[from "The Birth of a Service", 2008]

CHAPTER 9

Prior to 1948, domiciliary services had been provided by District Nurses, employed by the District Nursing Associations, of which there were twelve: eight were the Henry Bloom Noble Associations, set up under the will of the late H.B.Noble, and four were independent Rural Associations. These were voluntary local bodies, supported mainly by subscriptions, donations and gifts, although the eight Noble's Associations received an annual grant from the Trustees, and in the years immediately before 1948, the Rural Associations received some assistance from public funds towards the nurses' salaries. As the work of these bodies was so highly valued by the public, and the Board considered it desirable that voluntary interest and effort should be encouraged, the Associations were requested to continue, the Board undertaking to ensure that funding necessary to be able to cover their expenditure would be made available, and all agreed. By 1950 it had become clear that these nurses were disadvantaged in comparison with their hospital counterparts, with no uniformity of salaries and superannuation rights nor holiday, laundry and other allowances conforming to the Whitley Council scales, and this was righted by the Board assuming responsibility for their remuneration. Cars were also provided, but not immediately. The Lezayre, Andreas, Maughold and Bride nurse already had a car, and this was purchased from the Association. South Douglas used most of their funds to buy a car for the nurse. The Peel Association, whose nurse must have been more adventurous, bought her a "Corgi" scooter. For the rest, the Board decided at their meeting in January 1951, that an allowance of 3 per annum should be paid for the use of a bicycle. It had also been decided, in July, 1949, that some central coordination was necessary, leading to the creation of the post of a Superintendent Nursing Officer, responsible for their supervision, and also of the three Infant Welfare Health Visitors.

With the Board's assumption of responsibility for the payment and equipment of the nurses, some of the Associations became inactive, merely custodians of the funds they held. Some continued to take an interest, using their funds for associated purposes, providing equipment, or improving clinic facilities. Two ceased altogether, transferring their funds to the Board, to be held in trust for future use. Winding up the affairs of all the remaining Associations has been a long and time-consuming occupation, and an example of the complexities in which the Board could be involved is that the Castletown nurse's activities, and the maintenance of her residence, The Nurse's House in Douglas Street, had been financed by the Castletown Noble's Association, whereas the house itself was not owned by the Association, but by another charitable institution, the Taubman Trust.

The provision of domiciliary midwifery services was a pressing problem. Not all the District Nurses were qualified: those that were continued to be available as midwives for home confinements, although these were lessening in proportion to those in the Jane Crookall, but to be on the safe side, arrangements were made for their periodic service in the Maternity Home to keep abreast of modern practice. When a third Infant Welfare Visitor was appointed in July 1949, it was stipulated that she must also be prepared to act as a Nurse/Midwife. There was a Government Register of Midwives, which included women who, though not formally qualified, through experience and by medical recommendation had gained acceptance, and in the case of Ramsey and District, for which there was particularly poor provision, as a temporary measure the Board agreed that their services could be called upon, provided that they worked under a doctor's instructions and supervision. In the Summer of 1949 the Board were also giving consideration to the establishment of a Maternity Home in Port St. Mary; eventually this proposal was shelved as the situation gradually improved.

In 1948 the Board took over the establishment of two Infant Welfare Health Visitors, which, as mentioned, was increased to three, to give advice and guidance to expectant and nursing mothers, either in their homes, or at the Infant Welfare Clinics. These, of which were originally seven, and quickly increased by the Board to ten, were of necessity, in the absence of premises set aside for the purpose, held where acceptance could be found, sometimes with great difficulty. They included church halls, school premises, and in the case of Castletown, an old Nissen hut. Not all the premises or locations were entirely suitable, and the Douglas Clinic, originally in Pulrose, had to be moved to Rosemount for this reason. At some a doctor was also in attendance, but not for treatment; if in his or her view infants needed attention their mothers were advised to consult the doctor with whom the child was registered. Apart from having the baby checked over, and the then-accepted practical value of weighing it for the records, if only for the mother's peace of mind, there is no doubt that in those days of few cars and limited mobility, for otherwise largely house-bound mothers this weekly outing was a much appreciated social occasion, and at their meeting on 22nd. March, 1949, the Board solemnly agreed "that the provision of tea for mothers attending the clinics with their children might for the present be continued".

Another field of responsibility which fell to the Board was the Welfare Food Scheme, following the end of rationing in 1954, and the winding up of the Food Control Division of Government Office. This was designed to supplement the diet of children and expectant and nursing mothers with the issue of orange juice, cod liver oil, and vitamin tablets, and was taken on in July, 1954, the distribution being through the clinics. The products were free to all children under five, and to expectant and nursing mothers in necessitous circumstances. Unusually, these circumstances were not financial, but based upon the recipient's condition, the Board being disturbed to learn that children of even well-to-do parents were frequently ill-nourished, and consequently no bar was placed upon availability. In the year to March, 1956, for which figures are readily to hand, the uptake was 25,884 bottles of orange juice, 4,776 bottles of cod liver oil, and 594 packets of vitamin tablets. The juice was, of course, intended to supplement the intake of Vitamin C, and it is ironic that studies in more recent years have shown that the concentration process destroyed the vitamin content, so that although a pleasant addition to the diet, it had no practical value, unless it were psychological.

The Board had also taken over the Cheap Milk Scheme from the Local Government Board, providing for the supply of liquid or dried milk to expectant and nursing mothers, and children up to the age of five. At first this was at a reduced charge, being subsidised from public funds, unless the family financial circumstances were below a set level, when it was free, but in January 1951 the Board decided that this was both cumbersome and unjustified, and from then onwards a scale was introduced for the assessment of the household income; to those falling below the level, it was free, otherwise it was discontinued. In the year ended March 1956, the level was a household income not exceeding 5 a week, with the addition of 6/- (30p.) for each dependent member. There were 176 beneficiaries, including 6 nursing or expectant mothers.

The first requests for assistance for the sick or elderly in their own homes, to provide which the Board had permissive powers under the Act, eventually becoming the Home Help Scheme, left them in some disarray, it being undecided whether a referral could be made to the Board of Social Security under the National Assistance Act, an appeal made to the local District Nursing Association as an appropriate use of its funds, a direct grant made, or it should be left to the District Nurse to arrange, and one of each of these solutions was adopted in dealing with the first four cases. It was not long before the position was regularised as being the Board's direct responsibility, the Scheme put into operation, and suitable ladies recruited. It has been already mentioned that at that time the Board expected to deal directly with a surprising variety of matters, and certainly up to 1956 each application was put before it for consideration of its merits. In these early stages no statistics were kept, the Board merely reporting that the Scheme had been very successful, but it is known that at 31st. March 1959 there were 25 Home Helps active.


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