BAR1 THE HEALTH AND WELFARE OF THE LONDON BOROUGH OF BARNET 1967 MELVILLE. WATKINS, M.R.C.S.. L.R.C.P.. D.P.H. BAR 1 THE LONDON BOROUGH OF BARNET ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1967 MELVILLE WATKINS, M.R.C.S., L.R.C.P., D.P.H. Health and Welfare Department, Gateway House, 322 Regents Park Road, Finchley, N.3. To the Mayor, Aldermen and Councillors of the Council of the London Borough of Barnet: Mr. Mayor, Ladies and Gentlemen, It is with pleasure that I present my Report of the Health and Welfare Service of the Borough for the year 1967. In my Report dealing with the year 1966, I referred to the fact that consolidation was still very much the order of the day, but I can say that in 1967 considerable advances were made and though the development of the services, by reason of economic considerations, could not progress as completely planned, I am confident that the limited planned progress made augurs well for the future. The compilation of the Report follows the same pattern as in previous years and covers all the main facets of the Department's work. I should like, however, to draw attention to several new developments; first of which was the establishment of a Special Investigation Clinic at Vale Drive Clinic for the treatment of enuretic children. This service is under the direction of my Deputy and the enthusiasm with which it has been received and the results achieved are most gratifying. The second new development was the establishment of an In-Service Training Course which provides for approximately 30 persons of all disciplines within the Health and Welfare Department (mainly new recruits) being brought together to hear lectures given by Principal and Senior Officers on the responsibilities and work of the various sections of the Department and additionally talks by officers of other Departments involved in Social Services. In my opinion, this form of InService Training is of great value to the staff who are able to further their knowledge by taking part in discussion groups which follow each series of weekly lectures at present spread over five weeks but I anticipate the need for having to extend the course over a greater number of weeks. A course such as this provides an economic basis of training, which otherwise might have to be provided for by outside attendance. The enthusiasm with which the lecturers gave their services and the response from participants indicated to me the value of Local Authority officer participation at the base of operations. The corrected birth rate for Barnet indicates a continuing downward trend, the figure for 1967 being 14.3 compared to 14.6 (1966) and 15.3 (1965). The infant mortality rate showed an increase from 13.3 per 1000 live births in 1966 to 16.0; whilst representing an increase from 62 infant deaths in 1966 to 73 in 1967, this is nevertheless much lower than the figure for England and Wales. The statistics in relation to neo-natal and early neo-natal deaths are similarly affected. There was one maternal death and the peri-natal mortality rate i.e. stillbirths and deaths under one week of age was 23.3 per 1000 total live and stillbirths compared to 24.2 for the Greater London Area and 25.4 for England and Wales. There has been no serious outbreak of infectious disease during the year. 1 The year under review saw the introduction of the Abortion Act, 1967, and the National Health Service (Family Planning) Act, 1967. Requirements in respect of approval to carry out abortions in Nursing Homes brought one application for consideration. Turning to the implications of family planning, the Act confers on Local Authorities the general power, with the approval of the Minister of Health (and when the Minister directs, imposes a duty on them) to make arrangements for the giving of advice on contraception, the medical examination of persons seeking such advice and the supply (by subscription or directly) of contraceptive substances. The coming into being of this Act necessitated Local Authorities reviewing their family planning facilities in particular as regards the Domiciliary Services and, in my Report for next year, I will deal specifically with the considerations given and recommendations that the Council decides to make. During the year in question, it became obvious to me that certain Clinics could possibly be adapted to provide what is implied in the operation of a Health Centre. Arising out of the survey undertaken. it was found that East Barnet Clinic was capable of being adapted to provide Health Centre accommodation for five General Practitioners subject to minor reconstruction work and plans were prepared accordingly and for subsequent submission to the Ministry of Health and consideration by the Authority. I saw this as Barnet's first inroad into Health Centre accommodation, to be followed by other purpose-built Health Centres, the first two of which would be on the Hen don Aerodrome Site and in the West Hendon Redevelopment Area. From the survey, it became obvious that certain other Clinics, though not capable of providing Health Centre facilities, could possibly be considered in connection with applications being made by General Practitioners for accommodation and, in fact, the temporary use of one Clinic was ultimately permitted by the Council and with the approval of the Middlesex Executive Council. During 1967, the staffing situation generally improved but the administration service of the Department still needs to be strengthened. This aspect of the Department's work will no doubt be taken into account when the Management Services Unit's Report is issued on the Health and Welfare Department as a whole. The development of the Mental Health and Welfare Services progressed and during the year a 40-place Adult Training Centre at Fieldways, Wellhouse Lane, Barnet, came into operation. A start was also made in regard to Day Centre provision for the Elderly Mentally Confused at Park House Hostel. I am hoping that pending the establishment of purpose-built Day Centres, other premises within the Borough will be able to provide limited Day Centre accommodation. I am a firm believer in the fact that the full use of the Domiciliary Services and Day Centre care can go a long way towards minimising the need for persons to be taken into residential care. Homelessness, unfortunately, still remains a big problem and during 1967 there was a serious increase which could not have been foreseen several years ago. Urgent steps will need to be taken to resolve the position and what had originally been the forecast of Homeless Family Units necessary in Barnet will need to be increased. Whilst, as was expected, the year continued to provide periods of considerable stress and strain, I should like to record my thanks for the assistance given by all members of the staff and to acknowledge the interest and devotion to duty which they displayed. The Borough continues to be well served by Voluntary Organisations operating in the various fields of social welfare work. Their activities are widely appreciated and form a valuable adjunct to the Local Authority's own services and responsibilities. 2 Finally, I would like to say that it is with deep sincerity that I record ray thanks for the support and encouragement given to me by the Chairmen, Vice-Chairmen and Members of the Health and Welfare Committees and I acknowledge with gratitude the assistance and co-operation of the Chief Officers of other Departments. M. WATKINS Medical Officer of Health CONTENTS Page COMMITTEE MEMBERS, CHIEF AND SENIOR OFFICERS 7 VITAL STATISTICS 11 PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES 25 ENVIRONMENTAL HEALTH SERVICES 31 MENTAL HEALTH SERVICES 75 WELFARE SERVICES 87 PERSONAL HEALTH SERVICES 97 SCHOOL HEALTH SERVICES 121 GENERAL SERVICES 133 INDEX 141 5 HEALTH COMMITTEE as at 31st December 1967 Councillor (Mrs.) Clara Thubrun, J.P. (Chairman) Councillor V.H. Usher (Vice-Chairman) ALDERMAN: J.L. Freedman, J.P., M.A., LL.B. COUNCILLORS: H.R. Brooks E.C. George P.D. Mendel, J.P. (Mrs.) N.I. Cullinane G.H. Jobbins (Mrs.) J.E. Pudney (Mrs.) B.M. Franklin K.M.Klean N.R. Sutton A.I.B. (Mrs.) R.A. Freedman L. Marks, M.A. P.G.H. Woodruff J.P. (Mayor) M. Medway Co-opted Member: Dr. T.J. Carter WELFARE COMMITTEE as at 31st December 1967 Councillor (Mrs.) B.M. Franklin (Chairman) Councillor J.H. Felton, F.R.I.C.S., F.L.A.S., (Vice-Chairman) ALDERMAN: R.J. Norman COUNCILLORS: E.A.E. Asker, J.P. W.G. Hart L. Sattin, M.A.(Oxon) F.C.C.S., A.B.A.A. W. Lloyd-Taylor N.R. Sutton A.I.B. F.J. Collisson M. Medway (Mrs.) Clara Thubrun, R.J. Finigan, B.Sc(Econ) (Mrs.) J.E. Pudney M.B.E., J.P. G.A.J. Gunning, J.P. N.J. Sapsted P.G.H. Woodruff J.P. (Mayor) 7 STAFF OF THE HEALTH AND WELFARE DEPARTMENT as at 31st December, 1967 M. Watkins, M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health G.C. Young, M.D., M.B., B.Ch., B.Sc., D.P.H., L.M.S.S.A. Deputy Medical Officer of Health R.C. Greenberg, M.B.B.S., D.P.H. Mary Watson, M.B., Ch.B. Principal Medical Officers Mary K. Astin, M.B., Ch.B., D.P.H. M.L. Graeme, M.A., M.B., B.Chir., M.R.C.S. Senior Medical Officers J.T. Benson, D.M.A., F.I.S.W. Chief Welfare Officer Mrs. J.M.A.W. Foulkes, S.R.N., S.C.M., H.V. Principal Nursing Officer R.L. James, L.D.S., R.C.S. Principal Dental Officer Miss E. Johnston, S.R.N., S.C.M., Q.N., H.V. Health Education Officer and Home Safety Organiser C.H. Machin Principal Administrative Assistant K.J. Millen M.R.S.H., F.A.P.H.I. Principal Public Health Inspector W. Ward Principal Mental Welfare Officer 8 STATISTICS STATISTICS Area (in acres) 22,124 Population — Registrar-General's estimate Mid 1967 315,210 Number of Inhabited Dwellines. 1st Ami. 1967:— Houses and flats 98,922 Other properties with living accommodation 772 Rateable Value at 1st April, 1967 £22,352,338 Product of penny rate 1967/8 £86,800 LIVE BIRTHS MALES FEMALES TOTAL Legitimate 2,112 2,089 4,201 Illegitimate 195 168 363 2,307 2,257 4,564 Illegitimate live births per cent, of total live births:— Barnet 8.0 Greater London 11.4 Inner London 15.3 Outer London 8.7 RATE PER 1,000 POPULATION Garnet 14 5 Area Comparability Factor 0.99 Corrected rate — Barnet 14.3 Greater London 15.8 Inner London 16.5 Outer London 15.4 England and Wales (Provisional) 17.2 11 STILLBIRTHS MALES FEMALES TOTAL Legitimate 28 27 55 Illegitimate 4 3 7 32 30 62 Total live and stillbirths 2,339 2,287 4,626 RATE PER 1,000 LIVE AND STILLBIRTHS Bamet 13.4 Greater London 13.3 Inner London 13.5 Outer London 13.1 England and Wales (Provisional) 14.8 INFANT DEATHS (under 1 year of age) MALES FEMALES TOTAL Legitimate 30 35 65 Illegitimate 6 2 8 36 37 73 RATE PER 1,000 LIVE BIRTHS Harnet: Legitimate 15.5 Illegitimate 22.0 Total 16.0 Greater London 18.4 Inner London 19.8 Outer London 17.4 England and Wales (Provisional) 18.3 NEO-NATAL DEATHS (under 4 weeks of age) MALES FEMALES TOTAL Legitimate 21 28 49 Illegitimate 5 1 6 26 29 55 RATE PER 1,000 LIVE BIRTHS Barnet: Legitimate 11.6 Illegitimate 16.5 Total 12.0 Greater London 12.9 Inner London 13.5 Outer London 12.4 England and Wales (Provisional) 12.5 EARLY NEO-NATAL DEATHS (under 1 week of age) MALES FEMALES TOTAL Legitimate 14 27 41 Illegitimate 4 1 5 18 28 46 RATE PER 1,000 LIVE BIRTHS Barnet: Legitimate 9.8 Illegitimate 13.8 Total 10.1 Greater London 11.1 Inner London 11.5 Outer London 10.8 England and Wales (Provisional) 10.8 13 PERI-NATAL DEATHS (Stillbirths and Deaths under 1 week of age) MALES FEMALES TOTAL Legitimate 42 54 96 Illegitimate 8 4 12 50 58 108 RATE PER 1,000 LIVE AND STILLBIRTHS Barnet: Legitimate 22.6 Illegitimate 32.4 Total 23.3 Greater London 24.2 Inner London 24.9 Outer London 23.7 England and Wales (Provisional) 25.4 MATERNAL MORTALITY RATES (including abortion) per 1,000 total live and stillbirths Barnet 0.2 Greater London 0.3 Inner London 0.5 Outer London 0.3 England and Wales (Provisional) 0.2 14 DEATHS FROM ALL CAUSES Males 1,718 Females 1,738 Total 3,456 RATE PER 1,000 POPULATION Barnet 11.0 Area Comparability Factor 0.91 Corrected Rate — Barnet 10.0 Greater London 10.9 Inner London 11.1 Outer London 10.8 England and Wales (Provisional) 11.2 15 CAUSES OF, AND AGES AT, DEATH No. CAUSES OF DEATH NET DEATHS AT THE SUBJOINED AGES OF "RESIDENTS" WHETHER OCCURRING WITHIN OR WITHOUT THE DISTRICT All ages Under 4 weeks 4 weeks and under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 55 55 and under 65 65 and under 75 75 and over 1. Tuberculosis, Respiratory 10 - - - - - - 2 1 2 5 2. Tuberculosis, Other 1 — - — — — — — — — 1 3. Syphilitic Disease 2 - - - - - - - - 1 — 1 4. Diphtheria - — — — — - — — — — — — 5. Whooping Cough - _ _ _ — _ — _ _ — — _ 6. Meningococcal Infections - - - - - - - - - - - - 7. Acute Poliomyelitis _ — — — — — — — — — — 8. Measles 1 _ — 1 — — — — — — — — 9. Other Infective and Parasitic Diseases 9 - - - - 1 _ 1 1 1 2 3 10. Malignant Neoplasm, Stomach 65 - - - - - - 1 1 13 26 24 11. Malignant Neoplasm, Lung, Bronchus 211 - - - - - - 10 10 67 76 48 12. Malignant Neoplasm, Breast 84 - - - - - 1 9 12 24 15 23 13. Malignant Neoplasm, Uterus 24 - - - - - - - 2 9 6 7 14. Other Malignant and Lymphatic Neoplasms 349 - - - 1 2 3 9 35 87 104 108 15. Leukaemia, Aleukaemia 16 _ — — _ — _ 2 — 6 5 3 16. Diabetes 24 — — — — 2 — — 2 3 7 17. Vascular Lesions of Nervous System 432 - - - - 2 1 4 17 35 100 10 273 18. Coronary Disease, Angina 741 - - - - - 1 14 52 161 198 315 19. Hypertension with Heart Disease 43 - - _ - - 1 - 4 16 22 20. Other Heart Disease 370 — — — — — _ 4 5 29 70 262 21. Other Circulatory Disease 176 — — 1 — — — 3 5 17 39 111 22. Influenza — — — — — — — — — — — — 23. Pneumonia 251 3 11 1 — — - 1 3 12 40 180 24. Bronchitis 181 - 2 — 1 1 — - 5 24 65 83 25. Other Diseases of Respiratory System. 20 - - _ _ 1 1 3 1 12 2 26. Ulcer of Stomach and Duodenum 29 - - _ - - 1 - 2 5 6 15 27. Gastritis, Enteritis and Diarrhoea 15 - 1 - - - - - _ 2 3 9 28. Nephritis and Nephrosis 10 - - - - - - — 1 2 4 3 29. Hyperplasia of Prostate 10 - - - - - - - — 1 6 3 30. Pregnancy, Childbirth, Abortion 1 - - - _ 1 — — — - - 31. Congenital Malformations 20 9 3 _ 1 1 1 — - 1 2 2 32. Other Defined and Ill-Defined Diseases 227 42 1 1 1 4 3 8 19 22 36 90 33. Motor Vehicle Accidents 42 2 8 5 2 7 5 5 8 34. All Other Accidents 61 1 _ 2 1 5 4 5 9 10 7 17 35. Suicide 29 — — — — 1 1 4 9 7 6 1 36. Homicide and Operations of War 2 — - - - 1 1 - - - - - TOTALS 3,456 55 18 6 7 29 23 81 201 549 859 1,628 16 BIRTH RATE (For the areas covered by the five constituent authorities) 17 18 VITAL STATISTICS FOR THE PAST TWENTY YEARS (For the areas covered by the five constituent authorities) YEAR TOTAL LIVE BIRTHS BIRTH RATE (CRUDE) TOTAL INFANT DEATHS INFANTILE MORTALITY RATE 1948 4753 14.8 103 21.7 1949 4547 14.1 93 20.5 1950 4486 13.9 78 17.4 1951 4138 13.0 97 23.4 1952 4107 12.8 85 20.7 1953 4048 12.7 78 19.3 1954 4019 12.6 78 19.4 1955 4013 12.6 83 20.7 1956 4137 13.0 67 16.2 1957 4032 12.7 80 19.8 1958 4131 13.1 57 13.8 1959 4129 13.0 100 24.2 1960 4285 13.5 74 17.3 1961 4388 13.9 91 20.7 1962 4573 14.4 84 18.4 1963 4656 14.7 82 17.6 1964 4979 15.7 74 14.9 1965 4900 15.5 62 12.7 1966 4679 14.8 62 13.3 1967 4564 14.5 73 16.0 NUMBER OF DEATHS AND DEATH RATES FROM TUBERCULOSIS AND CANCER NUMBERS RATE PER 1, 000 POPULATION MALE'S FEMALES PERSONS BARNET ENGLAND AND WALES Respiratory Tuberculosis 5 5 10 0.032 0.037 Other Tuberculosis — 1 1 0.003 0.005 Cancer of lung and bronchus 170 41 211 0.669 0.584 Other Cancer 220 318 538 1.701 1.691 19 oz LIVE BIRTHS BY AGE AND PARITY OF MOTHER AND PLACE OF OCCURRENCE Parity of Mother ♦Place of Delivery All Ages Under 20 20- Age of Mother 25- 30- 35- 40- 45+ 0 1 1,640 (93.2%) 190 (10.8%) 746 (42.3%) 466 (26.5%) 161 (9.1%) 60 (3.4%) 16 (1.0%) 1(0.1%) 2 64 (3.6%) 5 (0.3%) 27 (1.5%) 21 (1.2%) 6 (0.3%) 4 (0.2%) 1 (0.1%) — — 3 55 (3.1%) 4 (0.2%) 27 (1.5%) 15 (0.9%) 6 (0.3%) 3 (0.2%) — — — — 4 2 (0.1%) — — 2 (0.1%) — — — - — — — — — — 1,761 1 1 1,029 (77.4%) 28 (2.1%) 279 (21.0%) 424 (31.9%) 201 (15.1%) 80 (6.0%) 17 (1.3%) — 2 81 (6.1%) — — 28 (2.1%) 34 (2.5%) 16 (1.2%) 2 (0.2%) 1 (0.1%) — — 3 215 (16.2%) 5 (0.3%) 93 (7.0%) 90 (6.8%) 25 (1.8%) 2 (0.2%) — — — — 4 5 (0.3%) 1 (0.1%) 3 (0.2%) 1 (0.1%) - - - -- --- 1,330 2 1 451 (67.7%) 6 (0.9%) 61 (9.2%) 160 (24.0%) 135 (20.3%) 72 (10.8%) 16 (2.4%) 1 (0.1%) 2 52 (7.8%) - - 3 (0.5%) 19 (2.9%) 16 (2.4%) 9 (1.3%) 5 (0.8%) — — 3 160 (24.0%) 1 (0.1%) 33 (5.0%) 62 (9.3%) 53 (8.0%) 10 (1.5%) 1 (0.1%) _ — 4 3 (0.5%) - - 2 (0.3%) 1 (0.1%) - - - - - - - - 666 3 1 185 (72.3%) 1 (0.4%) 13 (5.1%) 52 (20.7%) 60 (23.1%) 41 (16.0%) 17 (6.6%) 1 (0.4%) 2 18 (7.0%) — 2 (0.8%) 7 (2.7%) 5 (1.9%) 3 (1.2%) 1 (0.4%) — — 3 51 (19.9%) — — 8 (3.1%) 15 (5.9%) 20 (7.8%) 8 (3.1%) - - — — 4 2 (0.8%) - - 1 (0.4%) - - - - 1 (0.4%) -- - - - 256 4 1 91 (90.1%) - - 4 (4.0%) 28 (27.7%) 26 (25.7%) 25 (24.7%) 7 (6.9%) 1 (1.0%) 2 4 (4.0%) — — — — — — 3 (3.0%) 1 (1.0%) — — — — 3 4 6 (5.9%) - - - - 1 (1.0%) 4 (4.0%) 1 (1.0%) - - - - 101 5-9 1 76 (92.8%) - - 4 (4.9%) 14 (17.1%) 23 (28.1%) 24 (29.3%) 10(12.2%) 1 (1.2%) 2 3 (3.6%) — — — — 1 (1.2%) - - 2 (2.4%) — — — — 3 3 (3.6%) _ _ — 1 (1.2%) - - 2 (2.4%) - - - - 4 — — _ _ — - - _ — - - - - 82 10-14 1 5 (100%) __ _ 4 (80.0%) 1 (20.0%) - - 2 - - - - - - - - - - - - - - 3 — - - - - - — - — - - - — — - - 4 - - - - - - — — — — — — — — — — 5 21 Live Births by Age and Parity of Mother and Place of Occurrence (continued) Parity of Mother *Place of Delivery All Ages Under 20 20- Age of Mother 25- 30- 35- 40- 45+ 15+ 1 _ — — — — — — 2 _ _ — — — — — 3 - — — — — — — 4 — — — — — — — - Illegit. 1 322 (88.7%) 116 (32.0%) Ill (30.6%) 52 (14.3%) 23 (6.3%) 13 (3.6%) 7 (1.9%) _ _ 2 12 (3.3%) 3 (0.8%) 3 (0.8%) 4 (1.1%) — — 2 (0.6%) — — — — 3 14 (3.9%) 3 (0.8%) 6 (1.7%) 4 (1.1%) 1 (0.3%) - - — — — — 4 15 (4.1%) 8 (2.2%) 5 (1.3%) 1 (0.3%) - 1 (0.3%) - - - - 363 TOTAL 1 3,799 (83.3%) 341 (7.5%) 1,218 (26.7%) 1,196 (26.2%) 629 (13.8%) 319 (7.0%) 91 (2.0%) 5 (0.1%) 2 234 (5.1%) 8 (0.2%) 63 (1.4%) 86 (1.8%) 46 (1.0%) 23 (0.5%) 8 (0.2%) — — 3 504 (11.0%) 13 (0.3%) 167 (3.6%) 188 (4.1%) 109 (2.4%) 26 (0.6%) 1 (0.0%) — — 4 27 (0.6%) 9 (0.2%) 13 (0.3%) 3 (0.1%) - - 2 (0.0%) - - - - 4,564 * Place of Delivery 1. N.H.S. Hospitals 2. Non-N.H.S. Hospitals (Mainly Maternity Homes) 3. At Home 4. Other These statistics are registrations corrected for both area of usual residence of mother and date of occurrence within the calendar year as opposed to those supplied by the Registrar General which are corrected for area of residence only. <• OP*-- PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES PREVALENCE AND CONTROL OF INFECTIOUS AND OTHER DISEASES The following table shows the number of corrected notifications received during the year: Scarlet Fever 74 (79) Whooping Cough 136 (82) Acute Poliomyelitis: Paralytic - Non-Paralytic — — Measles 2694 (1853) Diphtheria — — Dysentery 39 (34) Meningococcal Infection 1 (4) Acute Pneumonia 21 (11) Smallpox — — Acute Encephalitis: Infective (1) Post-Infectious — (1) Typhoid Fever 5 (2) Paratyphoid Fever — (1) Erysipelas 5 (7) Food Poisoning 70 (35) Tuberculosis: Respiratory 84 (88) Meninges and C.N.S. 4 (3) Other 19 (12) Puerperal Pyrexia 74 (62) Ophthalmia Neonatorum 2 (3) Anthrax — — Cholera — — Plague — — Relapsing Fever — — Malaria — — Membranous Croup - - 3228 (2278) Figures in parenthesis were notifications received for the year 1966. Food Poisoning In February 1967 there was an outbreak of gastro-enteritis in a residential government establishment in the Borough involving 50 young men, of whom 17 had vomiting only, 6 diarrhoea only, and 27 vomiting and diarrhoea. The illness lasted for less than 24 hours, and all those affected recovered fully. The patients and kitchen staff were investigated, at the request of the Medical Officer of the establishment, but no organism was isolated. The general hygiene of the establishment was also 25 inspected, and was found to be satisfactory both in kitchen quarters and the lavatories and bathrooms. In investigations of this kind in well conducted establishments as is so often the case no "remains" of food which might have been the cause of the outbreak was available for laboratory testing. Sonne Dysentery In July there were outbreaks of dysentery due to Shigella sonnei in two of the Council Day Nurseries. At one of the Nurseries 2 members of staff and 22 children were found to be infected; at the other, 18 children were infected. In each Day Nursery those infected were excluded until free from infection and their family contacts were also investigated; in all 19 such contacts were found to be infected. None of those infected was seriously ill, and the Day Nurseries continued working throughout, though in a small number of children the carrier state persisted for several weeks. Typhoid Fever Five cases of typhoid fever occurred in the Borough in 1967. In the course of investigating these cases two symptomless carriers were discovered. The first case was an employee of the Council who became ill in December 1966. In January 1967 his infection was traced to a carrier working in a cafe where he had had a meal. This carrier had a history of typhoid fever 18 years before during most of which time she worked as a cook in a hotel in Africa. She was excluded from working in the food trade, and is being kept under regular surveillance. In April, 1967 a girl aged 3 years developed typhoid fever, and on routine testing of contacts her elder sister was found to be a symptomless carrier. The strain of Salmonella typhi in both children was the same, and was a type commonly found in Italy. A possible source of infection was an Italian au-pair girl who returned home shortly before the child became ill and who has not been traced in spite of repeated efforts by the Ministry of Health with the Italian authorities. An alternative source was the family's Italian holiday the previous autumn. The fourth case occurred in July when an immigrant from Bombay arrived unwell at London Airport, and came to stay in this Borough. She was admitted the following day to hospital with her baby daughter who happily remained unaffected. The fifth case, a boy aged 5 years, occurred in October 1967; the infection was probably acquired in Spain during a family holiday there in the previous month. This case illustrated how very mild some cases of typhoid fever can be clinically, particularly in children. None of his family showed any sign of infection. 26 INTERNATIONAL CERTIFICATES OF VACCINATION Three forms of International Certificates of Vaccination, namely:— small pox, cholera and yellow fever require authentication of the signature of the doctor providing the vaccination or inoculation of persons proceeding abroad. During the year 7,463 certificates were authenticated by the Department. 27 ENVIRONMENTAL HEALTH DIVISION ENVIRONMENTAL HEALTH SERVICES The Environmental Health Services are truly community services; they make an impact upon every household. Clean air, unpolluted water, food unadulterated, sound and of proper composition are basic human needs; or no less importance is adequate living accommodation in good repair and supplied with amenities and facilities sufficient to meet today's standards. Under my overall authority and that of my deptuy, the Division is in the charge of the Principal Public Health Inspector with an Assistant who freely acts as his deputy. The District Public Health Inspectors and their technical assistants are deployed in three areas, each under the day to day control of a Senior Area Public Health Inspector.Three Senior Public Health Inspectors have special responsibility in the fields of atmospheric pollution prevention, food and drugs control and the broad topic of housing. In addition there is a complement of disinfectors, drain tester, rodent operatives and mortuary technicians, the whole being supported by divisional clerical and administrative staff working under a Senior Administrative Assistant. The staff at Church Farm, Church Hill Road, East Barnet, cover the districts of Barnet, East Barnet and Friern Barnet; the staff at Green Shield House, Station Road, Edgware, serve Hendon, Edgware and Mill Hill; and those serving Finchley, Hampstead Garden Suburb and Cricklewood operate from Gateway House, Regents Park Road, Finchley. The detailed account which follows shows the ramifications of the work carried out which contributes greatly to the creation of healthy conditions in which people live, work and play. WATER SUPPLY Three Companies, namely, The Colne Valley Water Company, The Lee Valley Water Company, and the Metropolitan Water Board distribute water to the Borough. The supply is satisfactory both as to quality and quantity. Samples of raw water and water going into supply are taken by the Companies for bacteriological and chemical examination, and such were reported to conform to acceptable standards of purity. The waters are not liable to plumbo solvent action. The amount of naturally occurring fluoride varies; water supplied by the Colne Valley Water Company has a content of less than 0.1 ppm, that supplied by the Metropolitan Water Board has a content of 0.3 ppm, and in the case of water supplied by the Lee Valley Water Company, in general the content is less than 0.2 ppm; with regard to the latter there is a small source in New Barnet which has a natural fluoride content of 1.05 ppm which is rapidly diluted with water from another source having a content of less than 0.2 ppm. The whole district receives mains water direct and no supply is by permanent stand pipe. FOOD Part 1 of the Food and Drugs Act 1955, deals with the composition and labelling of food and 31 drugs, food unfit for human consumption, hygiene in connection with the sale and consumption of food, the registration of certain food premises and food poisoning. Part II of the Act deals with milk, dairies and cream substitutes; Part III regulates the provision and management of markets; Part IV contains provisions for the licensing, regulation provision and management of slaughterhouses and power is included for the provision of cold stores and refrigerators and Parts V and VI relate to administration, enforcement, legal proceedings and general provisions. The Senior Public Health Inspector having special responsibility for food and drugs control regularly meets his opposite numbers in adjoining Boroughs. Thus there is an interchange of views which with the co-operation of the Public Analyst helps is devising a sampling programme valid both locally and regionally in relation to a much wider sector of North West London. Formal and Informal Samples The following table shows the number and variety of samples submitted for analysis during the vear:- SAMPLE FORMAL INFORMAL Satisfactory Unsatisfactory Satisfactory Unsatisfactory Alcoholic beverages and spirits 10 9 - Almonds, ground — — 3 — Apple juice - - 1 - Apple sauce — — 2 — Arrowroot — — 1 — Baby food - — 2 - Bacon — — 1 — Baked beans — — 3 — Baking powder - - 1 — Blackcurrant syrup and drinks — — 6 — Bread — — 2 — Bread, milk — — 1 — Butter — — 10 - Cakes 1 — 1 — Cake mixes — — 3 — Canned fish — — 7 — Canned truit — — 16 1 Canned meat — — 40 1 Canned poultry — — 2 — Canned vegetables — — 5 — Cheese 1 — 13 17 Chuna — — — 1 Coffee/Chicory — - 2 - Coffee — — 4 — Condensed Milk — — 2 — Cooking fat - - 5 - Corn oil — — 1 — Cream — — 14 — Curry Powder - - 3 - Custard Powder — — 2 — Dried fruit — — 9 — Drinking chocolate - - 4 - Dripping — — 3 — Drugs — — 1 — 32 Formal and informal samples (continued) SAMPLE FORMAL INFORMAL Satisfactory Unsatisfactory Satisfactory Unsatisfactory Eggs - - 1 - Evaporated milk — — 1 — Fishcakes 5 Fish paste — — 11 - Flour, plain — — 6 — self raising — — 8 — wholemeal — — 1 — Fruit, fresh - - 5 - Gelatine - 2 Glycerine - - 1 - Honey - - 4 - Ice-pops _ _ 2 _ Ice-cream powder — — 2 — Jam 10 Jellies - - 5 - Lard - 6 - Lemon curd - - 3 - Macaroni cheese - - 1 - Margarine — — 15 — Marmalade — — 4 — Marzipan — — 4 — Meat, fresh — — 2 — Meat paste — — 9 - Meat preparations — — 7 — Milk — — 7 — Milk powder — — 4 1 Milk puddings — — 3 — Mincemeat — — 5 — Mixed herbs _ — 1 — Mixed peel — — 6 1 Mustard oil — - 1 - Olive oil - - 2 - Pectin 1 Pickles — — 3 — Potatoes — — 1 — Potato preparations — — 4 — Pudding mixes — — 1 — Rice _ 1 Rice flour _ _ _ 1 Rice, ground - — 4 - Saccharin - _ 2 Salad cream — — 5 — Sauces — — 2 — Sausages and sausage meat 6 1 29 — 33 Formal and informal samples (continued) SAMPLE FORMAL INFORMAL Satisfactory Unsatisfactory Satisfactory Unsatis factory Semolina - - 2 - Soft drinks — — 20 — Soups — - 14 1 Spices — — 8 — Stuffing — — 1 — Suet — — 4 — Sugar confectionery 2 — 14 — Tea 6 Tomatoes, canned — — 5 1 Tomato juice — — 2 — Tomato ketchup - — 5 - Tomato paste — — 2 — Vegetables, dried _ _ 1 _ Vegetables, fresh — — 4 — Vinegar — — 5 — 20 1 468 25 In addition to the above samples, the following were examined in the Department:— ARTICLE NUMBER OF SAMPLES Satisfactory Unsatisfactory Fruit 5 2 Fruit, canned 2 2 Meat, canned 1 - Mince 5 - Milk 114 - Milk powder 1 - Vinegar 4 — TOTALS 132 4 The number of samples reported as unsatisfactory was 4.6 per cent of the total analysed or examined. This figure includes samples reported as being unsatisfactory by reason of mis-statement or other errors in the labelling. Brief comments on the unsatisfactory samples follow:— Cheese The Cheese Regulations 1965 came into operation on the 1st February 1967. It had been evident for some time that many shopkeepers did not appreciate the difference between a soft spreadable 34 cheese and cream cheese and that to many customers cream cheese was any soft cheese that could be purchased loose from a tray. Cream cheese is now required to have a fat content of 45 per cent. Over half the samples of cream cheese purchased during the year were unsatisfactory by reason of their being deficient in fat; most of the samples should have been described by the new designation "full fat soft cheese" which should have a fat content of not less than 20 per cent, though in 3 instances the fat content was less than 20 per cent and their description should have been "medium fat soft cheese". In each instance the manager or proprietor of the shop was interviewed personally and the requirements of the new legislation explained. In the case of company owned shops letters were sent to the Head Offices of the companies to ensure that the managers were supplied with correctly worded labels. In five instances descriptions were applied to cheeses which are not prescribed by the Cheese Regulations. In the case of one sample the label was printed entirely in German and it was pointed out to the importers that the label indicating the nature of the cheese should be printed in the English language. Peeled Italian Tomatoes An informal sample of peeled tomatoes was found to contain an unduly high proportion of tin. The inner surfaces of the can showed that the high level of tin was due to severe attack by the contents on the tin plate of the can. The can which was examined proved to be the only one among stock taken over by the new proprietor when the shop changed hands just before the sample was purchased. Enquiries made of a number of wholesalers failed to trace any further supplies of the particular brand concerned and it was not possible, therefore, to pursue the matter further; it would appear that the can sampled had probably been on the shelf for a very long time. Rice Flour A packet of rice flour labelled "Creme de Riz" had a label printed entirely in French. A letter was sent to the importers pointing out that the labelling should include a statement in the English language describing the nature of the contents. A reply was received indicating their willingness to do this.- Chicken Curry with Rice One sample was found to be slightly deficient in meat content. The Canned Meat Product Regulations 1967 prescribing standards for a large variety of canned meats will come into operation on 31st May 1969. Low Fat Skimmed Milk Powder Large quantities of skimmed milk powder are now being imported from the continent in bulk and packeted in this country. Milk powder will readily absorb moisture and one sample was found to have a moisture content in excess of the amount permitted by the Dried Milk Regulations 1965. Chuna The contents of a small tin of a white looking substance purchased in a shop specialising in food stuffs for immigrants were found to consist of slaked lime, a substance not normally used in the preparation of food in this country. The label was printed in a foreign language; the attention of the importer was drawn to this and he agreed to have a label affixed with the necessary English description. 35 Cut Mixed Peel A sample of cut mixed peel was found to contain sulphur dioxide preservative within the permitted limits, but its presence was not indicated in the list of ingredients. The cartons are being reprinted and the omission made good. Cream of Tomato Soup Tn one sample the total fat content was 2.6 per cent which included 0.5 per cent of butterfat. The fat content should have consisted entirely of butterfat. Canned Fruit Two samples of fruit cocktail examined did not have the list of ingredients stated on the label. The attention of the importers was drawn to the omissions which were subsequently corrected. In the case of another sample, pineapple rings were depicted in an illustration on the can decorated with cherries, although there were no cherries in the can. The attention of the importers was drawn to the Food Standards Committee Report on Claims and Misleading Descriptions published in 1966, which recommended, inter alia, that ingredients or garnishings must not be portrayed if they are not present in the container. It was agreed that the cans should be relabelled. Fresh Fruit Five samples of grapefruit and oranges marked 'Seedless' were examined. In two cases the fruit was found to contain seeds and the proprietors of the shops concerned were requested to remove the misleading labels. Mince and Sausages The addition of sulphur dioxide to minced meat has been prohibited for a number of years in England and Wales. No samples were found to contain sulphur dioxide. Sulphur dioxide preservative is permitted in sausages provided that the amount uoes not exceed 450 parts per million and is declared at the time of sale either by means of a statement on the wrapper or by means of a notice conspicuously displayed in the shop. One sample of beef sausages was found to contain undeclared preservative and a warning letter was sent to the butcher concerned. In 8 other cases the declaration on the wrapper did not comply with the requirements of Paragraph 3 of Schedule 3 of the Preservatives in Food Regulations 1962, which states that the declaration of the presence of preservative shall be printed distinctly and legibly in dark block type upon a light coloured ground or in light block type upon a dark coloured ground, the type being not less than one-eighth of an inch in height, within a surrounding line. In none of the samples of sausages did the meat content fall below 65 per cent in respect of the pork variety of 50 per cent in respect of beef. Whilst these figures are not yet a legal standard they have been generally accepted by the trade. On the 31st May 1969 the Sausage and Other Meat Product Regulations 1967 will make these standards obligatory. During the year, 22 samples of pork sausages were examined and these had an average meat content of 73.1 per cent. In respect of the 13 samples of beef sausages examined the average meat content was 59 per cent. Ice Cream There are two small premises in the Borough where ice cream is manufactured. There are also 8 freezers in shop premises dispensing soft ice cream, in addition to an unknown number installed in vans and being operated by itinerant vendors. This latter type of vendor requires 36 supervision, the standards of hygiene of the individual salesman varying considerably as does the amount of supervision exercised by the companies owning or renting the vans. The following table shows the number of samples of ice cream submitted for examination under the Ice Cream (Heat Treatment, etc.) Regulations 1959 and 1963. TYPF. GRADING TOTALS 1 2 3 4 Hard ice cream Premises Prepacked 18 3 - - 21 Loose 87 50 30 18 185 Vans Loose 4 2 - 1 7 Soft Premises 3 6 3 3 15 ice cream Vans 13 2 1 4 20 Lollies All satisfactory 10 The bacterial cleanliness of ice cream is measured by the application of the methylene blue reduction test. The test affords a simple and valuable means for the routine grading of the product and has proved useful in indicating when further investigation is called for into the practices of manufacturers, distributors and retailers. The recommended provisional grading based on this test in which readings are taken half-hourly is:— Provisional Grade 1 2 3 4 Time taken to reduce methylene blue Fails to reduce in 4 hours 2½—4 hours ½ — 2 hours 0 In interpreting these results, note should be taken of the comments made in the monthly bulletin (October 1950) of the Ministry of Health and Public Health Laboratory Service which stated that "owing to the numerous factors governing the hygienic quality of ice cream, it is unwise to pay too much attention to the bacteriological results of any single sample. Judgement should be based rather on a series of samples. It is suggested that over a six-monthly period, 50 per cent of a vendor's samples should fall into grade 1, 80 per cent into grades 1 and 2 and not more than 20 per cent into grade 3 and none into grade 4". During the year attention continued to be given to premises where ice cream is sold loose, either over the counter or as a sweet with a restaurant meal. In spite of the advice given over the years concerning the care needed in the handling of loose ice cream, it is perhaps a little disappointing that nearly a third of the samples taken were reported as being Grades 3 or 4. Liquid Egg Considerable use is now made by the baking trade of bulk liquid egg. Sampling of this was carried 37 out to check that it had been properly pasteurised and the sampling programme arranged to cover all brands being used in the Borough. (i) Number of egg pasteurisation plants in the district Nil (ii) Number of samples of liquid egg submitted to the Alpha-Amylase test (a) Satisfactory 24 (b) Unsatisfactory Nil Milk Licensing and Sampling Milk (Special Designation) Regulations 1963 and the Milk (Special Designation) (Amendment) Regulations 1965) Licences were issued under the Milk (Special Designation) Regulations 1963 and the Milk (Special Designation) (Amendment) Regulations 1965 to 167 distributors of milk authorising the use of designations defined in these Regulations in relation to milk sold in the Borough. Fifty-three of the licences related to "Untreated" milk, 148 to "Pasteurised" milk, 119 to "Sterilised" milk and 53 to "Ultra heat treated" milk. "Ultra heat treated" milk is milk which has been subjected to a temperature of not less than 270°F for not less than one second. Milk thus treated has become known to the public as "Long Life Milk". In its unopened container it has a "life" of several months but must be used as ordinary milk once the carton is opened. In addition to the samples examined for fat content the following samples were obtained for examination under the Regulations:— UNTREATED PASTEURISED STERILISED No. of samples taken 46 99 9 Satisfactory 27 83 9 Failed 11 2 - Test void 8 14 — The Regulations prescribe tests to be applied to milk sold under a specific designation. The Methylene Blue Test for untreated and pasteurised milk is void if during the period of storage at atmospheric shade temperature that temperature at any time exceeds 70°F. Milk sold under the designation of "Untreated" milk must be bottled or cartoned at the place of production and must be conspicuously and legibly labelled with the words "Untreated Milk". It is a little surprising that there is still a demand for raw milk. The Ministry of Agriculture, Fisheries and Food is responsible under the Milk and Dairies (General) Regulations 1959 for the supervision, through its Divisional Milk Officers, of the actual process of milk production at the farm whilst the Council is responsible for ensuring that milk retailed is of a satisfactory quality both in respect of its chemical composition and bacteriological standard. 38 Following the failures of the samples of untreated milk to pass the Methylene Blue Test the Divisional Milk Officer carried out investigations at the farm concerned and officers of this Department concentrated on the supervising of the staff concerned with the washing of the bottles, a process carried out by hand. Staffing problems, no doubt, played some part in the difficulties experienced at the farm but the conditions improved considerably and no unsatisfactory samples were reported during the last quarter of the year. Tn addition to the above samples, 7 samples of raw milk were submitted to the Central Public Health Laboratory for examination for the presence of tubercle bacilli. This number is less than in 1966 as visits to farms were cut to the minimum during the latter part of the year when the foot and mouth disease outbreak was at its height. No sample was found to be infected. It has been recommended by the Ministry of Health that all milk which is not heat treated should be examined at regular intervals for the possibility of its being infected with brucella organisms. Seventy six samples were, therefore, taken of all untreated milk produced in the Borough. These samples have included milk from private institutions where a large number of persons would be at risk; none was found to be infected. One hundred and eighty bottles were taken from the four bottling establishments in the Borough and submitted for examination in respect of bacteriological cleanliness. Only one set of six bottles was considered unsatisfactory; these came from a bottling plant where the bottles are hand washed. Advice on the need to exercise continually the strictest hygiene practices was given to the staff of the plant concerned. I am grateful to Dr. C.E.D. Taylor, Director, Diagnostic Reference Laboratory, of the Colindale Laboratory and his staff both at Colindale and Coppetts Wood Hospital for the efficient service provided. Complaints concerning foodstuffs One hundred and eighty two complaints were received concerning foodstuffs. Every complaint was investigated and in 32 cases proceedings were recommended against the vendor or manufacturer as appropriate and in 27 other cases warning letters were issued. Where the complaints were only of a minor nature, the matters were dealt with informally by the giving of appropriate advice and information. The complaints were classified as follows:— (1) Foreign bodies (a) Insects etc. 25 (b) Metal objects 15 (c) Glass, stones etc. 14 (d) Hair, paper, string etc. 7 (e) Oil or grease 7 (f) Fabric 3 (g) Chewing gum 1 39 Complaints (foreign bodies continued) (h) Rubber glove 1 (i) Harmless matter e.g. Burnt dough in bread 10 83 (2) Quality (a) Unsoundness 15 (b) Mould growth 29 (c) Staleness 5 (d) Contamination with outside agent 2 51 (3) Damaged or dirty containers (a) Damaged containers 4 (b) Dirty containers e.g. milk bottles 23 27 (4) Complaints unfounded 20 20 (5) Labelling 1 1 182 It will be seen that complaints relation to "foreign bodies" accounted for nearly one half of the total complaints, a rather higher proportion than last year. The increase in the number of metal objects found is probably due to the increasing mechanisation of the food industry. With the greater use of machinery the possibility of the odd nut, bolt or screw coming adrift and being incorporated in the foodstuff in the process of manufacture is greatly increased. A number of complaints concerning particles of glass in bottles of milk distributed by two different companies were not satisfactorily solved. Until a satisfactory mechanical or electronic means is devised for examining filled bottles, this type of complaint is bound to occur from time to time. The carton is the obvious solution so far as this type of complaint is concerned. It, however, has its own problems, particularly that of the disposal of the empty carton when supplied to large consumers such as schools. The increase in the number of cases of food affected with mould growth related mainly to sliced and wrapped bread. The warm and humid summer months, together with the fact that there may be times when the bread is wrapped before being completely cool, encourages the growth of mould. The treatment the loaf often receives when taken into the home is not conducive to the inhibiting of mould growth. An unventilated breadbin in which a wrapped loaf may be placed provides ideal conditions for the growth of mould. A can of South African pineapple pieces labelled "grapefruit segments" was found to contain a pair of rubber gloves which may well have been inserted by a disgruntled worker. In the following twenty-one cases the Public Analyst was asked to examine the foodstuff which was the subject of complaint, in order to determine the nature of the foreign bodies or contaminating matter. 40 Articles examined Satisfactory Unsatisfactory Baked beans 2 — Bread and cakes — 5 Milk and/or milk bottles 2 7 Sausages 1 1 Yogurt - 1 Tooth paste 1 - Anti-histamine Tab'ets 1 fn the case of two tins of baked beans which were thought to have been the cause of illness, no evidence of any contaminant was found. Two specimens of bread examined were found to contain flour beetles and a rodent dropping respectively, whilst a bun round contained a piece of woven fabric which may have been used as a bandage. A sausage was also found to contain a piece of cotton fabric. Toothpaste and some anti-histamine tablets alleged to have caused the complainant to have a sore mouth were found to contain no harmful substances. Food unfit for human consumption Food shops and places in which food is manufactured or stored are visited by the public health inspectors. The majority of producers, wholesalers and retailers are anxious to sell food stuffs which are sound and of good quality, and where there is any doubt, or evidence of deterioration or unfitness, the advice of the public health inspector is sought. A large proportion of the spoilage of canned contents arises in the main from damage to the container after it has left the filling factory. The quality of frozen foods is good, and most of the instances of deterioration brought to the notice of the department have arisen from mechanical failure of refrigerator motors. The following list sets out the foodstuffs condemned during the year:Fresh Food Fish 585½ lbs Meat 2279½ lbs Poultry 108 lbs Tinned Food Cream 63 Fish 504 Fruit 4341 Fruit juices 701 Fruit puddings/pies 51 Meat 1054 41 Tinned Food — continued Meat puddings/pies 44 Milk 117 Milk puddings 34 Preserves 454 Soups 297 Vegetables 2547 Cereals 227 Drinks 116 Unidentified 939 Frozen Foods (in packets or cartons) Confectionery 397 Chickens 81 Fish 2697 Fruit/fruit juices 962 Puddings/pies 106 Ice cream 503 Meat 1837 Milk products 805 Vegetables 3821 Miscellaneous Beverages 12 bottles Biscuits 42 packets Bread 31 loaves Cereals 84 packets Confectionery 22 packets 91 1bs Dried fruit/fruit 22 packets 20 jars Milk products 38 packets 174 lbs Powders, gravy, spices etc. 171 packets Preserves 721 'bs 26 jars Pies 13 Sauces, pickles, condiments 276 jars Undefined 16 packets 3 jars 42 Food Hygiene The Food Hygiene (General) Regulations 1960-1962 lay down requirements in respect of cleanliness of food premises and of apparatus and equipment, the hygienic handling of food, cleanliness of persons engaged in the handling of food and their clothing, and the action to be taken where they suffer from or are carriers of certain infections; the construction of food premises, their repair and maintenance and the facilities, including sinks and wash basins, to be provided, and the temperature at which certain foods are to be kept. The Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations 1966 which came into operation on 1st January 1967 enable similar requirements to be applied to markets, stalls and delivery vehicles. At the request of the Minister of Health, I set down below in tabular form particulars of food premises provided with wash hand basins and an adequate supply of hot and cold water, soap and towels (Regulation 16) and those provided with sinks, hot and cold water, soap, clean cloths or other cleaning and drying facilities (Regulation 19) as required by the Food Hygiene (General) Regulations 1960. Class of Business Number at end of 1967 Number Complying with Reg. 16 Number to which Reg. 19 applies Number Complying with Reg. 19 Bakehouses and Bakers Shops 132 132 130 128 Butchers 163 163 163 163 Canteens 144 143 144 144 Confectioners 261 259 167 166 Dairies 17 17 17 17 Fishshops 77 77 76 76 Greengrocers 175 175 134 132 Grocers 320 320 317 314 Licensed Premises 200 198 200 198 Restaurants/Cafes 230 230 230 229 4284 visits were made to secure the obversation of hygienic practices in clean and properly equipped premises. Generally the equipment of retail and wholesale food premises is satisfactory, but with few notable exceptions, retail food firms make little effort to teach food hygiene to their staffs. Markets There are two markets in the Borough in which food is sold; one owned by the Council at Burnt Oak and known as the Watling Market. This operates on one day a week only. The other, privately owned, is at Barnet, and opens two days a week. Hawkers Hawkers of food and their storage premises are required to be registered under Section 11 of the Middlesex County Council Act 1950. The vehicles and storage premises used by these traders 43 were inspected and found to be satisfactory. At the close of the year there were 73 such hawkers on the register. Slaughterhouses There are two slaughterhouses in the Borough, neither of which is at present in use. Negotiations to lease the premises owned by the Council were still in progress at the end of the year. Three persons were licensed by the Council under the Slaughter of Animals Act 1951 as fit persons to slaughter animals. Poultry Inspection (i) Number of poultry processing premises within the district 1 (ii) Number of visits to these premises 9 (iii) Total number of birds processed during the year 9546 (iv) Types of birds processed Hens only (v) Percentage of birds rejected as unfit for human consumption Nil (vi) Weight of poultry condemned as unfit for human consumption Nil (vii) The live birds are bought by individual selection from farms in Hertfordshire, only healthy birds being selected. The processing premises consist of a building divided into two sections — for killing and for dressing. The staff engaged in the business are the proprietor, one male employee, and one female employed part-time. The birds are killed by dislocation of the neck and are not eviscerated. The carcases are immersed in a thermostatically controlled scalding tank and plucked in an electric defeatherer. They are delivered the same or the following day after slaughter to butchers in the Golders Green, Finchley, Harrow, Tottenham, Watford, Elstree and Cockfosters areas for sale in the fresh trade. As the birds are uneviscerated, inspection at the place of slaughter is limited but doubtful carcases are retained and inspected in accordance with the procedures recommended in Circular 22/61, of the Ministry of Health. Labelling of Food The Labelling of Food Order 1953 aims at providing the local authority with the legislation necessary to insist that foodstuffs should have informative labelling which does not mislead the purchaser. Unless special exemption is given, all pre-packed foods should have on the label or wrapper, the name and address of the packer or labeller or alternatively a trade mark together with the words "registered trade mark". There has been a growing practice to abbreviate this information as much as possible and whilst in the case of a large firm in a small town the name of the town may well be sufficient for correspondence to be delivered, the use of the name London, 44 Birmingham, etc., may be completely inadequate and it is not unreasonable to expect that a postal district be given. The abbreviation of or the omission of the word "registered" is similarly not acceptable. The Labelling of Food Regulations 1967 which, comes into operation in January 1971, however, make no provision for the use of a "registered trade mark" as an alternative for the name and address of the packer or labeller of the food. A total of 674 visits were made to premises concerning the Labelling of Food Order and 3121 labels examined in order to check the correctness of their claims. The Merchandise Marks Acts prohibit false or misleading written trade descriptions. During the year 476 premises were visited and the following articles of food examined for possible offences under the Acts:— Apples 389 Bacon 205 Butter 349 Currants etc. 86 Honey 10 Malt products 18 Margarine 317 Meat 248 Poultry 140 Raw cucumber 295 Salmon and trout 16 Tomatoes 425 Prepacked potatoes are now becoming more popular with the housewife. A number of different packs were examined during the year and in three instances the packers were informed of omissions in the labelling of the packs. The most frequent offences were the failing of greengrocers to label with the country of origin displays of apples, tomatoes and cucumbers. These omissions are pointed out when observed to the manager or proprietor of the shop and a letter sent if subsequent failures to label are noted. Legal Proceedings DATE OFFENCE FINE 27. 2.67 Sale of unsound radishes £10 £5.5s.0d. costs 27. 2.67 Sale of cakes affected with mould £20 £5.5s.0d. costs 27. 2.67 Sale of cakes affected with mould £20 £5.5s.0d. costs 12. 4.67 Sale of milk in bottle containing glass splinter £5 £3.3s.0d. costs 24. 4.67 Sale of milk in dirty bottle £5 £5.5s.0d. costs 24. 4.67 Sale of milk in dirty bottle £5 £5.5s.0d. costs 24. 4.67 Sale of milk in bottle containing piece of paper £5 £5.5s.0d. costs 26. 4.67 Sale of milk in dirty bottle £5 £5.5s.0d. costs 45 Legal Proceedings (continued) DATE OFFENCES FINE 26. 4.67 Sale of milk in dirty bottle £5 £5.5s.0d. costs 12. 7.67 Sale of carton of Yogurt containing glass splinter £20 £5.5s.0d. costs 13. 7.67 Sale of milk in bottle containing cement £25 £10.10s.0d. costs 17. 7.67 Sale of mouldy pork pie £5 £5 costs 31. 7.67 Sale of sausage roll containing piece of metal £10 £5.5s.0d. costs 9. 8.67 Sale of unsound sliced pork £10 £3.3s.0d. costs 4. 9.67 Sale of gateau affected with mould £20 £5.5s.0d. costs 6. 9.67 Sale of unsound steak pies £15 £5.5s.0d. costs 6. 9.67 Exposing unsound steak pies for sale £15 £5.5s.0d. costs 13. 9.67 Sale of milk in bottle containing glass splinter £10 £5.5s.0d. costs 13. 9.67 Sale of milk in bottle containing glass splinter £10 £5.5s.0d. costs 9.10.67 Sale of bread roll containing hessian fibres Conditional discharge £10.10s.0d. costs 18.10.67 Sale of milk in dirty bottle £20 £5.5s.0d. costs 18.10.67 Sale of milk in dirty bottle £20 No costs 18.10.67 Sale of milk in dirty bottle £20 No costs 18.10.67 Sale of milk in dirty bottle £20 No costs 20.11.67 Sale of loaf containing paper clip £20 £3 costs 20.11.67 Sale of loaf contaminated with oil and iron compounds £15 £3 costs 20.11.67 Sale of mouldy loaf £15 £3 costs 20.11.67 Sale of mouldy loaf £15 £3 costs National Pesticide Survey In November 1965 the Council agreed to participate in a scheme which had been proposed by the Association of Public Analysts and designed to enable a systematic enquiry to be carried out into the extent of contamination of foodstuffs by toxic chemicals (particularly organo-chlorine pesticide residues). The scheme was arranged to extend over a period of two years and came into operation in July 1966. The boroughs in Greater London were grouped into three areas, each borough being responsible for taking 18 samples during a four monthly period. During the months August to November 1967 the following foodstuffs were sampled by the Department for pesticide residues:— bread, cheese (2 samples) pork (2 samples), dripping, milk (2 samples) eggs, pears, apples, plums, sausages, canned meat, bacon, lettuce (2 samples) and potatoes. The Association of Public Analysts in its Annual Report for 1967 has pointed out that the use of newer instrumental techniques has enabled Analysts to detect minute traces of pesticide far below the level which would normally be considered objectionable. Such techniques are capable of detecting one part of certain insecticides in one thousand million parts of a food stuff. As in the 46 previous year all the samples examined were reported as being free from any residues. Public Control I am indebted to Mr. W.E. Child, the Public Control Officer, for supplying the following information in respect of work carried out by his staff. Labelling of Food Order NO. OF PREMISES VISITED 290 Correct Incorrect No. of Articles Examined 4704 7 No. of Articles Purchased 2 7 Merchandise Marks Acts No. of Premises Visited 566 Articles Examined Meat 516 Apples 625 Tomatoes 370 Poultry 804 Bacon 12 Cucumber 172 Offal 97 Others 49 Purchases Correct Incorrect 35 18 47 Food and Drugs Formal samples purchased and examined Fish 16 Meat 7 Apples 11 Citrus Fruit 2 Vegetables — Potatoes 1 Offal 4 Bacon — Others 22 Natural foods on inspection Premises visited 266 Fish 47 Meat 122 Apples 124 Citrus Fruit 4 Vegetables 42 Potatoes 9 Offal 4 Plums 7 Tomatoes 6 Pears 9 Others 124 CLEAN AIR Smoke Control Areas Satisfactory progress was made during the year in the Council's aim to rid the Borough of coal smoke nuisance by 1976 at the latest: details are shown in Table A on page 50. It is important that this pace be maintained in the years to come. Prices of smokeless appliances and costs of works of installation are increasing. The Gas and Electricity Boards and the solid fuel heating organisations are conducting intensive campaigns in smoke control areas and this means that more people are applying for grants. Many of course take advantage of the grant as a substantial down payment for modernising their space heating arrangements and pay the additional cost themselves. This all means that the cost of creating smoke control areas is bound to rise. But, the saving in tangible ways, less damage to building and other materials, less cleaning, more efficient use of national fuel resources, not to mention improvement of amenity and in community health, makes the whole operation economic in all senses of the word. Bearing in mind the steadily increasing cost it would even seem sensible actually to increase the pace of making smoke control areas and get the job done as quickly as possible! The map on page 51 shows the area of the Borough under smoke control and also 48 adjacent areas of neighbouring local authorities. The London Boroughs of Haringey and Camden will be completely smoke controlled by the end of 1968. Air Pollution Measurement The Department operates five stations for measuring by the volumetric method the amount of suspended particulate matter (smoke) and acid gases (sulphur dioxide) in the atmosphere. These stations are situated at:- East Barnet (Town Hall) Edgware (Library) Finchley (308 Regents Park Road) Friern Barnet (Town Hall) Golders Green (Library) The readings obtained are sent to the Warren Spring Laboratory of the Ministry of Technology for assessment and the results are used in connection with the National Survey of Air Pollution which the Ministry is conducting. General No very serious nuisance was caused by industry during the year. A number of instances of excessive smoke emissions were observed but these were all dealt with informally. Breakdowns occur with even the best and newest plant and the human failure element remains, as ever, with us. It is felt better as a general rule to seek co-operation with management rather than take an occasional prosecution to make an example. Instances of smoke from domestic chimneys in smoke control areas caused by burning bituminous coal were found. Again, this was due basically to a lack of understanding on the part of the householders, but these offences would not have occurred unless some trader had supplied the coal. The larger fuel merchants generally refuse to deliver coal to premises in smoke control areas and the Department assists by making available relevant maps and lists of roads. The small merchant, however, is at a disadvantage in not perhaps having the clerical resources to deal with the problem. Again most co-operate, when the position is explained. A Private Members Bill, to be supported by the Government, seeks to make it an offence to sell bituminous coal for use in a smoke control area. Should this become law the number of offences will no doubt fall. Whilst industrial smoke nuisance can now be prevented the only practical way, at the moment, of securing an acceptable level of sulphur dioxide at ground level is to discharge the products of combustion as high into the air as possible. Local authorities can reject the plans of certain buildings if the height of the chimney is not adequate. Co-operation of the Borough Engineer and Surveyor and Borough Planning Officer is necessary in this respect and I am pleased to say that a good working system of consultation is in operation. In assessing the necessary "safe" height for an industrial chimney the Department is guided by a Memorandum entitled "Chimney Heights" issued by the Ministry of Housing and Local Government. A series of graphs is provided for calculating height in relation to the amount of sulphur in the fuel to be used, the size and output of the plant, the height and length of the building and the locality. A greater height is required in a heavily built up area, where the 49 50 TABLE A SMOKE CONTROL ORDER DATE MADE DATE CONFIRMED DATE IN OPERATION ACREAGE NO. OF DWELLINGS CITHER PREMISES Orders made by London Borough of Barnet and Constituent Authorities As at 31st December 1966 7726 40,489 1,732 London Borough of Barnet (Ho. 2) (Burnt Oak, including Watling Estate) 2-2-66 10-5-66 1-10-67 917 5,043 228 London Borough of Barnet (No. 3) (West Finchley) 9-5-66 25-8-66 1-7-67 263 2,400 121 London Borough of Barnet (No. 4) (Golders Green) 31-8-66 7-12-66 1-9-67 232 1,386 85 London Borough of Barnet (No. 5) (East Barnet) 31-8-66 7-12-66 1-9-67 214 956 48 London Borough of Barnet (No. 6) (Edgware) 18-8-67 8-11-67 1-7-68 282 2,244 87 London Borough of Barnet (No. 7) (Friern Barnet) 18-12-67 29-3-68 1-10-68 377 2,427 121 London Borough of Barnet (No. 8) (Childs Hill/Cricklewood) SURVEY IN PROCESS - (164) - (1327) - (131) TOTAL 2,285 (164) 14,456 (1327) 690 (131) GRAND TOTAL 10,011 54,945 2,422 Acreage of Borough 22,124 Approximate number of premises (all types) 116,628 51 ground concentration of sulphur dioxide is already high, than in a country or more open area. Until this year the Memorandum required the minimum height for a chimney to be 40 feet but experience since the Memorandum was issued in 1963 has showh that this is unduly onerous for the smaller emitters. The revised edition this year excludes the smallest plants and the minimum height is now set at 25 feet. The Memorandum is, however, only a guide and the Department would still insist, if particular circumstances warranted it on a chimney high enough to prevent nuisance. The assessment of chimney height is not an easy task because of the large number of variables and indeed imponderables involved. I have already said in an earlier Report that office blocks do not come under control and this continues to be a grave omission. Schools are also excluded as education authorities do not have to submit plans for approval by the local authority. The Department of Education and Science, however, commend the Memorandum to local education authorities "as a source of guidance which it is normally desirable to follow". HOUSING Provision of Housing Accommodation During the year the number of purpose-built housing units provided by construction was 235. No units of accommodation were acquired from private owners, the Council having discontinued its previous policy in this connection for financial reasons. A total of 564 families had been rehoused by 31st December. Nearly all the remaining persons in the West Hendon Housing area were allocated tenancies and those who still awaited rehousing at the end of the period were in dwellings which were still the subject of negotiations for acquisition by the Council. In all, 172 families were rehoused from Housing areas. Pressure continued to remain high on the type of accommodation suitable for elderly persons unable to climb stairs and, wherever necessary, the Borough Housing Officer seeks my views on the medical aspects of such cases. Despite the aforementioned progress in rehousing, the number of persons applying to the Council for accommodation continued to increase, it being noteworthy that a high proportion of these were young married couples un able to find private accommodation in the Borough within their means. At the end of the year a total of 4,956 applications were registered. I am indebted to the Borough Housing Officer for the above information on the progress made by the Council in providing housing accommodation. Houses in Multiple Occupation The Housing Act 1961 contains provisions enabling a local authority to require the person having control of a house in multiple occupation to provide adequate facilities and amenities to meet the requirements of the families and individuals accommodated. A direction may also be given imposing a limit on the number of persons who may occupy any such premises having regard to the facilities available. In this respect the Council have adopted standards in 52 respect of natural and artificial lighting; ventilation; water supply; personal washing facilities, drainage and sanitary conveniences; facilities for the storage, preparation and cooking of food and for the disposal of waste water; and the installation for space heating. Much has been written during the past five years, since the Milner Holland Committee was appointed by the Government of the day to survey rented housing accommodation in Greater London, in respect of multiple occupation, its direct association with the addition of large numbers of coloured immigrants to our resident population, and the condition of squalor often encountered in this type of accommodation. It is not, however, realistic to assume that every multiple occupied property automatically provides bad housing conditions. Houses in multiple occupation in the Borough tend to be concentrated in areas of older Victorian type houses which no longer lend themselves to single family use and to localities situated within easy reach of underground tube stations or establishments employing large numbers of manual workers. Much of this accommodation is of the bed sitting room type used by a single person and if satisfactory standards are maintained fulfils a useful housing need for a group of the population not normally catered for in local authority housing schemes. The only real "problem area" is in Cricklewood near to the south western boundary of the Borough and immediately adjacent to the former Borough of Willesden which was highlighted in the Milner Holland Report as one of the London Boroughs with the highest incidence of multi-occupation. Here there is an indication of overspill of coloured immigrants and a detailed house to house survey of some 200 properties was carried out. The survey showed a lack of proper amenities and facilities and of suitable fire precautions rather than a high degree of ever occupation, and by the end of the year steps were being taken to deal with these matters. It is seldom if ever, that consideration is given by an owner to the fire hazards which accompany multi -occupation when this takes over in the average type of large old terraced house constructed originally for use by a single family. Furthermore, oil heaters continue to be widely used for space heating in this type of housing accommodation. This is always a potential danger and whilst their use cannot be prohibited it is necessary for tenants to be adequately advised on the proper siting, maintenance and use of oil heaters. The Housing Act 1964 widens the power of a local authority enabling it to take over control of a multi-occupied house summarily where immediate intervention is considered to be necessary to protect the health, safety or welfare of the residents. The procedure for making and operating control orders is difficult and lengthy and the financial implications may well be a liability to the local authority. These powers should only be used in extreme cases and during the year no property was encountered where it was necessary to consider the use of the control order procedure. During the year, a total of 1552 visits were made in order to establish the existence of multi-occupation or to carry out detailed inspections. Whilst comparatively few complaints reach the Department from persons occupying such accommodation, it is of vital importance that an adequate programme of inspection should be maintained so as to secure the proper maintenance of such premises and the provision of acceptable standards. It is now clear that this is best achieved by carrying out detailed inspections on a house to house basis in selected areas already known to be vulnerable. This is, however, unfortunately restr icted by the extent to which the resources of the Environmental Health Division can be allocated to this task. A great advance could of course be made if national legislation was made available on the lines 53 already existing in the Birmingham Corporation Act and elsewhere so that control of properties was made possible before multi-occupation was introduced. The interest shown by certain Housing Associations in properties within the Borough was noted. Such organisations often provide highly acceptable accommodation at realistic rents by the conversion of large old Victorian houses which would otherwise have only a limited life and would tend to deteriorate rapidly as a result of neglect and over occupation. They could, with encouragement, play a more important role under the leadership of the local authority in providing improved housing conditions. Clearance Areas By the end of 1967 demolition of the three remaining properties contained within the East Barnet Road Clearance Area had been completed. Three clearance areas, involving a total of twenty properties were represented to the Council under Part in of the Housing Act 1957. In The Burroughs, Hendon (six houses) and at Lodge Lane, North Finchley (four houses) the properties were contained within larger areas for which the Council had long term plans in respect of redevelopment and it was therefore agreed that these should be linked with Compulsory Purchased Orders. At the end of the year none of the Orders had been confirmed by the Ministry of Housing and Local Government. Individual Unfit Houses A total of twenty-two dwellings were reported as being unfit for human habitation and incapable of repair at reasonable cost. Such property in the main consists of old houses occupied by elderly tenants of long standing paying low controlled rents, which in fairness to the landlords give no margin to undertake desirable improvements and little or none to effectively halt the deterioration once it becomes clearly establi shed. In six cases the making of Demolition Orders was appropriate but in the remaining sixteen instances as the dwellings were attached to other properties it was necessary for the making of Closing Orders to be considered. In consequence of this action, together with that which had been commenced in previous years, ten unfit houses were demolished and twenty-one others closed. Twenty-nine families comprising in all a total of sixty-nine persons vacated unfit properties. In one instance an old age pensioner living alone was accepted into a British Legion residential home, whilst in another case the tenant's employers found the family suitable alternative accommodation. In all other cases the tenants were rehoused by the Council. In three instances where the unfit properties were close to the north western extremity of the Borough and some distance from the nearest available accommodation owned by the Council, arrangements were made for the rehousing to be undertaken on a reciprocal basis by the Elstree Rural District Council and the Greater London Council who made suitable houses available to the tenants concerned. Three Closing Orders made during previous years were determined. In each case in order that the property could be accepted as having a reasonable future life, the owner agreed to provide full standard amenities as part of the overall reconditioning. In two cases where the making of Closing Orders had been proposed undertakings were 54 received from the owners concerned to render the dwellings fit irrespective of the cost involved and in due course the works were satisfactorily completed. Slum Clearance and Redevelopment Steady progress was maintained in dealing appropriately with those properties included in the Council's Slum Clearance Programme for the five year period 1966 to 1970 and by the end of the year it was clear that there would be no difficulty in completing the programme within the allotted time. Those additional houses which were found to be unfit as a result of normal routine inspections were also dealt with; from experience gained since the formation of the new Borough at 1st April 1965, approximately 20 dwellings a year are revealed as unfit and incapable of repair at reasonable cost. Outside the areas which the Council have already designated as Housing Areas under the powers given in Part V of the Housing Act 1957, and which are programmed for comprehensive redevelopment during the next five years, there are no pockets of unfit houses. The problem of unfitness is largely confined to individual houses or small groups of properties which can be conveniently dealt with by Closure, Demolition or Clearance under Part II or Part III of the Housing Act 1957. However, following upon a "locality survey" which had already been carried out in respect of properties in the immediate vicinity of one of the largest groups of houses included in the Slum Clearance Programme, the Council agreed during the year to designate a further Part V Housing Area at Lodge Lane, North Finchley. This contained a nucleus of unfit houses which, when taken together with a number of adjacent properties found on inspection to be old and substandard to an extent which rendered improvement uneconomical, provided a site which was acceptable for a properly planned redevelopment. In all a total of 96 properties is involved in this area. A detailed survey of a further area of similar type to the above was also completed. This contained a total of 100 properties predominantly residential and providing accommodation for 115 families. At the end of the year the Council had under consideration a recommendation for clearance and redevelopment. Assisted Purchase and Improvement of Houses The Housing (Financial Provisions) Act 1958 provides, inter alia, that a local authority may (a) make advances for the purpose of acquiring houses and for altering, repairing or improving houses; (b) make grants for the provision of houses by. the conversion of buildings, and for the improvement of dwellings. The Borough Treasurer is primarily responsible for dealing with applications for advances for house purchase and I am informed by him that during the year 289 applications were approved, the gross sum involved being £1,016,735. These figures show a small increase on those for the previous year when, because of the national economic crisis, restrictions had to be imposed upon housing advances. An owner may seek an advance or grant towards the cost of substantial alterations which may involve structural work including the conversion of older houses into flats. The power to make 55 such advances or grants is exercised at the discretion of the local authority, and when the work is completed the house must comply with an accepted standard and still have an appreciable useful life. The House Purchase and Housing Act 1959, designed to supplement the previous grant provisions, enables local authorities to make advances for house purchase up to the full value of the property. The Act as amended by the Housing Acts of 1961 and 1964 also places a duty on the local authority to make grants towards the cost of improving older houses which still have a reasonable life and which at present lack standard amenities in the form of hot water supply, fixed bath or shower, wash hand basin, inside water closet, and a proper food store. As a matter of policy, inspections are made of older properties in the Borough which are found to be of a type lending themselves to improvement and which are not included in the Department's improvement area programme. Every effort is made in these cases to persuade either the landlord or the owner/occupier to carry out the appropriate improvements with the financial aid available under the terms of the improvement grants scheme. The Borough Engineer and Surveyor approves applications for Discretionary and Standard Improvement Grants and in each case the Department is consulted on the condition and future life of the property. During the year, 12 Discretionary Grants and 65 Standard Grants were paid. This included only tenanted properties. Improvement Areas At the end of 1966 the Council had agreed, as a pilot scheme, to designate Prospect Road, Childs Hill, N.W.2., as an Improvement Area under Part II of the Housing Act 1964. This comprised one complete road of thirty-eight terraced houses, identical in type, and constructed so as to lend themselves readily to improvement to the full standard. After the official declaration of the area an informal approach on the lines indicated in Ministry of Housing and Local Government Circular No. 53/64 was made in respect of all improvable dwellings, both tenanted and owner/occupied. The significance of what the Local Authority was doing was explained and attention drawn to the financial assistance available in the form of Standard Grant. Although there was initial reluctance on the part of some tenants to accept improvement on the grounds of rent increase, disturbance and inconvenience, consent was finally given in all but one case. By the end of the year efforts to secure improvement on a voluntary basis showed encouraging success. Two owner/occupiers were not prepared to do the work because of lack of funds or advancing years, and in the case of one tenanted house formal action was commenced because of a dispute between leaseholder and freeholder. In all other cases either improvement to provide full standard amenities had been completed or arrangements were in hand for carrying out the work. Detailed surveys were also completed of two further areas at Gratton Terrace and Brent Terrace, Cricklewood, each of which contained approximately one hundred small two storey terraced properties which were suitable for improvement. The estates, originally constructed to provide housing accommodation for railway workers, had recently passed into private 56 ownership. At the end of the year a report had been prepared for presentation to the Council on the desirability of designating these areas under Part II of the Housing Act 1964. It is now generally accepted that the existing procedures for securing compulsory improvement are both cumbersome and time consuming but until alternative legislation is available to this end, the results which can be achieved are well worth the effort. Compulsory Improvement of Dwellings outside Improvement Areas Section 19 of the Housing Act 1964 enables the tenant of an individual house which is not within an Improvement Area to make representation requiring the council to take action in order to secure improvement of the dwelling by the provision of full standard amenities. The initial approach must come from the tenant and it is unfortunate that greater advantage is not taken of this provision. More publicity would perhaps encourage a greater number of tenants to exercise their rights in this respect, but in many cases there is a reluctance to accept the increased rent level which must inevitably accompany any scheme of improvement, or a fear of creating bad tenant/landlord relationships. Representations were received under Section 19 from the tenants of three dwellings; after informal approach to the owners it was agreed in each case to consider the preparation of an appropriate improvement scheme and at the end of the year application for Standard Grant had been submitted to the Council in respect of one of the houses. The works necessary in respect of four representations outstanding from previous years were satisfactorily completed. Two were in respect of houses forming part of a terrace of eight properties in single ownership and one within a similar group of three properties. It was possible to secure the provision of full standard amenities in all eleven houses. Overcrowding The following statement provides a summary of the known cases of overcrowding existing or dealt with during the year, the standard of assessing overcrowding being that specified by the Housing Act 1957. (a) Number of dwellings known to be overcrowded at end of year 11 Number of families in occupation 15 Number of persons in occupation 59 (b) Number of new cases reported 14 (c) Number of cases relieved 8 Number of persons concerned 43 These are the only cases of statutory overcrowding recorded by the Department. Other cases must undoubtedly exist but the entire extent of the problem is not considered to represent a serious hazard. Overcrowding only rarely comes to light during the course of normal routine inspections or as a result of direct complaint. In the main, cases are brought to notice by tenants who are seeking 57 to improve their position on the Council's housing waiting list, or, on occasions, by an owner seeking to obtain possession of his property on the grounds that it is over occupied. When the existing standards whereby statutory overcrowding is judged were first introduced in 1935, compared with earlier standards they were considered to be high and on a wider basis. Now after more than thirty years they can no longer be accepted as being in accord with the present day conception of satisfactory living conditions. When assessing housing needs in respect of applications for housing accommodation, the Council therefore maintains a more realistic approach by awarding "points" on an ascending scale according to the degree of insufficiency of proper bedroom accommodation. Common Lodging Houses There are no registered common lodging houses in the Borough. Rent Acts The Rent Act 1957 which, amongst its other objectives, provides a tenant with certain protection against what may be regarded as an unjustifiable increase of rent when his accommodation is not being kept in a proper state of repair having regard to its age, character and locality; for this purpose machinery exists whereby a tenant may apply to the Local Authority for a Certificate of Disrepair. To the average tenant, the procedure laid down in the Act and which must be strictly adhered to is lengthy and involved and therefore continued to be little used. His primary concern, in almost every case, is to secure the execution of essential repairs as soon as possible, it is found that he normally prefers to make at the outset a complaint to the Department regarding nuisance or dilapidations and allow appropriate action to be taken under the Public Health or Housing Acts in order to obtain a remedy. The following figures show the number of applications for issue and cancellation of Certificates of Disrepair received and the action taken during the year. Applications for Certificates of Disrepair Number of applications for certificates 2 Number of decisions not to issue certificates — Number of decisions to issue certificates (a) in respect of some but not all defects 1 (b) in respect of all defects 1 Number of undertakings given by landlords under paragraph 5 of the First Schedule 2 Number of undertakings refused by Local Authority under proviso to paragraph 5 of the First Schedule — Number of Certificates issued — 58 Applications for Cancellation of Certificates Applications by landlords to Local Authority for cancellation of certificates 3 Objections by tenants to cancellation of certificates — Decisions by Local Authority to cancel in spite of tenants' objections — Certificates cancelled by Local Authority 3 The Rent Act 1965 was introduced primarily in order to give security of tenure to the occupiers of both furnished and unfurnished lettings and to fix fair rents by a system of rent regulation in respect of currently decontrolled households. At the same time a landlord of furnished accommodation is given some measure of protection in respect of a proved unsatisfactory tenant. The Act also introduced two new crimes, eviction by force and harassment of tenants by landlords. These arose directly from the findings of the Milner Holland Committee which was set up in 1963 in order to make a detailed survey of rented accommodation within the Greater London Area. The report indicated that although evidence showed that the great majority of landlords of privately rented accommodation in London treated their tenants with complete fairness it was nevertheless clear that a small minority was guilty of malpractice. Rents are fixed by a Rent Officer who is directly responsible to the Ministry of Housing and Local Government. In case of a dispute a final decision is given by a Rent Assessment Committee made up of independent experts. It is clear that the first phase of establishi ng new rents in the London Area will last for several years. Housing Statistics 1. Inspection of Dwelling Houses (i) (a) Total number of dwellings inspected for housing defects (under Public Health or Housing Acts) 4,773 (b) Number of inspections made for the purpose 10,504 (ii) Number of dwellings found to be unfit for human habitation 46 (iii) Number of dwellings (exclusive of those referred to under the preceding sub-head) found not to be in all respects reasonably fit for human habitation 1,133 (iv) Number of dwellings surveyed in existing Housing Areas and designated Under Part V of the Housing Act 1957 in connection with the Council's negotiations for acquisition 30 (v) Number of dwellings inspected in connection with proposed Improvement Area s and Improvement Grants Scheme 437 2. Remedy of defects during the year without service of formal notices: Number of defective dwellings rendered fit in consequence of informal action 267 59 3. Action under statutory power during the year (a) Proceedings under Sections 9 and 10 of the Housing Act 1957 (i) Number of dwellings in respect of which notices were served requiring repairs 1 (ii) Number of dwellings which rendered fit after service of formal notices: (a) By owners NIL (b) By Local Authority in default of owners NIL (b) Proceedings under Public Health Acts: (i) Number of dwellings in respect of which notices were served requiring defects to be remedied 73 (ii) Number rendered fit (a) By owners 38 (b) By Local Authority in default of owners NIL (c) Proceedings under Sections 16 & 17 of the Housing Act 1957 (i) Number of dwellings in respect of which Demolition Orders were made 7 (ii) Number of dwellings demolished in pursuance of Demolition Orders 3 (iii) Number of dwellings in respect of which Closing Orders were made 17 (iv) Number of dwellings closed in pursuance of Closing Orders 21 (v) Number of dwellings in respect of which undertaking accepted under Section 16(4) 2 CARAVANS There are in the Borough three sites licensed under the Caravan Sites and Control of Development Act 1960. One licence is for a single site at Brookhill, Stanmore and the other two licences are for sites on either side of the Barnet by-pass at Stirling Corner for 154 caravans. Conditions annexed to the licences provide, inter alia, for the provision of water supply, drainage, sanitation and washing facilities and refuse disposal. Periodical inspections are made to check compliance with these conditions and during the year 7 breaches of conditions were found. 5 had been remedied by the end of the year. Families who had been living in caravans in most unsatisfactory conditions in Arkley Lane and Saffron Green, Barnet, were placed in permanent houses and have now integrated with the community. Itinerant caravan dwellers who from time to time halt on verges of the main roads which traverse 60 the Borough present problems, both in respect of unsatisfactory conditions created by their business activities and socially by reason of their totally substandard existence, affecting particularly the needs of the elderly and the very young. Local authorities have been enjoined to consider the need to provide suitable caravan sites so that the worst aspects attributable to a nomadic existence can be corrected with the long term view of assimilating such families into the community at large. There are many problems to be faced, but I would support full participation in any concerted effort to provide a proper environment for gipsy and other itinerant families. INSPECTIONS AND COMPLAINTS Some 7881 complaints and requests for services were investigated and, where possible, defects or unsatisfactory conditions were remedied. The following table shows the nature and number of inspections made to ensure that people live and work in healthy surroundings, and that food is manufactured or prepared under hygienic conditions and sold in premises properly equipped. Housing Public Health and Housing Acts 8,096 10,504 Multiple Occupation 1,552 Rent Act 29 Overcrowding 47 Other housing visits 780 Clean Air Observations 371 21,476 Surveys, proposals and claims 15,639 Other clean air visits 5,466 Food Premises Bakehouses and bakers shops 279 4,284 Butchers 260 Dairies and Milk Shops 88 Grocers 301 Ice Cream 166 Restaurants, Cafes 767 School Meals Kitchens and Canteens 150 Stalls 190 Unsound Food 665 Other food premises visits 1,418 Factories Non-powered 41 485 Powered 286 Sites 12 Outworkers 146 61 Offices, Shops and Railway Premises 3,682 3,682 Drainage Drainage and Plumbing Works 2,419 2,924 Cesspools 505 Infectious Diseases 2,523 2,523 Animals Pet Shops 53 312 Riding Establishments 24 Boarding Establishments 17 Diseases of Animals Act 162 Others 56 Miscellaneous Visits Accommodation roads/Passages 89 6,441 Noise nuisance 679 Accumulations of Rubbish 1,135 Hairdressers 32 Caravans 155 Watercourses 427 Not classified 3,924 52,631 It is good policy that owners and others having responsibility for the good maintenance of premises should, as far as possible, be dealt with in an informal way. Most people respond, and this is reflected in the fact that of the 2207 informal notices served 1336 were complied with, only 98 statutory notices being required, and of these 64 had been complied with at the end of the year. LOCAL LAND CHARGE ENQUIRIES These refer to enquiries from the Town Clerk concerning outstanding notices, the progress of housing schemes and smoke control areas in relation to all types of property in the Borough, in pursuance of the provisions of the Land Charges Act 1925. The necessary searches were made and information supplied in respect of 8,921 properties. NOISE The Noise Abatement Act 1960 and the Public Health Act 1936, together with byelaws as to street noises, noisy animals etc., provide measures for dealing with noise or vibration which is a nuisance. Whether or not noise is a nuisance is a matter of opinion and is not readily capable of precise definition. Instruments are used for measuring noise levels and during the year the British Standards Institution published a Standard intended to meet the need for rating various noises of 62 industrial origin with respect to their effects on persons living within the vicinity. It gives tentative proposals for a method of measuring a noise together with a set of corrections covering a common range of environmental conditions, in order to predict whether the noise in question is likely to give rise to complaints. This is helpful but though reactions to noise may be predicted individuals have different thresholds of tolerance and in individual cases judgement of nuisance depends very much on subjective reactions. 121 complaints of noise were received during the year, and although not all were dealt with to the satisfaction of complainants, occupiers of factories and other business premises were not uncooperative. SHOPS AND OFFICES The Offices, Shops and Railway Premises Act 1963 and a number of Regulations made thereunder regulate working conditions in offices and shops. Public health inspectors, and shops inspectors of the Town Clerk's Department, collaborate in these measures to secure the health, safety and welfare of persons employed in such premises. The Town Clerk is responsible for the registration procedure and the publication of an annual report to the Minister of Labour. The following is an extract from the report, setting out the number of premises registered, an analysis of persons employed and the number of general inspections made. Table A — Registrations and General Inspections Class of premises No. of premises Total registered premises at end of year Registered premises receiving a general inspection Offices 36 732 221 Retail shops 127 2295 1299 Wholesale shops, warehouses 5 60 22 Catering establishments open to the public, canteens 11 242 38 Fuel storage depots 1 6 2 TOTALS 180 3335 1582 Table B - Number of Visits of all kinds by Inspectors to Registered Premises 5573 63 Table C — Analysis of Persons Employed in Registered Premises by Workplace Class of workplace No. of persons employed Offices 10406 Retail shops 8977 Wholesale departments, warehouses 1234 Catering establishments open to the public 1511 Canteens 184 Fuel Storage depots 22 TOTAL 22334 Total Males 10487 Total Females 11847 FACTORIES AND WORKPLACES The Local Authority is responsible for enforcing the provisions of the Factories Act 1961 and associated Regulations, in respect of cleanliness, overcrowding, temperature, ventilation, drainage of floors, and sanitary conveniences in factories where no mechanical power is used, and the provisions as to sanitary conveniences only in factories in which power is used. The following tabulated report in the form specified by the Ministry of Labour shows the number of factories registered, the number of inspections made and defects found and remedied. Premises Number on Register NUMBER OF Inspections Written notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Section 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 74 41 4 — (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 763 286 30 — (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding out-workers' premises) 26 12 — — TOTAL 863 339 34 64 Cases in which defects were found:— Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) 4 2 — 2 — Overcrowding (S.2) — — — — — Unreasonable temperature (S.3) — — — — — Inadequate ventilation (S.4) — — — 1 — Ineffective drainage of floors (S.6) — — — — — Sanitary Conveniences (S.7) (a) Insufficient — — — 2 — (b) Unsuitable or defective 37 21 — 8 — (c) Not separate for sexes 2 1 — 2 — Other offences against the Act (not including offences relating to Outwork) 9 5 11 4 — TOTAL 52 29 11 19 — OUTWORKERS Section 133 of the Factories Act 1961 requires the occupier of a factory to notify to the Local Authority the names and addresses of persons employed in their own homes. There are 164 outworkers so notified engaged in the following trades:— Wearing apparel 95 Household linen 1 Curtains and furniture hangings 1 Brass and brass articles 8 Artificial flowers 7 Making of boxes etc. 32 Stuffed toys 2 Cosaques, Christmas stockings, etc. 1 Lampshades 17 The Public Health Inspectors made 146 visits to such premises. No unsatisfactory conditions were noted. 65 RAG, FLOCK AND OTHER FILLING MATERIALS The Rag, Flock and Other Filling Materials Act, 1951 requires the registration of premises where filling materials are used in the manufacture of bedding, toys, baby carriages and other articles of upholstery and the licensing of premises where Rag Flock is manufactured or stored for distribution. Regulations made under the Act apply standards of cleanliness for filling materials and prescribe the form of records to be kept by occupiers of registered or licensed premises. Five premises registered under the Act were inspected and found to be satisfactory. SWIMMING POOLS There are 4 public swimming establishments as follows:— Squires Lane, Finchley (indoor). High Road, North Finchley. Daws Lane, Mill Hill, N.W.7. Goldsmith Avenue, West Hendon. All establishments are equipped with modern filtration and chlorination plants. During 1967 there were more than 366,000 visitors to these pools including nearly 70,000 school children. Whilst the indoor swimming pool is generally available throughout the whole of the year, the season for the three open air pools is usually from the end of April to the middle of September. Nine schools have teaching pools provided either by the Education Authority or by parent-teacher associations. There is also one privately owned pool which is open to the public. Samples taken by the Public Health Inspectors from all pools, additional to the daily checks made by the operating staffs, show that a generally high bacteriological standard was maintained. Public slipper baths are available at 3 sites in the Borough:- Cloister Road, Childs Hill Borthwick Road, West Hendon Squires Lane, Finchley. At prescribed times, Old Age Pensioners may have the free use of washing facilities at certain establishments. SANITARY CONVENIENCES There are 29 male and 27 female public conveniences adjoining the highways and 37 male and 37 female conveniences within the curtilage of the Council's parks and open spaces. 78 of these 66 conveniences have free hand washing facilities including 8 installations of an improved type of hand washing and drying machine. The majority of these conveniences are subject, in varying degrees, to vandalism and misuse which has an adverse effect on the benefits otherwise available to members of the public. SEWERAGE AND SEWAGE DISPOSAL Except for a few isolated areas, the Borough is provided with a separate system of foul and surface water sewers. The system which collects rain water only discharges into local natural water courses and the other system is linked with one of three treatment plants. A small area of the northern part of the district drains to the West Hertfordshire main drainage works at Maple Cross near Rickmansworth, whilst the remainder goes to the disposal works of the Greater London Council at either Edmonton or Mogden. The trunk sewers which convey the sewage to the disposal works of the Greater London Council are vested with that authority, but all the other sewers are the responsibility of the Borough Council. There are a few areas of old development where both rain water and foul sewage are conveyed by a single sewer into the foul system, but as these areas are redeveloped opportunity is taken to link them to the separate systems. In the more rural parts of the northern area there are also some properties which drain to cesspools, for which an emptying service is operated by the Council whereby 8 clearances per annum are carried out free of charge. Schemes are in the course of preparation to connect certain of these properties to main drainage. There are certain areas where flooding occurs during periods of abnormal storms and a comprehensive examination of the sewerage systems within the whole of each drainage area is to be carried out to ascertain the extent of the capital expenditure required to deal with the problem. REFUSE COLLECTION AND DISPOSAL The collection of refuse remains the responsibility of the local authority under the control of the Borough Engineer and Surveyor, but the disposal is the responsibility of the Greater London Council. Most of the vehicles used in this service are of the modern compression type operating on 44 collection rounds to give a weekly service. The refuse is taken to either Summers Lane, Finchley, where the Greater London Council arrange for its transportation to tipping areas outside London or to the refuse destructor on the North Circular Road, Hendon, N.W.2. operated by the same authority. Complaint was received from a number of people who live in the vicinity of the transfer station about dust created by the decanting of refuse from collection vehicles to the bulk transporters. This was referred to the Greater London Council. Special arrangements are made for the regular clearance of trade refuse as required, whilst a 67 service is available on prepayment for the collection and disposal of unwanted cars, furniture, garden refuse, rubble, etc. In addition members of the public may take any items which they wish to dispose of to either of the above mentioned depots of the Greater London Council during the hours of 8.0 a.m. to 4.0 p.m. on weekdays and 8.0 a.m. to 12 noon on Saturdays. In conjunction with the regular refuse collection service, arrangements are made for the collection and disposal of salvageable materials such as mixed paper, fibre boards, mixed rags. All ratepayers are therefore urged to keep items such as these separate from the normal refuse. ANIMALS The Animal Boarding Establishments Act 1963, with the Pet Animals Act 1951 and the Riding Establishments Act 1964 provide protective legislation to secure the well-being of cats and dogs, animals sold for pets, and horses hired out for riding. At the end of the year the following licences were in force, namely:— Animal Boarding Establishments Act 1963 3 Pet Animals Act 1951 20 Riding Establishments Act 1964 10 There is one establishment in the Borough, licensed by the Ministry of Agriculture, Fisheries and Food, for the detention of cats and dogs under quarantine following importation to this country. During the year 113 dogs were received at the premises after being authorised to land. The premises are kept under observation by the police and the Public Health Inspectors, to check on the presence and isolation of the animals for the required periods. Under the Movement of Animals (Records) Orders detailed records have to be kept by stockholders of the movement of cattle, sheep, goats and pigs to and from their premises. Animals noved on licence to premises within the Borough must be retained for 14 days before being removed elsewhere, unless a further licence is issued. During the year 568 pigs were moved into the district on 34 licences issued by the appropriate authorities covering the markets where the animals were purchased. Farm premises were visited to inspect the record books to ensure that the appropriate entries were made and that the animals were retained.The records show that the average numbers of stock held were:— Cattle 866 Pigs 2,749 Sheep 38 Poultry 28,340 The Diseases of Animals (Waste Food) Order 1957 requires that all waste foods to be used for the feeding of animals must be boiled to minimise the risk of spread of animal diseases. The boiling plants may only be operated if satisfactory and licensed. Sixteen licences were in force at the end of the year. Owing to an outbreak of Foot and Mouth Disease which assumed major proportions in Wales and 68 the Midlands during the latter part of the year, the Ministry of Agriculture, Fisheries and Food made the whole country subject to a Controlled Area Order, which required that no animals be moved without a licence. These licences are issued on behalf of the Authority by the Principal Health Inspector acting in his capacity as Inspector under the Diseases of Animals act. Some 31 licences were so issued permitting the movement within or into the Borough of 46 cows, heifers and calves, and 95 sows and 1641 pigs. Mr. J. Pickup, M.R.C.V.S., the Council's Consultant Veterinary Surgeon, retired on the 31st March 1967. Mr. J.H. Stockman, M.R.C.V.S., was engaged from the 1st April 1967 on a consultancy basis to assist in the inspection of animals and premises where necessary. RODENT CONTROL The Prevention of Damage by Pests Act 1949 places the onus on the occupier to rid his land and premises of rats and mice, but in practice it is found that the provisions of the Act are best administered by the Council providing a control service. This is carried out by a trained staff of rodent operatives and in accordance with recommendations of the Ministry of Agriculture, Fisheries and Food. In the case of dwelling houses, treatment is undertaken by the Council free of charge, and on a "time and cost" basis in respect of business premises. Treatment of sewers to reduce the level of infestation is carried out four times a year. Fluoracetamide, a dangerous poison, is used and the work is carried out by a specialist firm under contract. The arrangements for this work and its supervision are made with the co-operation of the Borough Engineer and Surveyor. The following table summarises the work carried out and is in the form required by the Ministry of Agriculture, Fisheries and Food. Properties other than Sewers Type of Property Non-Agricultural Agricultural 1. Number of properties in the district 116,628 41 2. (a) Total number of properties (including nearby premises) inspected following notification 2,811 4 (b) Number infested by (i) Rats 2,041 3 (ii) Mice 507 — 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 64 6 (b) Number infested by (i) Rats 40 1 (ii) Mice — — The Rodent Operatives made 13,371 visits during the year. 69 DISINFECTION AND DISINFESTATION Facilities for steam disinfection and disinfestation, and for the personal cleansing of verminous persons are provided for at the Disinfecting Station, North Circular Road, N.3. During the year 582 articles were treated, some of which were articles of clothing for dispatch abroad to countries which require a certificate that this has been done. Verminous conditions of premises and persons are fewer nowadays than ever before, but occasional ones are still to be found. The treatment of females and young children is done under supervision of a woman attendant specially employed. Requests for advice and assistance in dealing with insect pests increase in number and range over a wide variety. No less than 738 were in connection with wasps. Many of these insects are of no public health significance, but steps are taken to assist all enquiries. One must again express thanks to the Director of the Department of Entomology of the Natural History Museum for the helpful co-operation of his experts in the identification of numerous insects. Because of complaints from some residents of the depredations of the common squirrel, the Council decided to obtain traps and for a fee to hire them out upon request. "Wild" or "feral" pigeons are now a widespread pest, and in one area steps were, upon the request of residents, taken to reduce their numbers. Squirrels and pigeons are held in sentimental regard by many of the public, but often by wellmeant but misplaced kindness the invasion of residential districts by these creatures is encouraged. A charge is made for disinfection and disinfestation, with the exception of terminal disinfection carried out after a notifiable disease and the cleansing of verminous people. The following table shows the work done by the disinfectors:— Disinfection Rooms 32 Articles 582 Disinfestation Ants 10 Bugs 35 Cockcroaches 17 Beetles 7 Fleas 29 Lice 1 Articles for Destruction Dressings 91 Placentae 413 Household 31 70 MORTUARIES In accordance with the Council's decision the use of the mortuary in Hendon was discontinued and the service is now provided from the mortuary, North Circular Road, N.3. In the course of the year 565 bodies were received in the mortuary. EXHUMATIONS Licences for the removal of human remains under the Burial Act 1857 state, inter alia, "it is considered advisable that the Medical Officer of Health should be notified whenever such a licence is granted in order that he may be in a position to take any action that may be necessary in the interests of public health." Eight exhumations were carried out during the year and, where appropriate, were observed by a Public Health Inspector, to ensure compliance with the conditions in the licence. 71 MENTAL HEALTH SERVICES MENTAL HEALTH SERVICES Despite the imposed restraint in implementing the proposals contained in the 10-Year Plan, due to the National economic situation, it is nevertheless envisaged that forward planning of the mental health services will continue and from a revision of the priority of need will emerge realistic, albeit curtailed plans for long term development of the services. The provision of services to mentally infirm elderly still remains the first and most urgent priority. It is estimated that 12% of the population over the age of 65 i.e. something over 4,800 people are suffering from mental disorder which requires treatment. Over half of these old people are suffering from forms of mental illness which are reversible and most of which can be treated as efficiently as similar conditions in younger people. In addition the catchment hospital has become silted up with elderly people, many of whom no longer need the full facilities of a Psychiatric Hospital and whose discharge to community accommodation could make available beds urgently needed for the admission of acutely ill people in the community. The provision of a wide range of services including Day Hospital, Day Centres, Special Residential Hostels, Domiciliary Psychiatric Nursing and more intensive Social Work directed to the problems of the aged requires a concerted effort in which the local Health and Welfare Department has a key role. As mentioned in my previous report, plans for the development of the service include the provision of both Day Centres and Hostels for the elderly mentally infirm, but since these are not scheduled for commencement until 1968, Park House Hostel continues to be used on two days per week as a Day Centre under the direct charge of one of the Senior Social Workers. During 1967, the success of this experimental venture became apparent. An Occupational Therapy session under the guidance of the Council's Occupational Therapist was commenced in October and one of the benefits of this session has been the increased communication between the patients. The standard of work of some of the old people is much higher than might be expected — one old lady of over 80 years produces a constant supply of excellent cane trays. Stools, coffee tables, dish cloths, chamois car cleaners, mosaic ashtrays, leather work and toys are being made successfully and there has been surprisingly little wastage. A music programme of records was introduced with some success and a programme of guitar music is also planned. As a result of the increased socialization of these patients, a more adventurous programme was possible; one of the most successful outings was to the sea-side. Much of the success of the Day Centre would not be possible without the excellent help of the W.R.V.S. who assist with the supervision and care of the old people. Until such time as it is possible to extend the Day Centre arrangements for the elderly mentally infirm at Park House Hostel, the London Borough of Harrow continues to allocate four vacancies at their Marlborough Day Centre. Mental Subnormality The need for a hostel for trainable mentally subnormal adults has long been recognised and a 75 24 place hostel together with adequate facilities for adult training will be in the revised programming of capital projects. The restrictions in capital investment in the health and welfare service fortunately came after loan sanction had been granted for the purpose-built 40-place adult training centre at Mill Hill and the 10-place hostel in Finchley which will provide long and short term care for girls and boys between the ages of 3 and 16 years. It is anticipated that both these establishments will be completed and fully operational by the autumn of 1968. Some pride is felt in the achievements of the Borough's first 40-place adult training centre which opened on 10th January, 1967. The trainees soon adapted and their progress has been rapid. Emphasis has been directed to the practical training of the young adults. The social cohesion produced in the groups and the marked improvement in behaviour in some who were very disturbed has given great satisfaction to staff, the trainees themselves and their families. Admission and Discharge to Psychiatric Hospitals for the Subnormal The admission of the mentally subnormal child and young adult to psychiatric hospitals continues to present a major problem. The situation has become even more serious and although the closest contact is maintained with the catchment hospital, it is not possible for more beds to be made available, in consequence a great deal of time is spent seeking alternative placements through suitable private and voluntary agencies. The waiting list of those requiring permanent hospital care does not always reflect the true position, as throughout the year emergencies arise where immediate admission is necessary. Also, it is the practice of this department only to apply for hospital admission for those needing such care at the time. This reflects the fact that a comprehensive community care service provided for the subnormal considerably reduces the need for hospital admission. However, a study to ascertain future hospital needs will be undertaken as soon as possible. The number of patients awaiting admission for hospital care at the end of the year was ten of whom one was of extreme urgency. During the year, seventeen patients were admitted informally to psychiatric hospitals for the subnormal. There were seven cases of statutory admission. Twelve patients were discharged to community care. Short Term Care As the Borough will have no facilities for providing short-term care until the autumn of 1968, the arrangements for former years have continued. It is recognised that some relief to the family is necessary from the continual care of the subnormal member, and it is particularly essential that short-term care should be available when an emergency arises. However, the need unfortunately exceeds the availablity of places. Private placements are made or if these are not suitable, admission is arranged to the catchment hospital or other psychiatric hospitals able to offer vacancies. Short-term care during the summer period is always most difficult, and there have been some instances where placement has been impossible. The type of case where individual nursing care is needed can seldom be accommodated other than in a psychiatric hospital. 27 Patients were placed in hospital throughout the year and arrangements were made for 16 patients to be placed in private homes. The London Borough of Hillingdon continued to offer facilities for weekly boarding of the 76 subnormal at its Moorcroft Boarding Unit; children so placed attend the Junior Training School of that Borough. Holiday Camps Junior holiday camps were arranged by the London Boroughs of Enfield and Harrow and places were made available by those Boroughs for children to attend from the London Borough of Barnet. The adult camp was again arranged by the London Borough of Enfield, and this Borough was allocated twelve places. The holiday camps provide an invaluable service not only in giving relief to the parents during the summer holiday period, but also in achieving independence for the boys and girls attending, away from the normal home environment. Community Care for the Subnormal and Severely Subnormal Supervision in the Home The home visiting of children under the age of 16 and their families is undertaken by Health Visitors and a close co-operation is maintained with the Social Workers; the Mental Welfare Officer continues to be responsible for the care of those over the age of 16. Medical consultation with the Principal Medical Officer is available in either case. At the end of 1967 the number of subnormal and severely subnormal children and adults in Community Care was 447. Guardianship & Informal Foster Care At the end of 1967 the Council had only one patient for whom it was responsible under guardianship powers. Informal placements are made wherever practicable in order to avoid formal guardianship procedures, but there is still a need for the provision of private foster homes particularly for young mentally handicapped children. The number of patients in informal foster care or in homes or hostels run by voluntary organisations and private foster homes increased slightly in 1967 to 41. It is becoming increasingly difficult to obtain permanent placements where the home situation is such that it is either unsuitable or unable to contain a subnormal member of the family. Apart from the Guardianship Society there are a number of small private homes up and down the country that are used and annual visits are arranged to these patients. Personal knowledge of the homes used and a contact with patients out of the Borough is considered to be most necessary. Hostels for the Subnormal Work commenced in August, 1967 on the building of the short-term care hostel for 10 mentally subnormal children which should be ready for occupation by mid-1968. This will fulfil an urgent need and it is hoped to include a 24-place hostel for mentally subnormal adults in the plans for Mental Health projects during the next three years. In the meantime two places are available for adults at the London Borough of Brent Hostel at 191 Willesden Lane and one patient is resident in the Hertfordshire County Council Hostel at St. Albans. Junior Training Schools The two Junior Training Schools continue to play an important part in the Borough's Mental Health Service. New activities are being undertaken all the time and one that has been particularly enjoyed by the children is the introduction of swimming lessons. Various visits and outings have been arranged for the children to stimulate interest, and youth hostelling and camping are amongst the new ventures. 77 During the year a number of students have attended at the schools for teaching practice and numerous requests continue to be made by members of educational organizations both from this country and overseas to visit the schools. Special Care Units The Council's facilities in this respect are made available to contiguous Boroughs who have not been able to make provisions of their own and the distribution of places as laid down by the London Government Act has remained the same. Friem Baret Junior Training School London Borough of Barnet 58% London Borough of Enfield 12% London Borough of Haringey 30% Hendon Junior Training School London Borough of Barnet 61% London Borough of Brent 26% London Borough of Harrow 13% It cannot be ignored, however, that there are still a great number for whom no provision can be made and there is a very great need for the hospital services to provide Day Units for many of the more severely physically handicapped children and young adults whose prime requirement is nursing cars. Adult Training Centres Fieldways Adult Training Centre, Wellhouse Lane, Barnet, opened at the beginning of this year and by the end of 1967 there were 16 male and 19 female trainees attending. Difficulties had been experienced with transport arrangements and every effort is being made to shorten the travelling time. Despite the opening of Fieldways there are still insufficient places within the Borough for patients requiring training. It is hoped to absorb those awaiting admission in mid 1968 when the new Adult Training Centre at Mill Hill is opened. It is unlikely that the 45 trainees who attend the Edmonton, Uxbridge and Brentford Adult Training Centres can be accommodated within the Borough's own services until such time as the Adult Training facilities can be extended. Mental Illness Following the revision of the catchment areas of psychiatric hospitals, Naps bury, with effect from 1st April, 1967 became the sole psychiatric hospital for the mentally ill in the Borough. A close contact has always been maintained with this hospital and with the revision of the catchment area it has now been possible to arrange for four Mental Welfare Officers to attend regularly at Napsbury for meetings with Consultants and Social Workers. Social Work Service There has been a steady increase in the demand for the services provided and this entails a closer 78 integration of the medical, social and administrative services. Whilst the Mental Health Act, 1959 imposed a duty to appoint Mental Welfare Officers to act in psychiatric emergencies, this is no longer considered the main role of Social Workers in this field. Indeed it has been clearly demonstrated that emergency work can be markedly diminished by skilful and regular field work allied to early psychiatric referral. A fundamental principle of the Mental Health Service is that it will act as an educational and counselling agency disseminating skills through all the field staff of the Health and Welfare Department, and supporting as far as possible the work of other departments of the Council, of voluntary bodies and of all local community institutions. Thus a large number of people will be in a position to recognise disturbances in personality so that appropriate medical or other help can be obtained before serious illness supervenes. In addition to the community care and after care work of the field staff an emergency service is available at all times including Bank Holidays. Statistics relating to cases referred under the Mental Health Act are shown on pages 82 and 83. It is always difficult to present skills in terms of statistics but some idea of the volume of work undertaken by the officers and their supportive role in the community is represented in the fact that some 5,700 visits have been made during the year to both the mentally ill and mentally subnormal. In addition to social work the Mental Welfare Officers dealt with 207 informal and 303 statutory admissions to psychiatric hospitals. Hostel Park House Hostel continues to play an effective part in the rehabilitation of patients recovering from mental illness. During the year there was a change of Warden and as this coincided with the completion of a three year period of the running of the Hostel since its opening in the Autumn of 1964, an opportunity has been taken to study the results on residents in the Hostel and on those people who had passed through and who could be traced. The results of this study will be published in the coming year. Therapeutic Social Clubs It has not been considered necessary to organise a fourth therapeutic social club as the three existing clubs appear to be adequate to meet the need and have again provided a varied programme for those persons attending. The following attendances are encouraging to those who undertake the supportive roles in the clubs and who arrange enterprising activities to stimulate and help the interests of the members and enable them to achieve independent relationships outside the protective environment of the clubs. Park House 1021 Links 884 York Park 530 Hostel Accommodation Irrespective of the considerable number of persons who rehabilitate through the supportive services provided by the Social Workers in the field, psychiatric hospitals, voluntary agencies and the Borough's short-stay hostel, there were nevertheless 30 patients during the year who required long- 79 term hostels, and this Borough continues to use the following Associations who have a realistic approach to the problem of the long-term patient. Mental After Care Association S.O.S. Society Richmond Fellowship Jewish Welfare Board Day Centre for the Mentally III There are many services that are lacking for the young mentally ill the most important of which is Day Centre/Workshop facilities, and until such time as the financial position improves, the longterm planning for these establishments is necessarily curtailed. Those patients most urgently in need of this type of rehabilitation at the present time attend Day Centres through the courtesy of the London Boroughs of Willesden and Camden. Some Other Aspects of the Mental Health Services Drug Dependency This problem has received a good deal of publicity during the year; as far as this Department is concerned an essentially cautious approach has been adopted. So far the problem in this area does not seem to have reached too grave proportions, but since we are in close proximity to the centre of London it is easy for people to go into town to obtain drugs and to carry on activities associated with drug taking in an area away from their homes. Secondly it is possible for drug-takers to appear transiently in the Borough and then move on quite rapidly as soon as an interest is taken in them. In the past two years about 10 cases of heroin addiction have been personally known to the Department. The incidence of other drug-taking is not known although there has been considerable evidence that trafficking in and experimentation with L.S.D. and Indian Hemp has been going on in certain parts of the Borough. Requests for information have come from two main sources; firstly through the Education Department from Head Teachers and Principals of the Further Education Colleges and secondly from Youth Groups or adults who are running Youth Groups. Two "Teach-ins" were arranged for the Education Department, one for Heads of Secondary Schools and Principals of the Colleges of Education, which took place in October, and the second for representatives of the Common Rooms which took place in November. Each of these meetings was addressed by a Consultant Psychiatrist, by the Chief Inspector of Drugs at the Home Office and by a Senior Police Officer from the Drug Squad at New Scotland Yard. Experimental group meetings were held with young people at one of the Further Education Colleges and it is hoped to expand this work. The Principal Medical Officer (Mental Health) Dr. R.C. Greenberg met with a number of Youth Groups and other organisations to discuss with them the social effects of drugs and gain some understanding of the attitudes of young people themselves so as to discover the most efficient method of checking the present epidemic and preventing further spread. Information gained in this way was passed on to the Ministry of Health and the Department of Education and Science so that it could be used in preparing advice on this problem that both Government Departments intend to issue in the near future. Mental Health V/eek 1967 Mental Health Week, 5th to 11th June, 1967 was the second of three such weeks organised by 80 the National Association for Mental Health leading up to the 7th International Congress on Mental Health to be held in London in August, 1968. The theme this year was "Mental Health — Work to be done" and the intention was to attract people to undertake careers in the field of Mental Health. Mr. Christopher Mayhew was to have been the principal speaker for the opening meeting on 5th June, but he was unable to attend because of sudden developments in the crisis in the Middle East. His place was taken by Mr. L. King-Lassman LL.B., Middle Temple, Barrister at Law, who delivered a stirring address on the layman's attitudes and misapprehension in the field of Mental Disorder. A Brains Trust held on Thursday, 8th June was most successful and well attended by members of the public. A variety of interesting questions were put to the team of experts and the discussion which followed was both lively and informative; it was felt that benefit had been derived from this meeting. Members of the public were particularly encouraged to visit the two Junior Training Schools to enable them to acquire some understanding of the services provided and the skills that can be developed through training. Voluntary Bodies The Borough is particularly fortunate in having two very active and enterprising voluntary associations who organise functions and provide additional amenities for both the mentally subnormal and the mentally ill. Support is given by the administrative and social work staff in many of their undertakings to the mutual benefit of all concerned. 81 Number of persons under Local Health Authority care at 31st December, 1967 Mentally 111 Elderly Mentally Infirm Psychopathic Subnormal Severely subnormal Total Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over Under age 16 16 and over M F M F M F M F M F M F M F M F M F (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) (13) (14) (15) (16) (17) (18) (19) 1 Total number 1 2 73 159 13 28 2 14 6 92 65 52 45 87 86 725 2 Attending workshops/occupation training centres 2 2 5 6 10 3 20 15 42 35 46 42 228 3 Awaiting entry to workshops/occup. training centres 2 3 7 10 1 2 25 4 Receiving home training 5 Awaiting home training 6 Resident in L.A. home/hostel 3 4 7 7 Awaiting residence in L.A. home/hostel 8 Resident at L.A. expense in other homes/hostels 8 10 1 1 8 4 6 2 11 7 58 9 Resident at L.A. expense by boarding out in private household 1 1 10 Attending day hospital 1 5 6 11 Receiving home visits and not inc. in lines 2-10 (a) suitable to attend a training centre 12 20 7 20 59 (b) others 1 2 47 119 1 2 2 4 66 44 1 34 40 364 82 83 Cases of Mentally III Persons referred to Mental Welfare Officers during 1967 REFERRED BY:- UNDER 16 YEARS 16 YEARS AND OVER TOTAL MALE FEMALE MALE FEMALE GENERAL PRACTITIONERS 1 1 175 307 484 HOSPITALS, on discharge from IN PATIENT TREATMENT - - 56 80 136 HOSPITALS, after or during OUT PATIENT or DAY TREATMENT 1 - 33 46 80 LOCAL EDUCATION AUTHORITY 1 - 4 8 13 POLICE AND COURTS - - 29 16 45 OTHER SOURCES 3 - 118 162 283 TOTAL 6 1 415 619 1,041 Persons Under Mental Welfare Officers' Care At 31.12.67 MENTALLY ILL ELDERLY MENTALLY INFIRM SUBNORMAL TOTAL Under 16 years 16 years & over Male Female Male Female Male Female Male Female 1 2 62 145 13 28 181 151 583 WELFARE SERVICES WELFARE SERVICES SERVICES UNDER THE NATIONAL ASSISTANCE ACT, 1948 The Council's Welfare Services provide a range of services under Part III of the National Assistance Act, 1948 which extend to the care and wellbeing of persons in the community who, by reason of age, physical disability or other circumstances, have needs which cannot be met from other sources. The services include the provision of residential care for the elderly, temporary accommodation for homeless families, and a range of domiciliary welfare services. In brief it involves an ascertainment of need among the elderly and handicapped and directing efforts to enable the Council to meet that need or to utilise the assistance of voluntary bodies. Residential Accommodation The Council has 7 Residential Homes for elderly persons or other persons who, by reason of age, infirmity or other circumstances, require care and attention not otherwise available to them. Name of Home Number of Beds Disposition Beach Lodge, 66 Hendon Lane, Finchley, N.3. 32 Female The Cedars, Richmond Road, New Barnet. 38 Mixed The Leys, Barnet Lane, Elstree. 47 Female Morton Lodge, Ashfield Road, Southgate, N.14. 50 Mixed Redhill House, Burnt Oak Broadway, Edgware. 210 Mixed Storth Oaks, 1 Downage, Hendon, N.W.4. 31 Mixed Woodhill House, Kentish Lane, Essendon, Herts. 41 Mixed It is intended that the Council's homes be situate in various parts of the Borough so that persons admitted may, as far as possible, maintain some community association and continue contact with friends or relatives without undue difficulty. Redhill House, the former Poor Law residence, is programmed for closure in 1972/73 and the Ministry of Health has already given approval to a scheme to provide 4 new homes over 4 years which will enable the residents to be accommodated in units in different parts of the Borough. 87 During the year, the Meadowside Home in Holden Road, Finchley, N.12, was closed and later demolished. The 22 female residents were accommodated elsewhere, the staff moved to other premises and early in 1968 work will start on a new residential home for 50 residents. Improvements to the kitchen, dining hall, staff accommodation and the installation of a passenger lift, were completed at Woodhill House, and a new dining room extension, additional toilets and laundry facilities and an oil-fired boiler installation were provided at The Leys. The number of persons accommodated at the 31st December, 1967 for whom the Council was financially responsible was:- Barnet Council Homes 426 Barnet residents in other Local Authorities' Homes 61 Barnet residents in Voluntary Organisations' Homes 343 During the year, 130 persons were admitted to the Council Homes and 95 to voluntary organisation homes. In providing a residential service, it is important to give help to elderly or other persons for short periods, e.g., at times of crisis or for holidays, and 17 persons were so accommodated. The waiting list for admission to residential homes at the close of the year consisted of 31 men and 132 women. Until the new Meadowside home is open in the Autumn of 1969, no additional beds for.elderly persons will be available and names are therefore added to the waiting list only if there is an acute need. It is of interest to record that of the 130 persons admitted to the Council's homes during the past year, 53 were of an emergency nature and were persons whose names were not included on the waiting list. It is of particular significance that at the end of the year there were 27 voluntary organisation homes and 25 private homes for elderly or disabled persons registered with the Council; during the year, 7 were registered and 6 registrations were cancelled. Registration involves inspection visits to the premises to be carried out not less frequently than twice a year to ensure that the residents are being well cared for and the staff are suitable to undertake this work. A total number of 954 persons were accommodated, 744 in voluntary homes and 210 in private homes. Catering For some time, difficulty was experienced in obtaining cooks to work in the residential homes and even where cooks were employed, some support by other staff was found to be inevitable having regard to the application of the 40-hour week. In 2 homes, the position was 88 aggravated by a paucity of other staff and an acute staffing problem therefore arose. To ease the situation, deep frozen pre-prepared food was introduced for use in conjunction with conventional food stuffs. A wide variety of food permitted a 6 weeks' cycle of main meals and the techniques of cooking being simple to follow, cooking and serving time was reduced. The food was found to be attractive and with regard to the nutritional aspect, experiments by other Authorities have shown that it is possible to provide an acceptable, adequate, balanced, wholesome and palatable diet using unqualified staff. This pilot scheme will be watched with interest with a view to an extension of the system should the need arise. Homeless Families The Council has a responsibility to provide temporary accommodation for persons who, due to unforeseen circumstances, are in urgent need. It has extended this responsibility to provide accommodation for homeless families, accepting the principle of keeping the family together as a unit whatever the circumstances. Redhill Lodge, Burnt Oak Broadway, Edgware, accommodates 25 families, and Kelvedon, 27 Woodside Avenue, Finchley, N.12 accommodates 11 families. The number of persons resident in these units at the end of the year was:- Males (aged 16 and over) 28 Females (aged 16 and over) 35 Children (aged 5 to 15) 39 Children (aged under 5) 55 In addition there is a small reception unit at Redhill House. Valuable work is carried out by the staff of the Department and where appropriate the assistance of other Council Officers, and voluntary bodies is obtained: all work in harmony to set families on a new road to personal independence. During the year, 42 families totalling 151 persons were admitted and 44 families, totalling 175 persons, discharged. The Elderly Social Welfare Officers, together with other Officers of the Department and the Council and voluntary bodies, advise on the wide range of activities and services available. It is a notable feature of the community spirit of the residents of this Borough, that many organisations interest themselves, and give active help and support to elderly persons, and in appropriate cases the Council acknowledges this work by giving financial support. Clubs, day centres, work centres, and a wide range of social, educational and occupational opportunities are available, all contributing a part towards the wellbeing of elderly persons. 89 The Council itself plays a complementary role, having established a day/work centre at Etchingham Park, Finchley, N.3. The maximum number that can be accommodated in the day centre is 15 members; many of those who attend do not do so every day for various reasons. Some attend every day, others as little as one or two days per week, and this arrangement enables the benefit of attendance being spread over a larger number of persons; despite this there was a long waiting list at the end of the year. Many of those attending have some additional disability, other than infirmity associated with old age and the demands on the staff are constant and varied; nevertheless the staff cope with these demands with ability and an understanding of individual needs necessary in the Welfare Services. Although the space allocated for use as a work centre can accommodate 40 persons, part of this room is utilized for "socializing" between workers and members of the day centre and the number of workers is reduced accordingly; however, to satisfy the wishes of some workers and to complete work operations, both morning and afternoon sessions are operated. The source of employment is constantly under review and effective supervision of workers is essential to ensure the proper standard of work being returned to the employers. It is intended to extend the day centre principle whenever space and opportunity permits, and in fact, early ne xt year, the Health Clinic in Claremont Road will afford day care for some 10 persons on two days per week. A combined meals kitchens and old people's centre is now established at Brookhill Road, East Barnet, with the co-operation of the Women's Royal Voluntary Service and the East Barnet Old People's Welfare Association. This centre is housed in a converted building, previously occupied by the former East Barnet Urban District Council library. The meals-on-wheels service provided by the Women's Royal Voluntary Service throughout the Borough, plays a vital part in maintaining the health of elderly people and enabling them to remain in the security and comfort of their own home. 48,620 meals were delivered during the year. Not all parts of the Borough receive a 5 day service, but this is being extended as and when manpower and other resources allow. The Council subsidises the cost of the meals supplied. The contribution by luncheon clubs operated by the Women's Royal Voluntary Service, Old People's Welfare and other Associations, plays no less an important and supportive role to old people. Through this source, a total of 9,651 meeds were served in five different parts of the Borough, on one, two or three days per week. Notwithstanding the services outlined above, with an elderly population of 43,760, there is an increasing demand for a service to the community to be based on a framework of affluence, rather than subsistence, and therefore, a hard look at priorities must continually take place in view of the increasingly high cost of providing institutional care, whether within a hospital or a local authority setting. The Blind, Deaf or persons with a substantial physical handicap The Council has a duty to promote the welfare of all persons who are blind, deaf, or otherwise substantially or permanently handicapped by illness, injury or congenital deformity. In all these 90 services the emphasis is placed on meeting the social, vocational, recreational and rehabilitative needs of these persons; at all times striving to assist them to retain their independence at home with their families, or with their close support. Blind and Partially Sighted Persons The total number of persons registered at the 31st December, 1967, was made up as follows Male Female Total Under 5 years of age - 2 2 Aged 5 years to 15 years 9 4 13 Aged 16 years to 20 years 6 6 12 Aged 21 years to 64 years 90 86 176 Aged 65 years and over 138 360 498 243 458 701 Within these figures there are 16 persons working under sheltered conditions, 7 being employed in workshops for the blind, and 9 workers engaged at home in occupations ranging from physiotherapy to knitting. It is worthy of mention that 73 persons were employed under ordinary conditions, i.e. in the general community earning their own living. A total of 25 males and 69 females were newly registered during the year. Qualified Social Welfare Officers for the Blind are employed to assist this class of handicapped persons by promoting their general social welfare, supplying occupational and recreational opportunities, and by ensuring that those able to benefit by training and rehabilitation are given the chance to do so. The Partially Sighted Register comprised 164 persons of whom 31 were working and 96 were aged over 65 years; 34 were registered during the year. These persons receive the full support of the Social Welfare Officers in the same way as the registered blind. Handicraft Classes were held in different parts of the Borough each week, and dancing and cookery classes formed a feature of other social activities; 66 persons participated in an Assisted Holiday Scheme during the year. The needs of the deaf and blind are very demanding and the Council shares with neighbouring Boroughs the time of a Welfare Officer for this service. The Deaf and Hard of Hearing The Welfare Officer for the Deaf is concerned with counselling and interpretation for the deaf without speech, undertaking case work, and advising other social workers of the special problems of the Deaf. Special aids have been issued where appropriate, one of which is the Silent Door 91 Bell Device linked to the lighting circuit within the home, this being of particular help. Voluntary organisations provide spiritual and social activities, and the Council acknowledges the opportunities given to the deaf by the Royal Association in Aid of the Deaf, through its many Centres. Contact is maintained with Hard of Hearing Groups at Barnet and Hendon, both of which flourish under active leadership, and having a membership totalling 152 persons. Physically Handicapped Persons This group includes spastics, epileptics, persons suffering from multiple sclerosis, muscular dystrophy, arthritis, the residual effects of poliomyelitis, tuberculosis, and other diseases and injuries. The Register continues to increase, and the number at the end of the year was 1,166 persons, made up as follows General Classes of Handicapped Under 16 years of age 14 Aged 16 years to 64 years 511 Aged 65 years and over 641 1,166 The Council has a daily work centre at Heriot Road, Hendon, where up to 30 persons attended durinig week-day mornings. The co-operation of local firms is sought to obtain work of a suitable nature and a variety of assembly jobs are carried out by those attending. Council transport is used to convey some of the handicapped to and from the Centre. A new Rehabilitation Centre in Deansbrook Road, Edgware, is expected to be completed early in 1968. The purpose of the centre is to provide a rehabilitation service for blind, partially sighted and all classes of physically handicapped persons, including the deaf. Particular emphasis will be placed on assisting those whose disability is of recent origin and who after receiving hospital therapeutic treatment are returned to the community and who will benefit from the opportunity to engage in various work operations or learning communication, mobility or housecraft methods. Its opening is eagerly awaited to enable a greater contribution to be made to assist blind and handicapped persons towards a greater all round independence. The British Red Cross Society held afternoon craft classes each week at Edgware, Hendon Finchley and High Barnet. This service is much valued by the Council, and appreciated by all who attend. A weekly Choral Class, attended by handicapped persons, was held in North Finchley during school terms; each year the choir attends a festival. Wherever possible the Council extended its transport support to voluntary bodies to assist in social activities and holiday schemes; in some cases no charge was made, and in others a 92 limited mileage was allowed, without charge. During the year, 103 persons were assisted on the Council's holiday scheme. The frequent visiting advisory and counselling service performed by the Social Welfare Officers is of importance, together with the practical assistance given to those persons in need of help by way of the loan of aids to daily living and in this connection 136 such aids were issued. In addition, 64 adaptations to properties were made in an endeavour to maintain people's independence at home. Miscellaneous The Cbuncil has a duty to protect the movable property of persons admitted to hospital, residential, or other accommodation under Order of the Court, where there appears danger of loss; action was taken in four cases during the year. The Department accepts gift furniture, which is distributed to needy persons, but is particularly useful in assisting families rehoused from the Homeless Family Units. Voluntary Organisations Several references have been made above to the valuable contribution made in many aspects of the welfare service by voluntary organisations, other bodies, and some individuals, all of whom are concerned for the wellbeing of those who need support to maintain a reasonably independent existence in the community. It is of primary importance that the Council's Officers maintain a close and harmonious working relationship with the working partners with whom 'the Council is associated in this task. Their efforts are gratefully acknowledged, and wherever possible and needed, financial, or other support, is rendered. 93 PERSONAL HEALTH SERVICES PERSONAL HEALTH SERVICES Existing Clinic Provision A table setting out full information in respect of the Council's clinics and a key to the services provided will be found on page 115. General Practitioners/Domiciliary Staff Attachments The attachment of Health Visitors to General Practitioners was increased, whilst the complete attachment of midwives to General Practitioner Obstetricians was effected in September. Health Visiting The full complement of Health Visitors was retained during the year with only a small number of staff changes. Three student health visitors successfully completed their course and were taken on to the established staff and two health visitors were appointed specifically to deal with elderly people in two areas of the Borough where there is a heavy proportion of elderly persons. Health Visitors have taken a large part in the programme of direct health education and have given talks to groups of mothers in centres and to student nurses during their state registration training. They also began teaching in five more junior schools and three more senior schools. The amount of time given to student nurses from hospitals in the Borough by health visitors has steadily increased. It is usual for a student to spend a day with a health visitor on domiciliary duties and then return to the hospital for discussion with a member of the health visiting staff. The introduction of health visitors to Edgware General Hospital Geriatric Unit was a happy experience lasting for eight months during which time relationships were improved, and to cement this beginning, it was decided to second one health visitor with a special aptitude and interest in the care of the elderly to the unit for five sessions per week. She conveys the needs of the elderly known to the health visitors in the catchment area to the hospital staff and receives information in turn. Many difficulties of communication have been eliminated and this is proving to be a very worth while arrangement. The Council for Health Visitors Training referred two of the staff from a London College to the Borough to observe the administration of the public health nursing services prior to arranging management courses. The following tables show (a) the number of cases of various categories visited by Health Visitors and (b) staff attendance at Clinics. 97 (a) Home Visiting First Effective Total Effective Total No. Access No. of Visits at request of G.P. Or Hospital Expectant Mothers 1030 1717 382 — Children born in: 1967 5084 11435 2598 — 1966 4401 9280 1814 — 1962-65 6944 14179 2582 — Persons aged 65 or over 1990 4733 761 690 Mentally disordered 122 412 54 45 Persons discharged from Hospital (excluding Mental Hospitals) 229 297 35 162 Infectious Diseases (other than T.B.) 60 110 42 Other Visits as Health Visitor 952 1699 164 — Total as Health Visitor - 44252 8638 897 Cases seen as School Nurse - 1924 348 — (b) Attendances at Clinics Total number of attendances by Health Visitors at Local Health Authority Clinic Sessions 3518 Total number of attendances by Clinic Nurses at Local Health Authority Clinic Sessions 2153 Attendances by Health Visitors at School Health Services Clinic Sessions 409½ Attendances by Clinic Nurses at School Health Services Clinic Sessions 1676 Prevention of Homelessness - (Problem Families) Intensive case work with problem families continued to be undertaken by two family case workers. Families at risk of homelessness were successfully helped and progress was made in cases where there were marital and other problems. Support was given to the Warden at Redhill Lodge Hostel, who did excellent rehabilitative work with the resident families. The whole atmosphere within the Hostel improved greatly and a feeling of team spirit began to prevail. 98 Care of Mothers and Young Children Notification of Births Number of births in the London Borough of Barnet during 1967 as adj usted by inward and outward transfers: (i) Live Births (a) Domiciliary 499 (ii) (b) Institutional 4,110 4,609 (ii) Still Births (a) Domiciliary — (b) Institutional 64 64 4,673 Ante-Natal and Post-Natal Clinics Care is given either in the Clinics or in the patient's own home by the Midwife. Ante-Natal and Post-Natal Clinics are provided at 12 Clinics and the following tables show the numbers of ante-natal, post-natal, relaxation and mothercraft Clinic Sessions held. Ante-Natal Clinics (combined with Post-Natal) Clinic Total No. of Attendances No. of Sessions held Average attendance per Session Ante-Natal Post-Natal Oak Lane 314 6 48 6.7 Torrington 282 18 52 5.8 Central Hendon 241 10 49 5.1 Childs Hill 219 4 49 4.6 Mill Hill 442 13 52 8.8 Watling 153 1 48 3.2 West Hendon 723 2 52 13.9 Edgware 129 2 41 3.2 Sutton Road 461 17 52 9.2 Holly Park 58 4 52 1.2 Oakleigh Road 75 4 52 1.5 Claremont 14 — 36 0.4 TOTALS 3,111 81 583 5.5 A total of 681 women attended Clinics in the Borough for ante-natal examination and 48 for post-natal. 99 Attendance at Relaxation and Mothercraft Clinics Clinic No. of Sessions held Total No. of Attendances Average Attendance per Session Relaxation Broadfields 29 150 5.2 Central Hendon 1 3 3.0 Oak Lane 3 8 2.7 Combined Mothercraft and Relaxation Oakleigh Road 50 91 1.8 Mill Hill 47 342 7.3 Childs Hill 29 145 5.0 Edgware 45 187 4.2 Watling 38 127 3.3 West Hendon 41 223 5.4 Central Hendon 56 281 5.0 Oak Lane 42 208 5.0 Torrington 94 689 7.3 Sutton Road 51 134 2.6 Vale Drive 41 254 6.2 TOTALS 567 2,842 5.0 Congenital Malformations Notifications of congenital malformations are received from Hospitals, General Practitioners and Domiciliary Midwives and details of these are passed to the Registrar General. During the year 64 cases were notified in Barnet and the children's names are added to the "AT RISK" Register to ensure that they are examined at the appropriate time and that treatment is given where required. Child Welfare Centres The following table shows the sessions held and attendances at each of the Child Welfare Clinics:- 100 Clinics No. of Sessions Total Attendance Average Attendance No. of cases seen by A.M.O. No. of cases referred elsewhere Infant Welfare Sessions Claremont 50 1208 24.2 532 5 Colindale 52 1747 33.6 567 — Edgware 100 2700 27.0 986 16 Broadfields 51 2196 43.1 650 _ Watling 102 3762 36.9 1154 — Central Hendon 142 5157 36 3 2017 — West Hendon 98 2456 25.0 939 3 Childs Hill 100 4144 41.4 1152 19 Temple Fortune 63 2441 38.8 583 7 Holders Hill 48 1622 33.8 477 _ Mill Hill 102 3331 32.7 1422 — Sanders Lane 32 809 25.3 266 _ Torrington 103 4015 38.9 1157 — Oak Lane 78 2376 30.5 979 2 Essex Park 103 3727 36.2 1058 _ Oakleigh Road 51 1779 34.9 587 _ Holly Park 55 1244 22.6 709 _ Sutton Road 52 2196 42.2 797 — St. Marks 12 319 26.6 214 1 St. Stephens 52 1305 25.1 445 6 Osidge 156 4591 29.4 1958 — Ouaker Hall 24 352 14.7 162 2 Vale Drive 51 1072 21.0 536 14 East Barnet 100 4033 40.3 1784 9 Dollisfield 23 470 20.4 296 11 766 Finchley Road* 50 754 15.0 364 — 108 Watling Avenue* 7 63 9.0 55 - Sessions without a Doctor Dollisfield 28 305 10.9 Holly Park 47 383 8.2 — — Inglis Barracks 42 596 14.2 — — Oak Lane 25 403 16.1 — — Temple Fortune 39 873 22.4 — — Redhill Lodge 6 88 14.7 — — St. Marks 12 294 24.5 — — Sanders Lane 16 277 17.3 - - Toddlers Sessions Sutton Road 7 59 8.4 59 Watling 10 68 6.8 55 — West He ndon 2 26 13.0 7 — Oak Lane 51 745 14.6 564 1 Claremont 1 25 25.0 11 — Holly Park 1 13 13.0 13 - Oakleigh Road 3 33 11.0 31 - Developmental Clinics Broadfields 6 40 6.7 40 Mill Hill 7 91 13.0 54 — Temple Fortune 32 256 8.0 246 — Childs Hill 12 55 4.6 55 — Dollisfield 4 15 3.8 15 - Vale Drive 10 32 3.2 32 — Sutton Road 1 12 12.0 12 - TOTALS 2219 64558 29.1 23040 96 * General practitioners attachment Number of children who attended during 1967: Born in 1967 4290 Born in 1966 3774 Born in 1962/65 4767 TOTAL 12831 101 Mothers' Discussion Groups Discussion Groups in operation at the end of the year were as follows: Vale Drive Clinic Torrington Park Clinic Brunswick Park (Osidge) Clinic Mill Hill Clinic Childs Hill Clinic Midwifery There was a reduction in the number of home deliveries conducted by domiciliary midwives, 491 deliveries taking place with medical aid being summoned in 21 cases. In addition 571 early discharges from hospital were dealt with. 29 pupil midwives received their district training in the Borough, 6 living with midwives and the others in the District Home at Gervase Road, Edgware. 3 midwives attended statutory refresher courses. 2 new Infant Resuscitation Outfits were purchased and all the midwives were instructed at University College Hospital in their use. The hospital staff were most helpful and made the midwives very welcome. A model infant head was purchased to facilitate the teaching of resuscitation. During the year the Central Midwives Board issued a directive on the performing of episiotomies by midwives. All the staff concerned went to Edgware General Hospital and received instructions on the method suggested by the Board. Again every help was given by the hospital. During the year all Midwives were attached to General Practitioners and attended the ante-natal and post-natal clinics of Doctors who wished to see their maternity patients apart from the general surgery. Some midwives and pupil-midwives made a visit to Victoria Maternity Hospital, Barnet, to see the new Premature Baby Unit. The Matron of a Singapore hospital spent a week in the Borough studying the administration of the domiciliary midwifery services as part of her administrative course at Edinburgh University. Home Nursing In October it was de cided to fill two vacancies for home nurses by appointing nursing auxiliaries and to commence a pilot scheme for six months, whereby the auxiliaries, under the supervision of a senior home nurse, would relieve home nurses in one part of the Borough of bathing duties so that the home nurses' skills could be utilized to the full. Also in October one home nurse was attached full time to a group of general practitioners, 102 while a second nurse commenced liaison with another group practice. These two methods of co-operation will be watched closely so that it may be decided which of them provides the better service to the patient. An approach was made to one of the two large hospitals in the Borough with a view to consideration being given to planned early discharges of general cases in the future and in my next Report I will comment further. During the year the number of requests for blanket baths and general care of patients increased. The major part of the home nurses' work was with the elderly and chronic sick. The use of disposable enemas, syringes, etc. has eased the work considerably and the introduction of an evening rota system from 6-9 p.m. daily has helped spread the work load throughout the day and evening. Home nurses are afforded the opportunity to discuss their cases with other members of the Department's staff, such as health visitors, clinic nurses and visitors to the elderly and these discussions are proving to be of great benefit. No. of cases nursed 3,503 No. of patients under 5 at first visit 55 No. of patients 65 or over at first visit 2,309 Marie Curie Memorial Foundation The Authority continued to act as agents for the Foundation and during the year 14 patients were provided with a day and/or night nurse to assist in their care. In one case a haemoductor apparatus was borrowed from the Foundation. Loan of Nursing Equipment Nursing equipment continued to be loaned by the British Red Cross Society acting as agents for the Authority. Larger items of equipment required were purchased by the Authority. Incontinence Pads and Clothing Approximately 45,000 incontinence pads and 250 pairs of waterproof pants were provided free of charge to patients in need. Home Help Service The staff structure of the service was altered when the Home Help Organiser retired. One of the three Area Organisers was appointed Senior Organiser and an Assistant Area Organiser was appointed. The overall responsibility for the service was delegated to 103 the Principal Nursing Officer with a view to increasing the co-ordination between this service and the nursing services. The service operated from Central Office and two Divisional Offices. There was still an acute shortage of Home Helps in some parts of the Borough and informal talks were given to Women's Organisations by the organising staff for the purpose of recruitment but the number of applications for employment was disappointing. During the year there were fewer applications than in the previous year from patients for maternity help but there was an increase in the number of cases over 65 years of age. The following shows the type of assistance given during the year. Number of cases Aged 65 or over in 1967 Age under 65 in 1967 Total Chronic sick or Tuberculosis Mentally Disordered Maternity Others 1572 148 11 274 604 2609 Neighbourly Help Service 27 Neighbourly Helps were employed at the end of the year and were providing assistance to 27 individual households. Day Nurse'ries During the year, the three day nurseries continued to operate to full capacity and 15 more places in the York Park Nursery were made available to Barnet children by the gradual withdrawal of Borough of Brent cases. It was still the policy to admit priority cases, i.e. children from homes where the conditions are unsatisfactory from the health point of view, children of unsupported mothers, widows and widowers, and children who are handicapped either physically or mentally. Staffing at the nurseries remained fairly constant and at no time during the year were admissions curtailed because of shortage of staff. The following table shows the attendance at the individual Nurseries during the year- Name of Day Nursery No. of approved places Children on Register at 31.12.67 Attendances for the year Average daily attendance 0-2 2-5 0-2 2-5 York Park 60 44 19 2904 9249 ♦7.8 Kingswood 50 43 11 2570 8826 45.0 Wood Street 55 41 10 1946 7541 37.3 TOTALS 165 128 40 7420 25616 130.1 Figures include Londor Borough of Brent cases — allocated places at York Park during 1967. 104 Nursery Nurse Training During the year consultations were held between the Authority and the Ministry of Health regarding the possibility of training nursery nurse students within the Borough. I am grateful for the support and encouragement received from the Ministry and for the assistance given by the Chief Education Officer and the Barnet College of Further Education. It was decided that the proposition was a practical one and would meet the staff needs of those Departments of the Authority employing nursery nurses; furthermore it would reduce the travelling time of students who would otherwise receive training at the Tottenham Technical College. A tutor was to be appointed early in 1968 and it was hoped to recruit up to 36 students for a 2 year period of training who would all be college based. Private Day Nurseries and Registered Child Minders Applications for registration have steadily increased in number. Appropriate reports are submitted to the Health and Welfare Committee following initial visits by officers of the Borough Council. Regular supervisory visits to all day nurseries and child minders were paid throughout the year. At the 31st December 1967 there were 30 registered child minders and 46 private day nurseries. Clinics (or the Elderly A total of 57 sessions were held at West Hendon and Watling (Edgware) Clinics and 1407 attendances made, this showing an increase of 279 attendances over the number made in 1966. Chiropody In the former Middlesex County Council districts, a directly provided clinic and domiciliary service was continued and in the former Hertfordshire County Council districts, treatment continued to be provided at chiropodists' surgeries or through domiciliary visits. Agency arrangements with voluntary bodies continued, and in September approval was given to a further increase in the number of sessions held by the British Red Cross Society's Centre in St. Albans Road, Barnet, in view of the increasing demand for the service in that district. Whilst this continues to be a service very much understaffed, there was an increase in the number of persons treated as compared with 1966. 105 Category Persons provided with Treatment Directly by the Authority (including those treated by private chiropodists on behalf of the Authority) Through arrangements with Voluntary Organisations Elderly persons 2792 656 Physically handicapped 20 — Expectant and Nursing Mothers 24 Schoolchildren 33 — Children under 5 years 5 - TOTALS 2874 656 Recuperative Holiday Homes During the year 81 persons were admitted to recuperative holiday homes. There were also 31 applications approved but later withdrawn. Recommendations came in the main from General Practitioners, whilst others were received from hospitals and the medical staff of the Department Registration of Nursing Homes In accordance with the provisions of the Public Health Act 1936 and the Nursing Homes Act 1963 and Part III of the Mental Health Act 1959, the Re gistration and Inspection of Nursing Homes is the responsibility of the Local Health Authority. There are 15 Nursing H6mes registered with the Borough. Name and Address No. of Beds St. Mary's Maternity & Medical Nursing Home, 5 Maternity 46 Sunny Gardens Road, 6 Surgical, Medical & Chronic Hendon, N.W.4. Brent Nursing Home, 32 Medical & Chronic 4-6 Heather Gardens, N.W.ll. Cartref, 2 Chronic 196 Watford Way, N.W.4. Edgware Nursing Home, 13 Medical & Chronic 36-38 Orchard Drive, Edgware, Middx. 106 Registered Nursing Homes (Continued) Name and Address No. of Beds Clovelly, 19 Medical & Chronic 81 Torrington Park, N.12. Arkley Lawn Niirsing Home, 25 Surgical, Medical & Chronic Arkley, Barnet. Ellern Mede Nursing Home, 34 Chronic Totteridge Common, N.20. Preston Lodge Nursing Home, 16 Medical & Chronic 38 Station Road, New Barnet. Braeside House Nursing Home, 9 Medical & Chronic 76 Park Road, New Barnet. Bedford House, 23 Medical & Chronic Marshall Estate, Hammers Lane, N.W. 7. Convent of St. Mary at the Cross, 48 Incurable Orthopaedic Hale Lane, Edgware. Inverforth House, 139 Medical & Surgical Manor House Hospital, North End Road, N.W.ll National Kidney Centre, 3 1 Fairholme Gardens, N.3. Stuart House Nursing Home, 8 Medical 66 West Heath Road, N.W.3. Northumberland House, 30 Mental 237 Ballards Lane, N.3. 107 Nurses' Agencies The three Nurses' Agencies, Harley Nurses, Rupert House, Stonegrove, Edgware. The Hertford Nurses' Bureau, 45 Manor Road, Barnet. The Finchley Nurses Co-operation, 24 Eton Avenue, N.12. were inspected during the year and their licences renewed. A new agency, Nul-Sal Agency, 335 Long Lane, Finchley, N.2. applied for a licence. The premises were inspected and found to be satisfactory, and a licence was granted. Priority Dental Services The number of expectant and nursing mothers and children under five receiving dental treatment at clinics has gradually declined as a number of patients now seek free treatment from their own private dental practitioners. Attendances and Treatment Children under 5 Expectant and Nursing Mothers First Visit 616 130 Subsequent Visits 687 268 Total Visits 1303 398 Number of additional courses of treatment commenced 22 15 Treatment Provided: — — Number of fillings 1129 340 Teeth filled 896 270 Teeth extracted 259 62 General Anaesthetics 117 6 Emergency visits 41 19 Patients X-rayed 2 25 Patients treated by scaling etc. 81 80 Teeth otherwise conserved 268 — Teeth root filled 7 Inlays/Crowns — Number of courses of treatment completed during the year 351 58 Prosthetics Patients supplied with full upper or full lower (first time) 14 Patients supplied with other dentures 22 Number of dentures supplied 36 108 Anaesthetics General anaesthetics administered by Dental Officers 2 Inspections Children under 5 Expectant and Nursing Mothers Number of patients given first inspections 522 94 Number of patients who required treatment 294 79 Number of patients who were offered treatment 294 79 Fluoridation of Public Water Supplies No progress could be made with the fluoridation of local public water supplies for the measure depends upon approval of all Authorities who share the same water supply and the user Authorities of the three sources of water supplies in Barnet have not all agreed with the policy of fluoridation. Tuberculosis The Finchley Chest Clinic, High Road, Finchley, N.12, closed in August 1967 and the Borough is now served by two Chest Clinics: 1. Edgware Chest Clinic (attached to Edgware General Hospital) Chest Physician: Dr. H.J. Trenchard. 2. Barnet Chest Clinic (attached to Barnet General Hospital) Chest Physician: Dr. J.G. Hounslow. On the closure of Finchley Chest Clinic, arrangements were made by the Regional Hospital Boards for patients to be based on other Chest Clinics and those arrangements have been proved satisfactory insofar as the Authority is concerned. Some concern had been expressed at the possible loss of X-ray facilities in the Finchley area, but this matter has been resolved by the holding of one evening session per week for routine X-rays for general practitioners at Finchley Memorial Hospital. There are general medical outpatient clinics with two visiting consultants, each attending once a fortnight, at the Finchley Memorial Hospital and the North West Metropolitan Regional Hospital Board have indicated that should the pressure on this outpatient department increase, they would be prepared to increase the number of doctor sessions available. The Medical Director of the Mass Radiography Service has stated that in the event of the number of patients referred to the Finchley Memorial Hospital being greater than anticipated, he would be prepared to set up a mobile unit for either a morning or an afternoon per week. The Health Visitors and T.B. Visitors continue to carry out social visiting and act as a liaison between the patients and the chest physicians. 109 1. Number of cases of tuberculosis under treatment or supervision at 31st December 1967: Respiratory N on-Respiratory Men Women Children Total Men Women Children Total 1830 1326 85 3241 66 77 6 149 2. Number of cases of respiratory tuberculosis (whether notified or not) included under Section 1 above which were new to the Clinics (but exluding transfers from other Clinics) during the year ended 31st December 1967: * Classification Non-Bacteriologically Confirmed Bacteriologically Confirmed Men Women Children Total Men Women Children Total Group I 37 25 10 72 9 5 - 14 Group II 8 1 - 9 8 4 - 12 Group III 2 - - 2 10 2 1 13 Totals 47 26 10 83 27 11 1 39 3. Number of cases of non-respiratory tuberculosis included in 1 above, new to the Clinics (but excluding transfers from other Clinics) during the year ended 31st December 1967: Men Women Children Total 7 11 1 19 4. Number of cases included in 1 above, whose broncho-pulmonary secretion was positive during the year 60. * The three sub-divisions of new respiratory cases are estimated as as follows from the standard P.A. film: Group I Total area of disease not exceeding one third of one lung in aggregate. Group II: Total area of disease not exceeding two thirds of one lung in aggregate. Group III: Total area of disease exceeding (including miliary disease) two thirds of one lung in aggregate. Tuberculous pleural effusions, pleural thickening without obvious lung involvement and enlarged hilar glands Eire placed in Group I. Once again I wish to express my appreciation of the work carried out by the physicians in charge of the clinics and for statistical information received. Furthermore I wish to acknowledge their cooperation and assistance at all times. 110 The Care of the Unsupported Mother The Authority has one Mother and Baby Home, Guilford House, and this provides 14 ante-natal beds and 14 postnatal beds with 14 cots. No deliveries take place in the Home. Of the 160 referrals to the Department, 40 were admitted to Guilford House, 32 were admitted to other Local Authorities' Homes and 88 were not admitted. In addition, 91 cases were admitted to Guilford House from other Local Authorities. Family Planning Early in the year the Council approved the setting up of a domiciliary family planning service as a further extension of the service provided through the medium of the Family Planning Association. Some time elapsed before a doctor and nurse were appointed by the F.P.A, but by the beginning of September the domiciliary service was ready to be put into operation and General Medical Practitioners throughout the Borough were informed. The estimated cost of this service is £10.0.0. per patient per annum and the cases referred are vetted by a senior medical officer of the Department. By the end of the year, four families had been referred. The domiciliary service covers the need of persons unable to attend the F.P. Clinics and especially of those who otherwise would not take any action. The cost of large families to the community can be considerable and many are problem families burdened by poverty and ill health due to unwanted pregnancies occuring in quick succession, with the resulting lowering of standards. The parents may be socially maladjusted and mentally incapable, many themselves being products of broken and needy homes, and unable to care adequately for their children. These families are often below the Ministry of Social Security poverty line and the children find themselves physically, mentally and educationally at a disadvantage compared with children from small families. Housing problems are very real for these families, particularly as there is a shortage of houses with more than three bedrooms. The problem of uncontrolled fertility can be alleviated by persuasion and suitable educational methods but to be fully effective the necessary advice must be brought within the reach of those couples most in need of it. Cervical Cytology This diagnostic service continued during the year at the three clinics, Torrington, Childs Hill and East Barnet. A fourth weekly clinic was started at Watling Clinic at the beginning of May, this being made possible by the ability of Edgware General Hospital to provide the necessary technical facilities for the reading of up to 20 smears a week. Owing to staffing and accommodation difficulties at Barnet General Hospital, there was towards the middle of the year, a progressive contraction of cervical cytology work and the sessions at Torrington, Childs Hill and East Barnet were reduced from one a week to one a fortnight. 111 19626 patients attended for the first time during the year. In every case the patient and her doctor were notified of the result of the test. There were four positive results and these were referred through their General Practitioners to a Gynaecologist for further investigation. Some women were referred by their own General Practitioners but most attended of their own volition Many heard of the service through their attendance at Women's Organisations or from notices in the local press. Posters have been placed in clinics, libraries and other Council establishments, and in some doctors' surgeries. Near the end of the year the service was extended to allow for all women attending the the cervical cytology clinics to have a full examination of the breasts, abdomen and pelvis. Attendance at Cervical Cytology Clinics Clinic No. of Sessions Held Total No. of Attendances Average Attendance per Session Torrington 34 496 14.6 Childs Hill 30 364 12.1 East Barnet 32 406 12.7 Watling 34 453 13.0 TOTALS 130 1719 13.2 Vaccination and Immunisation In January a circular was received from the Ministry of Health in respect of new arrangements for payments to general practitioners for vaccination and immunisation records. These arrangements require general practitioners to send to the Local Executive Councils the necessary records and Which will permit of the Executive Councils making the appropriate payment of permitted fees. The Executive Councils submit to the Local Authority the necessary information which ertables the Statistical returns required by the Ministry of Health to be completed. Prior to the introduction of this circular the Local Authority paid a fee of 5/- to each general practitioner submitting details of vaccination and immunisation. A further Ministry of Health circular in April altered the arrangements for smallpox vaccine distribution. General practitioners in the Borough were informed that vaccine is now stored at main clinics in the Borough and that supplies may be drawn therefrom between 9 a.m. and 5.30 p.m. Monday to Friday. Vaccine is sent by post where requested. Immunisation in Childhood The Ministry of Health notified the Authority in December that the Joint Committee on Vaccination and Immunisation had reviewed the existing schedules of immunisation in childhood and had recommended that these should be replaced by a single schedule. The 112 Ministry stated that circulars to Local Health Authorities and to Executive Councils were being prepared and were expected to be dispatched early in 1968, and the Authority was being given information in advance, in order that consideration might be given to the changes that would be introduced when the schedule was adopted. The changes in the schedule, which affect the procedures in various ways, are numerous and I expect to report further on this subject in 1968 after the circular referred to has been received from the Ministry of Health. In his letter to the Authority regarding immunisation in childhood, the Ministry of Health Chief Medical Officer referred to the conclusion of the Joint Committee on Vaccination and Immunisation in 1966 that the injection of killed measles vaccine followed four weeks later by an injection of live measles vaccine, or one injection of live measles vaccine given alone, were effective and acceptable immunising procedures, and said that the Joint Committe, after studying further results of the Medical Research Council's trials of measles vaccines, now took the view that immunisation against measles was best effected by means of one dose of live, attenuated measles virus vaccine alone. The Committee was also of the opinion that measles vaccine should be given in the second year of life after the basic course of immunisation against Diphtheria, Tetanus, Whooping Cough and Poliomyelitis. The appropriate statistical tables are shown hereunder: Immunisation of Persons under the age of 16 completed during 1967 Table 1 — Completed Primary Courses Type of vaccine or dose Year ol Birth Others under age 16 TOTAL 1967 1966 1965 1964 1960-3 1. Quadruple DTPP 1 14 41 10 17 - 83 2. Triple DTP 1288 1707 248 47 63 11 3364 3. Diphtheria/Pertussis 2 1 _ 1 — 4 4. Diphtheria/Tetanus 126 288 47 17 74 93 645 5. Diphtheria _ _ 1 — 1 6. Pertussis — 2 _ _ 2 7. Tetanus — — 2 _ 25 438 465 8. Salk — 10 15 15 20 3 63 9. Sabin 1254 2084 348 104 212 91 4093 10. Total immunised against Diphtheria (Lines 1-2-3-4-5) 1415 2011 337 74 156 104 4097 11. Total immunised against Whooping Cough/Pertussis (Lines 1-2-3-6) 1289 1725 290 57 81 11 3453 12. Total immunised against Tetanus (Lines 1-2-4-7) 1415 2009 338 74 179 542 4557 13. Total immunised against Polio (Lines 1-8-9) 1255 2108 404 129 249 94 4239 113 Table 2 — Re-inforcing Doses Type of vaccine or dose Year of Birth Others under age 16 TOTAL 1967 1966 1965 1964 1960-63 1. Quadruple DTPP 1 45 8 54 2. Triple DTP — 713 1448 145 527 145 2978 3. Diphtheria/Pertussis — — — 2 18 10 30 4. Diphtheria/Tetanus — Ill 238 63 1945 960 3317 5. Diphtheria — 1 1 — 23 282 307 6. Pertussis — — — — _ — 7. Tetanus — 1 3 2 27 285 318 8. Salk — 2 7 6 46 16 77 9. Sabin - 677 984 110 2389 1151 5311 10. Total immunised against Diphtheria (Lines 1-2-3-4-5) - 825 1688 210 2558 1405 6686 11. Total immunised against Whooping Cough/Pertussis (Lines 1-2-3-6) - 713 1449 147 590 163 3062 12. Total immunised against Tetanus (Lines 1-2-4-7) 825 1690 210 2544 1398 6667 13. Total immunised against Polio (Lines 1-8-9) - 679 992 116 2480 1175 5442 B.C.G. Vaccination against Tuberculosis Contacts of tuberculosis were vaccinated at Chest Clinics in the Borough, and school children aged thirteen and over and students were vaccinated at school and at establishments for further education by the Department's medical staff. After consultations between the Principal Medical Officer, School Health, and one of the Chest Physicians it was agreed that the method of testing children prior to B.C.G. vaccination, which had been continued from the days of the Medical Research Council's Field Trials, should now be changed to that of the multiple puncture technique. This would appear to have certain advantages over the previous intracutaneous method, not least of which are its simple efficient and reliable operation coupled with its use by a trained nurse thus saving Medical Officer's time. Tuberculin Test and B.C.G. Vaccination No. of persons vaccinated through the Authority's approved arrangements under Section 28 of the National Health Service Act. A. CONTACTS (i) No. skin tested 217 (ii) No. found positive 51 (iii) No. found negative 166 (iv) No. vaccinated 111 B. SCHOOL CHILDREN AND STUDENTS (i) No skin tested 3148 (ii) No. found positive 317 (iii) No. found negative 2645 (iv) No. vaccinated 2603 114 Whooping Cough Vaccination The investigation by the Public Health Laboratory Service of the sero-types currently responsible for cases of Whooping Cough proceeded in 1967, and the Authority continued to co-operate. Smallpox Vaccination There were no reports of cases of generalised vaccinia or post-vaccinal encephalomyelitis or death from any other complication of vaccination. Smallpox Vaccination Persons aged under 16 Age at date of Vaccination Number of persons vaccinated or re-vaccinated Number Vaccinated Number Re-Vaccinated 0— 3 months 11 _ 3— 6 months 20 _ 6— 9 months 29 9—12 months 157 — 1 year 2461 — 2— 4 years 220 17 5—15 years 86 295 TOTALS 2984 312 CLINIC PREMISES Main Clinics Clinic Sessions (see Key Table on Page 115) Brunswick Park Road, N.ll. I.W.C. D OPH SP Town Hall, Hendon, N.W.4. C.S.C. OPH D I.W.C. SP CHIR A/N A/NE-M/C ORT Garth Road, N.W.2. C.S.C. I.W.C. SP CHIR A/NE-M/C A/N D DV C 149 East Barnet Road, Barnet I.W.C. C.S.C. D SP A/N(M) C Holly Park, N.ll. I.W.C. C.S.C. C.E. SP D CHIR A/N T Hartley Avenue, N.W.7. C.S.C. I.W.C. A/N SP A/NE-M/C CHIR D DV Oak Lane, N.2. C.S.C. I.W.C. T SP D OPH CHIR A/NE-M/C A/N 115 Main Clinics (continued) Oakleigh Road, N.20. I.W.C. A/N A/NE-M/C C.S.C. T Sutton Road, N.10. C.S.C. T DV I.W.C. A/NE-M/C A/N SP Torrington Park, N.12. I.W.C. C.S.C. SP CHIR A/N A/NE-M/C C Vale Drive, Barnet I.W.C. S.I.C. D ORT SP OPH A/NE-M/C DV 36 Cressingham Road, Burnt Oak C.S.C. I.W.C. C.E. OPH SP D A/N A/NE-M/C CHIR T C York Road, N.W.9. I.W.C. C.E. C.S.E. D A/N SP CHIR A/NE-M/C T Claremont Way, N W. 2. I.W.C. A/N T Approach Road, Edgware I.W.C. C.S.C. A/N A/NE-M/C SP CHIR Other Premises Etchingham Park Road, N.3. I.W.C CHIR St. Andrew's Church Hall, Lynford Gardens, Edgware I.W.C. A/NE DV Methodist Church Hall, Essex Park, Finchley, N.3. I.W.C. St. Stephen's Hall. Bells Hill. Barnet I.W.C. Dollisfield, Totteridge Lane, N.20. I.W.C. DV United Free Church Hall. Sanders Lane, N.W.7. I.W.C. St. Barnabas Church Hall, Cranbourne Gardens. N.W.ll. I.W.C. DV Quaker Hall. Waterfall Road, N.ll. I.W.C. St. Mark's Hall, Woodville Road, Barnet I.W.C. Congregational Church Hall, Colin Close, N.W.9. I.W.C. St. Mary Magdalen Church Hall, Holders Hill Road, N.W.4. I.W.C. 116 KEY TABLE I.W.C. Infant. Welfare Clinic C.S.C. Consultative School Clinic A/N Ante-Natal Clinic C.E. Clinic for Elderly OPH Ophthalmic SP Speech Therapy A/NE Ante-Natal Exercises only M/C Mothercraft only A/NE-M/C Combined Ante-Natal Exercises and Mothercraft ORT Orthoptic A/N(M) Ante-Natal Clinic — Midwife only D Dental CHIR Chiropody DV Development Clinic T Toddlers Clinic C Cervical Cytology S.I.C. Special Investigation Clinic. 117 SCHOOL HEALTH SERVICE SCHOOL HEALTH SERVICE Introduction During the year, every effort has been made administratively by the School Health Service to increase the degree of co-ordination of the services available to handicapped children and other children in the Borough. This co-operation with other services and Departments of the Authority resulting in greater demands on the School Health Service has only been limited by the need to maintain and improve the efficiency of the School Health Services itself. In this respect, the Assistant Medical Officers, Health Visitors/School Nurses, Clinic Nurses, Administrative Officers and Clinic Clerks all continue to play their part. School Population Once agam there has been an overall increase in the school population for the Borough and the following table shows the position at 31st December, 1967:- Schools No. of Pupils 90 Primary Schools 23,166 19 Secondary Modern Schools 10,119 14 Grammar Schools 7,745 1 Residential Special School (E.S.N.) 177 2 Day Special Schools (E.S.N.) 243 41,450 Periodic Medical Inspections Under the provisions of the Education Act it is the duty of every local education authority to provide for the medical inspection, at appropriate intervals, of pupils in attendance at schools maintained by them, and the authority may require the parent of any pupil in attendance at any such school, to submit the pupil for medical inspection in accordance with arrangements made by the authority. Although the Act thus provides a legal obligation on the parent to submit the child for e xamination, the parent has the right, should he so desire, to refuse treatment or obtain such treatment where he so wishes, This Authority's policy for the routine medical inspection of school entrants and leavers together with an intermediate examination during the last year at the primary •school has been continued through 1967. The following table shows the number of children inspected by years of birth and the state of their physical condition:- 121 Year of Birth Number of Pupils Inspected Physical Condition of Pupils Inspected Satisfactory Unsatisfactory 1963 & later 240 240 1962 1,979 1,978 1 1961 1,976 1,973 3 1960 373 370 3 1959 239 236 3 1958 195 194 1 1957 978 978 1956 1,806 1,803 3 1955 766 765 1 1954 254 254 _ 1953 2,187 2,185 2 1952 & earlier 1,274 1,274 — TOTAL 12,087 12,070 17 Percentage of pupils inspected whose physical condition was found:— Satisfactory 99.86% Unsatisfactory 0.14% Medical Treatment In the Tables of statistics which follow this section of the report, details are given of treatment (excluding uncleanliness and dental disease) of pupils attending maintained primary and secondary schools (including nursery and special schools), whether provided directly by the Council or arranged for through other agencies. Orthopaedic Clinics As had been anticipated the number of attendances at the Orthopaedic Clinic during 1967 decreased and only eleven pupils were treated. Children who required Specialist treatment were able to obtain this at the Royal National Orthopaedic Hospital where treatment is readily available to children of this Borough. A Principal Medical Officer of the Department, experienced in orthopaedics, after consultation with specialists at the hospital came to the conclusion that in most instances parents preferred to attend hospital and I could find no good reason therefore, to continue the provision of this facility at an authority clinic, until such time as the demand increased. Adequate arrangements were made for those few cases which had been, and needed to continue, under supervision. Ophthalmic Clinics The five school ophthalmic clinics continue to operate at the following centres throughout 122 the Borough, with ophthalmologists provided by the North West Me tropolitan Regional Hospital Board. Hendon Central Clinic. Watling Clinic. Oak Lane Clinic. Vale Drive Clinic. Brunswick Park Road Clinic. At Central Hendon Clinic and Vale Drive Clinic an orthoptist provides for the eye training of squinting children within the Borough. Audiometry Two Audiometer Operators carry out the routine audiometric testing of school schildren three times in their school life. At other times, children who fail to develop proper speech, or who may require to be considered for special educational treatment or subsequent to investigation by an Assistant Medical Officer be suspected of having some loss of hearing are seen by the Audiometer Operators and dealt with as special cases. The following Table shows the number of pupils whose hearing has been tested:- Sweep tests 11,586 Re-tests 676 Special tests 594 Re-tests 55 Audiology Those children who are considered to need more specialised investigation, after testing by the Audiometer Operator and consideration by the Medical Officer at the clinic, are referred to an audiology unit. Units are established in the London Borough of Haringey and the London Borough of Brent where the staff include a consultant otologist, medical officers, peripatetic teachers of the deaf, educational psychologist and audiometricians, and where if need be, the advice can be obtained of the Head Teacher or staff of a Special School for the Deaf. During the year a total of 25 children were provided with commercial hearing aids. Child Guidance Service Consideration has been given during the course of the year to the operation of a Child Guidance Service by the Authority, and discussions were continuing at 31st December, 1967. In the meantime, arr angements are made for children to be seen at Child Guidance Clinics 123 held in:- The Child Guidance Training Centre The Hampstead Child Therapy Clinic The Tavistock Clinic University College Hospital Speech Therapy The Authority employs the equivalent of five whole-time speech therapists who undertake sessions at various clinics, combining these with sessions in the Day Special Schools and Junior Training Schools in the Borough. During the year, a total of 570 children received treatment and supervision. Handicapped Pupils The Education Act, 1944, gave Local Education Authorities the responsibility of ascertaining handicapped pupils in their areas and of providing special educational treatment for such children. It is the duty of a Local Authority to ascertain these children from the age of two years. The School Health Service and Handicapped Pupils Regulations, 1959, defined the various categories of handicapped pupils as follows:- Blind Epileptic Partially Sighted Maladjusted Deaf Physically Handicapped Partially Hearing Delicate Educationally subnormal Children suffering from Speech Defects. Special educational treatment may be provided in an ordinary school, with special conditions applicable to the disability, or in a day or residential special school catering for the particular needs of children with one or more handicap. During 1967 a new Day Special School for educationally sub-normal pupils, Northway School, was established by the authority in addition to Oak Lodge School, the Borough being divided to form new catchment areas for each of these schools. The authority also maintains Swaylands School, Penshurst, Kent, a residential special school for educationally sub-normal boys, and is responsible for Winifred House Convalescent Hospital School, Barnet Gate. Future proposals for special education in the Borough as outlined in the Educational Development Plan include two Day Special Schools for Maladjusted Children and a Day Special School for Delicate/Physically Handicapped Children. Also envisaged in the plan is provision for a Residential Special School for Maladjusted Boys by means of extensions to Swaylands School. The following Table shows the number of handicapped pupils as at 31st December 1967:- 124  Special Day Schools Special Residential Schools Maintained Primary & Secondary Schools Independent Schools Not at School Total b. g. b. g. b. g. b. g. b. g. b. g. Blind 1 2 5 2 – – – – – – 6 4 Partially Sighted 2 4 – – – 1 – – 1 1 3 6 Deaf 2 4 5 5 – – – – 2 1 9 10 Partially Deaf 8 7 1 – 2 1 – 1 1 2 12 11 Delicate 4 2 3 7 3 1 2 – – – 17 10 Educationally Subnormal 95 71 19 7 2 4 – 1 1 1 117 84 Epileptic – – 4 – – – – – – – 4 – Maladjusted 1 2 49 9 8 2 2 2 1 1 61 16 Physically Handicapped 23 10 8 8 1 1 1 – 6 3 39 22 Speech Defects — — — 1 — — — — 1 — 1 1 Total No. Handicapped Pupils 136 102 99 39 16 10 5 4 13 9 269 164 SCHOOL HEALTH SERVICE STATISTICAL TABLES PUPILS FOUND TO REQUIRE TREATMENT AT MEDICAL INSPECTION (excluding dental disease and infestation with vermin) Year of birth For defective vision (excl. squint) For any of the other conditions recorded Total Individual Pupils 1963 & later 1 21 21 1962 60 154 197 1961 78 142 214 1960 22 39 56 1959 10 22 28 1958 15 17 30 1957 66 75 132 1956 155 159 273 1955 112 56 151 1954 44 24 64 1953 318 154 433 1952 & earlier 244 110 327 TOTALS 1125 973 1926 125 PERIODIC INSPECTIONS Defect Code No. Defect or Disease Entrants Leavers Total incl. all other age groups Special Inspections * T O T O T O T O 4 Skin 28 50 35 21 122 106 4 – 5 Eyes: (a) Vision 152 367 543 137 1125 703 121 132 (b) Squint 57 27 11 4 84 44 2 2 (c) Other 4 5 5 12 13 31 1 — 6 Ears: (a) Hearing 29 133 15 26 76 216 41 113 (b) Otitis media 21 39 3 5 28 65 4 – (c) Other 6 7 3 – 11 14 8 – 7 Nose and Throat 36 132 12 6 68 166 15 2 8 Speech 59 81 10 3 97 109 57 22 9 Lymphatic Glands 5 25 4 1 11 32 – – 10 Heart 8 49 7 21 16 92 1 4 11 Lungs 18 62 15 15 43 109 6 5 12 Developmental: (a) Hernia 9 14 2 1 19 19 2 1 (b) Other 5 89 6 8 28 143 7 14 13 Orthopaedic: (a) Posture 4 14 28 15 96 56 4 4 (b) Feet 20 38 47 46 109 129 7 6 (c) Other 7 24 15 16 32 50 1 3 14 Nervous System: (a) Epilepsy 3 6 8 1 16 14 2 – (b) Other – 3 – 3 1 12 1 2 15 Psychological: (a) Development — 19 1 11 6 40 2 3 (b) Stability 13 81 6 13 36 145 9 20 16 Abdomen 5 10 5 5 16 27 1 – 17 Other 35 50 26 21 105 109 23 13 * T — requiring Treatment 0 — requiring Observation 126 TREATMENT OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (including Nursery and Special Schools) No. of cases known to have been treated GROUP 1: Eye Diseases (e.g. blepharitis, conjunctivitis), Defective Vision and Squint (a) External & other, excluding errors of refraction & squint 16 (b) Errors of refraction, including squint 2,475 TOTAL 2,491 (c) No. of pupils for whom spectacles were prescribed 817 GROUP 2: Diseases and Defects of Ear, Nose and Throat Received ope rative treatment for: (a) Diseases of the ear 1 (b) Adenoids and Chronic Tonsilitis 25 (c) Other nose and throat conditions 1 Received other forms of treatment 41 TOTAL 68 Total No. of pupils in schools who are known to have been provided with hearing aids: (a) in 1967 25 (b) in previous years 61 GROUP 3: Orthopaedic & Postural Defects No. of pupils known to have been treated in clinics or at out-patients departments 11 GROUP 4: Diseases of the skin (excluding uncleanliness) Ringworm (i) scalp 2 (ii) body 4 Scabies 7 Impetigo 5 Other skin diseases 1 TOTAL 19 GROUP 5: Child Guidance Treatment No. of pupils treated at Child Guidance Clinics 165 GROUP 6: Speech Therapy No. of pupils treated by speech therapists 570 GROUP 7: Other Treatment given: (excl. B.C.G. vaccination) (a) Minor ailments 22 (b) Convalescent treatment under School Health Service arrangements 24 TOTAL 46 Education Act 1944 — Section 57 Cases dealt with under Section 57, Education Act, 1944 3 Cases de-notified under Section 57(a) Education Act, 1944 Nil 127 SCHOOL DENTAL SERVICE Dental treatment assists in the general wellbeing of the body by removing conditions which assist in the preparation of the ground for new diseases. Also mastication is brought to a higher degree of efficiency at a time of optimum nutrition and so helps in the general health of the expectant and nursing mother. Dentistry, therefore, takes its share of reducing the infant and maternal mortality rate. During childhood when growth makes great demands upon the body, it is essential that the children should have good teeth to help obtain maximum benefit from their foods. The filling of the teeth greatly assists in keeping the masticatory powers of the body and it is essential to see that the filling:extraction ratio is kept in the proper proportions. Orthodontic treatment, apart from restoring a more pleasing appearance to the patient, also plays a very important role in providing a more regular surface for the cleansing of the teeth. With irregular teeth the gum conditions can soon deteriorate and the focal point of many diseases resides in the pockets produced by such conditions. With this thought in mind it will be appreciated that time spent at the chairside talking to the patients about dental hygiene is time well spent and the result of such talks can save hours of chairside work on the patient later on. Following an announcement by the British Oxygen Company that they would no longer service the older types of Walten Gas Apparatus, it was decided that four older type gas and oxygen machines would be replaced by more modern apparatus. In 1967 these new machines were placed in the Hendon Central Dental Clinic, Childs Hill Dental Clinic, the Oak Lane Dental and the Watling Dental Clinic. This action means that each dental surgery is equipped with an anaesthetic apparatus of the later type models. One outstanding feature of these machines is that they are supplied with pin index fittings which take the new type of pin index cylinders. As the position of Nitrous Oxide and oxygen pin index locators are entirely different from each other there is absolutely no risk of placing the wrong cylinders to the appropriate part of the machine. A new air motor (high speed drill) was installed at Oak Lane Dental Clinic to replace an obsolete model which had broken down. At Childs Hill Clinic a new X-ray unit was installed with a special developing apparatus as there is no dark room. This has resulted in the children of that area being able to have their X-rays done on the premises, instead of travelling to the Hendon Central Dental Clinic. A new spot light was installed in the Orthodonitc Clinic at Hendon Central. This has meant that there is greater illumination inside the mouth to aid in the fixed orthodontic work. At Brunswick Park Road Clinic, Holly Park Clinic and East Barnet Road Clinic modern operating lights have been fitted, resulting in a far lighter field of work. With a school population of some 40,000 children, it is not surprising that a small proportion of them have damaged front teeth of one form or another. If only ½% of these children had a damaged incisor tooth, it would mean about 200 cases per year. The need to supply these children with a suitable service to restore as many of these teeth as possible made necessary a surgery devoted exclusively to this work. During 1967 a regular session was devoted to crowns and this will have to be increased to at least two sessions in 1968. The reasons for the incisor teeth needing this treatment are varied, the most common cause being the broken front tooth as a 128 result of an accident; another common cause is that repeated fillings can present an ugly appearance. Deficiency in enamel formation often gives rise to the need for this treatment. Ideally the tooth should be vital but often the operation has to be carried out on dead teeth. It has helped in this work to be able to use the new alluminous porcelain which came on to the market a year ago. It is a very strong form of porcelain and the colour is very true so that colour matching, which has caused trouble previously, is greatly improved. The real worth of this work is seen when the patient, a young girl or boy, looks into the mirror to see the finished result. The expression on their faces tells you that this work is really worth while. 1968 will bring an increase in crown and orthodontic work, two specialities which the Borough can be proud to possess. Ages 5-9 Ages 10-14 Ages 15 & over Total Attendances & Treatment: First visit 3776 3093 650 7519 Subsequent visits 6018 7927 2056 16001 Total visits 9794 11020 2706 23520 Additional courses of treatment commenced 326 189 41 556 Fillings in permanent teeth 2879 6496 2172 11547 Fillings in deciduous teeth 7168 746 — 7914 Permanent teeth filled 2213 5008 1594 8815 Deciduous teeth filled 5414 637 _ 6051 Permanent teeth extracted 69 476 155 700 Deciduous teeth extracted 2145 927 — 3072 General anaesthetics 882 453 40 1375 Emergencies 385 194 35 614 Prosthetics: Pupils supplied with full upper or full lower (first time) 1 _ 1 Pupils supplied with other dentures (first time ) 4 8 5 17 Number of dentures supplied 2 10 6 18 Number of pupils X-rayed 468 Prophylaxis 1186 Teeth otherwise conserved 2879 Number of teeth root filled 54 Inlays 19 Crowns 56 Courses of treatment completed 5943 129 Orthodontics: New cases commenced during year 348 Cases completed during year 132 Cases discontinued during year 85 No. of removable appliances fitted 579 No. of fixed appliances fitted 42 Patients referred to Hospital Consultant 10 Anaesthetics: General anaesthetics administered by Dental Officers 26 Inspections: a. First inspection at school No. of Pupils 23378 b. First inspection at clinic No. of pupils 2250 No. of a. and b. found to require treatment 11308 No. of a. and b. offered treatment 11308 c. Pupils re-inspected at school or clinic 591 No. of c. found to require treatment 405 Sessions: Sessions devoted to treatment 3568 Sessions devoted to inspection 242 Sessions devoted to Dental Health Education 401 Dental Laboratory The work of the dental laboratory has been greatly appreciated during the year. The benefit in having our own laboratory is that each dental surgeon can, at any time, have the closest cooperation by personal contact with the officers in the laboratory. In addition to the work undertaken for the London Borough of Barnet prosthetic work for the Boroughs of Enfield and Haringey was continued. During the year the laboratory provided a total of 22,574 units of work. 130 GENERAL SERVICES GENERAL SERVICES Health Education/Home Safety The Health Education/Home Safety Section of the Department continues to progress and to disseminate information by every possible means to secure physical, mental and social health. Health Education requires a maximum of co-operation in all facets of the work of the Department which aim at good health and wellbeing in the community. Health Education in Clinics Health Education supports the classes run for expectant mothers in relaxation and mothercraft and is also featured in programmes arranged for Old People's Clinics and Mothers' Discussion Groups. Health Education in Schools This is an important field of Health Education; most schools have a full year's programme while others require only one or two films or occasional talks, the former being given by Health Visitors, whilst the others are undertaken by the Health Education Section. Primary Schools: 10-11 year old children Full year's course 9 One or two term courses 1 Short courses 2 Secondary Schools: 13-15 year old children Full year's course 6 One or two term courses — Occasional talks 1 Grammar Schools: 17-18 year olds Occasional talks 2 Special schools 1 A dental campaign was carried out throughout the whole of one primary school, to estimate timing and methods in preparation for a campaign in all schools next year. Health Education in other Organisations Requests for talks on various health topics were received from various groups of people. Where appropriate these were given by staff from other sections, i.e. Health 133 Visitors, Public Health Inspectors and others, the majority however, were undertaken by the Health Education Section. Whilst large scale campaigns or big exhibitions have their place in a Health Education programme, it is felt that their impact is short-lived whereas Health Education in small groups with opportunity for discussion is of greater benefit and likely to be longer lasting. It is also more likely to be effective in changing attitudes and inculcating new habits. During the year, talks to a wide variety of organisations were given and a synopsis is given later in the Report. Mental Health Week Full co-operation with the Mental Health Division was given and this is referred to on Page 80. General Publicity The regular monthly programme of health topics for publicity was arranged and posters and leaflets were distributed to Borough Establishments. A number of requests came in for this kind of material from various sections of the community, which is encouraging since it denotes that there is a lively interest in health matters going on unseen. Where Ministry of Health Campaigns were sponsored, these were given every support. Home Safety Figures issued by the Royal Society for the Prevention of Accidents, obtained from the Registrar General, show that deaths from accidents in the home remain unchanged; it is still in the region of 8,000 per year; a higher rate than death from roads or any other place of accident. The Health and Welfare Department has been able to obtain from Edgware General and Barnet General Hospitals a monthly list of accidents occurring in homes of people living in the Borough who receive treatment at hospital. The vast number of home accidents which find their way to the general practitioner's surgery and those which are treated at home are, of course, unknown. The number must run into thousands per year in this Borough alone. In an effort to reduce this appalling figure a good deal of education in this field has been carried out, both as a subject in itself and in the teaching of other subjects. Publicity material is regularly distributed following the lines of RoSPA's quarterly campaign. Several Youth Organisations asked for training and examination of candidates for the the Duke of Edinburgh's Award in Home Safety and these were undertaken, since training of the young in home safety is considered to be of supreme importance. Finchley Carnival, July, 1967 and Friern Barnet Summer Show, 1967 It was considered that these two events were ideal opportunities for disseminating 134 information regarding home safety and an exhibition was prepared. It was decided to ask outside organisations to contribute towards this and several agreed to present a display. These organisations were:- North Thames Gas Board Safe use of Gas Eastern Electricity Safe use of Electricity Oil Appliance Manufacturers' Association Safe use of Oil Heaters British Pharmaceutical Society Medicines with Care The Health Education Section arranged a display on water safety and outdoor hazards. The total exhibition covered 800 sq. ft. To add interest and draw attention to the need for care at home a children's competition on "Spot the Hazard" was run with a total number of 550 children entering. A further feature was a demonstration of mouth-to-mouth resuscitation, give n by members of the British Red Cross Society and the St. John Ambulance Brigade. Many booklets and leaflets on Home Safety were distributed and it was felt that this had been a successful means of promoting Home Safety. Synopsis of talks arranged by the Health Education Section Youth Organisations, Clubs, uniformed groups 38 Young Wives' Groups, Women's and Mens' organisations 32 Parent/Teacher Associations 3 Old People's Clubs/Organisations 5 Synopsis of Subjects covered Personal Health Services 7 Environmental Health Services 5 Food and Drugs Inspection 6 Work of the Health Visitor 6 Work of the Public Health Inspector 5 Mental Health 1 Child Care and Development 4 Welfare Services 2 Health Hazards of Today 2 Care of the aged 5 Smoking 6 Home Safety 34 135 Synopsis of Subjects covered (continued) First Aid 9 Eye Care 1 Film shows on various health topics have also been arranged and undertaken. MASS RADIOGRAPHY During 1967 the Mass Radiography Unit of the North West Metropolitan Regional Hospital Board visited the Borough and 981 persons were X-rayed. During that year the total number of persons X-rayed by the static and mobile Units operating in the whole of the area covered by the North West Metropolitan Regional Hospital Board was 287,380. 340 cases of active pulmonary tuberculosis were discovered, fewer than in 1966, confirming the downward gradual trend observed in the past four years. Of the 340 active cases, 63% were found by routine radiography and 37% in doctors' referrals. In addition 243 cases of lung cancer were diagnosed this bein g 20 more than in 1966. The incidence in men rose sharply from 1.4 per 1000 in age group 45-54 to 4.8 and 12.8 per 1000 in age groups 55-64 and 65 and over respectively. SPECIAL INVESTIGATION CLINIC A Special Investigation Clinic was started on June 6th 1967 in the premises of Vale Drive Centre, High Barnet. The clinic is directed by the Deputy Medical Officer of Health, with a supporting staff of Nurse, Social Worker and Clerk. The purpose of the clinic is to investigate, treat, and conduct research into the main conditions of Enuresis and Encopresis and to a minor extent behaviour problems affecting children. Studies of children by various workers have shown that of children at the 5 year old age level, 15% suffer with bed-wetting. At the 10 year old age level the incidence falls to 5%, and at the 15 year old age level the figure is 1%. Although this denotes a tendency for spontaneous remission of enuresis, many years of suffering may pass before the child acquires continence. These statistics also indicate the immensity of the problem and additional aggravations are the secondary effects of emotional overlay and inter-family tension which may arise from persistent enuresis. Based on this premise the Special Investigation Clinic became operative, and referrals are accepted from various agencies. No child is accepted without parental approval, and in every case the child's general practitioner is first notified. Any objection from parent or practitioner is respected, and the child not accepted for treatment. There are divergent views on the aetiology of enuresis and encopresis and these involve theoretical considerations resulting in different disciplines of investigation and treatment. This particular clinic is orientated on the lines of Learning Theory Psychology with a practical application involving Behaviour Therapy. This does not signify that the 136 clinic has a particular separatism, on the contrary it enjoys a good relationship with many other disciplines and agencies. A particular emphasis is made on thorough medical examination and battery objective personality investigations. A link exists with Barnet General Hospital who kindly supply pathological services to the clinic. Apart from the regular staff the clinic also has the voluntary services of two postgraduate psychologists, who participate moreso in research and investigation and contribute to the scientific standard of the clinic. Statistics relating to the first six months of the clinic's operation are listed. Statistics from June 6th 1967 to December 31st, 1967 BOYS GIRLS TOTAL Total number of referrals: Under 5 17 10 27 5 — under 10 74 48 122 10 and over 31 11 42 122 69 191 Total number of patients not keeping first appointment: 24 18 42 Total number of patients seen: 63 32 95 Total number of patients discharged: 14 7 21 Total number of discharged patients who relapsed before December 1967: 2 – 2 Total attendances: 380 Total non-attendances: 147 137 ESTABLISHMENTS FOR MASSAGE AND SPECIAL TREATMENT The total number of establishments registered at the end of the year under Part XII of the Middlesex County Council Act, 1944, remained at 33. PERSONS IN NEED OF CARE AND ATTENTION Provision is made under Section 47 of the National Assistance Act 1948 as amended by the National Assistance (Amendment) Act 1951 for securing the necessary care and attention in hospital or other place, e.g. residential accommodation provided under Part III of the Act, for persons who are infirm or suffering from a serious chronic disease and who are unable to give themselves sufficient care nor are receiving it from other sources. A number of cases, mainly elderly persons living in poor conditions, were brought to my notice but with the help of the Social and Health Visiting Services and voluntary admission to hospital or home each case resolved itself without application of the statute. BURIAL AND CREMATION It is the duty of the Local Authority under Section 50 of the National Assistance Act 1948 to cause to be buried or cremated the body of any person who has died or been found dead in the area, in any case where it appears to the Authority that no suitable arrangements for the disposal of the body have been or are being otherwise made. The expenses incurred may be recovered from the estate of the deceased person, by death grant subject to the contribution conditions being satisfied, or from any person who for the purposes of the Act was liable to maintain the deceased person immediately before his death. Eight cremations were carried out during the year. CREMATION CERTIFICATES The Medical Officer of Health, Deputy Medical Officer of Health and a Senior Medical Officer are appointed Medical Referees under the Cremation Acts 1902 and 1952. During the year 747 certificates were examined and approved. DOMICILIARY LAUNDRY SERVICE This is a service to assist in one of the problems which arise in nursing the chronic sick and the aged, viz:- the cleansing and laundering of soiled bed-linen and clothing. 138 A service is provided to collect and launder soiled articles. The work is carried out by the Hendon Group Hospital Management Committee at Colindale Hospital. At the end of the year 23 persons were receiving assistance, and during the year 9,659 articles were laundered. MEDICAL ASSESSMENTS AND EXAMINATIONS Candidates for appointment to the service of the Council are required to complete a medical questionnaire which permits of the necessary assessment in regard to their medical fitness for the post in question. In cases where there is any doubt as to a person's fitness for employment a full medical examination takes place. No. of medical forms assessed 1,803 No. of medical examinations — Barnet 23 other Authorities 12 No. of medical examinations carried out under Ministry of Education Circular 249/52:- (a) Teachers' first appointments 118 (b) Entrants to Training College 311 20 medical assessments were carried out in relation to the ability of staff to undertake the duties of their posts or in relation to early retirement. 5 members of the Council's staff were recommended for premature retirement on the grounds of permanent ill health. DEPARTMENTAL SPECIAL TRANSPORT In connection with the operation of the Health and Welfare services and in respect of the considerable transport which is required for conveying the elderly and physically handicapped and blind persons to Craft and Choral Classes, Day and Work Centres and to a wide range of social and recreational activities for these persons, the Council's fleet was in 1967 increased by two 12 seater vehicles which gave a total of four 12 seater vehicles and two large coaches in operation at the end of the year. All of these special vehicles are fitted with tail lifts. All vehicles are staffed and maintained by the Borough Engineer and Surveyor's Department and once again I pay tribute to the excellent service the Department has at all times received and acknowledge the helpful and understanding manner in which the drivers of the special vehicles perform their duties. TRAINING COURSES During 1967 a wide variety of training courses, refresher courses, study days, etc. 139 were made available to the staff of the Department. The London Boroughs Training Committee continued to be prominent in arranging courses and study days for midwives, district nurses, school nurses and social workers. Courses and study days attended by staff inter alia embraced the following subjects: Diploma in Applied Social Studies Diploma in Municipal Administration Diploma in Home Teaching for the Blind Social Work Course leading to the National Certificate Family Casework Management of Hostels for Mentally Disordered Adults District Nurse Training Mental Subnormality Mental Development and Diagnostic Testing of the very young Drug Addiction Home Safety Work of Rodent Operators Applied Entomology Noise Control Living with Disability STUDENT ATTACHMENTS The Department continued to provide facilities for students' practical training in Health and Welfare establishments and students attending were engaged in University and Colleges of Technology studies covering the various disciplines in Health and Social Welfare work. In addition practical training facilities were made available in connection with the Council's Training Scheme, whereby up to 20 trainees a year are engaged and given an opportunity to work in the various Departments of the Council to enable them to decide on the form of Local Government service in which they are most interested and which will lead them to follow a career. EMERGENCY CALL SERVICE The Authority's Emergency Night and Weekend Telephone Service, established at the Town Hall, Hendon, which provides for the benefit of all Departments of the Council has continued to show that such a service is of distinct value insofar as emergency calls for midwives, mental welfare officers, social welfare officers and urgent matters of environmental etc. health need to be dealt with expeditiously. 140 INDEX INDEX PAGE A Abortion 2 Admission and Discharge to Psychiatric Hospitals 76 Adult Training Centres 78 Air Pollution Measurement 49 Animals 68 Ante-Natal Clinics 99 Audiology 123 Audiometry 123 B BCG Vaccination 114 Births and Birth Rates 1,11,17, 20, 21, 99 Blind and Partially Sighted 90, 91 British Red Cross Society — loan of equipment 103 Burial and Cremation 138 C Cancer 19 Caravans 60 Care of Mothers and Young Children 99 Care of the Unsupported Mother 111 Catering 88 Cervical Cytology 111 Chest Clinics 109 Child Guidance Service 123 Child Minders 105 Child Welfare Centres 100 Chiropody 106 Clean Air 48 Clearance Areas 54 Clinics for the Elderly 105 Clinic Premises 97,115 Clinic Sessions and Attendances 98 Committee Members 7 Common Lodging Houses 58 Community Care — Mental Health 77 Complaints — Environmental Health 61 Congenital Malformations 100 Contents 5 Cremation Certificates 138 D Day Centres for the Mentally 111 80 Day Nurseries 104 Day Nurseries Private & Registered Child Minders 105 Deaf and Hard of Hearing 90, 91 Deaths and Death Rates 1,12, 13,14,15,16,18,19 Dental Laboratory 130 Dental Services, Priority 108 Dental Services, School 128 Disinfection and Disinfestation 70 Domiciliary Laundry Service 138 Drug Dependency 80 Dysentery 26 PAGE E Elderly Persons 89, 105 Emergency Call Service 140 Environmental Health Services 31 Establishments for Massage and Special Treatment 138 Exhumations 71 F Factories and Work Places 64 Family Planning 2,111 Finchley Carnival 134 Fluoridation 109 Food 31 Food — Complaints 39 Food and Drugs 31,48 Food Hygiene 43 Food Poisoning 25 Food Samples, Formal and Informal 32 Food Unfit for Human Consumption 41 Friern Barnet Summer Show 134 G General Practitioner/Domiciliary Staff Attachments 97 General Services 133 Gift Furniture 93 Guardianship and Informal Foster Care 77 H Handicapped Pupils 124 Hawkers 43 Health Centres 2 Health Committee Members 7 Health Education and Home Safety 133 Health Visitors 97 Holiday Camps — Mental Health 77 Holiday Homes — Recuperative 106 Homes for Elderly and Disabled Persons 87 Home Help Service 103 Home Nursing 102 Home Safety 133,134 Home Visiting 98 Homelessness 2,89,98 Hostels — Mental Health 77, 79 Houses, Assisted Purchase and Improvement 55 Houses — Compulsory Improvement 57 Houses in Multiple Occupation 52 Housing 52 Housing Accommodation 52 Housing Re-development 55 Housing Statistics 59 I Ice Cream 36 Immunisation & Vaccination 27, 112 Improvement Areas 56 Incontinent, Laundry Service 138 Incontinent Pads and Clothing 103 141 PAGE Individual Unfit Houses 54 Infectious Diseases 25 In-Service Training Course 1 Inspections — Environmental Health 61 International Certificates of Vaccination 27 J Junior Training Schools 77 L Labelling of Food 44,47 Land Charges 62 Laundry Service 138 Legal Proceedings 45 Liquid Egg 37 Loan of Nursing Equipment 103 M Marie Curie Memorial Foundation 103 Markets 43 Mass Radiography 136 Massage and Special Treatment 138 Medical Assessments and Examinations 139 Medical Inspections & Treatment (Schools) 121,122 Mental Health Services 2, 75 Mental Health Week 80 Mental Subnormality 75 Merchandise Marks 45, 47 Midwifery 102 Milk — Licensing and Sampling 38 Mortuaries 71 Mother and Baby Home 111 Mothercraft and Relaxation Clinics 100 Mothers' Discussion Groups 102 N Neighbourly Help Service 104 Noise 62 Nursery Nurse Training 105 Nurses Agencies 107 Nursing Homes, Registration 106 O Offices and Shops 63 Ophthalmic Clinics 122 Orthopaedic Clinics 122 Outworkers 65 Overcrowding 57 P Personal Health Services 97 Persons in need of Care and Attention 138 Pesticide Survey 46 Physically Handicapped Persons 90, 92 Post-Natal Clinics 99 Poultry Inspection 44 Prevalence and Control of Infectious & Other Diseases 25 PAGE Prevention of Homelessness — (Problem Families) 2,98 Protection of Property 93 Psychiatric Hospitals 76,78 Public Control 47 R Rag, Flock and Other Filling Materials 66 Recuperative Holiday Homes 106 Refuse Collection and Disposal 67 Relaxation and Mothercraft Clinics 100 Rent Acts 58 Residential Accommodation 87 Rodent Control 69 S Sanitary Conveniences 66 School Dental Service 128 School Health Service 121 School Medical Inspections and Treatment 121,122 School Population 121 Sewerage and Sewage Disposal 67 Shops and Offices 63 Short Term Care 76 Slaughterhouses 44 Slum Clearance 55 Smallpox Vaccination 115 Smoke Control Areas 48 Social Work — Mental Health 78 Special Care Units 78 Special Investigation Clinic 136 Speech Therapy 124 Staff 8 Staff Training 1,105,139,140 Statistics — Mental Health Service 82,83 School Health Service 125,126,127 Vital 11,19 Student Attachments 140 Swimming Pools 66 T Temporary Accommodation 89 Therapeutic Social Clubs 79 Transport 139 Tuberculosis 19, 109 Tuberculosis BCG Vaccination 114 Typhoid Fever 26 V Vaccination 8s Immunisation 27, 112 Vital Statistics 1,11,19 Voluntary Organizations 81,93 W Water Supply 31,109 Welfare Committee Members 7 Welfare Services 87 Whooping Cough Vaccination 115 142 Printed and Published by Barnet London Borough Council