out free of charge at the school dental clinics. Orthodontic treatment, that is, for straightening of teeth which are not growing correctly, and other special forms of dental treatment are also provided.
The County Council provides day nurseries where young children, whose parents for various good reasons are not able to look after them at home, are cared for during the day. That these young children up to age of five are well catered for.
HOMES FOR MOTHERS AND BABIES
The plight of the unmarried mother has not been forgotten, and the County Council has two homes where unmarried mothers and their infants are cared for until more permanent arrangements can be made for the care of their infants and until they themselves find employment.
Similar assistance is also available, if necessary, for married women who for any reason have been deprived of the support of their husbands.
Home nurses who undertake the nursing of sick persons in their own homes are provided by the County Council. These nurses, before the passing of the National Health Service Act, were known as district nurses
Owing partly to the shortage of hospital beds and partly to the increasing complexity of medical treatment carried out by the family doctor in his patients’ homes, the demands on this greatly appreciated service are constantly increasing.
VACCINATION AND IMMUNIZATION
It is generally known that vaccination provides substantial protection against smallpox which, although now an uncommon disease in this country, provides a constant threat through cases imported from abroad.
Diphtheria, because of the growing practice of immunization against this disease, is no longer dreaded and the number of cases and deaths have fallen to a very low figure indeed. Immunization against whooping-cough, using modern preparations, is now also known to be a very useful measure.
Vaccination against smallpox and immunization against diphtheria are carried out free of charge to the patient by certain general medical practitioners who have agreed to co-operate in the County Council’s scheme.
Vaccination and immunization of infants and young children against diphtheria and whooping-cough is also carried out at the local clinic, free of charge. The illustration on this page shows a baby being immunized against diphtheria.
PREVENTION OF ILLNESS; CARE AND AFTER-CARE
Under the heading of vaccination and immunization we have already considered how some diseases are prevented by inoculation, but this is not the only way the County Council endeavours to prevent illness or, failing prevention, to care for those in the community who are ill or have been ill.
The care and after-care of tuberculous families is dealt with at chest clinics, where patients and those who have been in contact with them attend. These cases are also visited in their homes. Young susceptible ” contacts” of infective cases of tuberculosis are, when necessary, boarded out so as to remove them from the source of infection; a further measure of protection in such cases is inoculation against tuberculosis with B.C.G., which is a special vaccine prepared from a harmless form of the tubercle bacillus. Trained social workers are available to assist patients and their families in the numerous personal problems which so frequently arise in connection with this chronic disease. The County Council’s scheme for treatment includes the supply of garden shelters, extra clothing and, in certain cases, extra nourishment.
After illness or sometimes to prevent it, suitable cases, including school-children, are sent to holiday or rest homes.
The County Council also provides, within reasonable and practicable limits, for the loan of nursing equipment to patients in their own homes, at small hire charges which can in certain circumstances be reduced or even waived.
Schemes of health education and health propaganda are organized both for adults and for school children, so as to make known as widely as possible the best ways of living so as to enjoy good health.
Health visitors, welfare officers and other groups of health workers in their contact with the public, both at clinics and in the homes, have continual opportunities for teaching healthy living.
DOMESTIC HELP IN THE HOME
The County Council employs home helps to assist with the normal duties of running the household, where this is required because of the presence in the home of a person who is ill, lying-in, an expectant mother, mentally defective, disabled or aged. A charge is made, but this is reduced or waived where the family income is small. As in the case of the home nursing service, the demand on the home help service is constantly increasing.
MENTAL HEALTH SERVICE
The County Council’s functions regarding mental health have been greatly altered since the mental hospital service was nationalized. To-day, the scheme provides for the care of persons in the community (i.e., not in a hospital or institution) suffering from mental illness. In addition to doctors who specialize in this subject, the County Council employs mental welfare officers duly authorized to investigate cases reported and to arrange for hospital admission where necessary, and also supervision officers and psychiatric social workers. The latter deal particularly with the aftercare of cases discharged from mental hospitals.
The County Council’s scheme for the care of mental defectives includes arrangements for ascertaining and supervising cases cared for in the community whether under guardianship or not.
In addition the County Council has six occupation centres where mentally defective children attend daily and receive training designed to make them as useful citizens as possible. There is one industrial training centre for adults, where men are given training in woodwork, gardening, etc. Whether attending the centres or not, cases under supervision are regularly visited in their own homes.
HEALTH SERVICE AT AIRPORTS
Owing to the speed of air travel it is even more necessary at airports than at seaports to have a service designed to inquire into the health of persons arriving in this country and so minimize the risk of infectious diseases being imported in this manner.
Middlesex possesses in London Airport at Heathrow the principal airport in Great Britain, and there is a second extremely busy one at Northolt. At both these airports the County Council provides a team of doctors, nurses and receptionists to carry out health-control duties and also certain work on behalf of the Ministry of Civil Aviation in connection with the medical examination of air-crews, etc.
The illustration on page 198 shows the interior of a modern air liner being disinfected under supervision.
The County Council has a large fleet of ambulances both for the removal of accident cases to hospital and for the transport of sick persons. This service is organized as a part of the Fire and Ambulance Service and is more fully described in the section dealing with that service.
WELFARE SERVICES of to-day are much more extensive than those provided under the Poor Law prior to the passing of the Local Government Act of 1929. So much has been done since that time to improve the standard of living generally that there is now an entirely different approach to the problems of those who, whether through age, infirmity or otherwise, are in need of help from one of the many welfare services available. Some of these services are provided by Government Departments, such as the Ministry of Pensions and the National Assistance Board, some by voluntary bodies, some by the Regional Hospital Boards and some by various departments of the County Council.
Under the provisions of the Local Government Act of 1929, as mentioned earlier in this book, the County Council was made responsible for the functions connected with the relief of distress, which had previously been dealt with by the guardians of the poor in the County and, from 1st April, 1930, until 5th July, 1948, these were carried out by the County Council.
The National Assistance Act, 1948, and other social legislation which came into operation in that year, made sweeping changes in the arrangements for the welfare of people needing various kinds of assistance. Previously (apart from some already receiving monetary aid from the State, such as supplementation of old age pensions) financial grants to needy persons living in their own homes were made by the County Council, as “public assistance “, and provision was similarly made for institutional care for people who, for any reason such as old age, infirmity or chronic sickness, could not be assisted in their own homes. Under the new legislation the relief of financial distress became the duty of the National Assistance Board, whilst the responsibility for the care of the sick, including those suffering from chronic illness, passed to the Regional Hospital Boards. The duty of providing residential accommodation for the aged and for others who, whilst not being “sick persons “, could not look after themselves, remained with the County Council, the definition of “need” being broadened to cover those who require care and attention, and thereby including many who might previously have been excluded on account of their financial circumstances. In addition, the County Council was called upon to carry out certain other welfare services.
For these duties, laid down in certain sections of the National Assistance Act, the County Council set up a separate Welfare Department which succeeded, in certain respects, the Public Assistance Department, and the principal matters with which it is concerned may be placed in three categories: the first, that of providing residential accommodation for aged persons and others who need care and attention not otherwise available to them; the second, the provision of temporary accommodation for persons who in certain circumstances have become homeless; and the third, which covers a wide field, that of promoting the welfare of the blind, deaf and dumb and other permanently handicapped persons.
The description by Charles Dickens of the grim, prison-like workhouses of his day make a vivid impression on the minds of all who read his works, but probably considerably less is known about modern homes for aged people.
The County Council to-day provides accommodation for old people and others in its own homes or, by meeting the cost of maintenance, in homes managed by various voluntary organizations. The aim nowadays is to make the surroundings as homelike as possible, and both in the County establishments and in homes belonging to voluntary organizations the amenities are intended to provide a substitute for a normal home, meeting all reasonable requirements of the residents, including the provision of clothing where necessary, extra comforts which they cannot fully provide themselves out of their own resources, recreational facilities such as concerts, cinema shows, television, outings, books and periodicals and opportunity for religious worship.
A very important aspect of modern welfare is that poverty is no longer the criterion which decides who shall be helped. Shelter and care may now be given to a person who by reason, for instance, of age or infirmity, is in need of care and attention not otherwise available. Thus, elderly or infirm people in comparatively comfortable financial circumstances may be admitted to County homes, though they have to contribute towards their upkeep. Indeed, all residents contribute to the cost of maintenance according to their incomes, and those who have not sufficient means to meet the minimum charge are given financial help by the National Assistance Board. Everyone has the right to keep a part of his or her income for pocket money, the amount and the minimum contribution to be made being prescribed by the Minister of Health.
In recent years the number of old people seeking admission to homes has increased. Doubtless this is partly due to the benefits medical science and care have conferred upon us—people are living to a greater age than before—partly because old folk who formerly managed to live alone find themselves unable to cope with modern conditions and partly, perhaps, because welfare homes are very different places from the institutions of former days. The result is that County homes are always full, but unremitting efforts are made to secure large houses in suitable positions in or near the County which can be converted into homes. A number of new homes have been established since 1948 and some 2,000 aged and other persons are now provided for by the
County Council in its own homes or in voluntary organizations’ homes. The opening of new homes either by adaptation of existing properties, or by building when the present economic difficulties of the country have been overcome, will be a constant process during the coming years.
It is also the duty of the County Council to provide temporary accommodation for persons “who are in urgent need . . . arising in circumstances which could not reasonably have been foreseen”. The County Council is not a housing authority and these provisions of the National Assistance Act are not designed to deal with the inadequately housed. Housing in Middlesex is the responsibility of the various boroughs and urban district councils. The County Council’s responsibility relates to persons temporarily without accommodation as a re-suit of fire, flood or, in some cases, of eviction. Every week in Middlesex a number of families become homeless as a result of eviction, which may be due, for instance, either to a family having fallen into arrear with the rent, or because the landlord may have proved that he has a greater need of the premises, or because the family may have been evicted from furnished rooms.
Hostels have been provided by the County Council and efforts are being made to increase the amount of accommodation available for this purpose. The stay of each family should be short, but in many instances tends to be prolonged because of the post-war difficulty of finding permanent accommodation. Considerable assistance is given by various voluntary organizations, which will often accommodate the children or the wife and children when the whole family cannot be placed together. The plight of evicted families to-day is undoubtedly affected by the general housing shortage and it is anticipated that when the latter has abated to some extent the County Council’s difficult problem of providing temporary accommodation will assume more reasonable proportions. To provide for persons who may become temporarily homeless as a result of a widespread fire or flood, arrangements have been made whereby certain halls throughout the County would be available for short periods until the people could return to their homes or find accommodation elsewhere.
WELFARE OF THE BLIND AND OTHER HANDICAPPED PERSONS
Prior to 5th July, 1948, the County Council had for many years been providing welfare services for the blind under the provisions of the Blind Persons Acts, but from that date these became a duty under the National Assistance Act and have since been extended to the partially sighted—that is, those persons who, whilst not being certified as blind, suffer impairment of sight sufficient to cause a substantial and permanent handicap. These services are comprehensive and include arrangements with several well-established voluntary organizations for the blind for admission to special homes, occupational training, finding work for suitable persons in industry and commerce, employment in “sheltered workshops” where conditions are suited to the physical handicap, the provision of employment in their own homes and the disposal of the products of their work.
Specially qualified home teachers of the blind work in every part of the County. They visit the blind in their homes, attend to their general welfare, teach Moon and Braille systems of reading and give instruction in suitable handicrafts. Persons placed in “sheltered workshops” have their earnings supplemented by the County Council to ensure a minimum guaranteed weekly wage, whilst approved “home workers” have their earnings augmented by a flat-rate weekly payment intended as some compensation for their disability. In appropriate cases those who are, for reasons of age or incapacity, unsuitable for more active work, are taught pastime occupations by home teachers, either at their homes or in handicraft classes held locally, and the products of their activities, such as baskets, rugs and a variety of other articles, are disposed of by periodical sales of work, the proceeds of which, after deducting the cost of materials, go to the makers. The occupations followed in the “sheltered workshops” are varied and include basket-, mattress-and brush-making, boot-repairing, chair-caning and machine-knitting, whilst in the home workers’ scheme somewhat similar types of work are carried out, with the addition of piano-tuning and certain specialized employment, such as Braille copying and physiotherapy.
Social activities and recreation are not overlooked. Radio sets are supplied by the British Wireless for the Blind Fund and these are kept in repair by the County Council. Social clubs, assisted by voluntary effort, function throughout the County with manifold activities and some classes in old-time dancing are held which are much enjoyed.
There are to-day over 3,600 blind and partially-sighted persons in the Middlesex registers and more than half are over the age of sixty years.
So far, welfare services for the blind and partially sighted have been described. What of other handicapped persons, such as the deaf, hard of hearing, dumb, crippled, paralysed, etc.? The National Assistance Act gives the County Council power to provide services for these people, and schemes have been approved under which a start will be made in affording social welfare services for substantially and permanently handicapped people in Middlesex who need them. In due time these services will be comparable with those available to the blind and partially sighted.
OTHER WELFARE FUNCTIONS
Homes for aged and disabled people run by voluntary organizations or by private persons must now be registered by the County Council. This provision ensures that such homes provide reasonable standards of care and comfort for their residents, and they are periodically inspected by officers of the County Council’s Welfare Department.
Another task which needs careful handling is that of providing protection in cases where no other suitable arrangements can be made, for instance by relatives, of movable property belonging to persons admitted to hospitals or homes. Sometimes much work is involved, including correspondence with relatives, making detailed lists of articles, arranging for storage and insurance of the property and placing articles of value in safe custody.
THE ADMINISTRATIVE MACHINERY AT WORK
The administrative work of the County Welfare Service is carried out by the Welfare Department which, in addition to its headquarters staff, has local staffs in various parts of the County, which for this purpose has been divided into ten areas. In each of these there is an office from which area welfare officers and home teachers of the blind work. An old person, for instance, who finds it extremely difficult to manage in his or her own home, which may be no more than one room in another person’s house, can apply to the area welfare officer, and every effort will be made to find a place as soon as possible in a suitable residential home where, in pleasant surroundings, care and companionship will be available. Similarly anyone who, after enjoying sight, suffers the mental stress of finding blindness approach can be given much assistance in overcoming the effects of this tragic disability by a home teacher, who will show the best ways of meeting the new difficulties of home life, teach reading by the Braille system and, where appropriate, make further suggestions, such as a period of rehabilitation in a special home, training for new work, and so forth.
The work is full of human interest and there are opportunities to help the public in various ways other than those arising from the direct functions of the Welfare Department. The experienced officers dealing with the Service are often able to advise on particular problems and to secure from other statutory and voluntary sources the service required for the persons concerned.