Library LONDON BOROUGH OF BEXLEY ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER FOR THE YEAR 1971 BEX 32 LONDON BOROUGH OF BEXLEY ANNUAL REPORT of the MEDICAL OFFICER OF HEALTH and PRINCIPAL SCHOOL MEDICAL OFFICER for the year 1971 CONTENTS Members of the Health Committee Health Department Staff Introduction Statistics and Social Conditions Health Services in the Area Report of the Principal School Medical Officer Report on the Dental Services (1971) by the Chief Dental Officer J.H. Forrester, L.D.S., R.C.S.(Eng.). SECTION A. Environmental and Sanitary Circumstances in the Area SECTION B. Atmospheric Pollution SECTION C. Food and Food Premises SECTION D. Housing SECTION E. Offices, Shops and Railway Premises Act 1963 SECTION F. General An index is given at the beginning of each Section MEMBERS OF THE HEALTH COMMITTEE (as at December, 1971) Ex-Officio: The Worshipful the Mayor (Councillor Kenneth J. Smith, M.B.C.S.) Chairman: Councillor L.E. Francis Vice-Chairman: Councillor J.A. Clark Alderman J.F.L. Gates ,, Mrs. A.E.F. Orange ,, Mrs. M. Roberts Councillor N.C. Austin ,, M.A. Barrett ,, Mrs. D.P.C. Beazley ,, J.A. Clark ,,L.E. Francis ,, G. Green Councillor Mrs. R.M. Irvine ,, Mrs. A. Jamieson-Harvey ,, Mrs. K.E. Lloyd ,, Mrs. A.M. Martin ,, J.D. Minett " ,, A.A. Pease ,,A.N.L. Stuttle ,, Mrs. M.E. Vago ,, G.H.F. Mead Councillor J.C. McLean Dr. M.J. Barnard Mr. J.N. Powrie Co-opted Members: South East Metropolitan Regional Hospital Board Kent Local Medical Committee Executive Council for South East London and Kent 1 PRINCIPAL STAFF OF THE HEALTH DEPARTMENT (at 31st December, 1971) MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER: Dr. H. James, L.R.C.P., L.R.C.S.(E)., L.R.F.P.S.(G)., D.P.H. Deputy Medical Officer of Health & Principal School Medical Officer: Dr. F. Stang, M.D., L.R.C.P., L.R.C.S., D.P.H. Principal Medical Officers: Dr. S. Syrop, M.D., D.T.M. & H, D.P.H., D.C.H. Dr. G. Sethi, M.B.B.S., D.T.M. & H. D.P.H., D.I.H. Senior Medical Officers: Dr. M.B. Edge, M.B.Ch.B., D.P.H. Dr. R.M. Stellman, M.B., Ch.B. (1 vacancy) Principal Dental Officer: Mr. J.H. Forrester, L.D.S., R.C.S. (Eng.) Senior Dental Officers: Mrs. J.E.Sansom,B.D.S., L.D.S., R.C.S. Miss E.M. Scutt, L.D.S., R.C.S., B.D.S. Dental Officers — 5 (1.7 vacancies) Dental Auxiliaries — 4 (2.2 vacancies) Dental Surgery Assistants — 7 Medical Officer in Department (Senior): Dr. V.G. Wad, M.B., B.S., D.P.H. (Medical Officers in Department — 5) Full time equivalent. Chief Administrative Officer: Mr. C. Burgess Head of Administrative Support Division: Mr. G.A. Pearson Office Manager — 1 Administrative Officers — 4 Administrative & Clerical Staff — 35 Clinic Clerks — 9 (1.5 vacancies) Chief Public Health Inspector: Mr. P.R. Hickson, M.R.S.H., M.A.P.H.I. Deputy Chief Public Health Inspector: Mr. A.W. Kent, M.R.S.H., M.A.P.H.I. Senior Public Health Inspectors — 4 Public Health Inspectors — 6 Student Public Health Inspectors — 3 (2 vacancies) Clean Air Technical Assistants — 2 Foreman Disinfestation — 1 Rodent Operator — 3 Mortuary Attendant —1 2 Senior Area Nursing Officer and Non-Medical Supervisor of Midwives: Miss M.C. Gooderham, S.R.N., S.C.M. Queens Certificate, H.V. Certificate Mrs. N.G.V. Cooper, S.R.N., S.C.M., H.V. Certificate Mrs. F. Pearce, S.R.N., S.C.M., D.N. Certificate Assistant Area Nursing Officer (Senior) — 1 Assistant Area Nursing Officers — 2 Group Adviser/Health Visitors —3 Health Visitors — 43 (2.5 vacancies) Student Health Visitors — 5(1 vacancy) Clinic Nurses — 3(1 vacancy) Midwives —8(1 vacancy) District Nurse/Midwife — 6 District Nurses — 33 Nursing Auxiliary —8(1 vacancy) Nursery Assistants — 1 Area Nursing Officers; Health Education Officer: Miss M.D. Wesson, S.R.N., H.V. Chief Chiropodist: Mr. B.R. Marsh, M.C.H.S., S.R.C.H. Chiropodists — 5 (1.8 vacancies) Senior Speech Therapist —1(1 vacancy) Speech Therapists — 3 (1.3 vacancy) Physiotherapist — 1 (.5 vacancy) Messengers — 2 Orthoptist — 1(1 vacancy) Caretaker — 1 3 Health Department, 9, Brampton Road, Bexleyheath, Kent. To: The Worshipful The Mayor, Aldermen and Councillors of the London Borough of Bexley. Mr. Mayor, Ladies and Gentlemen, I have the honour of presenting my Report on the work of the Health Department of the Borough for the Year 1971. During the early part of the year a great deal of the work was associated with the separation of the Social Services from the Health aspects of the Local Authority Services with the formal function of a Social Services Department commencing on 1st April, 1971. Services with a predominant health commitment remained with the Health Department, although there were inevitably services passed to the Social Services Department in which health aspects were of vital importance. It appears quite clear to me that the community must look upon each and every person as a whole; neglect of certain social principles must inevitably eventually produce medical symptoms, while many an illness will present in its wake social problems. It is for this reason that the two Departments must continue to work closely together, so that adequate links will have been produced by the time the unification of the Health Services takes place. Another matter of considerable importance was the implementation of the Education (Handicapped Children) Act of 1970. This meant the transfer of the two junior training centres, Marlborough and Shenstone, to the control of the Education Committee. The Act's intention is that every child, irrespective of handicap, should attend a school suitable to his needs, and that in future no child will be destined to be considered unsuitable for education at school. Undoubtedly this is a far-sighted Act, which will prevent anomalies and the heartbreak of many parents having their child ascertained. These children will now come under the care of the School Health Service and very close medical observation will be maintained to ensure that no child is prevented by medical reasons from reaching its full potential. Almost simultaneously in May 1971 the Consultative Document on the re-organisation of the National Health Service was produced. This emphasised the urgent need of setting up close and lasting liaison links with all Local Authority Departments in preparation for the day when all health functions, save Environmental Health Services, will be transferred out of the immediate control of Local Government. One of the many decisions taken at that time was to split the Borough into three nursing areas coterminous with the Social Services area teams, each health service area having associated with it not only a Principal Medical Officer, but also an Area Nursing Officer, so trying to produce at daily working level co-operation between the field officers of the two Departments. This, to my mind, was even more important than the co-ordination of the two Departments at planning level. Incidentally, almost as a by product, this division into areas will before very long facilitate the introduction of a full Mayston structure of Nursing Management, with the appointment 5 of inter-disciplinary Area Nursing Officers responsible for all nursing services within their particular area of the Borough and the eventual appointment of a Chief Nursing Officer. Attachment of Nursing Staff to General Practitioners Probably no other single decision taken in the department will have wider reaching results than the gradual attachment of "Nursing Teams" to General Practitioner patient lists. A pilot project was agreed to in the northern part of the Borough and I am sure this will be expanded throughout the coming years across the whole Borough. I should particularly like to show my appreciation of the Nursing Staffs'full and enthusiastic co-operation in this scheme, in the face of occasional disappointment and a generally increased work-load. No praise is too high and I am sure I speak on behalf of all the General Practitioners and Medical Officers in the department in saying 'Thank you" to all members of the nursing staff. Health Centres The construction of the permanent health centre at Thamesmead continued and was nearing completion at the end of the year. The building, was expected to become operational early in 1972, when the services would transfer into it from the temporary health centre. Vital Statistics The local birth rate is remaining rather higher than for the rest of the London area, being equal to that for England and Wales. In a dormitory suburb such as Bexley, family planning must be kept in the forefront of any aim to improve general health standards among the population, and it is gratifying to see the gradual increasing awareness of the public in this respect. Looking at the causes of deaths in the Borough, it is seen that the Heart and Vascular Diseases accounted for by far the greatest number, i.e., 955 out of a total of 2149. Malignancy, for so long most feared as the terminal illness, accounted for 451 deaths. This nevertheless indicates a further rise in the number of deaths due to Carcinomas and from the classification it will be seen that by far the commonest site remains malignancy of the lungs and bronchi, the deaths in males being far higher than that in females. Perhaps one ought also to mention the increase in suicides and self inflicted injuries. One wonders how significant this really is? More and more it appears that a far greater amount of time, money and effort requires to be spent on the elucidation of the epidemiology of the Cardio Vascular Diseases, if a long and active life is to be our aim. Assessment Groups A somewhat unusual feature of the use of Clinics are the assessment groups catering for pre school children who are physically and mentally handicapped or are in need of assessment prior to placement in a suitable school by the time school entry age is reached. The usefulness 6 of these groups is quite apparent and fulfils a longfelt need. It gives a chance for Medical Officers to observe or have the child observed by a trained person, prior to giving their views about any handicap. School Health Service The Education (Milk) Act of 1971 was enacted during the year. Perhaps it suffices to say, whatever the arguments for and against, that a very large amount of time has been spent by departmental staff to ensure that no child who would benefit medically from the provision of milk was deprived of it. This has absorbed not only administrative and nursing, but also medical resources which are in very short supply. A continuing surveillance will be necessary not only to ensure that children are regularly examined to see whether they still require milk but also to assess any possible long term effect for good or ill. The Department has given considerable attention during the year to ensuring that the diagnosis and assessment of handicaps is made at a very early stage, and, in view of limited available resources, the "At Risk" Register was carefully reviewed and perfected. This has enabled the doctors to focus their attention and skills on children in most need, and efforts were made to provide in-service training facilities for Medical Officers and General Practitioners in this most important field of preventive medicine. Considerable efforts were expended in keeping communicable diseases under control and the general trend has continued in a downward direction. The continual sporadic cases of food poisoning cause some concern, particularly as so many of them are not diagnosed early enough to take effective remedial action. Cervical cytology clinics have been expanded into "Well Women" clinics and from the report on this section of the work of the department, one of the facts highlighted is the large amount of possibly undetected gynaecological disease in the general community. One of the most important tasks of the Department this year has been a re-appraisal of the objectives of the Department, involving the various professional disciplines, evaluating what is being done and gradually producing plans for the future. High on the priority list was the need to determine readiness by which General Practitioners might become interested in Health Centres. There already appears to be a considerable change in attitude and a gradual expansion of this programme will be seen to be fully justified. Recruitment of the more senior members of the staff has not been very easy, especially in the medical field, but at least a positive approach to the necessary commitments of the Department will, I hope, encourage new recruits to come to Bexley or deter existing staff from seeking new positions, except in the case of promotion. Once again, I would like to express my sincere thanks to all members of the Council and particularly the Chairman and members of the Health and Education Committees : to a wide range of colleagues in all branches of the Health Service and in the various departments of the Council, as well as all voluntary workers. Without their co-operation and helpfulness, effective provision of services to the public would have been much more difficult. 7 Finally, I would like to mention my gratitude to all the Staff of the Health Department, who have carried out their work so efficiently during the past year, often working far beyond the call of duty. Without their devoted help I could not have carried out my task. I am, Yours respectfully, HERBERT JAMES Medical Officer of Health & Principal School Medical Officer. December, 1971. 8 STATISTICS AND SOCIAL CONDITIONS Page Health Centres 11 General Conditions of the Borough 14 Vital Statistics 15 Births 15 Deaths and Death Rate 15 Infant Mortality 15 Maternal Mortality 15 Greater London Area and England and Wales 16 Comparison Table 1965-1971 17 Number of Births and Birth Rate camparison 19 (London Borough of Bexley and England and Wales) Birth Rates 21 Infant Mortality Rates 21 Table of Causes of Infant Deaths under 1 year of age 22 Classification of Deaths 23 Selected Causes of Death 23 Comparison Table 1965-1971 24 Table of Causes of Deaths in sex and age groups 25 9 HEALTH CENTRES The first temporary Health Centre at Thamesmead came into use in 1969. By the end of this year two General Practitioners and a Dentist were providing health care for 1,240 families. The average family size in Thamesmead is 3.4 (National average 2.4). There are 576 children under the age of five. Endeavours are being made to create a community spirit. A Tenants Association has been formed which organises a number of activities, including "A Good Neighbours Scheme", whereby all newcomers to the Estate are visited within a few days of their arrival by neighbours to inform them of the amenities available and to provide help in a practical way. The General Practitioners are in attendance for morning and evening surgeries which are run on an appointment system. Two Health Visitors, a Midwife and a District Nurse are attached to the Health Centre Practice, and a fairly comprehensive service is provided. Families are continually moving into newly completed houses, and these are all visited by Health Visitors to make their acquaintanceship and give information about the medical facilities, offering advice and counselling as necessary. The elderly citizens too, are seen, to assess their needs, to decide if, for instance, a district nurse, home help or advice from the Social Services is needed. Nursing aids and luncheon club meals are also available if required. All over 65's, on coming to the Centre are offered a full medical examination by the health centre doctors, and in the Autumn the Nursing Sister arranges their anti-flu injections. The temporary health centre offers comprehensive overall care to the whole community, and it is hoped to move into the permanent building early next year. Dr. P.M. Higgins, General Practitioner at Thamesmead Health Centre, reports: "During this period the temporary health centre was still in use due to delays in completing the Lakeside Centre. The list of patients, 3037 at the beginning of the quarter, rose to 3,376 by December 31st. Surgeries, child health and ante-natal clinics were staffed by the two partners, one of whom took over responsibility for the Family Planning Clinic, the other also looking after the nurses at Guy's. Although the list was comparatively small both were fully stretched: consultations continued at an abnormally high level and the constant influx of new residents, many with long standing problems requiring assessment, placed a great load on the service. The dental services also began to find themselves busy and short of space. It became difficult to fit into the centre all the activities that were desirable: every afternoon was occupied with some form of clinic or group activity and the consulting rooms were continuously in use. A social worker attended part-time, the district nurse began to work in the centre, regular meetings with others working in the community — clergy, social workers, teachers — were held, and students from Guy's began to attend. 11 Only a small part of Thamesmead had been completed and there was very much a village atmosphere amongst the residents. The easy relationships that had developed amongst those working in the health centre were matched by friendly relationships with the community and with others working there. A St. John Ambulance Brigade began to hold regular first aid classes each week in the centre and other meetings were also held there from time to time. The new Lakeside Centre was nearing completion and we are all looking forward to working in more spacious accommodation with better facilities and the opportunity to expand the services available. At this stage the following services were being provided: — Surgeries every morning and every afternoon except Wednesdays Child Health Clinic Developmental Assessment Clinic Family Planning Clinic Ante Natal Clinic Dental services Slimmers Club Mothers Group Audiometry Deaf Aid Service Mothercraft and Relaxation Classes The staff included dentists, doctors, health visitors, district nurse, social workers, dental auxiliary, receptionists and secretary." At the beginning of this year a site for a Health Centre within the redevelopment of Erith Town Centre was made available. Space is unfortunately very limited but 0.543 of an acre has been allocated. The Health Centre will be connected by a pedestrian route to the Shopping Centre. The Health Centre is basically a single storey building with a small first floor extension. The ground floor contains the Consultation, Examination, Treatment, Dental and Chiropody rooms; the first floor contains a Common Room for Case Conferences and Professional Meetings, an office for the Centre Supervisor, one for the Health Visitors and another for a Social Worker. This Health Centre will provide for three Group Practices (7-8 Practitioners) and facilities for Child Health Clinics, Health Education, School Dental Service, Chiropody and Family Planning. In addition, advice will be available from a Social Worker and there will be facilities for the issuing of Nursing aids and Welfare foods. 12 GENERAL CONDITIONS OF THE BOROUGH One change in the physical features of the Borough was the extensive development of the new town of Thamesmead which has been taking place on the low lying ground bordering the River Thames at Abbey Wood, and will ultimately provide accommodation for approximately 17,000 additional residents in the Borough. There is a relatively small number of immigrants in the Borough, the Erith area being the most popular place of residence. To assist the Asian immigrants to obtain the maximum benefit from the various services available in the Borough, an interpreter is employed by the Bexley Council of Social Service, the local authority making a grant to the Council of Social Service towards her salary. The interpreter's services are freely available to the various sections of the Health Department as required. A number of immigrants are employed in the department as medical offices, health visitors, district nurses, midwives, social workers, etc. which is of great help when dealing with their compatriots. 14 VITAL STATISTICS 1971 Area of Borough (including foreshore) 15,896 acres Population (Registrar General's estimate mid 1971) 216,525 Number of inhabited houses 73,443 Shops with dwellings 803 Offices, Restaurants, Hotels, etc. etc. 8,779 Rateable value (April 1971) £11,541,470 Product of a penny rate 46,404 Births Total Legitimate Illegitimate Live Births — Male 1791 1711 80 Female 1677 1599 78 3468 3310 158 Still Births - Male 19 19 — Female 21 21 — 40 40 — Birth rate per 1,000 population 16.0 Number of deaths — all ages 2,149 Death rate per 1,000 population 11 -1 Infantile Mortality Deaths under 1 year 57 Infant deaths per 1,000 live births 16 Maternal Mortality Deaths of women from diseases or accidents associated Nil with childbirth, including abortion. Maternal death rate per 1,000 total births Nil Deaths from pulmonary tuberculosis 4 Death rate per 1,000 population 0.01 Deaths from cancer of lung and bronchus 126 Death rate per 1,000 population 0.58 Deaths from all forms of cancer 469 Death rate per 1,000 population 2.17 15 VITAL STATISTICS — Greater London Area and England and Wales Greater London Area England and Wales Live births per 1,000 population 15.2 16.0 Deaths per 1,000 population 11.5 11.6 Infantile mortality (deaths under 1 year)per 1,000 live births 17.4 18.0 Maternal mortality per 1,000 total births 0.12 0.17 16 17 VITAL STATISTICS - LONDON BOROUGH OF BEXLEY SUMMARY 1965 - 1971 1965 1966 1967 1968 1969 1970 1971 Stillbirths Number 55 47 53 51 37 34 40 14 15 15 14 13 ) 13 ) 12 ) Rate per 1000 live and still births 14.29 12.42 14.21 14.00 11.00) 10.00) 11.00) 8.00% 8.00% 8.38% Illegitimate Live Births (% of total live births) 4.03% 4.52% 5.08% 5.1% 4.74% 4.80% 4.56% Infant Mortality Number 56 47 58 52 54 54 57 19 19 18 18 18 ) 18 ) 18 ) All infants per 1000 live births 14.76 12.50 15.77 14.77 16.00 ) 16.00) 16.00) 19 19 18 18 17 ) 17 17 ) Legitimate infants deaths per 1000 legitimate live births 14.56 12.90 16.04 14.89 15.00) 16.00 16.00 ) 25 25 24 23 25 ) 26 ) 24 ) Illegitimate infants deaths per 1000 illegitimate live births 19.61 5.90 10.69 16.85 30.00) 18.00 ) 32.00) Male infants per 1000 male live births 14.67 11.65 19.39 17.29 N/A N/A N/A Female infants per 1000 female live births 14.86 13.54 11.86 12.68 N/A N/A N/A Neonatal Mortality Rate Number 39 31 45 35 39 39 36 Males per 1000 live births 9.95 5.80 15.72 12.10 N/A N/A N/A Females per 1000 live births 10.62 10.82 8.47 8.07 N/A N/A N/A 13.00 12.9 12.5 12.4 12.00 ) 12.00 ) 12.00 ) All infants per 1000 live births 10.28 8.29 12.23 10.08 11.00 ) 11.00 ) 10.00) Early Neonatal Rate Number 33 24 41 30 35 31 29 Males per 1000 male live births 7.85 3.71 15.20 10.95 N/A N/A N/A Females per 1000 female live births 9.55 9.20 6.78 6.34 N/A N/A N/A 11.3 11.1 10.7 10.10 10.00 ) 11.00 ) 10.00 ) All infants per 1000 live births 8.70 6.40 11.15 8.65 10.00 ) 9.00 ) 8.00) Perinatal Mortality Rate (still births and deaths under Number one week of age) 88 71 92 81 72 65 69 Males per 1000 male live births. 26.22 15.69 26.42 18.22 N/A N/A N/A Females per 1000 female live births 19.44 21.91 23.87 27.76 N/A N/A N/A 26.9 26.3 35.4 24.7 23.00 ) 23.00 ) 22.00 ) All infants per 1000 live and still births 22.86 18.77 25.19 23.00 20.00 ) 19.00 ) 20.00 ) 18 VITAL STATISTICS (contd.) 1965 1966 1967 1968 1969 1970 1971 Reproductive Wastage (still births plus all infant deaths) Number 111 94 111 103 91 88 97 Males per 1000 live and still male births 32.9 23.54 30.57 34.58 N/A N/A N/A Females per 1000 live and still female births 24.697 26.19 28.87 23.63 N/A N/A N/A All infants per 1000 live and still births 29.26 24.85 29.75 29.68 25.90 25.65 27.97 Maternal Mortality Number of maternal deaths NIL NIL 2 3 NIL NIL NIL Rate per 1000 total live and still births - - 0.54 0.85 - - - Birth Rate Live birth rate per 1000 of the estimated population 17.60 17.36 17.10 16.10 16.10 15.79 16.00 Live birth rate per 1000 of the estimated population England & Wales (from Reg. Gen.) 18.1 17.7 17.2 16.9 16.3 16.00 16.00 Population 215,480 215,180 215,330 215,470 215,610 215,140 216,400 Population (National) 47,763,000 48,075,000 48,391,000 48,593,000 48,827,000 48,988,000 48,815,000 Red Figures = National VITAL STATISTICS 1971 BEXLEY LONDON BOROUGH Local Authority Area England and Wales (Total) Males Females Total Estimated mid-year home population. – – 216,400 48,815,000 Live births Total 1,791 1,677 3,468 783,165 Legitimate 1,711 1,599 3,310 717,491 Illegitimate 80 78 158 65,674 Stillbirths Total 19 21 40 9,898 Legitimate 19 21 40 8,826 Illegitimate – – – 1,072 Total live and still births Total 1,810 1,698 3,508 793,063 Legitimate 1,730 1,620 3,350 726,317 Illegitimate 80 78 158 66,746 Deaths of infants under 1 year of age Total 31 26 57 13,726 Legitimate 28 24 52 12,140 Illegitimate 3 2 5 1,586 under 4 weeks of age Total 21 15 36 9,113 Legitimate 20 14 34 8,121 Illegitimate 1 1 2 992 under 1 week of age Total 17 12 29 7,750 Legitimate 16 12 28 6,903 Illegitimate 1 — 1 847 Deaths — all ages 1,180 969 2,149 567,345 19 Local Authority Area England and Wales - - Live birth rates, etc. Livebirths per 1,000 home population (crude rate) 16.0 16.0 Area comparability factor 1.00 1.00 Local adjusted rate 16.0 16.0 Ratio of local adjusted rate to national rate 1.00 1.00 Illegitimate live births as percentage of all live births 5 8 Stillbirth rate Stillbirths per 1,000 total live and still births 11 12 Infant mortality rates Deaths under 1 year per 1,000 live births 16 18 Deaths of legitimate infants under 1 year per 1,000 legitimate live births 16 17 Deaths of illegitimate infants under 1 year per 1,000 illegitimate live births 32 24 Neonatal mortality rate Deaths under 4 weeks per 1,000 per live births 10 12 Early neonatal mortality rate Deaths under 1 week per 1,000 total live births 8 10 Perinatal mortality rate Stillbirths and deaths under 1 week combined, per 1,000 total live and still births 20 22 Deaths rates, etc. — all ages Deaths per 1,000 home population (crude rate) 9.9 11.6 Area comparability factor 1.12 1.00 Local adjusted rate 11.1 11.6 Ratio of local adjusted rate to national rate .96 1.00 20 BIRTH RATES (The Birth Rate is the number of live births per thousand population). (The Stillbirth Rate is the number of stillbirths per thousand total live and still births). Birth Rate Stillbirth Rate Bexley England & Wales Bexley nd & Wales 1970 15.8 16.0 10.0 13.0 1971 16.0 16.0 11.0 12.0 INFANT MORTALITY RATES Bexley England & Wales 1970 16.0 18.00 1971 16.0 18.00 The birth rate increased slightly from 15.8 to 16.0 per thousand live births compared with 18.00 for England and Wales. The infant mortality rate was the same as in 1970. i.e. 16.0. It is gratifying to know that the death rate in Bexley remains lower than in England and Wales, but it would have been even more gratifying if a reduction had been achieved over the previous year. Details of these infant deaths are shown in the following table:— 21 INFANT MORTALITY Deaths from stated causes at various ages under 1 year of age Causes of death as certified DAYS MONTHS 0 1 2 3 4 5 6 7 14 21 28 2 3 4 5 6 7 8 9 10 11 12 Acute puralent tracheo bronchitis 1 1 Acute tracheo bronchitis 1 3 2 1 Bronchopneumonia 1 2 1 Respiratory distress 2 Respiratory failure 1 Respiratory arrest 1 1 Respiratory distress syndrome 3 1 Respiratory cardiac arrest 1 Pulmonary haemorrhage prematurity 1 Cerebral haemorrhage 1 Cerebral anoxia 1 Cerebral venous sinus thrombosis 1 Cardiac failure 1 1 1 Congestive cardiac failure 1 Cardiac arrest 1 Acute cardiac failure 1 Acute Meningitis 1 Meningitis 1 Asphyxia neonatorum 3 1 Acute gastro-enteritis 1 1 Primary apelectasis 2 Intra cranial haemorrhage 1 Intraparpum asphyxia 1 Intra ventricular haemorrhage 1 Extreme prematurity 2 1 Prematurity 3 1 Primary hyrocephalus 1 Superior sagittal sinus thrombosis 1 Haemorrhagic disease 1 Pleurisy and pneumonia 1 19 2 4 2 2 5 2 7 3 2 5 2 1 1 22 CLASSIFICATION OF DEATHS CAUSES OF DEATH Coronary heart disease has taken the largest toll of deaths in the borough and the incidence as expected is highest in the 45 year and above age group. In second place are the cerebral vascular accidents and bronchitis is third. Cancer of the lungs and respiratory passages comes fourth in the causes of death. Can one hope that the reduction is a foretaste of things to come? Forty-nine fatal accidents took place. There were thirteen cases of suicide. A definite increase over the year 1970. No maternal deaths were recorded during the year. 1971 1970 Ischaemic Heart Disease M 361 353 F 219 227 Cerebrovascular Disease M 113 91 F 126 143 Bronchitis & Emphysema M 114 96 F 24 37 TOTAL — All Malignancies M 197 207 F 122 144 Malignant Neoplasm, Lung, Bronchus M 109 120 F 17 19 Suicide M 7 6 F 6 4 23 24 CLASSIFICATION OF DEATHS WITH AGE DISTRIBUTION 1971 DEATHS IN AGES OF RESIDENTS OF LONDON BOROUGH OF BEXLEY CAUSES OF DEATH Sex All Ages Under 4 weeks 4 weeks and under 1 year 1-4 5-14 i 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Enteritis and other diarrhoeal diseases M 2 — 2 - - - - - - - - - F 1 - 1 - - - - - - - - - Tuberculosis of respiratory system M 4 - - - - - - - - 2 2 — F - - - - - - - - - - - - Late effects of respiratory T.B. M - - - - - - - - - - - - F 1 - - - - - - - 1 - - - Other Tuberculosis M - - - - - - - - - - - - F - - - - - - - - - - - 1 Acute Poliomyelitis M - - - - - - - - - - - - F 2 — — — 2 — — — — — — — Other infective and parasitic diseases M - - - - - - - - - - - - F 1 - - - - - - - 1 - - - Malignant Neoplasm, Buccal Cavity etc. M 2 - - - - - - - - 1 1 — F - - - - - - - - - - - - Malignant Neoplasm, Oesophagus M 9 - - - - - - - 1 1 5 2 F 3 - - - - - - - - - 2 1 Malignant Neoplasm, Stomach M 31 - - - - - - - 3 9 13 6 F 20 - - - - - - 2 2 8 2 6 Malignant Neoplasm, Intestine M 33 - - - - - - 1 1 8 14 9 F 23 - - - - - - 2 1 7 6 7 Malignant Neoplasm, Larynx M 5 - - - - - - - - - 3 2 F - - - - - - - - - - - Malignant Neoplasm, Lung, Bronchus M 109 - - - - - - 1 8 35 47 18 F 17 - - - - - - 1 2 6 5 3 Malignant Neoplasm, Breast M - - - - - - - - - - - - F 48 - - - - - 1 2 10 12 14 9 Malignant Neoplasm, Uterus F 11 - - - - - - 1 1 3 5 1 Malignant Neoplasm, Prostate M 8 - - - - - - - - 2 2 4 Leukaemia F 8 - - - - 1 1 - - 2 2 2 F 5 — — — — 1 — — — 1 3 — Other Malignant Neoplasms M 68 — — 1 1 — — 2 4 18 20 22 F 69 — - 1 — 1 2 2 6 18 17 22 Benign and Unspecified Neoplasms 1 1 F 4 2 - 2 Diabetes Mellitus 3 1 1 1 — F 13 — — — — 1 — — — 3 2 7 Avitaminoses, etc. M - - - - - - - - - - - - F 1 - - - - - - - - 1 - Other Endocrine etc. diseases M - - - - - - - - - - - - F 6 - - - - - - - - 1 1 4 Anaemias M 2 - - - - - - - - - 1 1 F 2 - - - - - - 1 - - - 1 Mental Disorders M 3 - - - - - - - - - - 3 F - - - - - - - - - - - - 25 Deaths in ages of residents of London Borough of Bexley (contd.) CAUSES OF DEATH Sex All Ages Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Meningitis M 3 1 — — — 1 — — 1 — — — F 1 - 1 - - - - - - - - - Multiple Sclerosis - 1 - - - - - - - 1 - - - F 5 - - - - - - - 1 2 2 — Other diseases of nervous system M 14 — 2 — — 1 — 1 1 2 5 2 F 12 1 — — 1 — — — — 4 — 6 Chronic Rheumatic Heart disease M 7 — — — — — — 2 — — 2 3 F 14 — — — - — — — 1 5 4 4 Hypertensive Disease M 18 - - - - - - - 2 2 5 9 F 26 - - - - - - - 2 5 6 13 Ischaemic Heart disease M 361 - - - - - 1 7 29 92 130 102 F 219 - - - - - - 2 8 23 66 120 Other forms of Heart disease M 30 - - - - - - - 1 - 14 15 F 41 1 1 - - - - - 1 3 2 33 Cerebrovascular disease M 113 — 1 — — — — 3 7 16 38 48 F 126 - - - - - 1 1 4 18 32 70 Other diseases of circulatory system M 37 - - - - - - - 1 3 16 17 F 36 - - - - - - 1 — 3 7 25 Influenza M 1 - - - - - - - - - - 1 F 1 - - - - - - - - - - 1 Pneumonia M 68 1 1 - - - - - 2 4 12 48 F 125 — 2 — — — — 2 1 8 15 97 Bronchitis and Emphysema M 114 — — — 1 — — — 2 15 47 49 F 24 1 7 16 Asthma M 2 - - - - - - 1 1 — — — F 2 - - - - - - 1 - 1 4 - - Other diseases of respiratory system M 22 1 3 - - - - - 1 8 5 F 8 — 5 - - - - - - - 2 1 Peptic Ulcer M 9 - - - - - - - - 2 3 4 F 6 - - - - - - - - 1 — 5 Appendicitis M - - - - - - - - - - - - F 1 - - - - - - - - - 1 - Intestinal obstruction and Hernia M 4 - 1 - - - - - - - - 3 F 4 - - - - - - - - 1 — 3 Cirrhosis of Liver M 3 - - - - - - - 1 — 1 1 F 3 — — — — — — — 2 — 1 - Other diseases of digestive system M 6 1 - - - - - - - 2 1 2 F 12 - - - - - - - 1 3 4 4 Nephritis and Nephrosis M 3 - — — 1 1 - - - - 1 - F 9 - - - - - - - 1 1 4 3 Hyperplasia of Prostate M 5 - - - - - - - - - 1 4 Other diseases, Genito-urinary system F 6 - - - - - - 1 1 - 1 3 F 12 - - - - - - 1 1 - 3 7 Diseases of skin, subcutaneous tissue M - - - - - - - - - - - - F 1 - - - - - - - - - 1 - 26 Deaths in ages of residents of London Borough of Bexley (contd.) CAUSES OF DEATH Sex All Ages Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Diseases of Musculoskeletal system M 3 - - - - - - - - - 2 1 F 9 - - - - - - - - - 2 7 Congenital anomalies M 5 - - - - - - - 2 1 1 — F 8 3 1 — 2 — — — — 1 — 1 Birth injury, difficult labour,etc. M 11 11 - - - - - - - - - - F 5 5 - - - - - - - - - - Other causes of perinatal mortality M 6 6 - - - - - - - - - - F 5 5 - - - - - - - - - - Symptoms and ill defined conditions M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - Motor vehicle accidents M 21 — — — 2 6 8 — 3 - 2 — F 11 — — — 4 3 1 — — 1 1 1 All other accidents M 9 — — — — 2 2 2 — — — 3 F 8 — — — 1 — — 2 — - 1 4 Suicide and self-inflicted injuries M 7 - - - - - 1 1 1 3 1 — F 6 — — — — 2 — — 2 1 1 — All other external causes M 2 - - - - - - 1 - - 1 — F 1 - - - - - - 1 - - - - TOTAL ALL CAUSES M 1,180 21 10 2 5 12 13 23 75 225 403 391 F 969 15 11 2 10 8 5 22 49 142 220 485 27 HEALTH SERVICES IN THE AREA Page Congenital Abnormalities 31 Control of Communicable Diseases 34 Measles 34 Food Poisoning 35 Poliomyelitis 35 Dysentery 35 Meningococcal Infection 35 Whooping Cough 35 Infective Jaundice 36 Tuberculosis 36 Prevention of Tuberculosis 36 Age Morbidity Relationship of Measles March/May 1971 38 Infectious Disease Notifications 39 Vaccination and Immunisation 40 Care of Mothers and Young Children 40 Child Health Clinics 40 Clinic Attendances 42 Distribution of Welfare Foods 43 Cervical Cytology 46 Family Planning 47 At Risk Register 48 Assessment Groups 49 Non-Accidental Injury to Children 53 The Work of the Community Nursing Services 55 Health Education 61 Hospitals 64 Renal Dialysis 65 Chiropody 66 Rehousing on Priority Medical Grounds 67 Staff Medical Examinations 68 29 HEALTH SERVICES IN THE AREA (continued) Page Social Services Department 69 Nursery and Child Minders 70 Nurseries and Child Minder Regulations, 1948 70 Recuperative Care 70 Day Care for Under 5's on Medical Grounds 71 Reasons for Placement of Under 5's on Medical Grounds 71 Registered Nursing Homes 72 30 CONGENITAL ABNORMALITIES During the year 128 (compared with 83 in 1970) children were notified by Doctors and Midwives in charge of confinements. Some of the children showed more than one congenital abnormality (see table). A return of the notified abnormalities are made every month to the Director and Registrar General — Office of Population Censuses and Surveys. A steady fall of congenital abnormalities affecting the central nervous system can be observed. This is very gratifying as survivors would be severely handicapped throughout life. Eye, ear, alimentary system, heart and circulation show a steady rate throughout the years. Certain malformations, however, show a rise in numbers and further scrutiny is indicated; those affecting limbs have risen from 31 in 1969 to 38 in 1971. When these figures are analysed it is found that the main increase has taken place in such deformations as talipes and dislocation of the hip. Both conditions are curable if detected early during infancy. In the group containing abnormalities of the musculoskeletal system we find a rise from 2 to 13. This is mainly due to minor defects, e.g., wider sutures, varying size of fontanelles of the skull. Both rises can be traced to more detailed reporting of minor abnormalities since the introduction of the "Short Index of Congenital Malformation" issued by the Office of Population Census and Surveys, which formed the basis of reporting this year. Most of these abnormalities do not give rise to any symptoms as the child grows up. These national figures may in due course provide valuable evidence for hitherto undetected hereditary, environmental, geographical or seasonal factors which may influence all development of congenital abnormalities. This it is hoped will enable us to establish the cause and diminish the occurrence. A special blood test (Guthrie Test) is now carried out by midwives during the first ten days of life on every child born in this borough to detect phenylketonuria. This was previously the cause of severe subnormality in otherwise physically normal children and adults and often led to lifelong need for institutional care. There are three children in this Borough who were detected in 1968, 1969 and 1970. All three are on special diets and are reported to be making good progress as regarding physical and mental development. No case was detected this year. 31 INCIDENTS OF CONGENITAL ABNORMALITIES 1970 1971 CENTRAL NERVOUS SYSTEM Anencephalus 4 4 Spina Bifida 2 1 Hydrocephalus 2 1 Other 3 1 TOTAL 11 7 EYE AND EAR Eye 1 2 Ear 4 2 Other — 3 TOTAL 5 7 ALIMENTARY SYSTEM Cleft Lip 5 1 Cleft Palate 7 4 Tracheo—Oesophageal Fistula — 4 Other 6 3 TOTAL 18 12 HEART CIRCULATORY SYSTEM TOTAL 5 7 RESPIRATORY SYSTEM - OTHER TOTAL — 1 URINO-GENITAL SYSTEM Hypospadias or Epispadias 6 10 Undescended Testicle — 7 Hydrocele 4 5 Other 4 4 TOTAL 14 26 LIMBS Polydactyly 2 2 Syndactyly 4 5 Reduction Deformity Hand or Arm — 1 Talipes 17 22 Disclocation of Hip 3 4 Other 2 4 TOTAL 28 38 32 1970 1971 MUSCULO SKELETAL SYSTEM TOTAL 2 13 OTHER SYSTEMS TOTAL 2 17 OTHER MALFORMATIONS Mongolism 4 7 Other 4 2 TOTAL 8 9 GRAND TOTALS 93 137 DEATHS DUE TO CONGENITAL MALFORMATIONS BORN IN 1971 1970 1969 Total number of malformations 137 93 91 Total number of children 128 83 71 Number of deaths due to malformations during the 1st year 10 8 12 33 CONTROL OF COMMUNICABLE DISEASES Like all local Health Authorities, it is the policy of the London Borough of Bexley to give the highest priority to prophylactic immunisation against diseases of infancy and childhood. It is gratifying to see from the attached graph, that the incidence of the diseases is showing a downward trend in the under-fives especially and children of school age generally. It needs to be emphasised, however, that it becomes more important when a disease shows a downward trend, that efforts to maintain this trend should be continued There may be a sense ot false security developing in the community whereby this decrease in the incidence of infectious diseases makes people complacent about taking advantage of the protection given by immunisation. This is the reason why one has not only to keep immunising procedures alive and active, but also explore the availability of further prophylactic measures. Particular importance has been given to boosting children's immunity to polio and tetanus before they leave school. Bexley figures compare favourably with the national figures for all immunisations, and it is only lately that smallpox, because of the policy of the Department of Health and Social Security, has ceased to be a major field of activity of health departments except in an emergency situation. In the ever-shrinking world of to-day, no part of the world should ever consider itself free from the possibility of an epidemic, and one sees at various times of the year, fears of the import of exotic diseases like cholera, smallpox and typhoid into this country. At present the apprehension only rarely comes true, and it is due to intensive surveillance and case-finding methods applied by Officers of the Health department that major outbreaks are prevented. But the very fact that there is on occasion a great deal of alarm nationally, means that not only surveillance but advice to the travelling public outside England and Wales, as well as immunisation of those who are at risk, cannot be over-emphasised. MEASLES It is a fact, that but for measles immunisation, there would be many more cases of measles. There were more cases of measles notified in the year 1971 (772) as against 1970 (459), reflecting the biennial trend of measles. However, comfort can be derived from the fact that the general trend is towards a decline in the number of cases of measles. Continuous and concerted efforts have been made in the last few years to vaccinate as many children as possible across the Borough, as can be seen from the fact that there were 2,000 + cases in 1967 as against 700 this year. Letter CMO 18/71 from the Department of Health and Social Security drew attention to the decrease in the prevalence of measles which stated that notifications in the six weeks ending 22nd October, in the whole of England and Wales ranged between 467 and 1,017 giving the lowest weekly figures for more than twenty years. Had measles prevalence followed the natural pattern in 1968-71 there might well have been some 850,000 more cases with a consequential increased number of deaths. 34 Concern was expressed that in four weeks 87 notifications of measles were received and investigations revealed that none of these patients had been vaccinated. General Practitioners and nursing staff were therefore urged to encourage the public to take advantage of vaccination. FOOD POISONING Sporadic cases of food poisoning were notified from time to time in the summer of 1971 with a total notification of 39 which is the lowest in the last five years. An analysis of cases notified is given below: FOOD POISONING CASES 1971 Total number of cases not confirmed (cause not known) 33 Total number of cases of Salmonella Typhimurium 5 Total number of cases of Salmonella Newport 1 T otal 39 POLIOMYELITIS One case of Poliomyelitis was notified but on investigation it was found to be a case of Type 1 Virus naturally occurring strain of Polio Virus which unfortunately ended in fatality because of Bulbar Paralysis in an unvaccinated child. All the contacts, adults and children, were vaccinated with Sabine Vaccine. DYSENTERY 27 cases of Dysentery were notified to this Department. None of them was fatal and nearly all of them were in children below five years of age. Only 13 of these cases were confirmed. It is noticeable that Shigella Sonnei notification is lower in Bexley than in many other boroughs in England and Wales, but there is a tendency for dysentery to decrease. MENINGOCOCCAL INFECTION 9 cases of Meningococcal Infection were notified from the hospitals in the area. All of them recovered. WHOOPING COUGH The notification in the last five years does not show any significant trend. Whooping Cough remains an anomaly when one looks at the fact that Diphtheria has been nearly completely wiped out through triple immunisation in children. Considerable doubt must be thrown on the efficacy of whooping cough vaccine as administered at present. 35 MISCELLANEOUS There were no cases of: Diphtheria, Smallpox, Encephalitis, Typhoid, Paratyphoid Fever or Tetanus, in this Borough during the year. INFECTIVE JAUNDICE Since the introduction of this notification in 1968, the number of cases notified remains steady. All of them were hospitalised and recovered. TUBERCULOSIS From the Chest Clinic, Dr. M. Price, the Consultant Chest Physician, informed us of 25 cases of Pulmonary Tuberculosis and 10 cases of Non-Pulmonary from the hospitals and Chest Clinics in the area. TUBERCULOSIS IN THE LONDON BOROUGH OF BEXLEY 1967/71 No. of Cases Pulmonary Non-Pulmonary Deaths 1967 46 9 12 1968 23 13 2 1969 26 9 5 1970 12 4 3 1971 25 10 5 PREVENTION OF TUBERCULOSIS Chest Clinics are held at: Erith & District Hospital, Erith Queen Mary's Hospital, Sidcup Consultant: Dr. M.Price West Hill Hospital, Dartford Consultant: Dr. P. Goldman During the year, 58 babies were vaccinated at birth, 162 children were referred following positive results of Heaf tests carried out in schools. There was no infective positive case detected in the Day Nurseries, Play Groups or Schools among the children or staff during the year. A. CONTACTS i Skin tested 133 ii Found positive 9 iii Found negative 118 iv Vaccinated 178 v Babies vaccinated at birth 58 36 B. SCHOOL CHILDREN AND STUDENTS excluding those known to have received BCG vaccination already. i Skin tested 1,878 ii Found positive 231 iii Found negative 1,526 iv Vaccinated 1,526 The number of new notifications of pulmonary tuberculosis in 1971 has continued to follow the national trend of general decrease in the number of. notifications but the decline is now less marked. The cases of non-pulmonary tuberculosis are also less common but a significant proportion of these occurs in the elderly. 37 38 39 VACCINATION AND IMMUNISATION Total adjusted live births 1971 — 3442 NUMBER OF PRIMARY COURSES GIVEN Disease Against which Protection Given YEAR OF BIRTH Others under 16 years  1971 1970 1969 1968 1967-4 Diph/Tet/Pert 59 2,000 750 62 37 8 2,916 Diph/Tet - 69 24 4 32 19 148 Tetanus - 48 6 - — 602 656 Poliomyelitis 53 1966 758 74 101 334 3,286 Measles 5 1,080 940 266 357 18 2,666 Rubella - - - - - 2,002 2,002 NUMBER OF BOOSTER DOSES Diph/Tet/Pert — 24 154 132 343 15 668 Diph/Tet 2 3 25 35 2,784 71 2,920 Tetanus — 1 5 5 18 309 338 Poliomyelitis 6 27 158 146 2,857 1,134 4,328 CHILDREN IMMUNISED PRIMARY COURSE BOOSTER COURSE Diph/Tet/Pert 2,917 Diph/Tet/Pert 668 Diph/Tet 148 Diph/Tet 2,920 Tetanus 656 Tetanus 338 Poliomyelitis 3,286 Poliomyelitis 4,351 Measles 2,666 Rubella 2,002 SMALLPOX VACCINATION AGE WHEN VACCINATED 3-6 6-9 9 Months 1 -2 2-4 4-5 5-15 Months Months — 1 Year Years Years Years Years Total Number Vaccinated 4 2 30 516 874 14 204 1,644 Number Re-vaccinated - - 10 34 16 456 516 CARE OF MOTHERS AND YOUNG CHILDREN (a) Child Health Clinics. There are twenty-two Health Service Centres in the borough (7 purpose built or converted, 5 in hired accommodation), providing some or all of the following services: Ante-natal Care, Cervical Cytology, Family Planning, Mothercraft and Health Education (including Slimming Clubs), advice to parents and developmental screening of children, dental care and distribution of Welfare foods. 40 Ante-natal care is now provided mainly by General Practitioners in conjunction with the Midwives in their own practises or by the Midwives in Local Authority Clinics. All Ante-natal patients are referred for relaxation and mothercraft classes to the Clinics supervised by Midwives or Health Visitors. Mothercraft and Health Education, described in greater detail later on in this report, now include Slimming Clubs. The first such Club was started voluntarily by a Midwife. It met with such success and demands for more facilities that during the year the following Clinics have made this service available: Wren Road, Colyers Lane, Hainault and Sidcup Hill. They are supervised by Midwives and Health Visitors and form a fruitful medium for Health Education in correct nutrition and have shown an additional bonus in that several women stopped smoking and have encouraged their husbands to stop also. Each applicant to a Slimming Club has her weight checked and the General Practitioner is contacted to keep him informed of the diet used and any problems arising. The Clubs are very popular and the only difficulty has been to stop women attending after they have reached their ideal weight. The Child Health Service is increasingly being undertaken by sessional Doctors, quite often local General Practitioners. The number of children seen in Child Health Clinics by Doctors shows a steady decline from 1969, indicating that more of this work is being carried out by General Practitioners in their practices. Our own Clinics are increasingly geared to developmental screening by Doctors and Health Visitors. The rise in specific screening by Health Visitors is reflected in the increase in their sessions: 129 in 1969 and 250 in 1971. In view of the need for training in developmental screening, three courses have been held in the borough for Doctors. These were recognised by the Executive Council under Section 63 and each course of about twenty Doctors was divided approximately equally between General Practitioners and Departmental Medical Officers; our two neighbouring Boroughs seconded a number of their Departmental Medical Officers to these courses. A further course was held for Health Visitors, dealing with the special aspect of screening for early hearing defects. New members of the Nursing Staff are sent from time to time to relevant courses in this field. The dental care of the under fives is receiving increased attention by Health Visitors and the Dental Staff, and is described in more detail by the Chief Dental Officer. Welfare foods and certain proprietory brands are sold during Child Health Clinic sessions. In addition, dried milk and vitamin compounds are available at the Brampton Road Health Department, Town Hall, Erith and Sidcup Hill during office hours. 41 42 CHILD WELFARE CLINIC ATTENDANCES MURCHISON AVENUE EX-SERVICEMEN'S CLUB. BEXLEY 315 BROADWAY, BEXLEYHEATH WROTHAM ROAD. WELLING STATION APPROACH, WELLING R.A.C.S. HALL, FALCONWOOD PARADE BEDENSFIELD CLINIC CONGREGATIONAL HALL STATION ROAD, SIDCUP ST. ANDREW'S HALL, WREN ROAD THE OVAL CLINIC 71 SIDCUP HILL. SIDCUP HAINAULT CLINIC CONGREGATIONAL HALL PICARDY ROAD ST. AUGUSTINE'S SCHOOL BEDONWELL SCHOOL TOWN HALL, CRAYFORD COLYERS LANE COMMUNITY CENTRE SLADE GREEN METHODIST HALL, RISEDALE ROAD THAMESMEAD TEMPORARY HEALTH CENTRE TOTAL FOR THE YEAR — ALL CLINICS - Comparative Figures 1971 1970 1969 CHILDREN ATTENDING FOR THE FIRST TIME IN 1971 WHO WERE BORN DURING: 1966-69 392 228 570 496 676 329 149 352 232 778 107 169 195 184 349 239 53 162 237 320 6,190 6,230 7,178 1970 169 95 302 175 281 89 52 94 99 365 43 138 129 124 234 194 79 91 202 115 3,070 3,088 3,504 1971 127 51 260 167 295 89 44 113 71 321 57 145 142 149 175 184 178 99 144 110 2,921 2,954 3,160 TOTAL ATTENDANCES 3,533 1,396 5,792 4,207 5,953 2,039 1,702 3,103 2,651 6,196 1,462 3,034 2,501 2,942 3,921 3,735 3,512 3,246 3,487 2,239 66,651 69,496 72,617 ATTENDANCE OF CHILDREN SEEN BY MEDICAL OFFICER 1,320 520 2,280 1,734 2,287 955 559 920 758 2,690 640 1,059 815 1,026 1,337 1,210 1,247 612 1,132 915 24.016 25,996 24.090 NO. OF CHILDREN REFERRED ELSEWHERE 44 30 82 55 106 64 25 16 12 109 8 6 4 2 22 1 28 35 12 661 616 694 NO. OF SESSIONS (a) MEDICAL OFFICERS 9 1 11 76 87 94 44 3 2 51 45 66 29 34 45 22 39 4 6 668 813 1,056 (b) SESSIONAL G.P.'s 92 47 140 39 68 10 1 57 50 113 4 35 101 67 69 57 82 13 69 78 1,192 1,085 833 (c) HEALTH VISITORS 38 3 1 43 40 50 1 2 6 2 47 2 15 250 118 129 DISTRIBUTION OF WELFARE FOODS 1971 N.D.Milk C.L.O. A, D & C Drops A & D Tablets Orange Juice St. Approach, Welling 95 363 - 321 6,925 Wrotham Road, Welling 57 181 9 130 5,576 Falconwood, Welling 76 123 - 76 2,863 315 Broadway, Bexleyheath 120 204 29 156 5,951 Bexley Village 3 88 3 87 2,696 Murchison Avenue 16 112 - 121 4,074 Barnehurst 9 466 - 68 4,634 Colyers Lane 113 191 - 103 3,371 Crayford 250 224 - 112 4,088 Hainault 23 129 - 65 2,282 Bedonwell 16 380 - 123 5,009 Picardy Road 63 335 - 49 1,915 St. Augustines 255 221 - 33 2,043 69 Sidcup Hill 108 169 10 198 4,031 Slade Green 135 6 - 15 1,796 Station Road, Sidcup 83 252 - 217 5,728 Wren Road, Sidcup 13 79 - 64 2,508 The Oval, Sidcup 82 464 - 341 7,528 Bedensfield 2 58 - 15 1,149 Thamesmead - 131 - 16 1,340 Town Hall, Erith 214 11 1 5 633 9, Brampton Road 54 108 24 105 2,699 TOTAL 1,787 4,295 76 2,420 78,839 PREVIOUS YEAR 1970 2,256 2,084 - 3,364 82,488 43 44 DISTRIBUTION OF WELFARE FOODS 1971 Adexolin (Liquid) Cow & Gate (Milks) Chocolate (Milk) Farex Glucose Lactogel Marmite Ostermilk Robinson's Mixed Cereal T ruf ood (Full cream) Trufood (Half cream) St. Approach, Welling 1,811 730 243 252 34 - 1,390 1,520 - - - Wrotham Road, Welling 1,261 381 103 133 - - 1,320 351 - - 6 Falconwood, Welling 445 176 129 57 - - 635 727 9 — - 315 Broadway, Bexleyheath 1,050 524 212 201 46 - 1,339 1,280 - - - Bexley Village 229 86 55 34 - - 466 192 5 - - Murchison Avenue 839 95 59 43 1 - 519 1,043 8 - - Barnehurst 537 322 242 32 3 - 826 656 - - 204 Colyers Lane 394 391 184 87 - 1 697 790 8 - - Crayford 662 477 199 78 - 2 904 909 - - - Hainault 411 406 107 104 44 - 767 670 - - - Bedonwell 892 277 284 136 29 - 1,639 1,565 - 251 8 Picardy Road 461 488 77 93 41 6 422 714 - - - St. Augustines 327 587 93 114 113 4 391 1,113 - — - 69, Sidcup Hill 106 13 24 38 - - 292 690 1 10 2 Slade Green 250 363 108 94 18 2 524 993 - - - Station Road, Sidcup 1,380 90 185 168 57 2 1,012 1,381 - - - Wren Road, Sidcup 635 147 91 79 12 - 568 831 - - - The Oval, Sidcup 1,541 308 339 217 64 - 1,934 2,459 - - - Bedensfield 116 15 63 37 18 — 483 515 2 — — TOTAL 13,347 5,876 2,857 1,997 480 17 16,128 18,399 33 261 220 PREVIOUS YEAR 1970 18,042 7,766 3,764 2,622 466 72 15,304 24,964 875 - - 45 DISTRIBUTION OF WELFARE FOODS 1971 (contd.) Trufood (Humanised) Trufood (Follow-on) S.M.A. Cow & Gate (Special) Farleys F.C. Adexolin (Capsules) Scotts Baby Cereal Gate Cereal Food St. Approach, Welling 92 — 342 — — — — — Wrotham Road, Welling 121 3 248 46 — — — — Falconwood, Welling 48 — 99 4 4 — — — 315 Broadway, Bexleyheath 303 — 250 16 — — — — Bexley Village 3 — 45 — — — — — Murchison Avenue 54 — 118 — — — — — Barnehurst 177 — 256 4 — — — — Colyers Lane 181 — 214 — — 1 — — Crayford 389 — 482 — — — — — Hainault 64 — 260 — — — — — Bedonwell — — 305 — — — — — Picardy Road 98 — 247 — — — — — St. Augustines 159 — 231 — — — — — 69, Sidcup Hill 29 — 24 — — — — — Slade Green 150 — 330 — — — — — Station Road, Sidcup 141 — 329 — — — — — Wren Road, Sidcup 49 — 129 — — — — — The Oval, Sidcup 191 — 505 — — — — — Bedensfield — — 53 — — — — — TOTAL 2,249 3 4,473 70 4 1 — — PREVIOUS YEAR 1970 3,071 — 5,353 20 — 12 446 565 (b) Cervical Cytology Cervical cytology, a test for the early detection of cancer of the neck of the womb, was introduced in 1966. Regular sessions are held at 3 clinics. In addition, during this year 12 sessions were held on the premises of Standard Telephone's and Cables Ltd. These tests are also carried out by General Practitioners and in Family Planning Clinics. (See Table). Until October the examination was limited to cervical smears only. Since then additional examinations of the breast and abdomen have been added. This has reduced the number of women who can be examined per session, and has laid the foundation for a "Well Women's Clinic" which is perhaps an even more important factor in view of our findings. During the year 3,218 were examined with the following results:— 2,549 — completely satisfactory 440 — referred to General Practitioners for other conditions 228 — needed further tests 1 — case was positive F.P.A. Standard Telephones General Practitioners 1969 1970 1971 1677 1971 2394 272 90 282 1136 1451 1923 3085 3512 4599 (c) Family Planning Family Planning is provided in this borough through the agency of the Family Planning Association. The Council makes nine clinic premises available free of charge and two hospitals; Erith and Queen Mary's Hospital also provide premises for this purpose; in this way nineteen sessions per week are available. These sessions provide advice on contraception and include I.U.D. (Insertion of Intra uterine Device), sub fertility and marital problems. The Council give a block grant of £2,700 to provide a free service for women in whom pregnancy would be detrimental to health. 46 FAMILY PLANNING ASSOCIATION CLINICS Location Day Time Bedensfield F.P.A. Clinic Wednesday 1.30 - 3.30 p.m. Child Welfare Centre, Ellenborough Road, North Cray, Kent. Belvedere F.P.A. Clinic, Monday 2.00 — 4.00 p.m. School Health Centre, Monday 7.00 — 9.00 p.m. Bedonwell Road, Tuesday 7.00 — 9.00 p.m. Erith, Kent. Bexleyheath F.P.A. Clinic, Monday 7.00 — 9.00 p.m. 315 Broadway, Tuesday 1.30—3.30 p.m. Bexleyheath. Wednesday 7.00 — 9.00 p.m. Thursday 7.00 — 9.00 p.m. Colyers Lane F.P.A. Clinic, Thursday 7.00— 9.00 p.m. 154 Colyers Lane, Friday 9.30- 11.30 a.m. Erith, Kent. Crayford F.P.A. Clinic, Wednesday 7.00 — 9.00 p.m. Welfare Centre, Thursday 10.00 — 12.00 noon Rear of Town Hall, Crayford, Kent. Erith F.P.A. Clinic, Tuesday 7.00 — 9.00 p.m. Out-patients Department, Thursday 7.00 — 9.00 p.m. Erith & District Hospital, Park Crescent, Erith. Sidcup Oval F.P.A. Clinic, Monday 10.00 — 12.00 noon The Welfare Centre, Tuesday 7.00 — 9.00 p.m. The Oval, Sherwood Park Avenue, Sidcup. Sidcup Queen Mary's F.P.A. Clinic, Wednesday 7.00 — 9.00 p.m. The Out-patients Department, Thursday, 1st Queen Mary's Hospital, in month 7.00 — 9.00 p.m. Frognal Avenue, Thursday, 3rd Sidcup. in month 7.00 — 9.00 p.m. St. Augustine's F.P.A. Clinic, Thursday 10.00 — 12.00 noon Child Welfare Centre, Abbey Road, Belvedere. Thamesmead Temporary Health Centre, Wednesday 2.00 — 4.00 p.m. F.P.A. Clinic, Thamesmead. Welling F.P.A. Clinic, Wednesday 7.00 — 9.00 p.m. Child Welfare Clinic, 1st & 3rd Thursday in month 7.00 — 9.00 p.m. Station Approach. 2nd & 4th Thursday in month 7.00 — 9.00 p.m. 47 48 AT RISK REGISTER FOR 1971 Year of Birth Total Died Left District To Handicapped Cleared Observation 1966 1967 1968 1969 1970 1971 Pre-natal 1. Rubella or Virus Infection 2 0 17 19 1 0 18 2. Blood Incompatability 1 41 42 1 2 1 38 3. Hyperemesis 0 6 6 0 0 6 4. Ante partum haemorrhage 1 0 86 87 5 3 79 5. Chemeo-Therapy Major surgery 1 0 9 10 0 10 6. X-ray during pregnancy 1 102 103 3 3 97 7. Thyrotoxicosis 0 1 1 0 1 8. Diabetes 2 6 8 0 8 9. Toxeamia of pregnancy 1 1 3 220 227 2 9 10 206 10. Other comps. of pregnancy 1 1 49 51 2 4 45 11. Psychiatric illness 0 20 20 1 2 17 Peri-natal 12. Prolonged or difficult labour 1 4 1 9 475 490 2 19 30 439 13. Post-maturity 3 172 175 4 5 7 159 14. B.W. 4 lbs. Gestation 36 weeks 2 3 3 142 150 3 6 141 15. Foetal distress 0 88 88 6 3 79 16. Birth asphyxia 5 163 168 1 2 7 158 17. Prolonged poor sucking 1 0 90 91 1 1 6 83 Post-natal 18. Jaundice 3 228 231 1 6 3 221 19. Convulsions 0 13 13 1 0 12 20. Respiratory distress cyanotic attacks 1 43 44 2 2 40 21. Congenital abnormality 1 7 137 145 5 2 2 15 121 Genetic 22. Family history of deaf, blind, etc. 3 84 87 2 4 81 23. No applicable factor 1 6 9 8 14 70 108 1 7 13 87 24. Diseases 1 4 4 3 4 16 1 1 0 14 25. Social conditions 1 3 4 4 72 84 1 4 5 74 26. Special reasons 2 4 13 19 1 1 17 "AT RISK" REGISTER A register is kept of all children who are reported by the Doctor, Midwife or Health Visitor, because of some factor noted either before, during or after pregnancy, which may make them more liable than others to develop a mental or physical abnormality. These children are periodically examined until they are either cleared or transferred to the register for handicapped children. These are children in need of special arrangements to enable them to benefit from education to their fullest capacity. This register is kept up to date, and children are removed or added following screening tests and examination in hospital or clinics. ASSESSMENT GROUPS The Council has continued and extended the provision of special assessment groupsdescribed in detail in the previous report. They are held in clinic premises, and cater for pre-school children who are physically or mentally handicapped, or have a home environment which may render them so. These groups meet on 2 mornings each week; they are kept small in number — 6 to 10 — and are sometimes extended to include children not handicapped. At the end of the year 2 new groups were established, at Bedonwell and Colyers Lane, in addition to Ellenborough Road and Murchison Avenue. The reports of the supervising Medical Officers are given below. All the Groups suffered from the fact that transport has so far not been provided but it is hoped to remedy this in the coming year. Dr. R.M.F.Stellman, who supervises the groups at Bedensfield and Murchison Avenue reports: In each group there is a Supervisor who has had special experience in Nursery Nursing and two or three assistants, all of whom have put much thought and preparation into the care of the children. At Bedensfield the speech therapist visited once a fortnight till July, but owing to shortage of staff and pressure of work these visits were reduced to once a month from September. At Murchison Avenue, the speech therapist has called in frequently and the physiotherapist has given advice to parents and treatment to children. There is frequent contact with doctors and other hospital staff and with head teachers of Infant Schools and Special Classes. During the year many student nurses, teachers and social workers have visited the group to observe the activities and to discuss the progress of particular children. Each child who has left for a special school or class has been assessed in the clinic, and reports and recommendations have been sent to the Education Authority. Parents are encouraged to discuss their difficulties and are involved in assessing the progress made by their children. Most mothers are very appreciative of the help given in this way and many have been helpful to other mothers who have problems similar to their own. 49 The following table shows the number of children admitted and discharged, with the reasons for admission and the placements on discharge. Bedensfield Murchison Number still in Group from 1970 6 5 Number of new admissions 15 12 Reasons for Admission: Physically handicapped 4 3 Retarded 2 5 Speech Defect 1 Visual Defect 1 Behaviour, social reasons 6 4 Handicapped Parents 1 Placements on Discharge: Marlborough Special School 2 4 Infant Special Class 1 1 Education Nursery Class 2 1 School for Physically Handicapped - 1 Ordinary Playgroup 5 1 Ordinary Infant School 2 Left area 2 Still in Group December 1971 9 7 The following table shows the length of time the children remained in the Groups. Bedensfield Murchison Up to 1 term 5 3 2 terms 2 3 3 terms 3 4 4 terms - 1 5 terms 1 6 or more 1 Still in Group 9 6 Dr. S. Cohen, Medical Officer in Department, who supervises the Colyers Lane Assessment Group reports: "The Colyers Lane Assessment Group was started in March, with five handicapped children, meeting Monday and Wednesday mornings. The needs of three at least of these children were so urgent that we started the Group even before the special play equipment arrived, which was not until some weeks later. This was unforeseen but educative since we found that the children made use of the space and a minimum of ordinary clinic toys, each other and each other's parents, in a most interesting way and that this sufficed for the first four weeks to bring a sense of belonging to the Group. 50 Parent participation has been a feature of this Group from the beginning. For maximum benefit this needs careful supervision and control, i.e. not all the mothers stay all the time. Problems have arisen from time to time owing to parent participation, but our experience has been that the discussion and working out of these problems has greatly enriched our understanding of the children, the parents and of each other. The first five children were (ages given are those on admission): Simon, aged 3 years —tuberose sclerosis, with uncertain degree of mental retardation, poor spatial sense, and much obsessional activity. Withdrawn after a short time because of difficulty of transport and mother's illness. Provision of local authority transport would have enabled us to do more for him. He now attends a school for severely sub-normal children. Helen aged 2½ years—ambulant hemiplegic child, with some intellectual handicap. After a short time with us was ready for admission to normal playgroup. Peter, aged 4½ years — over protected, misguidedly pressurised child, with mild congenital heart disease, distorted speech and unusual pattern of retardation, with strongly autistic features. Aggressive and disruptive on admission. He formed a strong attachment to the Group Supervisor and through this it was possible to modify his behaviour and definite educational potentials were revealed. Susie, aged 4½ years — severely retarded child with a history of infantile spasms and without speech. Some autistic features. Showed some promise of personality development for a few months but deteriorated, following return of fits. Little over-all improvement. Trevor, aged 3½ years — emotionally deprived child born with cleft lip and palate. Severely affected by separation for hospitalisation to the point of showing classic infant depression. On admission he was withdrawn and rejected play and relationships. He has made steady progress since and is now co-operating in play and speech training and asserting himself within the Group. It is too soon to say how far his emotional damage is remediable. He is still a very retarded but a much happier child. FURTHER ADMISSIONS: Donald, aged 2½ years — child with fits from early infancy and for first year no useful vision or hearing could be demonstrated. Provision of a hearing aid at eighteen months seemed to bring him to life and on admission he could see and hear (without his aid) and was using single words readily and in imitation, although his behaviour was very disturbed. He had screaming spells and was often "out of reach". Has improved considerably — no longer screams when frustrated. Using short sentences. Much more amenable in general. Our observations suggest vision may be below par and this will be investigated. Patrick and Stewart. Both of these are normal 2 to 3 year olds, whose mothers were going through a depressive phase owing to family troubles and were unable to meet the demands of this age Group. Both children showed speech delay, excessive shyness and rejection of adults and children alike. They required careful, individual integration into the Group. The mothers 51 were encouraged to attend with them and were mutually supportive. The children improved dramatically and subsequently integrated very well into normal playgroup. Their presence in the Group was very stimulating to the others and it is interesting that following their admission the three year old brother of Susie elected to stay and join the Group. This child had caused us a good deal of concern because of his excessive shyness, tendency to "scribble talk" and obvious needs for more attention from his mother, whose time was so fully taken up by the handicapped child. We feel that although Susie improved only a little, this young brother benefited a great deal from being in the same Group and having individual attention and understanding in his own right. Lee, aged 4 years — a slow starter, very little development in first year of life due to athetoid cerebal palsy. On admission the problem was an apparently intractable block in expressive speech, although some understanding was clearly there. She was otherwise a normal, attractive looking child. Attends the Nuffield Centre monthly for speech therapy and we have worked in liaison with this unit. Has improved greatly in understanding, quality of play and has made excellent relationships with staff, parents and the other children. Emotional problems which we feel may be related to the amount of therapy this child has needed, are beginning to resolve. The Group has also been found to be a useful setting for the assessment of children attending the routine child health clinic, who show emotional or developmental disturbance. They invariably join in afterwards and their response to the Group play situation adds useful information to that gained in individual testing. At present we have eight children regularly attending, three of whom we expect to leave at the end of this term. There is a waiting list of 4, with a possible fifth one who (a child with spina bifida) we are prepared to take now if the mother consents. Two siblings with potentially serious speech delay as a result of emotional deprivations (maternal depression) are only able to attend on one day though they urgently need two, and this is due to the inability of the mother to provide transport twice a week." Dr. M.B. Edge, Senior Medical Officer who supervises the group at Bedonwell, reports:— BEDONWELL "This group was started in October and within a few weeks there were eight children attending regularly. Five of these children had been fully assessed by the end of the year and future provision discussed with the parents and the consultants concerned with their primary care. Where indicated formal recommendation has been sent to the appropriate authority. The ages of the children and the handicapping conditions are listed, (in the table) with an indication as to future placement:- 52 Handicapping condition D.O.B. Possible future provision Spastic athetoid quadriplegia 13.12.68 School for physically handicapped as evidence of intellectual ability has been observed. Blind and Deaf. (Mother had rubella during pregnancy and is unsupported). 1.2.69 Pathways Assessment Unit prior to Residential School for Blind-Deaf children. Down's disease 16.10.68 School for severely subnormal recommended; may warrant E.S.N. School. Congenital heart lesion 3.6.69 Ordinary playgroup — ordinary school. Post encephalitic hemiparesis, and speech disorder 16.3.68 Day School for physically handicapped recommended. For trial in Nursery School and may cope with ordinary school. Blind. (Mother had rubella during pregnancy) 19.8.69 Moved from area. Overactive normal child — behaviour problems. 69 Nursery school and ordinary school. Spina bifida 18.6.69 Day school for physically handipupils. All the children made noticeable progress even in this short period and benefited considerably from the stimulation and opportunities provided. The good attendance record (often involving long journeys for the mother) is an indication of the success of the group and the need for such a unit — not only to help the children reach their potential, but to afford social contact and support for other members of the family." NON-ACCIDENTAL INJURY TO CHILDREN (Battered Baby Syndrome) This subject was discussed in detail in my previous report. The standing advisory committee met for the third time at the Brook Hospital this year. Twenty-one cases have been notified this year and added to the register. Each child is followed up after conditions are satisfactory for at least twelve months. In any child moving out of the district while under observation the Deputy Medical Officer of Health contacts the Medical Officer of the Authority into which the child is moving, on the telephone, and records are then sent to the responsible Medical Officer. This avoids delays in the continuity of supervision and provides help which is usually required by these families. 53 Primary prevention: We have concentrated on signs of impending battering. In monthly lunch time working seminars Doctors and Health Visitors have discussed early symptoms. It is therefore interesting to note that the cases which have come to light during the last year appear to be of a less damaging nature to the child than in previous years. Some may already have been prevented as Health Visitors and Doctors are identifying stress situations in families which might have escaped observation previously, and is reflected in the number of "threatened" injured and the action taken. Secondary prevention: Hospital staff. General Practitioners and Local Authority staff from Health and Social Services Departments have established good links and suspected cases of wilful injury receive immediate attention in the Health Department, whose Deputy Medical Officer of Health is the co-ordinating Officer. Immediate help to parents is made available by admitting the child to hospital, by making a Social Worker or Health Visitor available for intensive work with the family, and/or by calling in other supportive services. Thus, rehabilitation of the family is carried out as a team effort. An analysis of the twenty-one cases reported shows that: In six cases no actual injury was inflicted on the child, but injury was threatened and reported to General Practitioners, Health Visitors or Social Workers, and the help given consisted of rehousing, foster care and later adoption, intensive visiting by a Health Visitor and Social Worker and in three cases psychiatric treatment of the mother. In four cases reported with scalds or burns (none of severe degree): one was established as accidental, one older sibling was admitted to E.S.N. School, one was taken into care and one is receiving more intensive visits by the Health Visitor. In four cases reported with bruising or scratches: one only needed intensive family counselling and three were cleared during follow-up as accidental and needed no further treatment or advice. In six fractures reported by clinics or hospital staff: one was cleared on X-ray, one needed intensive counselling by the Senior Medical Officer and Health Visitor, as the mother suffered from a rare muscular weakness and lacked insight into her own condition before she was able to guard against injury to her child. One child conceived before marriage, whose parents are only 18 years old, was adopted by the grandparents after a greenstick fracture which healed under their care without residual handicap. In one case, with parents of low ability, mother was sterilised and the child taken into care. One unsupported mother stopped work and was put on Social Security and rehoused and appears to be doing well. One remains under intensive supervision by Health Visitor and Social Worker. One death was reported by the mother, whose child was admitted and died in hospital, while she was on a visit to her maternal grandmother. The mother is unsupported but no previous shortcomings in the child's care had been observed. Enquiries from the hospital established sudden death from brain haemorrhage and a blood disorder which could have caused this. The mother appeared very anxious for reassurance. All the children reported, except two, were under the age of 2 years. Of the ten confirmed as having had wilful injuries inflicted all were under the age of two. 54 Thus it can be seen that ten children must be assumed to have been subjected to wilful injury by a parent, but another six were in need of help which, but for the present vigilance and publicity — as all these were reported either by the patients themselves or relatives — might have resulted in injury to the children. However, these findings should not be taken complacently as it is generally felt that we deal at present only with a small number who come to our attention who might be compared with the tip of an iceberg. It is the submerged large number which still causes us concern who are in need of help which at present is not made available to them. Further efforts will therefore be made to detect these. THE WORK OF THE COMMUNITY NURSING SERVICES Miss M.C. Gooderham, the Senior Area Nursing Officer reports: HEALTH VISITING The pattern of health visiting work carried out in this Borough includes routine duties in connection with expectant mothers, mothers and young babies, the young child, the school child, the elderly and the family with problems. The Health Visitor helps those awaiting hospital admission and needing advice and reassurance. Where parents or children are to be admitted for hospital treatment their parents often need guidance in order to prepare the child and minimise any mental trauma which may result from this enforced separation. Health Visitors organise Child Health, Cytology, Slimming and Health Education, etc. and take an active part in the School Health Services. It is inevitable that the Borough with varying degrees of social needs demands an extensive knowledge and aptitude of the Health Visitor and makes the home visiting aspect extremely varied and worthwhile. Where extensive help is thought desirable and where this is acceptable to the family the health visitors are ready to ask for the help required from the Social Services Department. They keep in contact with social workers and other services, including voluntary, and wherever possible build up close personal relationships with them. Social/medical problems continue to be one of the main concerns of the health visitor. The health visitor, as she becomes increasingly involved in general practice, finds the volume and variety of her work growing rapidlly. STUDENT HEALTH VISITORS Four Student Health Visitors have been sponsored by the Council during the year. The theoretical training is given at various Technical Colleges. The Health Visitors who have completed the field work instructor's course take students for practical training. 55 CLINIC NURSES Owing to the nation-wide shortage of health visitors the establishment is made up with clinic nurses (S.R.N.s.). These nurses assist the health visitors in clinical sessions, school medical inspections and selected follow-up visiting. The clinic nurses are a valuable section of the nursing personnel and efforts are being made to increase their job satisfaction by extending their scope e.g. to infectious disease visiting and possibly family planning in the future. This could be a full time speciality or in addition to general duties; in the School Medical Service, simple health education after hygiene inspections in schools and some follow-up visits after school medical inspections. MIDWIFERY Domiciliary midwives attended 417 confinements during the year and also undertook the care of 474 patients discharged home after hospital confinements before the tenth day; the latter figure consists mainly of those cared for under the Council's planned early discharge scheme. Also included in this figure are those who took their own discharge from hospital. The planned early discharge scheme has now been extended to the hospitals in the Woolwich Group used by Bexley residents. At Queen Mary's Hospital and Hainault the planned early discharge scheme in which the general practitioner obstetrician and domiciliary midwife deliver and care for specially booked mothers in hospital, is working well. The mother is discharged home as soon as practicable and being cared for by the same doctor and midwife, this gives a degree of continuity of care that has been found most desirable. 275 of the 474 early discharges came into this category. We are most appreciative of the co-operation and consideration we have had from Queen Mary's, West Hill and Hainault Hospitals colleagues. PUPIL MIDWIVES We have continued to take part II pupils from Queen Mary's, British Hospital for Mothers and Babies Hospitals during the year and 49 pupils have completed with us the District part of their training. The new integrated scheme for training pupil midwives will commence at Queen Mary's Hospital in May 1972. OBSTETRIC NURSE EXPERIENCE Facilities are provided for nurses in general training to accompany the Domiciliary Midwives on the District and to attend sessions at the Ante-Natal Clinics, and during the year 48 nurses received this experience. 56 TRAINING FOR CHILDBIRTH The demand for psychoprophylaxis continues to rise. The training and the traditional relaxation class is offered in conjunction with mothercraft teaching sessions to expectant mothers. DISTRICT NURSING The function of the home nurse is not only limited to carrying out treatments as instructed by the general practitioner but also to instructing and advising the patient and relatives in the best methods of nursing and feeding. In addition she has to ensure that the most efficient methods are employed to make the patient as comfortable and as mobile as possible and to reduce to a minimum the inevitable loneliness of a housebound patient who may be living alone. MARIE CURIE MEMORIAL FUND There was an increase in the number of persons who were assisted through the Marie Curie Memorial Fund grant to the Council this year; (16 patients received this service) the existence of this Fund makes a valuable contribution to a selected group of patients who need whatever assistance can be given to them. They and their relatives are grateful for it and have sent several donations to the Marie Curie Memorial. TRAINING FOR THE NATIONAL CERTIFICATE IN DISTRICT NURSING State Registered Nurses are given training for three months in association with the Kent County Council for the National Certificate of District Nursing. This scheme is sponsored by Bexley Council and the students are required to work within the Borough for a further year on completion of the course. During the year 5 students completed their District Nurse Training. REFRESHER COURSES These continue tor be arranged regularly for the nursing staff enabling them to keep up to date with modern nursing techniques. 25 members of staff went on refresher courses during the year. NURSE TRAINING The 1969 General Nursing Council Syllabus recommended a period of three months community experience as one option for a student nurse training for State Registration. Arrangements have been made with the Queen Mary's Hospital Nurses Training School to provide the experience commencing January 1972. The General Nursing Council has approved a scheme whereby student nurses spend six weeks of their training in the community to see all aspects of the Local Authority Health Services. 57 PRACTICAL WORK INSTRUCTORS We have had eight of our more experienced District Nurses trained as practical work instructors in order that the students obtain full benefit from their period on the District. NURSING AUXILIARIES These valuable members of the staff have an important role to fulfil within their own right as well as helping the District Nursing Sisters. The basic work of nursing auxiliaries is bathing, washing, dressing and undressing (especially the aged, but not patients who are acutely ill), assisting patients in carrying out walking exercises in order that they remain ambulant, foot hygiene and assisting District Nursing sisters with the care of heavy cases. All have a planned course of preparation for their work, as a nursing auxiliary in hospital or who have been trained through the St. John Ambulance or Red Cross Nursing Aids Schemes, or by District Nurses practical work instructors. They will be essential members of the teams which we hope to build up for Attachment Groups. ATTACHMENT OF THE NURSING STAFF TO GENERAL PRACTITIONERS A new scheme for attachment of nursing staff to family doctor practices was started during 1971 in the Northern part of the Borough as a pilot project. The nursing team consists of Health Visitors, District Nursing Sisters, Midwives, and is responsible for providing services to persons (at least those within the Local Authority Boundary) on the lists of specified general practitioners to whom they are attached and with whom they have regular consultation. They may be attached to more than one practitioner or group. In the case of the District Nursing Sister and Midwife she will not normally provide services to patients not on the doctors lists but, for the time being health visitors may still retain some responsibility for providing local authority services e.g. child health, school health and health teaching to persons not on the lists of the practitioners to whom they are attached. Although the expected antipathy to any change was evident in the early discussions, the nursing staff involved became increasingly enthusiastic after some experience of working in this way. They state that their own work is much more satisfying and there is no doubt that the patients get a better service. This enthusiasm is spreading to unattached staff, many of whom are now enquiring about the possibility of schemes being considered in the centre and southern areas. Staff are to be congratulated on their enthusiasm in embarking on this new pattern of work; they have made outstanding progress during the year. Success and progress in any organisation depend on team work and I would like to take this opportunity of thanking all the nursing staff for their co-operation and help in such a rapidly changing health service. 58 THE COMMUNITY NURSING SERVICE CASES VISITED BY HEALTH VISITORS Total number of visits to children under 5 years. 13,567 Persons aged 65 or over. 356 Mentally Disordered Persons 25 Persons, excluding maternity cases discharged from Hospital 21 (Other than mental hospitals). Number of Tuberculous Households visited. 162 Number of Households visited on account of other infectious 1,105 diseases. Other cases visited, i.e. Nurseries and Child Minders, Expectant 1,964 mothers, etc. HEALTH VISITORS AND CLINIC NURSES ATTENDED THE FOLLOWING SESSIONS Screening of Hearing, Relaxation and mothercraft, 2,145 Slimmers Clubs, Mothers Clubs, etc. M. & C.W. Clinic Sessions 5,323 Staff Medicals 123 Time equivalent to 2,550 sessions was taken up by clerical work, i.e. keeping of children's records (0—5 years), school records, correspondence, etc. HEALTH VISITORS (A) SESSIONS WORKED 1971 1970 Number of sessions (half days) devoted to: i) Health Visiting 5,542 5,484 ii) Child Welfare Centres 5,323 5,347 iii) Ante-natal, Post-natal, Relaxation Mothercraft etc. Clinics 2,145 2,240 iv) School Clinics 638 354 v) Other School Nursing 1,528 1,627 vi) Staff Medicals 123 143 vii) Health Education 296 238 viii) Clerical 2,550 2,421 Total Sessions 18,145 17,854 59 (B) CASES VISITED FOR THE FIRST TIME IN THE YEAR 1971 1970 i) Children born in 1966—69 7,312 7,890 ,, ,,1970 2,660 2,729 ,, ,, 1971 3,595 3,646 ii) Persons aged 65 or over 356 213 iii) Others (excluding School Nursing cases) 2,913 3,364 Total 16,836 17,842 (C) NUMBERINCLUDED IN ITEM (B) i) Mentally disordered persons 25 13 ii) Persons discharged from hospital (other than Mental Hospitals) 21 11 iii) Tuberculosis households 162 661 iv) Households visited on account of other infectious diseases 1,105 825 (D) NUMBER INCLUDED IN ITEM (B) AND, WHERE APPROPRIATE, ITEM (C) WHO WERE VISITED AT THE SPECIAL REQUEST OF A GENERAL PRACTITIONER OR HOSPITAL i) Persons aged 65 or over 184 102 ii) Mentally disordered persons 19 5 iii) Persons discharged from hospital (other than 9 Mental Hospitals) 6 (E) TOTAL NUMBER OF VISITS To:- i) Children under 5 years of age 32,767 ii) Persons aged 65 years or over 730 No Access Visits iii) Other, excluding School Nursing Cases 6,492 Total 1971 39,989 8,719 Total 1970 40,976 9,464 (F) INTERVIEWS OR REFERRALS IN GENERAL PRACTITIONER SURGERIES (NOT INCLUDED IN ABOVE) Total 1971 1,015 Health Visitors and Clinic Nurses attended the following Sessions for the School Health Service Periodical School Medical Inspections 963 School Hygiene Inspections 298 Vaccination and Immunisation (including BCG) 262 60 HEALTH EDUCATION Prior to June of this year, when a Health Education Officer was appointed, health education was undertaken by individual members of the Health Department as the need arose, and by professional staff in their daily contact with the public in the home, and at clinic sessions. Miss Wesson, Health Education Officer, reports: Since June the acquisition of basic equipment has played an important part in the setting up of this section, together with the establishment of lines of communication with statutory and voluntary bodies. A Health Education Committee has been inaugurated to decide health education policy throughout the Borough, and a multi-disciplinary working party has been set up. A regular supply of posters on health topics and home safety subjects have been distributed to clinics, hospitals and general practitioners. The public have availed themselves of the services of the section, and students from schools and colleges have made frequent visits for information and literature for projects. Requests for speakers, from many sources, have been met as far as possible, but due to lack of staff this service has had to be limited. The help given by doctors and nursing staff has been greatly appreciated particularly as much of this work has entailed evening sessions. MATERNITY AND CHILD WELFARE SECTION As will be seen from the statistics, relaxation and mothercraft classes have flourished, and co-operation with local maternity hospitals has enabled health visitors to participate in hospital classes and pupil midwives to visit local authority classes. PARENTCRAFT CLASSES These classes are held in the evenings to enable fathers to attend, but they have not proved to be the success visualised. MOTHERS DISCUSSION GROUPS Mothers discussion groups conducted by health visitors have been successful, many health topics have been introduced into these sessions, and outside speakers have been invited, for specific subjects. These groups have also been valuable for young children, who have been given an opportunity to play together. This has been especially valuable to those unable to attend a play group. HEALTH EDUCATION IN SCHOOLS Four senior schools have health visitors visiting regularly to conduct courses on child care and health subjects. Other schools have had occasional speakers on various subjects. 61 A pilot scheme in a Primary school on the subject of "Growing Up" was undertaken at the end of the Christmas Term. Parents of fourth year junior pupils were invited to see two films on this subject followed by discussion with the staff and Health Education Officer. The parents were then invited to return on another evening with their children to view the films together. This proved to be a most acceptable way of coping with this subject, parents appreciating the support the school was able to give without taking the responsibility away from the parents. Teachers and medical and nursing staff had a combined seminar on the subject of "Drugs" in November. The speaker was Dr. Anthony Wood from the Health Education Council. This subject naturally stimulated a great deal of discussion and interest and further action is being considered. In the Spring Term an exhibition is to be arranged at the Teachers' Centre in Sidcup to stimulate more interest amongst teachers on the subject of health education in school. YOUTH CLUBS Youth Clubs have taken an interest in health education and speakers have been requested on various subjects. In October a Senior Medical Officer and the Health Education Officer took part in a day conference on Drugs arranged by the youth leaders for all those concerned with the guidance of young people. SLIMMING CLINICS A most successful venture has been the introduction, since June, of slimming groups at various clinics throughout the Borough. These groups are conducted with the approval of the participant's general practitioner, and the demand has been such that waiting lists have had to be compiled. In addition to discussions on sensible eating and problems of dieting; films, demonstrations and discussions on many aspects of health have been introduced. It is interesting to note that although these groups are open for men as well as women, only one gentleman has enrolled, but there have been many reports that overweight husbands have also lost weight (sometimes more than their wives)! The credit for this effect has been given to the fact that increased knowledge about nutrition has been reflected in family menus, and therefore both parents and children have benefited. THE ELDERLY Concern by the Health and Social Services departments on the subject of Hypothermia led to two interesting lectures given by Dr. William Budd, Consultant Geriatrician from Joyce Green Hospital, Dartford, to the combined professional staff of the two departments. Arrangements have now been made for a symposium to be held early in the New Year for the home-helps on this important subject. The importance of stressing good nutrition, and the prevention of home accidents has been carried out by all district nurses and health visitors in their daily contact with the elderly. Talks on these subjects have also been given to groups of senior citizens. 62 THAMESMEAD In Thamesmead the residents have formed a health education group which meets once a month. The general practitioners and health visitors are working closely with this group, and it is hoped that when the new health centre opens next year, more support will be given to the group from the community. DENTAL HEALTH Dental health education has been undertaken in close co-operation with the Chief Dental Officer, and has included visits to schools and clinics, as will be seen in the Chief Dental Officer's report. At the end of the year play group leaders were invited to participate in a new project on dental health education for under fives. The dental auxiliary commenced visits to play groups to talk to the children and their parents on this important subject; following each talk a toothbrush, mug and toothpaste was given to each child and individual counselling for the parents was available if required. The response to this project has been overwhelming, and next year a programme will be planned to incorporate as many playgroups as possible into the scheme. SMOKING AND HEALTH Following the report of the World Health Organisation on Smoking and Health, a report was submitted to the Health Committee who agreed that a pilot scheme be set up for an anti-smoking clinic for council employees who were heavy smokers. This clinic commenced in the Autumn for a period of ten weeks and has been led by one of the principal medical officers who also smokes cigarettes. Group discussion techniques were used for the course and the majority of participants have been able to reduce their consumption of cigarettes. An evaluation will be undertaken when the course finishes early in the New Year. The first six months following the establishment of the Health Education Section have revealed the enormous potential there is for health education within the Borough. The demands on the service have gained momentum with each passing day, and it is obvious that in the coming year activities in the health education field will need to be extended over a wide area to enable the general public to obtain the maximum benefit from this form of positive health. Summary of sessions SHOWING PARTICIPANTS IN HEALTH EDUCATION Type of Session No. of Sessions Number attending Relaxation 451 3618 Parentcraft 7 114 Mothers Discussion Groups 444 6,980 Slimmers Group 123* 1,926* * Figures for six months only. 63 HOSPITALS Good liaison exists with hospitals in the Borough and the many situated in neighbouring boroughs, but caring for the citizens of Bexley. In the three hospitals receiving maternity cases, the Deputy Medical Officer of Health and Senior Area Nursing Officer attend the maternity liaison committee. The following hospitals are situated in the Borough: Bexley & Welling Hospital, Upton Road, Bexleyheath Bexley Maternity Hospital, Erith Road, Bexleyheath Russell Stoneham Maternity Hospital, Perry Street, Crayford Erith & District Hospital, Park Crescent, Erith Hainault Maternity Hospital, Lesney Park Road, Erith Queen Mary's Hospital, Sidcup The hospitals adjoining the Borough are: Brook General Hospital, Shooters Hill Road, S.E.18. Joyce Green Hospital, Dartford. The Memorial Hospital, Shooters Hill, S.E.18 St. Nicholas Hospital, Tewson Road, S.E.18. West Hill Hospital, Dartford. In addition, the following teaching hospitals receive the bulk of referrals from this Borough: Guy's Hospital, Newcomen Street, S.E.1. King's College Hospital, Denmark Hill, S.E.5. Detailed paediatric assessment is at present carried out at Guy's Hospital (Newcomen House). The Paediatrician at the Brook Hospital hopes that an assessment centre will be equipped at the Brook Hospital in the next year. This will enable Medical Officers in the Department to work in close co-operation with a multidisciplinary team. Parents will in this way save long journeys to Guy's Hospital and benefit from on-going guidance and help by one team. 64 ADAPTATIONS OF HOMES FOR RENAL DIALYSIS Hospital authorities provide and maintain the kidney machines for the use of patients in their own homes. The homes are converted by the Council and a charge is made according to the Council's assessment scheme. In cases where the applicant is found unable to contribute, the installation is made free of charge. By the end of the year 5 homes were adapted, all privately owned homes. The earliest adaptation took place in October 1969 and the most recent in May 1970. One additional conversion was stated at the end of 1971. For this purpose, one room, usually a bedroom, has been converted to take the necessary equipment. This includes a sink and special shelving to hold a month's supply of concentrated fluid used for dialysis and sterile dressings. Floors are made water-proof, and walls and ceilings easily washable. The room is further equipped with a telephone paid by the hospital authorities to enable the patient to contact the hospital in case of any difficulty during dialysis. By the end of the year, one district nurse had been specially trained at Kings College Hospital to assist patients with problems of home dialysis. 65 CHIROPODY SERVICE The Council provides a chiropody service for men and women over 65, expectant mothers, and physically handicapped persons at a reduced fee of 35p per treatment which, can be further reduced or supplied free on assessment. All persons on social security receive a free service. Mr. B.T. Marsh, Chief Chiropodist reports: The service is maintained by Chiropodists employed by the Council (Direct Service) and by Private Chiropodists (Contractual Service). Treatment is available in Council clinics, private surgeries, and for housebound cases, in the patients' homes and the Council's Old Peoples' Homes. Basically the Chiropody Service has remained unaltered except that a higher proportion of new patients have been treated through the Direct Service Chiropodists with a consequent reduction of treatment of new cases by the Contractual Chiropodists. The Direct Service operating in 4 Old People's Homes was increased to provide treatment in Dovedale Old People's Home opened during the year. The Verruca service for school children introduced in 1970 by the Chief Chiropodist, and assisted by a trained nurse, expanded rapidly in this year. The service is provided at 315 Broadway, Bexleyheath, and 69 Sidcup Hill, Sidcup. New Cases Clinic Cases treated during Attendances the year Children 516 2,436 3,234 The direct domiciliary service is maintained by the Chief Chiropodist and 2 sessional chiropodists, and by the end of the year, amounted to 15 sessions a week, equivalent to 1.5 full time chiropodists. The direct clinic and Old People's Homes service is maintained by one full time chiropodist and six sessional chiropodists and by December amounted to 25 sessions a week (equivalent to 2.5 full time chiropodists). There are 5 clinics in the Borough, which provide chiropody treatment as follows Clinic No. of sessions a week 315 Broadway, Bexleyheath 9 69 Sidcup Hill, Sidcup 4 Wren Road, Sidcup 3 Town Hall, Crayford 3 St. Augustines, Belvedere 3 66 DIRECT SERVICE No. of Sessions No. of Treatments No. of Patients Clinics 884 4,233 975 Domiciliary 494 2,240 517 Old People's Homes 128 917 249 CONTRACTUAL SERVICE No. of Treatments Surgery Domiciliary No. of Patients 6,288 3,753 1,182 REHOUSING ON PRIORITY MEDICAL GROUNDS This report is confined to one specific issue — Priority Rehousing on Medical Grounds. Duties and functions of Local Authority appertaining to public health aspects of housing are dealt with elsewhere in the Report. The present scheme of rehousing on priority medical grounds has been operating successfully with slight alterations for several years. The scheme overrides the points system and in extreme cases even the required twelve months period on the waiting list is waived. The procedure at present adopted after full consultation with the Housing Manager is as follows:— The Housing Manager notifies the Medical Officer of Health of any applicant bringing forward medical reasons for rehousing. After obtaining the written consent of the applicant to approach the family doctor and/or hospital consultant, either or both of them are contacted by individual letter, routine questionnaire or telephone call as appropriate. Similar procedure is adopted for a small proportion of cases (6%) referred to me from other agencies, i.e., the Health Department staff, general practitioners. Director of Social Services. Not infrequently a direct approach is made by a prospective applicant. Where there is any possibility that the applicants claim can be substantiated, my Principal Medical Officer or a Senior Medical Officer visits the home by appointment and writes out a detailed report at the time of the visit. The Housing Manager is subsequently advised whether or not the application has my support. The borderline cases are discussed at the Group Officers Meeting held once a month. If the application does not have medical support it is dealt with in the usual way, i.e., on the points system. I feel I ought to make it very clear that because of council housing shortage, the medical criteria are not only very stringent but also faithfully adhered to. The visit from my Senior Medical Staff fulfil an additional role since their visit often brings forth a hitherto unmet need, e,g. urgent repair to property, various social needs including closer supervision from medical or social agency. 67 Once a month a group officers' meeting is held. The Housing Manager or his Deputy takes the Chair, his Department being represented by the Applications and Lettings Officer, Senior Housing Assistant and the Home Visitor. The Principal Medical Officer and a Senior Medical Officer attend. The recommendation of this meeting gives the Housing Manager executive power to proceed. The breakdown of applications dealt with between 1st January 1971 to 31st December 1971 is given below. Figures for 1970 are given in brackets. No. of new referrals including second applications after a lapse of 12 months Review cases (in addition to previous column) Applications supported Applications not supported Applications still being dealt with No. of visits by Medical Officers No. of interviews with applicants in Health Department 498 50 (approx) 147 208* 193 325 60 (approx) (501) (164) (185) - (336) *These will proceed on the points system as mentioned in paragraph 5. It is generally held that the scheme described above when viewed against the scarcity of resources is satisfactory. However when faced with the health problems of today, many of which are directly connected with the environment, one cannot but reflect how many of them could have been prevented had the health aspect been fully considered at the inception of the planning stage. In looking to the future I hope for strong links to be forged between all professions involved in providing the community with the best possible housing. STAFF MEDICAL EXAMINATIONS A Staff Medical Service is run by this Department to ensure that the person employed is physically fit to carry out the duties of the post to which he has been appointed by the Council. All candidates entering Teacher Training Colleges are examined irrespective of their case history and so are all those which are required by the Department of Education and Science (28 RQ). In addition, all canteen assistants, midday meal supervisors, school secretaries, clerical assistants and laboratory technicians employed by the Education Department are called for full medical examination. All heavy vehicle drivers have the statutory medical examination after clearance of their previous history with their general practitioner. 68 We are also concerned with the examination of employees referred to us who have been absent from work for a longer period, or who appear to be unfit for their job. Examinations are held with a view to consideration of retirement due to ill health, of an employee on medical grounds. It is the Council Policy to examine Manual Staff after 4 months employment, the Employing Department providing the information about their job requirement. During the year 950 medical examinations were arranged as against 1,268 in 1970. The difference is explained by the fact that more frequently a medical enquiry was established before the person was called for a medical examination. Thereby resulting in more people being passed on the reports received from the General Practitioners and Consultants as well as X-ray reports. In 1971, all medical histories and medical reports were made available for the medical officer before conducting the session, thus less employees needed to be medically examined and could be passed without being called for medical examination. 1970 1971 No. of health statements submitted 1,537 1,463 No. of sessions arranged 139 103 Medical Examinations arranged. Staff and Manual 883 530 Review and Special Cases 74 120 Teacher Training College Admissions 233 231 Medical Certificates completed for Department of Education and Science 70 55 Medicals arranged for other authorities 8 14 TOTAL 1,268 950 Males examined 363 237 Females examined 905 713 SOCIAL SERVICES DEPARTMENT The closest possible working relationship has been maintained with this newly established Department at all levels to avoid disruption of existing services and enhance new ones. As an example of the former the continuing screening of applications for day nurseries, playgroups and childminding may be quoted and for the latter the involvement of the Deputy Medical Officer of Health as medical adviser to the Adoption Committee. 69 The Department acts in all matters where medical advice is required. Medical and nursing staff have visited old people's homes and children's homes, and a Senior Medical Officer has continued the supervision at the hostel for mentally severely handicapped children. Applications for installation of telephones are also cleared on medical grounds in doubtful cases, and 4 were cleared in this way during the year. NURSERY AND CHILD MINDERS The Health Department has continued to supervise this service at the request of the Director of Social Services. During the year no new Day Nurseries have been registered but two new Play Groups have been established. At the same time, the number of registered child minders has increased from 272 approved to 330. In all, 1735 children are in regular part time or full time day care in private Day Nurseries or Play Groups throughout the borough. An additional 568 children are looked after by Child Minders. Three applications were received from applicants not considered suitable, who were persuaded not to proceed with their application for registration. Courses for Play Group and Day Nursery Staff are available in evening classes provided by Adult Education. Lectures at these courses were given by Doctors and Nurses as well as staff from the Education Department. These classes attract an average of thirty students and attendance is usually very good. NURSERIES AND CHILD MINDERS REGULATIONS, 1948 1971 1970 Premises registered at end of year: Number of premises 53 51 Number of places provided 1,735 1,625 Persons registered at end of year : Number of persons 330 272 Number of places provided 568 526 RECUPERATIVE CARE This Scheme provides holidays for persons who are recovering from illness or operations. Applications are usually received from General Practitioners on behalf of their patients. In co-operation with the Director of Social Services medical recommendations are received in the Health Department and authorised by the Medical Officer of Health for action by the Director of Social Services. Applicants have to complete an assessment form and accordingly receive a free service or have to contribute. 70 During the year 27 applications were received. Of these, 20 were supported and 4 decided not to proceed with their application. Of the 20 successful applicants: — 9 were over the age of 60 7 were over the age of 70 2 were over the age of 80 The remaining applicants suffered:— one from mental ill health, and one from the effects of a sudden bereavement. It is noteworthy that 18 out of 20 applications were, in fact, elderly citizens. DAY CARE FOR UNDER 5's ON MEDICAL GROUNDS The Borough does not provide a day nursery. Day care is, however, provided free of charge for special cases recommended by the Medical Officers, General Practitioners and Health Visitors. The children are placed in suitable private nurseries, playgroups or with childminders. At the end of the year there was one child placed by the Council in a day nursery, and eleven in playgroups. In these cases no charge fell on the parents. REASONS FOR PLACEMENT OF UNDER 5's ON MEDICAL GROUNDS MEDICAL Withdrawn child — unsupported mother 1 Behaviour problems reactive to difficult home situation 2 Recommended by Child Guidance Clinic for language stimulation 1 Retarded general development and speech 2 Developmental retardation 1 Visual handicap 1 Asthma 1 Deafness + associated speech defect 1 Behaviour problem due to parental involvement with blind, partially deaf, epileptic brother 1 Behaviour problem in single parent family 1 12 71 REGISTERED NURSING HOMES There are four private nursing homes registered in the borough. These homes are visited periodically by Senior Nursing Staff and Principal Medical Officers when special concern is expressed or a complaint received. During inspection visits, which are usually made without prior notice, attention is drawn to such matters as general care and nursing, diet and fire prevention. Special visits are paid during the cold weather to ensure that adequate heating is provided. During the year one home has undertaken extensive alterations to comply with new regulations in fire prevention and satisfactorily carried out. Organisation or Proprietor Address Type of Home No. of Residents Remarks Mrs. Knight, S.R.N. The Elmhurst Nursing Homes, 11 Victoria Road,Sidcup. Chronic sick and aged 14 Female patients May be prepared to consider male patients Mr. P. Fitchett The Winston Nursing Home & Clinic Ltd., 31 Crook Log, Bexleyheath. Chronic sick and aged 22 Male or Female patients Does not take senile or mentally handicapped patients Mr. M.J.W. Dent, S.R.N., R.M.N. Hatherley Nursing Home, 12 Hatherley Road, Sidcup. Chronic sick and aged 9 Male and Female patients Mrs. Memsley, S.R.N. The Eaves Nursing Home, 64 Picardy Road, Belvedere, Kent. Chronic sick and aged 18 Female 72 REPORT of PRINCIPAL SCHOOL MEDICAL OFFICER 73 SCHOOL HEALTH SERVICE The School Health Service is the longest established mandatory service to cover a specific population group. As far back as 1904 medical policy makers stressed the negative effect of physical defects on school performance and suggested that discovery of such defects be made a matter for team work between school Medical Officers and teachers. Subsequent changes in the social pattern brought about the Education Act 1944 which gave a much wider remit to the School Health Service. Whilst it is the duty of the Local Education Authority to provide every child with education according to his age, ability and aptitude, it is the duty of the School Health Service to seek out and assess children requiring educational provision either as an alternative or a complement to the "normal" school. To achieve the objective that every child is given help to attain its full potential the Service must fulfill three conditions: 1. Involve itself with the child before his school entry age. 2. Evolve a simple but foolproof procedure to cover the whole school population. 3. It must be truly comprehensive i.e. capable of calling in all the specialist services to advise on conditions likely to affect the child's educational and social growth adversely. EARLY DIAGNOSIS The Health Department is alerted to a handicapping condition in one of many ways. 1. The "At Risk" register — this is reported on in the Maternity and Child Health Section. 2. The information and/or request for action can come from members of the M.O.H's staff e.g. Health Visitors; other Local Health Authorities on change of address, family doctors or Hospital Consultants. As soon as practicable a full assessment by a suitably qualified and experienced Medical Officer is arranged, preferably at the child's home where the conditions for examining the child and counselling the parents are optimal. Before the initial assessment is made an on going two way communications is put in train between bur own specialists in developmental paediatrics and the Hospital Paediatrician. Following such an assessment, ancillary support services can be brought in e.g. rehousing, day placement, with or without subvention of fees. A child requiring skilled handling and/or observation is placed in one of the four assessment groups. From the educational aspect, such early and accurate assessment has manifold advantages to the child. When a sufficiently firm diagnosis is made the Chief Education Officer is advised 75 regarding future school placement. Early recommendation gives the Chief Education Officer a better chance of securing special placements which are in short supply. The following table illustrates the handicaps assertained for special schooling. Category of Educational Handicap YEAR OF BIRTH 1968 1969 1970 1971 TOTAL E.S.N, (including S.S.N.) 7 5 12 5 29 Physically handicapped 11 3 6 1 21 Blind 2 - - - 2 Partially sighted 3 1 - - 4 Deaf - - - - - Partially hearing 3 2 1 - 6 Epileptic 1 - - - 1 Delicate 1 6 - - 7 Speech defects - - - - - Maladjusted - - - - - TOTAL 28 17 19 6 70 CHILDREN IN NORMAL SCHOOLS On the 31st December 1971 the total school population in London Borough of Bexley stood at 36,705. 9,400 pupils received periodic medical examinations and of these 17 i.e. .06% were found to be in an unsatisfactory condition. In addition, there were 642 special inspections, and 3,578 re-inspections. The following table gives the number of defects found at periodic and special medical inspections during 1971. 76 Defect Code No. Defect or Disease PERIODIC INSPECTIONS Special Inspection Entrants Leavers Others Total (1) (2) 4 Skin T 45 76 80 201 O 269 92 104 465 5 Eyes (a) Vision T 93 102 133 328 2 O 223 196 150 569 (b) Squint T 46 4 12 62 O 57 9 20 86 (c) Other T 11 5 7 23 O 42 24 16 82 6 Ears (a) Hearing T 30 12 18 60 6 O 118 24 48 250 18 (b) Otitis Media T 17 5 3 25 O 162 6 15 183 (c) Other T 3 2 - 5 O 42 7 20 69 7 Nose and Throat T 38 14 8 60 1 O 530 41 99 670 8 Speech T 25 3 5 33 3 O 110 6 10 126 9 Lymphatic Glands T 8 1 3 12 O 211 6 22 240 10 Heart T 15 1 2 18 O 167 15 33 216 11 Lungs T 25 6 14 45 O 150 33 43 226 12 Developmental (a) Hernia T 9 - - 9 O 31 2 4 37 (b) Other T 11 - 7 18 2 O 78 5 25 108 13 Orthopaedic (a) Posture T 1 3 6 10 O 15 11 16 42 (b) Feet T 8 17 16 41 O 86 45 89 220 (c) Other T 5 24 14 43 O 153 60 53 266 14 Nervous System (a) Epilepsy T 2 3 3 8 O 19 4 4 27 (b) Other T - 3 3 O 32 18 22 72 15 Psychological (a) Development T - 1 1 2 O 57 9 47 113 (b) Stability T 1 1 2 4 O 165 27 91 283 16 Abdomen T 11 2 5 11 O 60 17 37 114 17 Other T 23 17 17 57 3 0 151 84 107 342 T denotes defect requiring Treatment O denotes defect requiring Observation 77 Hygiene inspections were carried out on 21,375 (1970—19,716) pupils by school nurses and 136 (1970—74) children were found to be infested with vermin. The periodic medical inspections are carried out three times during the child's school life i.e. on entry, during the first year in Secondary School and on reaching the school leaving age. The parent is not only advised of medical examinations but cordially invited to attend. The "school leaver" inspection is of particular relevance regarding the child's future since the Careers Service depends on the School Health Service for guidance regarding any employment restrictions. Over and above the periodic and special medical inspections which includes vision testing by Snellen's card the Service is responsible for: 1. Vision testing on Keystone apparatus carried out by a specialist school nurse, each child being tested at the ages of 6,8 and 10. The colour vision test on Keystone is added for the last group of children to enable advice to be given about appropriate employment. The Ishihara test for colour vision is given to all boys on leaving school since normal colour vision is essential for certain occupational fields. 22 boys failed the Ishihara test in 1971. 2. Hearing is tested clinically by the school doctor during Medical inspections. In addition all children are screened routinely by "sweep audiometry" at the age of 7. If hearing loss is suspected in a child of any age, an audiometric test can be requested by a Local Authority or family doctor, teacher or Health Visitor. NURSERY EDUCATION The general arguments favouring early education apply to a handicapped child with even stronger force. The importance of the early years in a child's intellectual development is now widely recognised. It is also known that a child's development proceeds in a definable sequence and that, if the acquisition of an early skill is impeded, later stages of intellectual development may be retarded or even precluded. It is therefore vitally important that positive steps should be taken at as early an age as possible to minimise the adverse effects of handicapping conditions on a young child's emotional, social and intellectual development. Nursery education can play a crucial part here, not only by helping the child directly but also indirectly by helping his parents to develop a constructive attitude to his handicap. At the other extreme to rejection, there is the more subtle danger of over-anxious protection which can deny a child the experience on which his development depends. Nursery education also provides an ideal opportunity for prolonged and systematic observation of a handicapped child, so that as part of the process of comprehensive assessment already referred to, a precise estimate can be made of his future educational needs. The Borough has one nursery school and three nursery classes attached to Infant Schools. This is insufficient to meet the demand even of children very much in need of organized activity and education. The Principal School Medical Officer recommends children for whom nursery school admission is indicated on medical grounds. The co-operation received by the Health Department from the Chief Education Officer in the face of great shortage of nursery places is very much appreciated. 78 CHILDREN RECEIVING SPECIAL EDUCATION EDUCATION (HANDICAPPED CHILDREN) ACT. 1st April 1971 is thought to be the landmark for Education of Severely retarded children. The new Education (Handicapped Children) Act transferred the responsibility for those children who previously were ascertained as "unsuitable for education at school" and were catered for by the Local Health Authorities, to the Local Education Authorities. The provision acquired a new look through the abolition of statutory examinations and the schools previously known as Training Centres became Schools for severely subnormal pupils and the training of specialised teachers was given a new impetus. The change was welcomed by staff and parents alike. The following are the special schools within the Borough: Woodside, Marlborough and Shenstone. In addition there are seven special classes attached to primary schools catering for children with developmental delay. The Partially Hearing Unit is attached to Crayford Secondary School. Partially hearing children of primary school age are accommodated at the special unit attached to Darrick Wood School (London Borough of Bromley). Cerebral Palsy children attend the Phoenix Centre at Farnborough Hospital, London Borough of Bromley until the age of 8. Physically handicapped children attend Charlton Park School (London Borough of Greenwich). It is anticipated that our children will be taking up possibly half the places in the new purpose-built school for the physically handicapped in Chislehurst (London Borough of Bromley). In all there are 275 children receiving education in special schools. This number is made up as follows :— Boys Girls Marlborough 32 25 Shenstone 28 14 Meldreth 1 — Helen Terry — 1 Cheyne Hospital 1 — Phoenix Centre 4 3 Woodside 68 68 134 111 In addition 30 other children are receiving education in Out-of-Borough schools. 79 For obvious reasons a child in a special school calls for more time and expertise from the School Health Service than the rest of the school population. Each child is examined once a year by a Senior Medical Officer at the school; not infrequently, the medical examination is followed by an impromptu case conference in which both parent and teacher participate. The children in out-of-Borough schools are seen at home during the school holidays. WOODSIDE SCHOOL, FOR E.S.N. CHILDREN Dr. May Edge, the Senior Medical Officer responsible for the School, reports as follows: — "As the new school building was not completed by September 1970, a unit for 26 E.S.N. children was started in temporary accommodation. By April 1971 it was possible to use the top floor of the purpose-built school and the original nucleus of children was amalgamated with another special unit making a total roll of 62. This was increased by September 1971 to 129, with a staff of 11 teachers. This rapid expansion, combined with problems arising from the education of older children, so called "late" admissions, added to the load of work both on the teaching and medical side. The Autumn term 1971 saw the establishment of a Diagnostic Unit for young children and the school started to function, divided into Junior, Middle and Senior Departments. The Parent Teacher Association was formed in November, following an extremely well-attended Parents Day. 97 children were examined by the end of the year. All the parents attended for these examinations. The child's hearing is tested by the Audiometrician and children are assessed and seen regularly by the Peripatetic Teacher for the deaf. The day-to-day health care is in the competent hands of a State Registered Nurse working at this school as the Welfare Assistant and apart from her daily work she is available for counselling of children, staff and parents. The smooth running of the School Medical Officer's work is largely due to the fact that skilled nursing help is available at this school. Shortage of Speech Therapists was responsible for insufficient time being given to the Woodside children but fortunately this situation was remedied after the new year. When the school returned to work after Christmas 1971 it held 140 pupils in 10 classes. In its first year of life this school can justifiably claim considerable success in view of many initial difficulties." MARLBOROUGH SCHOOL, FOR SEVERELY RETARDED CHILDREN Dr. Rose Stellman — Senior Medical Officer responsible for the school reports as follows:— "The school was originally known as Sidcup Training Centre, and after its transfer to purpose-built premises, as Marlborough Training Centre. During the first year under the wing of the Education Department several improvements were made, i.e. sound-proofing of the assembly hall, which doubles as the dining-hall, clerical help was made available and there was a more liberal provision of teaching and play equipment. 80 The School Medical Officer spent 34 sessions in examining every child at the school, in addition 14 comprehensive assessments were carried out. Over and above the regular sessions the School Medical Officer pays frequent ad hoc visits, to advise on medical problems and to comment on special equipment. Close liaison is maintained with family doctors and consultants. The Physiotherapists and Speech Therapist attend regularly to advise the staff and treat the children. SHENSTONE SCHOOL FOR SEVERELY RETARDED CHILDREN This School was formerly known as Shenstone Training Centre, and the excellent work carried out in the face of many difficulties, not the least the premises, is of special credit to the staff. The medical aspect was shared between two School Medical Officers. 51 children were medically examined and 42 of their parents attended. SPECIALIST SERVICES Any parent of a child where Consultant opinion is required can, if he so wishes, be referred to a Hospital. There are, however, specialities with a particular bearing on education and it has always been thought advisable for the Authority to provide its own Consultant services closely attuned to local conditions. OPHTHALMIC CLINIC The 3 Opthalmic Clinics under the aegis of the Health Department hold two sessions each per week. The relevant figures of 1971 are given below:— Clinic No. of Appointments sent No. of Attendances Keystone Referrals Cases from P.H. Medical Officers Prescription for Glasses Errors of Refraction (including Squint) Crayford 1716 1138 132 171 194 1131 Danson 2190 1931 211 265 577 1375 Hainault 1517 909 162 121 213 723 OTOLOGY CLINIC The Clinic, situated at 315 Broadway, operates for two sessions a week under its Director, the Otologist Mr. D.N. Stewart. The object of the Clinic is an early and accurate assessment of the child's hearing, leading to positive recommendation for effective treatment both on the medical and education side. The Otologist is prepared to carry out the surgical treatment personally after consultation with the family doctor, thus remaining in the overall charge of the management of the child. 81 The Clinic practises the team approach through invariable involvement of the Audiometricians (2 full-time officers) and the Peripathetic Teacher of the Deaf. Specialist advice is frequently given by the Educational Psychologist and the Senior Speech Therapist. The Clinic refers children for opinion to other consultants, notably the Child Psychiatrist. The referrals come from Audiometricians (following routine or screening or special examination of school children—see page 78), School Medical Officers and Local Health Authority Child Health Clinics, and increasingly from the family doctors. A very happy working relationship with the General Practitioners in the borough is especially noteworthy. MEDICAL EXAMINATIONS OF SCHOOLCHILDREN PRIOR TO EMPLOYMENT Such statutory examination is required for every child attending school to ensure that employment will not be detrimental to the child's health or educational progress. The Departmental Medical Officers have carried out 172 such medical examinations during 1971. CHILD GUIDANCE CLINIC The Child Guidance Clinic is located at Crook Log. There are two part-time Psychiatrists supplying 12 sessions per week, appointed by the Regional Hospital Board, 2 Educational Psychologists engaged by the Education Department and 1 Senior Psychiatric Social Worker now attached from the Social Services Department. it has been found almost impossible to maintain a full establishment of staff, and 2 psychiatric social workers posts have been vacant during the year. Psychologists, apart from their assessment work in the clinic, visit schools and work in close contact with school medical officers and teachers. The Director of the Child Guidance Clinic, Dr. Margaret Munro reports: — "542 (1970, 504) families visited the Child Guidance Clinic during the year, of these 201 (1970, 234) attended for the first time. Families with children of any age from birth to school leaving age may be seen at the Clinic, and some 10% of the children seen are pre-school age. Families are referred by the Medical Officers in the Health Department, the Social Services Department, the Education Department, family doctors, and a small number by the parents themselves". SPEECH THERAPY CLINIC I am indebted to our Senior Speech Therapist Mrs Christine Green for the following report:— "The Borough was operating only a skeletal speech therapy service in 1971 due to shortage of staff. Instead of the required one senior and three basic grade therapists, there was only one basic grade therapist full-time at Murchison Avenue Clinic, and one at Sidcup Hill Clinic until 13.9.71. The latter changed to part-time (21/33 hours) until the end of the year when she left the Borough service. Consequently, only the most urgent cases could be seen. 82 Despite the heavy case-loads, a certain amount of the almost equally essential advisory work was carried out. Regular visits were made to the special schools and primary schools for screening purposes, consultations and advice to teachers. Talks were given to groups of parents, teachers and student nurses. A certain amount of career work was undertaken, in the form of dissemination of information, and receiving visitors in the clinic. Students from speech therapy colleges visited the clinics regularly, for observation, and to work under the therapist's supervision. FUTURE DEVELOPMENTS It is anticipated that in future a much more comprehensive service will be given, since in October 1972 the full establishment of four therapists was realised. However, it is probable that even this is irtsufficient to cater for the true need for speech therapy services, which has until now never been ascertained in the Borough of Bexley. To this end, a speech therapy survey is under way, and from the results already obtained, it seems that the present establishment is insufficient to provide a really efficient service, with screening, advisory and prophylactic measures in addition to basic treatment. Even from the figures readily available, it is evident that, if the College of SpeechTherapists' recommendation of a minimum of one therapist per 10,000 children is accepted, then with the population of approximately 50,000 children under 14 years of age (Registrar General's estimated population figures for the Borough of Bexley for mid 1971), an establishment of at least five full-time therapists is needed." PROPHYLAXIS PROGRAMMES IN SCHOOLS The overall programme can be considered under two headings. Firstly, it is both administratively convenient and medically advisable to reinforce the immunological state of the child while still in school following the prophylaxis procedure at pre school age. To this end children of Secondary school age are offered Tetanus and Polio booster injections. Clearly children who missed such prophylaxis in the pre-school age are given a full course of Tetanus or Polio, or both. Secondly, there are two prophylactic agents particularly relevant to adolescents. These are B.C.G. which protects against tubercolosis and Rubella vaccines. The latter is only offered to girls. Immunisation in schools is carried out as part of the comprehensive school Health Service and the statistics are as follows:— Number of children immunised 1. Tetanus 602 2. Polio 435 3. Rubella 2002 83 B.C.G. Skin tested 1878 Found positive 231 and referred to chest physician when necessary Found negative 1526 Vaccinated 1526 MILK IN SCHOOL ISSUED ON PRIORITY MEDICAL GROUNDS Circular 12/71 (Provision of Milk and Meals (Amendment No. 2) Regulation 1971) abolished the supply of free milk to children of Junior School age in all schools except that for handicapped pupils. The act however, gave the Local Education Authorities the power to supply it for individual children on priority medical grounds. The Bill proved to be very controversial at every level of community life and the issue emotive. It became the task of the Health Department to identify the medical priority groups and every effort was made to ensure that no child likely to benefit from school milk was left out. An immediate total screening took place through scrutiny of school medical records by Medical Officers in the Department, in addition Head Teachers and family doctors as well as parents were invited to put forward such children for consideration. The parents were then informed of the Principal School Medical Officer's intention to recommend the child for milk on a temporary basis and were given the opportunity to indicate their wishes. Subsequently all remaining children were individually examined during School Medical Inspections and milk was continued or withdrawn according to the findings. Figures for the above exercise are as follows: — No. of Schools 49 No. of S.H. Records screened 13,182 No. recommended by Medical Officers 2,181 No. recommended by Headteachers 274 No. recommended by both Medical Officers and Headteachers 79 Total to receive milk 2,376 After completion of the screening procedure 23 children were referred from other sources e.g. General Practitioners, and social agencies. 237 parents indicated they did not wish their children to receive milk in school. It is envisaged that the exercise will have to be repeated every year for the children transferring from Infants to Junior Schools. 84 REPORT on the DENTAL SERVICES (1971) by the CHIEF DENTAL OFFICER J.H. FORRESTER, L.D.S., R.C.S.(Eng.) 85 Mr. Forrester, Chief Dental Officer reports: Staffing Estabs. 1971 1970 1971 Designation No. of Posts In Post Principal School Dental Officer 1 1 1 Senior Dental Officers 2 1 2 Dental Officers 4.25 3.4 3.7 Dental Auxiliaries 2 0.8 1.8 Superintendent Dental Surgery Assistants 1 1 1 Dental Surgery Assistants 8.25 5.8 7.8 TOTAL 18.5 13.0 17.3 The staffing situation was improved by the recent appointment of a sessional Dental Officer to a Senior Dental Officer post, 1 Dental Auxiliary to Thamesmead Health Centre and the equivalent of 2 full time Dental Surgery Assistants in support. The Whitley Salary Scale for Dental Surgery Assistant recruitment still creates difficulty in view of the age bar, which prevents appointment of young experienced Dental Surgery Assistants because a competitive salary cannot be offered. Clinics The policy of replacing obsolete equipment has continued, although not at the speed envisaged, due to financial restrictions which only permitted re-equipment of Woodside Road Clinic. Inspections All but 9 schools were inspected in 1971 covering approximately 80% of the school population. The failure to inspect all schools was due to the prolonged illness of one of the Dental Officers. Of the children inspected, 31% did not attend a dental practitioner for regular dental care, and 38% were found to be in need of treatment. I wish to record my appreciation of co-operation of Head Teachers and Staff in organising these inspections. 87 Treatment In 1971, 3777 school children received treatment. Of those commencing a course of treatment, 72% completed the course. The pattern of treatment provided can be indicated by the ratio of teeth filled to extracted, which was 22:1 in permanent dentition. Of permanent teeth extracted .38% were removed for reasons of orthodontic treatment. In the deciduous dentition the ration was 3.0:1. It was necessary to fit only 3 dentures. The fact that the greater number of extractions is undertaken for 5—9 age group indicated the poor state of children's teeth on entry to schools, a condition which could be resolved by fluoridation of water supplies. In the specialised field of orthodontics, 55 removable appliances were fitted and 5 fixed. The demand for this type of treatment is rapidly increasing. It was necessary to increase orthodontic sessions to 2 a week, which was undertaken by a Senior Dental Officer who has specialist qualification in this field. General anaesthetics were administered by general medical practitioners. Dental Decay Prevention and Health Education The most effective prevention is obtained through chairside instruction in the routine of oral hygiene. This is undertaken by Dental Officers and Auxiliaries for their patients. In the general field of Dental Health Education, instruction in prevention was undertaken by a Dental Auxiliary, as indicated in the table provided. No. Visited No. Instructed Schools (Primary) 25 4232 M. & C.W. Clinics 79 2101 Mothers Clubs 5 82 Ante-Natal Clinics 1 8 Play Groups 2 90 Dental Health kits containing a plastic beaker, a tube of toothpaste and a toothbrush were distributed to 1,088 new entrants and to 90 children in Play Groups. Towards the latter part of the year talks were extended to include expectant mothers and children in play groups, as it was felt that information should be given as early as possible. Maternity & Child Welfare Treatment for this priority group is not offered at particular sessions but is integrated with other children's treatment in order to provide full "Family care". Approximately 7% of dental services is given to this group. The pattern of treatment provided is increasingly orientated towards preservation, as is indicated by the ratio of extractions to 88 filled teeth, which is 10 : 1 in pre school children. It is hoped that by attendance of Dental Personnel at Ante-natal Clinics and Play Groups, a greater number of pre-school children will seek early treatment, in order that such preventive measures as the application of Topical Fluoride Solution may be used in an effort to reduce the incidence of dental caries. 89 SECTION A ENVIRONMENTAL AND SANITARY CIRCUMSTANCES IN THE AREA Page Water Supply 93 Bacteriological Results 94 Chemical Examination 95 Sewerage and Sewage Disposal 96 Public Health Acts — Statutory Notices 96 Swimming Pools 96 Noise 97 Rats and Mice 97 Disinfection 98 Disinfestation 98 Fox, Pigeon and Wasp Control 98 91 ENVIRONMENTAL AND SANITARY CIRCUMSTANCES Water Supply A generous supply of safe and wholesome water is of inestimable value to public health. The Borough is supplied with such a supply by the Metropolitan Water Board whose principal local sources are the excellent well waters of the Cray Valley. The following extract from the Metropolitan Water Board's report on the water supplied to this Borough is reproduced by kind permission of Dr.Windle Taylor, Director of the Metropolitan Water Board's Water Examination Department: — "1. (a) The supply was satisfactory both as to (i) quality, and (ii) quantity throughout 1971. (b) All new and repaired mains are disinfected with chlorine; after a predetermined period of contact the pipes are flushed out and refilled; samples of water are then collected from these treated mains; and the mains are returned to service only after the analytical results are found to be satisfactory. The quality control from these laboratories is carried out by means of daily sampling from sources of supply, from the treatment works or well stations, from the distribution system, and through to the consumer. Any signs of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structually separate dwellings supplied in the area, but the population supplied direct according to the Registrar-General's estimates at 30th June 1971, was 216,172. (ii) No houses were permanently supplied by stand-pipe. (d) No artificial fluoride is being added, and where the fluoride content is indicated in the analyses it represents the naturally occurring fluoride in the water. 2. (a) The supply was derived from the following works and pumping stations:— River Thames — derived water from the Thames Valley Group. Well water from Bexley, Crayford, Darenth, Eynsford, Horton Kirby, Wansunt and Wilmington Pumping Stations. No new sources of supply were instituted and there were no changes to the general scheme of supply in the area. (b) On account of their hardness content and alkaline reaction the Board's river and well water supplies are shown to be not plumbo-solvent. It should, however, be appreciated that all types of water pick up varying amounts of metal from the material of water piping particularly when it is newly installed; this applies to copper, zinc, iron and also to lead." 93 94 METROPOLITAN WATER BOARD — Water Examination Department BACTERIOLOGICAL RESULTS - YEARLY AVERAGES, 1971 OF THE WATER SUPPLIED TO THE LONDON BOROUGH OF BEXLEY Source of supply BEFORE TREATMENT AFTER TREATMENT Number of samples Agar plate count per ml. Coliform count Escherichia coli count Agar plate count per ml. Coliform count E. coli count 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Count per 100 ml. Per cent. samples negative in 100 ml. Count per 100 ml. Number of samples 20-24 hours at 37°C. 3 days at 22°C. Per cent. samples negative in 100 ml. Per cent. samples negative in 100 ml. River Thames - Derived 8,154 53.9 — 40.37 12.2 54.91 5.1 3,901 8.4 99.51 99.97 Bexley 263 0.1 8 100.0 — 100.0 — 254 0.1 12 100.0 100.0 Crayford No. 1 161 0.0 2 99.38 — 99.38 — 256 Crayford No. 2 153 0.8 53 99.35 0.1 99.35 0.1 0.0 7 100.0 100.0 Crayford No. 3 101 0.0 1 99.01 — 100.0 — Darenth 250 0.0 14 99.20 — 100.0 — 256 0.0 4 100.0 100.0 (a) Eynsford Well 161 0.0 10 98.14 — 98.14 — 255 (b) Eynsford Borehole 197 0.0 3 99.49 0.1 99.49 0.1 0.1 13 100.0 100.0 (a) Horton Kirby No. 1 134 0.0 29 88.81 0.3 95.52 0.1 251 (b) Horton Kirby No. 2 169 0.0 5 98.22 — 98.82 — 0.1 3 100.0 100.0 (a) Wansunt Borehole 249 0.1 14 99.60 — 100.0 — 254 1.2 8 100.0 100.0 (b) Wansunt Well 232 6.0 129 99.57 — 99.57 — Wilmington 248 0.8 74 97.18 0.2 100.0 — 245 0.3 13 99.18 100.0 METROPOLITAN WATER BOARD — Water Examination Department Average results of the chemical examination of Water supplied to the London Borough of Bexley during 1971 Milligrammes per litre (unless otherwise stated) Description of the Sample Number of Samples Ammoni- acal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs.from KMn04 4 hrs.at 27°C. B.O.D. 5 days at 20°C Hardness (total) CaC03 Hardness non carbonate CaC03 Magnesium as Mg Sodium as Na Potassium as K (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) River Thames — Derived 364 0.029 0.084 6.1 1.04 281 90 5 23.5 5.1 Bexley 5 0.011 0.019 6.0 0.09 308 74 (a) Crayford No.1 4 0.007 0.033 8.8 0.23 388 143 (b) Crayford No.2 4 0.010 0.020 7.3 0.09 292 70 (c) Crayford No.3 4 0.007 0.023 8.5 0.24 347 110 Darenth 4 0.009 0.021 6.2 0.11 285 60 Eynsford 8 0.009 0.016 4.9 0.06 266 52 Horton Kirby 9 0.004 0.014 5.8 0.07 268 59 Wansunt 53 0.160 0.038 7.6 0.19 340 99 Wilmington 4 0.020 0.029 9.0 0.19 295 74 Description of the Sample Chloride as CI Phosphate as P04 Silicate as Si02 Sulphate as S04 Natural Fluoride as F Surfaceactive material as Manoxol OT Turbidity units Colour (Burgess units) pH value Electrical ConductI ivity (micromhos) (1) (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) River Thames - Derived 34 2.3 10 64 0.15 0.02 0.1 13 7.8 580 Bexley 23 0.10 0.0 3 7.2 570 (a) Crayford No.1 35 0.10 0.0 2 7.1 790 (b) Crayford No.2 30 0.15 0.0 1 7.2 590 (c) Crayford No.3 31 0.10 0.0 2 7.1 670 Darenth 21 0.10 0.0 1 7.2 550 Eynsford 19 0.10 0.0 1 7.3 500 Horton Kirby 19 0.10 0.0 0 7.3 480 Wansunt 31 0.10 0.1 3 7.1 690 Wilmington 28 0.15 0.0 1 7.4 560 95 Sewerage and Sewage Disposal Apart from a very few individual domestic and industrial premises which are drained to cesspools, all premises in the Borough are connected to the sewerage system. The sewage is conveyed by trunk sewers principally to the treatment works of the West Kent Main Sewerage Board at Dartford. The exception being the premises in Thamesmead and other parts of Abbey Wood where the sewage goes to the large Southern Outfall Works of the Greater London Council at Crossness. The addition of parts of Abbey Wood to this point of treatment arises due to a rationalisation of design in connection with the development of Thamesmead. The Borough Engineer and Surveyor states that during the year all new premises erected have been connected to the main foul system and that the work to the major scheme affecting the Northern parts of Erith and Belvedere has continued with a scheduled completion time in the first part of 1972. Maintenance of sewers and, where necessary, pumping stations has continued as finances are allocated. For those concerned with public health and with providing and maintaining the network of sewers it is certainly not a case of 'out of sight, out of mind' and considerable quantities of finance must be regularly injected into this vital service and the ancillary service of surface water drainage. Public Health Acts — Statutory Notices Occasions still arise, often as a result of tenants' complaints, when the Public Health Inspector has to make use of the powers contained in the Public Health Acts to deal with conditions which are considered to be prejudicial to health or a 'nuisance'. In many cases it is considered necessary to send a preliminary written notice to the owner or agent and 138 such notices were issued. Where works are not carried out following the service of a preliminary notice an Abatement notice is served and 21 were served during the year. In no case was it necessary to seek a 'Nuisance Order' from the Courts for non-compliance with an Abatement notice. The service of Abatement notices has been greatly facilitated by the use of delegated powers with subsequent ratification by the Council. Swimming Pools. The Council operates three covered swimming pools, one at Lamorbey, one at Erith and the other at Crook Log. Bexleyheath, and there are open-air pools in Danson Park and Martens Grove. In addition, a small number of schools have swimming pools principally provided by parent/teacher associations. A large factory in the area has its own open-air pool, and an indoor pool is provided at a large children's residential home belonging to one of the other London Boroughs but situated in this Borough. 96 The staff of the swimming pools concerned keep a careful control of the water purity but in addition regular samples are taken by the Public Health Inspectorate for bacteriological examination and routine spot checks are also carried out for chlorine control with the Lovibond Comparator apparatus. During the year only one of the 143 samples submitted to the Public Health Laboratory Service for bacteriological examination were reported as unsatisfactory which speaks well of the efforts of the staff of the various pools in maintaining effective chlorination of the water. Noise The apparently ever increasing amount of noise to which people are subject continues to give concern. The vexed question of aircraft noise is excluded from the Noise Abatement Act. Whilst the whereabouts of London's third airport was of major concern to many areas it was expected to have at most a marginal effect on this Borough perhaps arising from the flight paths involved: We knew that we would not have to endure the horror of the third airport being close at hand. The Borough, however, is not unaffected by traffic noise either from the size of vehicles or from the volume of traffic and increasing care must be given to the routing of traffic and the incorporatioh into the design of roads of features that lessen the intrusion of traffic noise on work and leisure. Complaints of noise received from the public vary through the full range of 'private' noise nuisances, those noises controlled by byelaws, for example noisy animals and wirelesses, etc., and noise from industrial sources. Many of the latter do not admit to easy investigation, judgement or remedy. Many in fact would be below the guide-lines suggested in the British Standard Code of Practice but, nevertheless, are the cause of considerable annoyance and inconvenience, and warrant such action as is possible. During the year a Working Party of the Noise Advisory Council issued a report on 'Neighbourhood Noise' that amongst other things set out the suggested provisions of a new Noise Abatement Act in which was included provision for making Noise Abatement Areas. Rats and Mice It is the responsibility of occupiers of premises to notify the Council if their premises are infested to any marked degree by rats or mice and to keep their premises free from such infestations. In practice many 'complaints' are received and in the interests of good sanitary conditions the Council provides a control service recovering, in some cases, a charge for the service provided. Over seven hundred infestations by rats and nearly six hundred infestations by mice were dealt with by the Rodent Operators employed in the department. In addition, many more 97 premises were inspected either where infestations were suspected or for example, during the 'routine' inspection of food premises by Public Health. Inspectors. A service is provided for Council establishments under the control of other departments. Infestations of rats, especially in domestic premises, are often associateed with garden sheds, compost heaps, etc., and good maintenance of these and the general reduction of 'clutter' at the bottom of some gardens is often the answer to the householders' problem. Mice in domestic premises, particularly where it is difficult or impracticable to use either of the main rodenticides used, again call for special vigilance and perseverance by the householder in order to effect total clearance and the service provided by the Council can best be regarded as supplementary to the householder's efforts. Five written notices have been served during the year under the Prevention of Damage by Pests Act 1949. Disinfection Arrangements exist with a neighbouring London Borough (Greenwich) to disinfect articles of clothing and bedding that cannot otherwise be properly disinfected on site. The few occasions that arise are supervised by a Public Health Inspector who also gives advice at the premises and, where necessary, supervises disinfection there although the gaseous disinfection of premises is now rarely required. Disinfestation To meet the occasions when persons or personal clothing requires disinfestation arrangements exist for their attendance at a Cleansing Station in a neighbouring Borough. A small number of complaints of bed bugs and fleas, including animal flfeas, are still received each year. Although very few of these have been 'heavy' infestations they quite naturally cause disturbance to occupiers and call for thorough attention, advice and use of appropriate insecticides. Fox, Pigeon and Wasp Control Complaints are received from residents regarding 'nuisances' caused by foxes, pigeons and wasps. Whilst it is not the function of this department rigorously to control any of these species, we, nevertheless, give advice and where necessary, service where considerable inconvenience is being caused. One hundred and forty-six foxes and nearly fifteen hundred feral pigeons were killed during the year. The department received over one hundred and sixty requests, most of them during July and August, to deal with wasps' nests in and around houses, adjacent to footpaths, etc. Where these nests were accessible they were dealt with at a charge to the occupier. In other cases, for example where access behind tiles, etc., was required, the complainants were referred to a local pest control firm. 98 SECTION B Page Atmospheric Pollution 101 Domestic 101 Industrial 101 Measurement 102 Chimney Heights 102 99 ATMOSPHERIC POLLUTION Atmospheric Pollution — Domestic Towards the end of 1970 the Council, in order to meet the situation expected to arise due to shortage of solid smokeless fuel, took the advice of the Ministry and obtained suspension until the 31st March 1971 of various Smoke Control Orders covering approximately 40 per cent of premises in the Borough covered by such Orders. In fact the situation which developed, coupled with a mild winter, produced no noticeable effects. The operative date of an Order due to come into operation late in 1970 was likewise deferred and subsequently came into operation on the 1st April 1971. A further Smoke Control Order, the eleventh made either by this Council or its predecessors, was made and confirmed during the year and work to bring the Order into operation during 1972 was well in hand towards the latter part of the year. The Order covers approximately 7,500 premises in the Welling and Falconwood district. The work of processing the numerous applications for grants towards the cost of carrying out approved and necessary work of adapting fireplaces to comply with Smoke Control Orders and the final approval of works and accounts, proceeds in a well ordered fashion, in close co-operation with the various fuel suppliers and appliance fixers and the other Departments of the Council. The evidence of the success of the Smoke Control Programme in London and locally is clearly 'visible' Atmospheric Pollution — Industrial Industrial processes likely to give rise to atmospheric pollution are mainly situated in the northern part of the Borough in the Belvedere, Erith, Slade Green and Crayford areas. Heavy engineering activities have declined in recent years but various chemical, road surfacing material and other processes flourish in premises of a wide variety of sizes and when these contribute to atmospheric pollution generally or are the cause of annoyance to residents or nearby industry, they have increased rather than decreased the amount of time which has to be given to their control. The welcome increase in public awareness of pollution and atmospheric pollution in particular, makes its contribution to keeping this important aspect of the Public Health Inspector's work in the forefront for whilst the existence of dark smoke is now rare, there are many problems of odour, dust and grit that constantly need attention. 101 Measurement For the purposes of measuring the degree of certain aspects of atmospheric pollution, various gauges are in operation in various parts of the Borough. Daily readings of smoke and sulphur dioxide are taken at four places where standard Volumetric equipment is in operation and each month the contents of the three standard Deposit gauges and the one 4-point Directional gauge are reported upon by the Analyst retained by the Thames-side Joint Committee for the abatement of Atmospheric Pollution, upon which Committee two members of this Council serve. Apart from supplying local information e.g. in the case of the Deposit Gauges, the amount of dust from cement works, the results are used in Regional and National Surveys. Chimney Heights Chimneys provided for large furnaces are required to satisfy the local authority and the Clean Air Act 1968 as respects to the height of the chimney. These requirements are quite apart from any planning or other permission needed or any approval of the furnace or its ancillary plant, including any systems to clean the flue gases. Discussions with consulting engineers and their contractors, the assessment of the technical detail and the use of published recommendations has in all cases produced an agreed height that can be approved allowing proper dispersal of flue gases. 102 SECTION C FOOD AND FOOD PREMISES Page Food Inspection 105 Food Sampling 105 Imported Food Regulations 105 Bacteriological Examination of Food and Water 106 Food Complaints 106 Milk Supply 107 Food Hygiene (General) Regulations 1970 107 103 FOOD AND FOOD PREMISES Food Inspection Numerous requests were made during the course of the year for Public Health Inspectors to examine food considered to be unfit. In addition, food at many places of storage and sale has been subject to routine inspection by Public Health Inspectors. On no occasion was it necessary to use the powers contained in the Food and Drugs Act 1955 for the seizure of unfit food; all food having been dealt with under the established 'surrender' procedures. Approximately 110 tons of unfit food were dealt with during the year, some 60 tons of this being accounted for by one consignment of goods damaged in a food warehouse fire. A fair proportion of the remainder surrendered as unfit resulted from breakdowns of refrigerated storage cabinets in shops and supermarkets and, whilst some failures are inevitable, the resultant loss of food emphasises the need for careful and regular servicing of equipment. There are no premises situated in the Borough which are used as a slaughter-house or for poultry processing. Food Sampling Samples of food and drugs are regularly taken under Food and Drugs Act 1955 and submitted to the Public Analyst for analysis. The following table shows the number of samples taken and the number found to be unsatisfactory. No. of Samples Taken Unsatisfactory 847 76 The number of unsatisfactory samples was more than double that of 1970. The main causes of the unsatisfactory samples reported by the Public Analyst were excessive preservatives, excessive tin content, prohibited colourings, unsatisfactory labelling, and deficiencies in meat content. Where possible follow-up samples were taken and matters were found to be rectified. The unsatisfactory samples were drawn to the attention of retailers and manufacturers. All samples are submitted to Dr. Amphlett Williams who has been the Council's Public Analyst for the purposes of the Food and Drugs Act 1955 since the 1st April 1965. During the year the Council appointed Mr. S.J. Bush as an additional Public Analyst. Imported Food Regulations The Imported Food Regulations 1968 contain measures for the protection of public health in relation to imported food, and require that the regulations are to be enforced by both port health authorities and inland local authorities. As a result a vast increase in the work of food 105 inspection has taken place in the Borough, There are two large imported food warehouses in the Borough and a few smaller ones taking in special commodities e.g. fresh fruit and vegetables, meat, etc. The main sources from which the food arrives here are Italy, Spain, Canada, Israel and Ireland. During the year 159 samples of Imported Food were taken and submitted for examination by the Public Analyst, the results are included in the paragraph on Food Sampling. Bacteriological Examination of Food and Water Arrangements exist with the Public Health Laboratory Service at Preston Hall near Maidstone to carry out bacteriological examination of certain samples and the following table shows the number of routine samples submitted. Water 6 Water (Swimming Pools) 143 Ice Cream 48 Milk 24 One sample of swimming bath water, one of milk and two of ice cream were reported as unsatisfactory. Repeat samples were reported on favourably and investigations showed no problems. Food Complaints Some persons who have purchased food which is in their opinion unsuitable for consumption have during the course of the year complained to the department and the following table shows the number of such complaints and the number of special samples submitted to the Public Analyst. No. of Complaints Investigated 95 No. of Special Samples submitted to Public Analyst 20 The number of complaints received was lower than in 1970. Bread, Milk and meat products continue to be the foods most complained of. Insufficient attention to stock rotation at the retail outlet was responsible for many of the complaints. Prosecutions in six cases, were successfully taken to Court. The offences were varied — wire in yoghurt, glass in milk bottle, metal in cake, unfit ham, dirty milk bottles, and mouldy cheese cake. Fines and costs for these offences totalled £171. In the cases where the complaints were of a minor nature or where the complainants were not willing for formal action to be taken then informal action has been taken in conjunction with the retailers, distributors or manufacturers as the case may be. 106 Milk Supply — General Milk is distributed throughout the Borough by six main distributors, three of whom have large distribution depots in the Borough. There are no bottling or processing plants. Apart from house to house deliveries there are some T30 retail outlets mainly grocers shops and supermarkets, although the increased use of waxed cartons and plastic containers has extended the sale of milk in refrigerated cabinets to other outlets as has the increased sale of "long life" milk. All milk sold in the Borough has to be sold under a "special designation" i.e. untreated, sterilised, pasteurised or ultra heat treated and must comply with the appropriate regulations. Twenty-four samples of milk were submitted for bacteriological examination and five samples for chemical examination; all these samples were reported as satisfactory. In view of the virtual absence of untreated milk no samples have been submitted for special examination for the presence of brucella abortus. Food Hygiene (General) Regulations 1970 The above Regulations set out requirements relating to premises, equipment and food handlers and apply to approximately 1,000 premises of various sizes and nature throughout the Borough ranging from the small corner shop to the large food factory. There is a constant need to advise persons on the need and manner of complying with the Regulations which form an essential part in the process of the protection of food. Advice is also given to persons proposing to open or operate food premises to which the Regulations apply. During the year it has been necessary, in addition to verbal notices, to serve 48 written notices on occupiers drawing their attention to various defaults. In one case,Court proceedings were instituted but the premises closed down and ceased business before the date of the Court Hearing. 107 SECTION D Page Housing 111 Housing Act 1957 — Unfit Premises 111 Housing Acts 1964—1969 — Improvements 111 Housing Act 1961 — Houses in Multiple Occupation 112 Housing Act 1969 — Qualification Certificates 112 Caravans and Caravan Sites 113 Common Lodging Houses 113 Rent Act 1968 113 109 HOUSING Housing Act 1957 — Unfit Premises Further progress was made to deal with unfit property and during the year 2 Demolition Orders, 13 Closing Orders and 2 Closing Orders of parts of buildings, were made. In addition 3 undertakings were given by owners not to relet property and these were accepted by the Council in lieu of making Closing Orders. There were no Clearance Areas declared during the year although certain areas of the Borough were surveyed with a view to ascertaining whether the properties fell within the scope of Part III of the Housing Act 1957 (Clearance Areas). Housing Acts 1964-1969 — Improvements As mentioned in the Annual Report for 1970 information is passed to this department from the Town Clerk of all applications made to the Council for Improvement Grants. This enables the department to comment in cases where a house is already subject to a Closing Order, where any action may be contemplated by way of Slum Clearance, or where any other material information is known. Nine representations were made by tenants under Section 19 of the Housing Act 1964 with a view to providing standard amenities within their dwellings. (The standard amenities are a bath in a bathroom, a hand basin, a sink, hot and cold water supply to those fittings and an internal watercloset where this is reasonably practicable). In four cases the Council served Immediate Improvement Notices on the owners to provide those amenities. It is anticipated that Immediate Improvement Notices will be served in the forthcoming year on the remaining five properties. Seven properties were provided with the standard amenities as a result of Immediate Improvement Notices being served prior to this year. The Department of the Environment made approaches to this authority and to the other London Boroughs with a view to launching a campaign of house improvement in April 1972. As a result a number of meetings were held between Officers of this Council and those of the Department of the Environment, London Electricity Board, South-Eastern Gas Board, and other interested parties with a view to preparing and launching the campaign. The Council have not yet declared any General Improvement Areas although a few meetings were held at Officer level to consider the possibility of so doing. The making of a General Improvement Area, however, cannot be taken lightly as the amount of work involved is considerable not only in the Health Department but in other departments of the Council. In the right area there is an opportunity to give impetus to house improvement by the making of General Improvement Areas, especially where this can be linked with environmental improvements and the powers contained in the Housing Act 1969 are worthy of detailed study as part of a general programme of dealing with unsatisfactory dwelling houses. 111 Housing Act 1961 — Houses in Multiple Occupation Although presenting no serious problem in the Borough, a number of houses which were known to be in multiple occupation were visited to ensure that they complied with the provisions of the Housing Acts. The Borough Engineer and Surveyor is responsible for ensuring that the properties reach the required standard in so far as Means of Escape in Case of Fire is concerned and these visits are normally carried out jointly by members of that department and the Public Health Inspectorate. In some cases informal notices were served and these were generally complied with. The Council has adopted a Code of Practice setting out minimum standards to be achieved in such premises and this code is drawn to the attention of owners whenever necessary. Housing Act 1969 — Qualification Certificates The Housing Act 1969 provides for properties which are fit for human habitation, in good repair having regard to their age, character and locality and with the standard amenities to become regulated tenancies within the meaning of the Rent Act 1968. The Town Clerk receives all such applications but the technical work, inspections, etc., are carried out by the Public Health Inspectorate. The following figures are a guidance of the work involved during the year. Qualification Certificates issued 360 Applications refused or cancelled 126 Applications held in abeyance (at 31st Dec.1971) pending negotiations with the owners, agents, etc. 20 Total applications received 506 In a number of cases Qualification Certificates have been issued after applications have been held in abeyance to give the owner the opportunity of carrying out repairs considered necessary to bring the house up to standard. In addition to the above, the following applications were made in cases where the properties lacked the standard amenities but where the owners intended providing the standard amenities. Applications for Provisional Approval granted 108 Applications refused or cancelled 11 Total applications received 119 Dealing with these applications has involved a considerable amount of work. Well over 2,000 visits and inspections were carried out and consequently a considerable amount of administrative work was also involved. 112 In a number of cases it was found that the electrical installation of the properties was thought to be defective and the Borough Engineer & Surveyor's Electrical Engineering Section were asked, therefore, to call and test the electrical installations in properties. Where it was found that the properties were defective in this respect owners were required to renew the electrical installation. Caravans and Caravan Sites Four site licences are currently in force permitting the use of land for residential caravans. Three of these licences are in respect of single caravans and the remaining licence permits six caravans. These sites have not caused any trouble with regard to the maintenance of satisfactory conditions. Approximately fifteen caravans have remained on the verge of the A.20 trunk road forming the Southern boundary of the Borough and immediately adjacent to the London Borough of Bromley. The actual number of caravans has varied throughout the year but the problems which started in 1966 when caravans were first regularly parked on this verge continue. The problems are aggravated by the absence of sanitary facilities and the site conditions, which are never good, are generally poor especially during and following periods of inclement weather. In order to assist with the removal of rubbish, "skips" are stationed on the site and periodic clearance of the site and ditch is carried out by the Borough Engineer and Surveyor's Department. Discussions have continued with persons representing the caravan dwellers and preliminary layouts have been prepared for a proposed site to meet the requirements of the Caravan Sites Act 1968. Common Lodging Houses There are no premises in the Borough which are classified as Common Lodging Houses and to which may be applied the provisions of the Public Health Act 1936 regarding registration. Rent Act 1968 The number of "controlled" tenants who avail themselves of the provisions contained in the Rent Act 1968 under which they can obtain from the Council a Certificate of Disrepair authorising them to reduce the rent continues to be small. During the year only three such applications were received and each of them resulted in an undertaking being obtained from the landlord to carry out the necessary repairs within the prescribed period of six months and thus avoiding the necessity to reduce the rent. 113 SECTION E WORKPLACES Page Offices, Shops and Railway Premises Act 1963 Premises and General Inspections Accidents Hoists and Lifts Factories Act 1961 Factory Inspections Outworker Premises. 115 WORKPLACES Offices, Shops & Railway Premises Act 1963 Premises and General Inspections. The number of registered premises, 1,576, remained about the same as last year. Six hundred and twenty-one visits were made to premises during the year and about one-third of the premises registered received a general inspection. Much of the enforcement is by verbal notices although twenty written notices were served during the period. Accidents Forty-two notifications of accidents were received during the year none of which was fatal although two were serious. Nine accidents were investigated in detail and recommendations made although it was not considered necessary to forward details to H.M.Factory Inspectorate. This is a slight increase on the previous year. It is still thought that many accidents qualifying for notification are not, in fact, notified although occupiers are reminded that notification is a statutory requirement. Hoists and Lifts Fifteen occupiers of premises had their attention drawn to deficiencies in the operation and defects to the mechanism of hoists and lifts at their premises. Most of these were licensed premises and it has been found that now the various brewers have become accustomed to the requirements of the Hoists and Lifts Regulations, repair work is being carried out more quickly than last year. Factories Act 1961 Factory inspections (a) The following table shows the number of premises on the Local Authority register of the various classes of factories. Inspections are carried out and, where necessary, defaults in complying with the Sanitary Accommodation Regulations and other applicable Regulations are drawn to the attention of the occupier. 117 No prosecutions have been instituted during the year. Premises (1) Number on Register (2) Inspections (3) Number of written Notices (4) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 38 10 (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 494 303 2 (iii) Other premises in which Section 7 is enforced by the Local Authority (excluding outworkers premises) 40 105 - TOTAL 532 418 2 2. Cases in which DEFECTS were found. Particulars Number of cases in which defects were found. Found Remedied Referred To HM Inspector By HM Inspector (1) (2) (3) (4) (5) Want of Cleanliness (S1) Overcrowding (S2) Unreasonable temperature (S3) 1 Ineffective drainage of floors (S6) Sanitary Conveniences (S7) (a) Insufficient (b) Unsuitable or defective 7 7 - 7 (c) Not separate for sexes Other offences against the Act (not including offences relating to outwork) 7 7 1 7 118 (b) Where new factories or alterations to existing factories are proposed that require Planning Permission and/or Building Regulations control and an application is made to the Local Authority for the required approval, then arrangements exist between the Borough Engineer & Surveyor and the Chief Public Health Inspector for plans to be passed between departments for perusal. Once again this year this process has been instrumental in bringing to light the need for many aspects of design and layout to be reconsidered at the plan stage. Outworkers Premises A total of 156 persons were notified to this Authority, by the Local Authorities in whose area their employers are in business, as being employed in their homes undertaking "outwork". The making of various forms of wearing apparel was the most frequently notified form of outwork, 119 persons being so notified. A further 37 persons were engaged in making or finishing lampshades. No unwholesome premises were found to be in use and no proceedings taken. 119 SECTION F GENERAL Page Diseases of Animals Act 1950 123 Slaughter of Animals Act 1958 123 Pet Animals Act 1951 123 Animal Boarding Establishments Act 1963 123 Riding Establishments Act 1964—1970 121 GENERAL Diseases of Animals Act 1950 The above Act and Orders made thereunder impose on Local Authorities duties regarding the control of specific diseases of animals for example foot and mouth disease, fowl pest, swine fever, etc. Amongst those duties is the routine control of the movement of swine and their retention for certain periods at premises (except a slaughterhouse) following authorised movement. As in previous years functions under this Act can be more efficiently carried out on an agency basis and for several years now this Council has had a very satisfactory arrangement with the Corporation of London with whose Veterinary Officer close liaison is maintained. Slaughter of Animals Act 1958 Any person who slaughters, or stuns prior to slaughter, an animal for food is required to do so humanely and to hold a licence under the above Act. It is customary for licences to be issued by the Local Authority in whose area such persons are employed as slaughtermen as they are best able to determine that the person is a fit and proper person to be so licensed. No licences have been issued or renewed by this Council since the private slaughterhouse at Belvedere ceased business during 1968. Pet Animals Act 1951 Those persons who keep pet shops or otherwise carry on a business of selling animals as pets are required to hold a licence. Nineteen annual licences were issued during the year, a fee of £2 is payable in respect of each licence. Inspections of premises are carried out from time to time in order to ensure that the conditions subject to which the licences are issued are being complied with. Animal Boarding Establishments Act 1963 Premises used for the business of boarding other peoples' animals, usually dogs and cats, are required to be inspected and annually licenced. Where the boarding is incidental to another business, for example an overnight stay at a Veterinary Surgeon's establishment, no licence is required. Three premises were licensed and appropriate conditions attached to the licences. One small premise which had been used for the boarding of cats for many years ceased to operate on being sold for redevelopment. 123 Riding Establishments Act 1964-1970 Any person who keeps horses for the purpose of letting them out on hire for riding or for them being used, in return for payment, for instruction in riding is required to hold a licence issued by the Local Authority under the above Acts. Licences in respect of six riding establishments situated within this Borough were in force; two premises ceased being used as riding establishments during the year. Prior to the issue of the licences veterinary reports on the horses at riding establishments are received from the Veterinary Officer of the Corporation of London. Inspections, inquiries and licences have had regard to the amendments and extensions of the Riding Establishments Act 1964 which are contained in the Riding Establishments Act 1970 which came into operation on January 1st, 1971. 124 Printed by the Reprographic Section. Town Clerk's Department. London Borough of Bexley. Town Hall. Erith. Kent.