BR019 LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 1967 L. R. L. EDWARDS. M.D. (Lond.), M.B., B.S., M.R.C.S., L.R.C.P.. D.P.U. Medical Officer of Health and Principal School Medical Officer SHERMAN HOUSE, SHERMAN ROAD, BROMLEY Telephone: 01-460 9900 LONDON BOROUGH OF BROMLEY Annual Report OF THE MEDICAL OFFICER OF HEALTH AND PRINCIPAL SCHOOL MEDICAL OFFICER 1967 L. R. L. EDWARDS. M.D. (Lond.). M.B., B.S., M.R.C.S., L.R.C.P., D.P.H. Medical Officer of Health and Principal School Medical Officer SHERMAN HOUSE, SHERMAN ROAD. BROMLEY Telephone: 01-460 9900 3 INDEX See Page 154 for Index to School Health Service Report. Page A Ambulance Service 41 Animal Boarding Establishments 148 Accidents (Street) 25 B Bacteriological Examinations— Sundry 115 Births 22 C Care of Mothers and Young Children 31 Care of Unmarried Mother and Her Child 31 Cervical Cytology 32 Child Minders 32 Chiropody 38 Clean Air Act 132 Common Lodging Houses 128 D Day Care 81 Day Nurseries 31 Deaf Children 30 Deaths 22 Dental Services, M. & C.W. and School Health 42 Diphtheria 51 Diseases of Animals 146 Disinfection 132 Disinfestation 132 Drainage and Sewerage 130 Dysentery 51 E Environmental Health Services Erysipelas 51 Page F Factories Act 140 Food and Drugs Act—Sampling 101 Food Complaints 117 Food Poisoning 52 Food Premises 119 H Health and Welfare Committee 7 Health Education 45 Health Visiting 34 Home Help Service 39 Home Nursing 36 Home Safety 45 Housing and Slum Clearance .... 120 Housing — Improvement Areas 126 Housing — Improvement Grants 126 Housing Inspections 127 Housing—Public Health Acts 126 I Ice Cream Sampling 114 Immigrants — Medical Arrangements 38 Infant Mortality 25 Infectious and Other Diseases 51 Inspection and Supervision of Foods 100 Introductory Review 11 M Marie Curie Foundation Fund 36 Maternal Mortality 25 Maternity and Child Welfare 29 Meals and Recreation for the Elderly 83 5 INDEX—(continued) Page Page Measles 52 Meat Inspection 116 Meningococcal Infections 52 Mental Health Services 59 Mental Subnormality 65 Meteorological Observations 21 Midwifery 32 Milk Sampling 114 Milk—Special Designations Regulations 120 Mortuaries 141 Moveable Dwellings 129 N National Assistance Acts 38 Nursing Homes 32 O Offices, Shops and Railway Premises Act 137 Ophthalmia Neonatorum 52 Outwork 141 P Pet Animals Act 148 Pigeon Destruction 136 Physically Handicapped 84 Pneumonia 53 Poliomyelitis 53 Population 22 Puerperal Pyrexia 53 R Rag Flock 120 Recuperative Care 32 Registration—Disabled and Old People's Homes 82 Rehousing 125 Rent Act, 1957 127 Residential Care 79 Riding Establishments 148 Rodent Control 135 S Scarlet Fever 53 Smallpox 53 Staff 8 Statistics—Environmental 148 Statistics—Vital 19 Statutory Notices 128 Swimming Baths 146 T Temporary Accommodation 84 Training Centres 63 Tuberculosis 53 Typhoid Fever 54 U Unsound Food 113 V Vaccination and Immunisation 37 Venereal Diseases 40 Vital Statistics 19 W Water Supply 142 Welfare—Blind and Partially Sighted 88 Welfare Foods 31 Welfare—Handicapped Persons 84 Welfare Services 77 Whooping Cough 54 7 HEALTH AND WELFARE COMMITTEE (as at 31st December, 1967) Chairman : Alderman Miss B. James, J.P. Vice-Chairman : Councillor Mrs. S. M. Stead The Mayor: Alderman Mrs. A. L. Gunn, J.P. Councillors: Mrs. N. V. Carter D. J. W. Eves H. W. Haden Mrs. M. J. Higgins M. B. Kenward J. A. Mansi, M.R.C.S.(Eng.), L.R.C.P.(Lond) K. A. Pawsey Mrs. M. M. Read J. P. Sheridan, A.M.I.E.I. W. H. Stephenson C. E. Stickings. B Sc.. Ph.D. B. H. Taylor, L.D.S., R.C.S.(Eng.) Mrs. D. E. L. West, M.B.E. Co-opted Members : Miss A. Denholm, S.R.N. Miss M. E. Lambert, S.R.N., S.C.M., M.T.D. H. J. Lester, O.B.E., J.P., F.C.A. G. D. Stilwell. M.R.C.S(Eng), L.R.C.P.(Lond.) 8 STAFF OF THE HEALTH AND WELFARE DEPARTMENT (as at 31st December, 1967) MEDICAL AND DENTAL STAFF: Medical Officer of Health and Principal School Medical Officer: L. R. L. EDWARDS, m.d.(Lond.), m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Deputy Medical Officer of Health and Deputy Principal School Medical Officer: A. J. I. Kelynack, m.b., b.s., d.p.h. Senior Medical Officer (School Health): H. B. Carter-Locke, m.b., b.s., m.r.c.s., l.r.c.p., d.p.h. Senior Medical Officer (Maternity and Child Welfare): P. A. Currie, m.r.c.s., l.r.c.p. Senior Medical Officer (Mental Health): Sara Syrop, m.d.(Warsaw), d.p.h., d.c.h., d.t.m. & h. Assistant Medical Officers: (Mrs.) E. M. Davis, m.b., b.s.(Lond.), m.r.c.s., l.r.c.p., d.c.h. •(Mrs.) A. Gall, m.a., m.b., b.ch. (Mrs.) G. L. Hobbs, m.r.c.s., l.r.c.p. E. Gaynor Lewis, m.b., b.ch., d.t.m. & h. (Mrs.) A. J. Jones, m.b., ch.b. (Mrs.) J. C. Lister, m.b., b.s.(Lond-). (Mrs.) B. R. Luscombe, m.r.c.s., l.r.c.p. (Mrs.) I. F. Maclean, m.b., ch.b. (Mrs) C. M. Maxwell, m.a., m.b., b.chir. (Mrs.) J. C. Van Essen, m.b., ch.b. ♦Part-time. 10 General Practitioners attend clinics on a sessional basis. Principal Dental Officer: Mrs. C. M. Lindsay, l.d.s., r.f.p.s.(Glasgow). Dental Officers'. R. G. Cooper, b.d.s., l.d.s., r.C.s.(Eng.). (Mrs.) I. T. Creed, l.d.s., r.c.s.(Eng-). (Mrs.) M. M. Alford, l.d.s., r.c.s.i. (Mrs.) M. I. Kininmonth, l.d.s. (Part-time). (Mrs.) A. R. Leach, b.d.s. (Mrs.) A. P. O'Reilly, l.d.s., r.c.s.(Eng.). 4 Dental Officers (Sessional), 2 Anaesthetists (Sessional), 1 Orthodontist (Sessional), 1 Dental Hygienist, 10 Dental Attendants. Orthopaedic Surgeon (in conjunction with Regional Hospital Board): K. F. Hulbert, f.r.c.s. Physiotherapist: Mrs. V. Norman, m.c.s.p. (Sessional). Senior Speech Therapist: Mrs. M. M. Evans, l.c.s.t. 3 Speech Therapists (2 Part-time). Ophthalmologists: 6 (Sessional). Orthoptist: Mrs. D. A. Ivil, d.b.o. (Part-time). Chest Physicians (in conjunction with Regional Hospital Board): D. G. Madigan, b.a., m.b., b.ch., b.a.o., n.u.i. E. W. Street, m.r.c.s., l.r.c.p. Psychiatrist: 1 (in conjunction with Regional Hospital Board) (Part-time). 9 NURSING AND ALLIED STAFFS: Superintendent Home Nursing Service: Mrs. J. Symington, s.r.n., s.c.m., d.d.n. Deputy Superintendent Home Nursing Service: Mrs. M. O. Tierney, s.r.n., q.n. 39 Home Nurses. Superintendent Health Visitor: Miss B. N. Chandler, s.r.n., s.c.m., h.v.cert., Dip. Soc. Studies(Lond). Deputy Superintendent Health Visitor: Mrs. M. M. Connolly, s.r.n., s.c.m., q.n., h.v.cert. Group Adviser: Mrs. L. A. Hamilton, s.r.n., s.c.m., H.v.cert. 39 Health Visitors, 5 Student Health Visitors. Non-Medical Supervisor of Midwives: Miss G. I. Simmons, s.r.n., s.c.m. Deputy Supervisor of Midwives: Miss M. C. Martin, s.r.n., s.c.m. 29 District Midwives (including 2 Part-time). Senior Home Help Organiser: Miss J. Woodrow, m.i.o.h.h.o. Deputy Senior Home Help Organiser: Mrs. E. F. Thompson, m.i.o.h.h.o. 5 Area Home Help Organisers. PUBLIC HEALTH INSPECTORS' STAFF: Chief Public Health Inspector: J. C. Kermode, m.a.p.h.i., m.r.s.h. Deputy Chief Public Health Inspector: W. T. Weedy, m.a.p.h.i., m.r.s.h. Divisional Public Health Inspectors: A. I. Bell, m.a.p.h.i. P. R. Light, m.a.p.h.i., a.r.s.h. E. U. Williams, m.a.p.h.i. 15 Public Health Inspectors, 3 Technical Assistants, 5 Trainee Public Health Inspectors, 1 Senior Rodent Operator, 7 Rodent Operators, 3 Disinfector/Handymen, 2 Mortuary Keepers. WELFARE SERVICES STAFF: Chief Welfare Officer: J. Hanson, o.b.e., d.m.a., f.i.s.w. Deputy Chief Welfare Officer: J. R. Gill, d.m.a., a.i.s.w. Casework Supervisor: Mrs. E. K. Lemare-Long, a.m.i., m.s.w. 4 Senior Social Welfare Officers, 1 Spec. Social Welfare Officer (Deaf), 12 Social Welfare Officers (1 Part-time), 2 Occupations' Officers, 1 Industrial Work Organiser, 8 Trainee Welfare Assistants. Staff at 8 Residential Homes: 8 Matrons, 10 Assistant Matrons, 1 Warden, Chaplains and other staff. Chief Chiropodist: A. S. Jones, s.r.c., m.c.l.s. 1 Senior Chiropodist, 3 Chiropodists (Sessional). 10 MENTAL HEALTH STAFF: Principal Mental Welfare Officer: H. J. Vagg, a.r.s.h., a.i.s.w. Deputy Principal Mental Welfare Officer: A. F. Puckett, m.s.m.w.d., a.a.p.s.w. 3 Senior Mental Welfare Officers. 10 Mental Welfare Officers, 2 Trainee Mental Welfare Assistants. ADMINISTRATIVE STAFF: Chief Administrative Officer: N. H. Collins, a.C.C.s., a.r.s.h. Senior Administrative Officer: S. F. Judd, a.r.s.h. Central Administration: Senior Administrative Assistant: R. D. Billings, a.C.C.s. 2 Administrative Assistants, 1 Secretary, 1 Co-ordinating Secretary, 2 Clerical Assistants, 4 Clerks. 4 Shorthand-Typists, 1 Supernumerary Junior Clerk, 3 Telephonists (2 part-time), 1 Driver/ Storekeeper. Environmental Health: Senior Administrative Assistant: B. Adams. 2 Administrative Assistants, 3 Clerical Assistants. 4 Clerks. 2 Shorthand-Typists, 1 Supernumerary Junior Clerk. Maternity and Child Welfare: Senior Administrative Assistant: G. R. L. Smith. 2 Administrative Assistants, 3 Clerical Assistants, 4 Clerks, 1 Supernumerary Junior Clerk. Mental Health: 1 Administrative Assistant. 1 Clerical Assistant, 1 Clerk. 1 Shorthand-Typist. School Health : Senior Administrative Assistant: Miss D. W. Gardner. 1 Administrative Assistant, 4 Clerical Assistants, 6 Clerks 1 Supernumerary Junior Clerk. 1 Shorthand-Typist (Part-time). Welfare: Senior Administrative Assistant: J. W. Meeks. 3 Administrative Assistants. 1 Secretary. 4 Clerical Assistants, 3 Clerks, 1 Shorthand-Typist (part-time), 4 Clerks (Residential Homes). 1 Supernumerary Junior Clerk. Area Offices and Clinics: 6 Clerical Assistants. 9 Clerks (2 part-time), 3 Clerk/Typists. 20 Clinic Clerks (Part-time). Health Education and Home Safety Officer: J. Bretton. 11 To: THE MAYOR, ALDERMEN AND COUNCILLORS OF THE LONDON BOROUGH OF BROMLEY Mr. Mayor, Ladies and Gentlemen, I have the honour to present a report for the year 1967 on the services administered by the Health and Welfare Department of the London Borough of Bromley. This report is set out to the requirements of Ministry of Health Circular 1/67. In addition to the factual information provided for the year under review, important changes and trends in the fields of health, sociology and environment are reported by the senior officers. To be of real significance, these trends should be noted over a substantial period of time and an advantage of the time factor in the preparation of these reports is that members can rely on the validity of the observations. Statistics I have collated from various sections of the report, facts which reflect local and national experience and can stimulate much thought and discussion on future policies. (1) Birth Rate. The number of births in this Borough during 1967 was 0.9 per 1,000 lower than in 1966 and 1.4 per 1,000 lower than in 1965. The figure of 15 births per 1,000 population is well below that for Greater London (17.0) and England and Wales (17.2). (2) Maternal and Infant Mortality. There were no maternal deaths and the Infant Mortality (16) per 1,000 births was lower than Greater London (18.4) and England and Wales (18.3). (3) Increasing Population with a density of 7.7 persons per acre. (4) High Total Rainfall of 28.71 inches. (5) Mortality of Cancer of the Lung shows little change over three years, and that change is a decrease in preponderance of male over female deaths. (6) 395 children were injured, with 3 deaths, resulting from street accidents. (7) Increase in the percentage of admissions to residential homes from hospitals and in respect of persons living alone. (8) Percentage of admissions to residential homes of persons over the age of 85 was higher than the national average (36% compared with 27.5%). National Health Service Act, 1946 Health Centres During the year, a party of members and officers visited Bristol and Hythe to obtain information on capital and revenue costs and 12 provision of services from these pioneer health centres. Reports were submitted to the Policy Sub-Committee and the main Committee and meetings were held with representatives of the Local Medical Committee and the Executive Council. Against the background of the serious situation in general medical practice arising from problems of recruitment and retirements which had not been alleviated by the setting up of group practices and the policy of the Committee to attach Local Authority staff wherever possible, the Committee decided to investigate the probable grouping and the setting up of a Feasibility Study for an area shown to be one of maximum need. This logical approach tempered with caution was necessary in spite of enthusiasm on both sides because of the probable cost and scarcity of sites for such a project, the more urgent need to develop other services, and the restrictions on attachment of local authority staff. Personal Health Services In spite of full publicity through co-operation with voluntary services, there has been a disappointing fall in first attendances for cervical cytology. This is part of a national pattern, and it is interesting to speculate why the general public has less faith in this method of health screening than in mass radiography for chest diseases. The finding of only 11 cases of carcinoma-in-situ out of 2,144 examinations is justification enough from a medical point of view but perhaps not enough from a lay point of view. The report sets out the organisation and rationalisation of a screening system for the earliest detection of deafness entailing co-operation between Assistant Medical Officers and Health Visitors and full follow-up and supervision. This is one of many services where medical and nursing staff of the Authority are developing special skills and side by side systems of record keeping of babies born at risk of handicap are being developed in full co-operation with the Hospital Paediatric Services. Amenity provisions of Nursing Homes vary but close and friendly supervision is maintained by the regular visits of a Senior Medical Officer who is also responsible for the supervision of private Day Nurseries and Playgroups in the Borough. Full clinic facilities have been granted wherever possible on request to the Family Planning Association and it is possible, from statistical evidence already mentioned, that the efforts of the Association added to private action, are succeeding in this area of Greater London. Reports of the Home Nursing, Home Help and Chiropody sections show the increasing demands of this service for the domiciliary care of the elderly. Geriatric Units discharge to home care increasing numbers of patients needing more time and more specialised nursing attention and equipment. Full-time Home Helps cannot be recruited and it 13 is possible to provide only basic requirements in some cases and minimal help to those with relatives close at hand. The quality of care in the Home Nursing and Home Help Services is under constant review and in spite of the restricted time and finance available, attendances at lectures and inservice training courses are being developed. As promised in an earlier report, reappraisal of the work carried out by the Home Nursing Service has been carried out and the evidence shows that the pattern of the service is changing so that increased skills are needed. There is a need for an additional male nurse and the number of enrolled nurses and nursing auxiliaries employed is about right for the service. Mental Health Act 1959 The development of this service has continued on the principles of policy which the Committee have approved from the initiation of the service. Firstly a policy of primary prevention which accepts the wider role of the Mental Health Officer as health educator to the family and in a wider sense to the community. Secondly, a policy of full integration with the Hospital, the Special Clinics and General Medical Practitioner services by attachment of experienced officers. The report shows how rapidly these policies have been implemented to enable social support for the mentally disordered patient and family to be maintained throughout the period of treatment and after-care. Co-operation with the voluntary associations, which is a twoway process, has resulted in the setting up of a large number of social clubs and the Mental Welfare officers have played a most active part on the steering committees and subsequent committees of management. The officers have also helped in a similar way with two special playgroups set up in the Borough. The report records the need for a Special Care Unit at the Training Centre and this will be incorporated in the new Junior Centre to be opened in 1969. The need for special medical supervision of this Unit does not require qualification. Stembridge Hall Day Centre, as the first mental health capital project, appears in the report for the first time though opened in September 1967. Over a period of nine months, out of 34 referrals, only two patients relapsed and were re-admitted to hospital. This high success rate was due to careful selection. Although the period of review is short, it is clear that success in obtaining contracts for industrial work and in providing a gateway to open employment and social rehabilitation is being achieved through the enthusiasm and ability of the supervisory staff at the Centre. In the report for 1968, a review will be included of the work at Rydal Mount, a fifteen place short stay hostel for the ex-mentally ill patient which will be operational early in that year. This hostel 14 is part of a large programme of Adult Training Centres, Work Centres and Hostels for mentally subnormal adults and children. While the needs have been evaluated and established, the priorities must be reviewed from time to time in terms of relative urgency, availability of alternative provision of service, provision for the greater number in need, and the economics of site and financial resources. National Assistance Acts 1948/62 The Chief Welfare Officer has presented a comprehensive report on the development of the Welfare Services in the Borough. In a similar way to the complementary Mental Health Services, co-operation with the Hospital Services and General Medical Services has been developed. There has been an increased percentage of admissions to residential homes from hospital and an expansion of the service provided in personal aids to nursing at home and of adaptations to homes. At the same time, attention has been drawn to the need to evaluate whether the capital programme provides adequate future residential homes. The point is made that this Authority has a higher than national percentage of admissions of persons over 85 years of age with the obvious lesson that these residents need more care and attention. The competing claims of hospital care, residential home care and community care services needs evaluation and constant review. A meeting under the auspices of the Regional Hospital Board has been held to discuss these questions but now, after several years, it seems appropriate that another meeting should be called to discuss these very difficult questions. In spite of the immediate difficulties of providing residential accommodation, the termination of joint-user arrangements with Orpington Hospital has been accomplished and residents suitably accommodated in more appropriate homely surroundings. The development of day care in residential homes to provide for those elderly in the community, companionship and relief from home surroundings during the day has continued with benefit to the residents and staff of residential homes and joy to those elderly persons for whom transport can be provided. This valuable service must inevitably be limited by the special transport needed and the other calls to clubs, outings, and entertainment, for these vehicles. The Section has been particularly concerned with the development of services for the handicapped, especially the Blind and Deaf, and the officers have given a great deal of time outside normal hours to attendance at Centres and Clubs, and at meetings of voluntary organisations greatly concerned in these developments. In this connection, greater help is being given to the younger 15 handicapped. The appointment of a Specialist Welfare Officer for the Deaf and the project of a Training Unit to include training in deaf welfare for Social Work trainees deserve special mention and thanks to the Council for the support of its members. The development of sheltered housing units to supplement the housing specially provided for the needs of the elderly by the Council and Housing Associations is gathering momentum in the Borough but much more needs to be accomplished. Public Health Services The report emphasises the need for more routine inspections to be carrried out at food premises, offices and shops and certain types of dwellings. The Slum Clearance programme has been accelerated and co-operation with the Borough Planning Officer in surveys has led to review and better co-ordination on slum clearance and redevelopment. Progress in Smoke Control has been maintained in spite of the pressures of other work in view of the obvious benefits to environmental health of this Borough and neighbouring areas both in the short and long term. The rationalisation of food sampling between neighbouring authorities is proceeding with the objective of decreasing duplication of routine sampling, and special co-operative investigations included one between the London Boroughs to determine the presence of residual pesticides. Byelaw requirements for Hairdressers and Barbers added to the list of visits for registration purposes but is a welcome addition to hygienic measures. The problem of fouling of footpaths by dogs ought to be less in a Borough with so much open space and with such an excellent record in hygiene. I commenced this introductory letter by presenting a number of statistics without commentary but indicating the variety of health problems from flooding and increasing population of the elderly to a falling birth rate and problems of health and safety education which exist in the Borough. Each requires constant review and evaluation of the services that are provided. The use of more sophisticated records and the aid of the computer may bring to the surface more problems than are revealed in the body of this report. Change is a stimulus and a challenge. No department could now be better adapted to challenge. May I conclude by thanking the Heads of Sections and all my staff for their zeal, hard work and real participation in providing services for this authority during the past year. At the same time, I 16 wish to acknowledge the valuable contribution of all voluntary organisations and other Authorities concerned with bettering the positive health of the Borough and to express my appreciation of the help and advice of other Chief Officers and the staff of their departments. Finally, I would like to thank the Council and, in particular, the Chairman and members of my Committee for the real partnership of members and officers which makes service in the London Borough of Bromley such a happy and rewarding commission. L. R. L. EDWARDS, Medical Officer of Health. GENERAL 19 VITAL AND OTHER STATISTICS Population (mid-year 1967) 302,660 Area (acres) 39,293 Density of population (persons per acre) 7.7 Number of domestic properties (1.4.67) 97,068 Rateable value at 1.4.67 £16,092,327 Product of Penny Rate £66,000 Rate in the pound (domestic) 12/- Births: Males Females Total Legitimate 2,186 2,008 4,194 Illegitimate 160 166 326 (Total) 4,520 Crude birth rate per 1,000 estimated total population 14.9 Adjusted birth rate for comparison with other areas 15.0 (Area comparability factor for Births = 1.01) Illegitimate live births per cent, of total live births 7.2 Birth rate for Greater London 17.0 Birth rate for England and Wales 17.2 Stillbirths: Males Females Total Legitimate 35 24 59 Illegitimate 3 2 5 (Total) 64 Stillbirth rate per 1,000 total births 14 Stillbirth rate per 1,000 estimated total population 0.1 Stillbirth rate for Greater London 13.3 Stillbirth rate for England and Wales 14.8 Total births (live and still): Males Females Total Legitimate 2,221 2,032 4,253 Illegitimate 163 168 331 (Total) 4,584 20 Infant Mortality: Males Females Total Legitimate 40 27 67 Illegitimate 4 3 7 (Total) 74 Infant mortality rate per 1,000 total live births 16 Legitimate infant deaths per 1,000 live legitimate births 16 Illegitimate infant deaths per 1,000 live illegitimate births 21 Infant mortality rate for Greater London per 1,000 live births 18.4 Infant mortality rate for England and Wales... 18.3 Neonatal mortality rate (deaths under four weeks per 1,000 total live births) 10.8 Neonatal mortality rate for Greater London ... 12.9 Neonatal mortality rate for England and Wales 12.5 Early neonatal mortality rate (deaths under one week per 1,000 total live births) 8.4 Early neonatal mortality rate for Greater London 11.1 Early neonatal mortality rate for England and Wales 10.8 Perinatal mortality rate (stillbirths and deaths under one week combined, per 1,000 total live and still births) 22.0 Perinatal mortality rate for Greater London 24.2 Perinatal mortality rate for England and Wales 25.4 Maternal Mortality: Maternal deaths (including abortion) Nil Maternal mortality rate per 1,000 total live and still births Nil Maternal mortality rate for Greater London 0.33 Maternal mortality rate for England and Wales, per 1,000 total births 0.20 Deaths: Males Females Total 1.515 1,558 3,073 21 Crude death rate per 1,000 estimated total population 10.2 Adjusted rate for comparison with other areas 9.9 (Area comparability factor for deaths = 0.97) Death rate for Greater London, per 1,000 population 10.8 Death rate for England and Wales 11.2 Tuberculosis death rates: All forms (per 1,000 population) 0.04 Pulmonary (per 1,000 population) 0.033 Non-Pulmonary (per 1,000 population) 0.003 Cancer death rates: All forms (per 1,000 population) 2.3 Lung and Bronchus (per 1,000 population) 0.6 Other forms (per 1,000 population) 1.7 Staff Medical Examinations: Number of Health Declaration forms received 870 Number of recommendations without medical examinations 685 Number of medical examinations carried out... 185 Other Medical Examinations: Premature retirement 2 Following prolonged sick leave 5 Partial surrender of superannuation allowance 1 Medical examinations on behalf of other authorities 15 Medical examinations on behalf of West Kent Main Sewerage Board 8 Meteorological Observations The Director of Parks has kindly furnished the following information from the records at the Climatological Station, Church House Gardens: Total rainfall 28.71 inches Mean maximum daily temperature 58.76°F. Mean minimum daily temperature 40.80°F. Highest maximum temperature 86°F. (5.6.67 & 11.7.67) Lowest minimum temperature 14°F. (8.1.67 & 8.12.67) 22 Population The Registrar-General's estimate of the population of the Borough, mid-year, 1967, was 302,660, an increase of 980 over the figure "for the previous year. This figure gives a density of 7.7 persons to the acre. The natural increase of population, measured by excess of births over deaths, was 1,447. The figure for 1966 was 1,656. Births There were 4,520 live births allocated to the Borough during 1967, after adjustments for inward and outward transfers, this being a decrease of 255 over the figure for the previous year. Of the 4,520 live births, 3,600 occurred in hospital and 920 in private dwellings. 2,346 of these births were males and 2,174 females. The crude birth rate for the Borough was 14.9 per 1,000 population, and the adjusted rate, for use when comparing one area with another was 15.0. The birth rate for 1967 was 0.9 lower than that recorded for the previous year, and 1.4 below that of 1965, and is also well below the figures of 17.0 and 17.2 for Greater London and England and Wales respectively. In addition to the live births, there were 64 stillbirths, representing a rate of 14 per 1,000 total births. This rate is above that of 13.3 for Greater London, but below that of 14.8 for the country as a whole. The figure for the Borough for 1966 was 15.0 per 1,000 total births. Deaths 3,073 deaths were registered in 1967, giving a crude death rate of 10.2 per 1,000 population. This rate, when standardized by the comparability factor, gives a figure of 9.9 for comparison purposes. The rates for Greater London, and England and Wales were 10.8 and 11.2 respectively. Comparative figures for the year 1966 were: Bromley 10.3, Greater London 11.1, England and Wales 11.7. The following table shows causes of death as given in the Registrar-General's statistics, which are classified in accordance with World Health Organization Nomenclature Regulations. Sex LIVE BIRTHS STILL BIRTHS Legitimate Illegitimate Total Legitimate Illegitimate Total Males 2,186 160 2,346 35 3 38 Females 2,008 166 2,174 24 2 26 Totals 4,194 326 4,520 59 5 64 23 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE FOR 1967 (Registrar-General's Return) Causes of Death Sex All ages Under four weeks Four weeks and under 1 year Age in Years 1 5 15 25 35 45 55 65 75 and over 1. Tuberculosis, respiratory M 6 1 3 1 1 F 4 — — — — — — — — 1 1 2 2. Tuberculosis, other forms M — — — — — — — — — — — — F 1 — — — — — — — — — — 1 3. Syphilitic disease M 3 — — — — — — — — — — 3 F 1 — — — — — — — — — — 1 4. Diphtheria M _ _ _ — F — — — — — — — — — — — — 5. Whooping Cough M — — — — — — — — — — — — F — — — — — — — — — — — — 6. Meningococcal infections M — _ _ _ — _ — _ — _ _ — F — — — — — — — — — — — — 7. Acute poliomyelitis M _ _ _ _ _ _ _ F — — — — — — — — — — — — 8. Measles M 1 __ 1 _ _ _ _ _ _ _ _ F — — — — — — — — — — — — 9. Other Infective A parasitic diseases M — — — — — — — — — — _ F 3 — — — — — — 2 — — — 1 10. Malignant neoplasm, Stomach M 23 1 1 ? 6 11 7 F 33 — — — — — — — 2 2 14 15 11. Malignant neoplasm, lung bronchus M 148 — — — 4 10 55 54 25 F 41 — — — — — — 2 8 10 12 9 12. Malignant neoplasm, breast M — — — _ — — — — F 76 — — — — — 2 7 9 26 19 13 13. Malignant neoplasm,uterus F 18 — — - — — — 1 3 2 7 5 14. Other malignant and lymphatic neoplasms M — — — 1 4 4 1 4 16 50 47 63 F 161 — — — — 2 1 7 18 30 43 60 15. Leukaemia, aleukaemia M 10 1 1 1 1 1 1 1 3 F 6 — — 2 1 — 1 — — — — 2 16. Diabetes M 7 _ _ _ _ — _ 1 — 4 2 F 11 — — — — — — — — 2 3 6 17. Vascularlesions nervous system M 118 — _ 2 2 25 31 58 F 207 — — — — — — 1 9 21 35 141 18. Coronary disease, angina M 413 _ _ _ _ _ _ 11 59 107 120 116 F 279 — — — — — — 1 7 21 58 192 19. Hypertension with heart disease M 18 — — — — — — — 2 3 5 8 F 22 — — — _ — — — — 1 2 19 20. Other heart disease M 77 _ _ _ _ 3 9 16 49 F 151 — — — — — — — 3 10 17 121 21. Other circulatory disease M 76 _ — _ _ 2 13 20 41 F 111 — — — — — — 1 6 10 18 76 22. Influenza M — — — — — — — — — — F 1 — — — — — — — — — — 1 23. Pneumonia M 109 1 2 — — — 1 — 1 9 16 79 F 178 — 3 — — — — 1 1 6 23 144 24. Bronchitis M 97 1 4 — — — — — 3 9 31 49 F 30 — — — — 1 — — — 4 7 18 24 Causes of Death at different periods of life for 1967— Causes of Death Sex All ages Under four weeks Four weeks and under 1 year Age In Years 1 5 15 25 35 45 55 65 75 and over 25. Other diseases of respiratory system M 21 — — 1 — — — — — 5 9 6 F 6 — — — — — — — — 1 — 5 26. Ulcer of stomach and duodenum M 11 — — — — — — — — 2 5 4 F 12 — — — — — — — — — 1 11 27. Gastritis, enteritis & diarrhoea M 3 — — 1 — — — — — — 2 — F 14 — 2 — — — — 1 — 1 5 5 28. Nephritis & nephrosis M 4 — — — — — — — — 2 2 — F 4 — — — — — — — — — 2 2 29. Hyperplasia of prostate M 14 — — — — — — — — 1 3 10 30. Pregnancy, childbirth, abortion F — — — — — — — — — — — 31. Congenital malformations M 15 9 5 — — — — — — — 1 — F 9 4 3 — 1 — — — — — 1 — 32. Othe defined & ill-defined diseases M 84 17 1 2 1 3 1 2 3 15 20 19 F 122 15 1 1 — 2 — 2 7 8 26 60 33. Motor vehicle accidents M 28 — — — 2 8 3 1 1 4 5 4 F 14 — — 1 — 1 — 2 1 4 1 4 34. All other accidents M 19 1 — — — — — — — — — — F 19 — — 1 2 — — — 2 1 4 9 35. Suicide M 13 — — — — 1 1 3 4 3 1 — F 22 — — — — 1 3 5 4 4 3 2 36. Homicide & operations of war M 1 — 1 — — — — — — — — — F 2 — 2 — — — — — — — — — Total all causes M 1,515 30 14 6 8 22 10 31 11? 324 407 551 F 1,558 19 11 5 4 7 7 33 80 165 302 925 Accidental Deaths During the year 80 residents died from accidents of all kinds, including 42 in motor vehicle accidents. DEATHS FROM CANCER Male Female Total 1967 1966 1965 1967 1966 1965 1967 1966 1965 Malignant neoplasm, stomach 28 39 35 33 32 26 61 71 61 Malignant neoplasm, lung, bronchus 148 136 154 41 32 36 189 168 190 Malignant neoplasm, breast — — — 76 64 70 76 64 70 Malignant neoplasm, uterus — — — 18 22 15 18 22 15 Other malignant and lymphatic neoplasms 191 151 149 161 187 169 352 338 318 Totals 367 326 338 329 337 316 696 663 654 Rates per 1,000 population: — All forms 2.3 Lung and bronchus 0.6 Other forms 1.7 25 Maternal Mortality It is pleasing to report that for the second year in succession no maternal deaths occurred in the Borough. The maternal mortality rate for Greater London for 1967 was 0.33 per 1,000 total live and still births, and England and Wales 0.20. Tuberculosis There were ten deaths attributed to pulmonary tuberculosis and one from non-respiratory tuberculosis, giving a death rate of 0.04 per 1,000 population. Street Accidents 1,656 street accidents occurred in the Borough during 1967. 2,317 persons were injured and 33 died. These totals include 395 children under 15 years of age who were injured, and 3 who died. Infant Mortality There were 74 deaths of infants under one year during 1967. 67 of these were legitimate and 7 illegitimate, giving a rate of 16 per 1,000 total births. The rates for Greater London and England and Wales were 18.4 and 18.3 respectively. Of the 74 infant deaths, 49 were under four weeks old, giving a neonatal mortality rate of 10.8 per 1,000 total live births. The neonatal mortality rate for Greater London was 12.9 and for England and Wales 12.5. There were 38 deaths of infants under 1 week of age, giving an early neonatal mortality rate of 8.4 per 1,000 total live births. The rates for Greater London and England and Wales were 11.1 and 10.8. The perinatal mortality rate for the Borough (stillbirths and deaths under one week combined, per 1,000 total live and still births) was 22, and those for Greater London and England and Wales 24.2 and 25.4 respectively. 26 TABLE I DEATHS OF INFANTS UNDER 4 WEEKS OF AGE Cause of Death AGE TOTAL 24 hours 1-7 days 8-28 days Prematurity 11 4 - 15 Asphyxia Atelectasis 4 - - 4 Acute Tracheo Bronchitis - - 2 2 Staphylococcal pneumonia - - 1 1 Birth injury (aspiration pneumonia) 1 - - 1 Cardiac respiratory failure - 3 1 4 Congenital heart disease 1 5 3 9 Thrombocytopenic purpura - 1 - 1 Multiple Congenital abnormalities 1 - - 1 Haemolytic disease of the new born 1 1 - 2 Intra-uterine anoxia 1 - - 1 Intra partum aspiration of liquor 1 - - 1 Patous Syndrome - - 1 1 Cerebral and congenital disorder - 1 - 1 Tracheo—oesophagal fistula 1 - - 1 Encephalocele - 1 - 1 Downes Syndrome - - 1 1 Septicaemia - - 1 1 Neoroblastoma - - 1 1 22 16 11 49 PERSONAL HEALTH SERVICES 29 PERSONAL HEALTH SERVICES These services are provided under Part III of the National Health Service Act of 1946. MATERNITY AND CHILD WELFARE Peter A. Currie, m.r.c.s., l.r.c.p., Senior Medical Officer. Constant and repetitive references will doubtless be found in other pages of this report to the financial stringencies which have been imposed. This has meant a certain curtailment of the development of some aspects of the personal health services, and to the further training of professional staff. It is particularly noticeable in the difficulty experienced in establishing a screening system for the earliest detection of deafness. It had been hoped that all the medical staff would be able to attend a course of instruction on this, at one of the London hospitals—in fact, only three were able to attend. However, encouraged by their enthusiasm, local arrangements were made for a similar course, on a smaller scale, for the remaining Assistant Medical Officers, and all the Health Visitors. It is now possible to carry out screening testing of children at 6 months old at the infant welfare clinics. This is expounded in the report of the two Assistant Medical Officers who have been appointed as liaison officers for the deaf children. Cognisant of the fact that Health Centres play a very important part in the structure and integration of the health services, active attachment and liaison schemes involving 25% of the health visiting staff are in operation, but it is at present impractical to further develop the attachment of midwives and district nurses on account of geographical and staffing difficulties respectively. I feel sure that as more attachment schemes are arranged, increasingly successful integration will undoubtedly develop. After very full provision had been made for the cytology service, it was disappointing to find the national apathy reflected in the low attendances at the Council's clinics. It is possible that an appointment system was not the best way of encouraging attendance, and the provision of "open" clinics will be made, together with teams visiting local factories and business establishments employing a considerable female labour force. Pressure is being maintained, as far as possible within the present financial strictures, to give wider publicity to this service. The last paragraph of my previous report referred to the establishment of a complete "At Risk" register. It has been 30 possible, with the full co-operation of the Paediatricians and Obstetricians at the local hospitals, to compile a deliberately restricted list of "At Risk" categories, which will operate from 1st January, 1968. What promises to be a most rewarding and instructive line of research has been the implementation of the Perinatal Survey. In this we are co-operating, chiefly through the domiciliary midwifery service, with a paediatrician at Farnborough hospital. It will be appreciated that it is too early to give more than mention of this project as it entails investigations over the next 2-3 years, but without doubt certain very interesting and significant findings have been observed. INTERIM REPORT ON THE DEAF CHILD E. Gaynor Lewis, m.b., b.ch., and Bronwen Luscombe, m.b., b.ch. On return from the course of instruction at the Nuffield Hearing and Speech Centre, London, we arranged a symposium on the course for the remaining Assistant Medical Officers, which in turn was followed by a training course in screening techniques for infants of 6-9 months, for all the health visitors. In order to eradicate minor mistakes in techniques, which are known to occur, it is proposed to hold a Refresher Course in mid 1968. The screening is done mainly by health visitors, but is also used in the routine developmental testing of infants by the assistant medical officers. There are no statistics available, but the value of the service is evidenced by the discovery already of several unsuspected cases of hearing impairment in infants. Naturally, priority is given to children already in the "At Risk" categories, but in view of the fact that 50% of cases arise where there is no ground to suspect a hearing impairment it is proposed to develop the scheme to include all children. Any child failing these tests is first seen by the Medical Officer at the clinic and subsequently may be referred to the General Practitioner, or direct to hospital with the former's consent. Facilities exist at a special clinic for the follow-up of these children. In this connection particular attention is paid to the assessment of the "whole" child and its development. Health Visitors are particularly asked to enquire about speech or language problems, particularly from the age of 2 years, as failure to talk may be indicative of a failure to hear. We would like to express our appreciation of the co-operation and helpful advice extended to us by the Consultants in this field, at the local hospitals. 31 CARE OF MOTHERS AND YOUNG CHILDREN Under Section 22 of the National Health Service Act, 1946. it is the duty of every Local Health Authority to make arrangements for the care, including in particular, dental care of expectant and nursing mothers and of children who have not attained the age of five years and are not attending primary schools maintained by a Local Education Authority. Care of the Unmarried Mother and her child There is one Home for unmarried mothers within the Borough, which is maintained by the Rochester Diocesan Council for Social Work. This Home has accommodation for up to fourteen expectant and nursing mothers and is used by several local authorities. During the year the Council accepted financial responsibility for the maintenance of 43 unmarried mothers at various Mother and Baby Homes. Costs at these Homes continue to rise, though generally the increase is not as high as in previous years. Financial assistance on a per-capita grant of £4 2s. Od. per case has also been made to two Moral Welfare Associations, who report they have dealt with 182 cases during the period of this review. Welfare Foods All child welfare clinics sell Welfare Foods in addition to a range of Proprietary Baby Foods. Sales for the year were:— 10,775 tins of National Dried Milk 4,007 bottles of Cod Liver Oil 6,459 packets of Vitamin tablets 132,313 bottles of Orange Juice Proprietary foods to the value of £16,288 6s. l0d. were sold during the same period. Birth notifications Of the 5,866 births notified, 4,940 occurred in hospitals and 926 were domiciliary births. Day Nurseries Every effort is made to ensure that all day nurseries registered with this authority maintain suitable standards. Consistent with the national trend, the number of day nursery places continues to increase. Number of registered Day Nurseries 65(54) Number of places provided 2,099(1,395) (Figures in parenthesis represent 1966) There are no day nurseries maintained by the Council. 32 Child Minders The number of child minders registered at the end of the year was:— Number of registered Child Minders 43(49) Number of places provided 481(623) (Figures in parenthesis represent 1966) Nursing Homes Details of the homes at present on the Register are as under:— Number of Nursing Homes at 31.12.66 18 Number of Nursing Homes at 31.12.67 19 Nursing Homes closed during 1967 1 Nursing Homes registered during 1967 2 Number of beds provided at 31.12.66 317 Number of beds provided by 31.12.67 404* Mother and Baby Homes at 31.12.67 included above 1 (Registered under Nursing Homes Act) Number of beds provided 14 Number of cots provided 14 Cervical Cytology There was a great reduction in the number of attendances at clinics in the Borough during 1967, a trend which appears to be national. Clinics were also established at some of the factories in the area where there is a large female labour staff. Of the 2,144 women examined, 11 were found to have an invasive carcinoma in situ, and, in a further 7 cases a further opinion was considered necessary. Recuperative Care The demand for short recuperative holidays for persons who have had an illness, or operative treatment, continues. During the year the Council accepted financial liability for 45 cases. MIDWIFERY Miss G. Simmons, s.r.n., s.c.m. Non-Medical Supervisor of Midwives Under Section 23 of the National Health Service Act, 1946, it is the duty of every Local Health Authority to provide a domiciliary midwifery service. The past year has seen an increase in the planned 48 hour discharges from hospital with a corresponding drop in home confinements. The system is working smoothly with good 33 co-operation between this department, hospitals, general practitioners and domiciliary midwives. In the Orpington and Farnborough areas a part-time midwife is responsible for the care of these mothers, visiting them before their confinement and helping to arrange for their care on discharge from hospital. Group attachment has been considered and a trial scheme was drawn up, but it was felt to be impracticable until General Practitioners' practices could combine geographically. There has been an increased demand for classes in "preparation for labour" and there are six such classes in the Borough which are well attended. Training of Pupil Midwives Eight members of the staff are approved teaching midwives and they undertook the training of 33 pupil midwives from the local hospitals during the year. Pupils are accommodated in private lodgings while undergoing district training. Refresher Courses One midwife attended an approved post-graduate course to comply with statutory requirements, and three attended a weekend seminar in "training for childbirth". SUMMARY OF DOMICILIARY MIDWIVES' WORK Number of domiciliary confinements attended by midwives under N.H.S. arrangements. Number of cases delivered in hospitals and other institutions but discharged and attended by domiciliary midwives before 10th day. Doctor not booked Doctor booked Total (1) (2) (3) (4) 6 786 792 808 Total number of home visits made by midwives—46,224 Ante-Natal and Post-Natal Clinics Number of women in attendance 1,178 Ante-Natal Mothercraft and Relaxation Classes Number of women who attended during the year 1,649 CARE OF PREMATURE INFANTS (1) Number of live premature babies notified during 1967 who were born: — (i) at home or in a Nursing Home 17 (ii) in hospital 206 34 (2) The number of those born at home or in a Nursing Home:— who were nursed entirely there ... ... 17 who were transferred to hospital on or before the 28th day — who died during the first 24 hours - who died in 1 and under 7 days - who died in 7 and under 28 days — who survived at the end of one month 17 (3) The number of those born in hospital:— who died during the first 24 hours 2 who died in 1 and under 7 days 1 who died in 7 and under 28 days 2 who survived at the end of one month 201 (4) The number of premature stillbirths who were born:— (i) at home or in a Nursing Home — (ii) in hospital 55 Notifications of intention to practise In accordance with the rules of the Central Midwives Board, 139 midwives notified their intention to practise within the Borough during the year 1967. Congenital Malformations Information concerning congenital malformations or abnormalities apparent at birth was collected and supplied to the Registrar General. The following is a summary and analysis of the information received during the year. INCIDENCE OF CONGENITAL MALFORMATIONS A. Summary of Notifications (i) Number of notifications received during the year 61 (ii) Number of births included in (i) above 46 (iii) Number of still births included in (i) above 15 (iv) Total number of malformations notified as apparent at birth 73 (v) Number of children with multiple malformations 7 HEALTH VISITING Miss B. N. Chandler, s.r.n., s.c.m., h.v.cert., dip.soc.studies (lond.) Superintendent Health Visitor The Health Visiting establishment remains at 40 and there was one vacancy at the end of the year. The five sponsored 35 Health Visitor Students were successful in passing their examination and replaced staff who retired or left the service. In Service Training The usual refresher courses were cut out this year due to financial stringencies, but it is hoped to resume these courses next year as they are a necessity in maintaining efficiency. The technique of screening tests for deafness was taught to all the Health Visitors by two Medical Officers, by courtesy of the staff at the Holy Child Nursery in Chislehurst, so that all children can be tested in early infancy to exclude hearing impairment, or to treat it if found, at the earliest possible time, so that speech development is not impaired. One Fieldwork Instructor was trained during the year to replace one who left and students from the University of Surrey, and Croydon Technical College, received their practical training in the Borough. Staff meetings have been held at monthly intervals when a topic of interest has been discussed, with a speaker, or film, on a subject relevant to the work. Training of Students by Health Visitors Lectures and discussions have been held at the local hospitals for Student Nurses to gain an insight into the local authority Health and Welfare services and the students have accompanied the staff in their work to observe the services at first hand. Students from other disciplines have also spent time with the Health Visitors as part of their training. At Risk Register A new system of record keeping of babies born at risk of handicap has been introduced to try and ensure their constant surveillance in an area where there is a lot of population movement. Family Planning Clinics Following the Government's decision to extend the above service, a new clinic was opened in Penge by the Family Planning Association on local authority premises, and further facilities are being made available to expand the service throughout the Borough, so that Family Planning advice is readily available to all who require it. General Practitioner / Health Visitor Co-operation Seven Health Visitors are working full-time with partnerships or groups of General Practitioners and three Health Visitors work in liaison with a specific practice but are geographically based. Further attachments have been requested but with the present establishment these requests have been impossible to meet. 36 Co-ordination of Services The co-operation between workers at all levels has been strengthened, and by co-ordinating both statutory and voluntary services for the benefit of the public in the Borough, the Health Visitor is being increasingly used as the liaison worker in bringing the: appropriate services to the individual or family unit. HOME NURSING Mrs. .(. Symington, s.r.n., s.c.m., d.d.n. Superintendent, Home Nursing Service Under Section 25 of the National Health Service Act, 1946. it is the duty of every Local Health Authority to make provision in their area for securing the attendance of nurses on persons who require nursing in their own homes. The Home Nursing establishment is 41 full-time nurses, plus 3 Home Nurse/Midwives. During the year there were 4 retirements, these positions being filled within a reasonable time. Sickness among the staff has been considerable, but loyalty of their colleagues pulling together enabled the service to be maintained. The pattern of nursing is changing, demand for the nursing of aged and Geriatric cases has increased, and these, coupled with terminal patients, make a heavy call upon the service. The number of patients attended during the year was 3,284, of which 1,297 were over 65 years of age. A total of 111.888 visits was made during 1967. Courses for District Nurses Since the last report, the Diploma of District Nursing has been awarded to nine District Nurses. A further five nurses have recently taken the examination, the results of which are awaited. Marie Curie Foundation Fund This service, which deals with cases of terminal carcinoma, is complementary to that already rendered by the District Nurses. Full use has been made of the night attendances these patients so desperately need, enabling them to stay in their own homes. Attachments In this field, discussions are in hand to provide a pilot scheme whereby General Practitioners are able to have a District Nurse attached to their Group practice, but the present financial stringency and shortage of staff will delay its implementation. 37 VACCINATION AND IMMUNISATION Under Section 26 of the National Health Service Act, 1946, every Local Health Authority is required to make arrangements with Medical Practitioners for the vaccination of persons in the area of the authority, against smallpox and the immunisation of such persons against diphtheria. VACCINATION AGAINST SMALLPOX A total of 2,981 children, mostly between one and two years of age, received primary vaccination and 139 children were re-vaccinated during the year. DIPHTHERIA IMMUNISATION Primary Course—Number of persons under age 16 Type of Vaccine or dose YEAR OF BIRTH Others under 16 Total 1967 1966 1965 1964 1960/63 1. Quadruple - 1 - - - - 1 2. Triple 1,545 2,195 132 65 92 8 4,037 3. Diphtheria/Pertussis — — - - - - - 4. Diphtheria/Tetanus 12 25 5 7 39 5 93 5. Diphtheria — — — — — 1 1 6. Pertussis — — — — — — - 7. Tetanus — 1 1 3 9 58 72 Totals 1,557 2,222 138 75 140 72 4,204 Re-inforcing doses—number of persons under age 16 Type of Vaccine or dose 1967 1966 1965 1964 1960/63 Others under 16 Total 1. Quadruple — - - - - - - 2. Triple — 497 1,955 381 1,705 - 4,538 3. Diphtheria/Pertussis — - - - 1 - 1 4. Diphtheria/Tetanus — 32 147 38 1,464 114 1,795 5. Diphtheria — — 1 — 1 - 2 6. Pertussis — — — — — — - 7. Tetanus — — 2 3 36 97 138 Totals — 529 2,105 422 3,207 211 6,474 PRIMARY ORAL POLIOMYELITIS VACCINATION Completed Primary Course YEAR OF BIRTH Others under 16 Total 1967 1966 1965 1964 1960/63 M. & C.W. Clinics 546 1,935 133 60 147 34 2,855 G.P.'s Surgeries 348 1,013 123 33 203 15 1,735 Totals 894 2,948 256 93 350 49 4,590 Received re-inforcing dose YEAR OF BIRTH Others under 16 Total 1967 1966 1965 1964 1960/63 M, & C.W. Clinics - 5 10 8 1,561 64 1,648 G.P.'s Surgeries - 37 86 36 1,198 132 1,489 Totals - 42 96 44 2,759 196 3,137 38 CHIROPODY During the year 1967, the service grew quite considerably. The total number of domiciliary treatments given was 8,287 and a further 15,746 surgery treatments brought the grand total to 24,033 treatments, an increase of 2,572 over the figure for the previous year. A further 1,819 treatments were also provided for residents in the Borough's residential homes. Five clinics are at present used and these were augmented by the use of 26 private contractual Chiropodists' surgeries. Persons eligible for treatment under this authority's scheme include women over the age of 60 years, men over 65 years of age, registered physically handicapped persons, and expectant and nursing mothers. It has not yet been financially possible to include school children under the scheme. Patients are normally seen at a clinic or surgery, but if there is medical need then domiliciary treatment is provided. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS Arrangements to cover the special problems which arise in connection with the health and treatment of long-stay immigrants to this country have been laid down by the Ministry of Health. During the year 159 persons were notified to the department and 97 successfully visited. This not infrequently involved more than one visit. Some persons were not known at the addresses given and others, despite repeated visits, had not been contacted by the end of the year. NATIONAL ASSISTANCE ACT, 1948, SECTION 47 NATIONAL ASSISTANCE (AMENDMENT) ACT, 1951 Under this section of the Act as amended by the National Assistance (Amendment) Act, 1951, powers are given to the local authority for the compulsory removal of persons suffering from grave chronic disease, or who are aged, infirm or physically handicapped and who are living in insanitary conditions and unable to devote to themselves and not receiving from other persons proper care and attention. Although several cases were visited and investigated during the year it was not found necessary in any instance to apply for a removal order as, with the assistance of other interested bodies we were able to effect some improvement in the conditions found to exist. 39 HOME HELP SERVICE Under Section 29 of the National Health Service Act 1946, the Local Health Authority may make arrangements for providing Home Help in households where such assistance is required owing to the presence of any person who is ill, lying in, an expectant mother, aged, or a child not over compulsory school age within the meaning of the Education Act 1944. The following is a summary of the cases in which assistance was given between January 1st and December 31st, 1967. Aged 65 or over on first visit in 1967 1,967 Under 65— Chronic Sick and T.B. 216 Mentally disordered 28 Maternity 413 Illness 344 Family Care Service 39 cases, involving 122 children, received assistance. Family Welfare Service 3 cases received assistance in 1967. Night and Evening Service 5 cases received assistance during the year. It will be seen that home help was supplied in 3,015 homes during the year 1967. In Service Training The Annual Week-end School of the Institute of Home Help Organisers at Scarborough was attended by the Deputy Senior Home Help Organiser, and a course of lectures by Geriatric Consultants on the problems of the aged and chronic sick was attended by most of the organising staff. Training provided by Home Help Organisers Student Health Visitors, Nurses, Social Welfare and Children's Officers have been out with the Home Help Organisers as required by their Training Bodies, to enable them to see the work of the Home Help Service. Short lectures have also been given by the Senior Organisers to these students, outlining the work of the section and giving opportunities for any queries on the service to be answered. 40 Home Visits Home visits by Organisers during 1967 totalled 11,936. The service continues to meet the heavy demands upon it and those in real and genuine need of help are always given high priority. Conditions of full employment and high standards of living render recruitment somewhat difficult, and it is not always possible to provide as much help in some instances as requested, but basic requirements both for the aged living alone and for maternity patients are met, and will continue to be met. A minimal quantity of help is provided to people who have relatives living with them or who have sons and/or daughters living close by. VENEREAL DISEASES Under the National Health Service Act of 1946, diagnosis and treatment of venereal diseases became a responsibility of the Regional Hospital Boards and the functions of the local health authorities were limited to those of prevention. This involves the tracing of contacts wherever possible, and health education. There are no treatment centres for these diseases within the Borough. I am indebted to the Physicians at the undermentioned treatment centres for the following statistics for 1967: — New cases of residents treated during 1967. Treatment Centre Syphilis Gonorrhoea Other Conditions Total Dreadnought Seamen's Hospital, Greenwich — 6 25 31 Miller Wing, Greenwich District Hospital — — 21 21 St. Bartholomew's Hospital — 5 28 33 St. John's Hospital, Lewisham 3 23 100 126 St. Thomas's Hospital — 5 31 36 The London Hospital (Whitechapel Clinic) — 1 19 20 Totals 3 40 224 267 41 LONDON AMBULANCE SERVICE The ambulance service for the whole of Greater London is provided by the Greater London Council. Ambulance stations within the Borough are sited in Hayes Lane, Bromley and Croydon Road, Penge, but service is provided in addition from other stations sited outside the Borough. There is a main control in Bromley which covers the whole of South East London for nonemergency work. All emergency calls are routed directly to a Central Emergency Control at Ambulance Headquarters which directs ambulances by radio and by direct telephone lines to ambulance stations. 42 DENTAL SERVICES Mrs. C. M. Lindsay, l.d.s., r.f.p.s.(glasgow) Principal Dental Officer Dental Service for Nursing and Expectant Mothers and Children under School Age A fully comprehensive maternity and child welfare dental service is provided in the Borough for all expectant and nursing mothers, also children under five who are not yet eligible for treatment within the School Dental Service. All types of treatment as in private practice are available, including treatment of orthodontic cases and the service is operated from all the school dental clinics. Details of the work carried out during 1967 are given on page 43. School Health Dental Service There has been a full complement of staff during the year 1967. Whilst one full-time and one part-time dental officer resigned, finding replacements presented little difficulty. During the interregnum a full-time service was maintained at the clinics by the employment of part-time dental officers. Indeed, the Principal School Dental Officer has been able to refer applicants for dental officer posts to other areas, which is most gratifying in the present difficult times of staff shortage. Statistics appertaining to the work of the Dental Services in 1967 are given below. These show an increase of 1,548 permanent and 556 deciduous fillings over the previous record achievement of 1966. The total number of teeth extracted remains approximately the same. There is a slight decrease in the number of permanent extractions. General anaesthetics for dental extractions are administered by medical practitioners to whom our thanks are due for their excellent services. There were 189 orthodontic cases treated during the year of the establishment of the Borough (1965). This year the number has risen to 600 of which 146 were successfully completed. The growing interest by parents in this branch of dentistry is notable. I should like to thank all the Head Teachers who have been contacted, for their courteous and willing help in the advancement of dental health in their schools. 43 DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN UNDER 5 YEARS A. Number of Visits for Treatment During Year: Children 0-4 (incl.) Expectant & Nursing Mothers First Visit 485 47 Subsequent Visits 516 130 Total Visits 1,001 177 Number of Additional Courses of Treatment other than the First Course commenced during year 77 47 Treatment provided during the year: Number of Fillings 908 127 Teeth Filled 689 98 Teeth Extracted 47 25 General Anaesthetics given 26 3 Emergency Visits by Patients 8 12 Patients X-Rayed 5 6 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 84 39 Teeth Otherwise Conserved 56 Teeth Root Filled — 4 Inlays - — Crowns - 7 Number of Courses of Treatment completed during the year 327 32 B. Prosthetics: Patients supplied with F.U. or F.L. (First Time) 9 Patients supplied with Other Dentures 4 Number of Dentures supplied 13 C. Anaesthetics: General Anaesthetics Administered by Dental Officers - D. Inspections: Children 0-4 (incl.) Expectant & Nursing Mothers Number of Patients given First Inspections during year A. 369 D. 25 Number of Patients in A and D above who required Treatment B. 153 E. 12 Number of Patients in B and E above who were offered Treatment C. 151 F. 12 E. Number of Dental Officer Sessions (i.e. Equivalent Complete Half Days) Devoted to Maternity and Child Welfare Patients: For Treatment G. 169 For Health Education H. 7 44 ATTENDANCES AND TREATMENT Ages 5 to 9 Ages 10 to 14 Ages 15 and over  First Visit 3838 3364 609 7811 Subsequent Visits 5189 6591 1244 13024 Total Visits 9027 9955 1853 20835 Additional courses of treatment commenced 988 652 138 1778 Fillings in permanent teeth 2878 6675 2030 11583 Fillings in deciduous teeth 6851 719 - 7570 Permanent teeth filled 2046 3949 1336 7331 Deciduous teeth filled 4839 469 — 5308 Permanent teeth extracted 49 274 65 388 Deciduous teeth extracted 1310 306 — 1616 General anaesthetics 441 139 11 591 Emergencies 154 59 19 232 Number of Pupils X-rayed 320 Prophylaxis 2,505 Teeth otherwise conserved 601 Number of teeth root filled 38 Inlays 3 Crowns 20 Courses of treatment completed 5,450 ORTHODONTICS Cases remaining from previous year 332 New cases commenced during year 298 Cases completed during year 146 Cases discontinued during year 10 Number of removable appliances fitted 291 Number of fixed appliances fitted 3 Pupils referred to Hospital Consultant 2 PROSTHETICS Pupils supplied with F.U. or F.L. (first time) — Pupils supplied with other dentures (first time) 1 Number of dentures supplied 1 ANAESTHETICS General Anaesthetics administered by Dental Officers 2 INSPECTIONS (a) First inspection at school. Number of Pupils 36,839 (b) First inspection at clinic. Number of Pupils 2.600 Number of (a) + (b) found to require treatment 12,039 Number of (a) + (b) offered treatment 9,572 (c) Pupils re-inspected at school or clinic 1,669 Number of (c) found to require treatment 1,014 SESSIONS Sessions devoted to treatment 2,704.75 Sessions devoted to inspection 198.25 Sessions devoted to Dental Health Education 89 45 HEALTH EDUCATION AND HOME SAFETY The Aims of Health Education Recent discoveries in Science and Medicine have given mankind mastery over so many factors in his environment that the man-in-the-street just does not realise those vast regions of nature which simply have not been explored, and when some tragic epidemic occurs he is staggered, feels that "somebody" is to blame, and that a scapegoat must be found, preferably amongst those shadowy but powerful people, the "Scientists", the "Health Authorities" or the "Government", who did not stop the tragedy from occurring. People forget how much we do not yet know about human illness, but even with our present knowledge, fail to realise that "public health" is a "public concern". Hygiene is a communal activity which concerns all of us, not just some of us, and prevention of disease will not be achieved by casting responsibility upon the shoulders of the few. Progress in controlling infection is truly a team effort, not confined to the work of the medical men, but needing the conscious attention of Education Authorities, Commerce, Industry, and, in fact, the whole community. Until the public generally and particularly those in positions of responsibility, feel this way, progress will remain slow. The improvement in health of the British public over the last 100 years has been a combined exercise, essential roles being played firstly by the visionaries and pioneers, later by other dedicated workers in the Public Health Service, by Bacteriologists, Engineers, Public Health Inspectors and others. There must be added to this team, however, the people who have often developed and provided the weapons for the medical man, Industrial Organisations, whose own research staff have produced excellent drugs and antibiotics for the cure of illness, together with the disinfectants and detergents which have done so much to prevent the spread of infection and help control outbreaks of communicable disease. It has been learned that one of the objects of health education is to inform people, to give them facts so that they may better understand the reasons behind modern health principles and precepts. 46 The three aims of health education are:— (1) To ensure that the community regards health as an asset; (2) to equip the individual with skills, knowledge and attitudes to help solve his own health problems; (3) to promote the development of the health services. But. more important still, is the application of this knowledge. It is no easy task, when ingrained habits and customs have sometimes to be broken down, and personal likes and dislikes, as well as prejudices and emotions, counteracted. Success depends not only on expert teaching, but on sympathy, patience, and the correct approach appropriate to the age, sex, personality and the social and educational background of those to whom it is directed. Advice, guidance and practical help go shoulder to shoulder with teaching, particularly with regard to the older age groups. The principles to be adopted to assist older people to preserve their health and well-being are now better understood, but it is not always so easy to put them into practice. The large number of organisations, voluntary and statutory, that are now engaged in the task of helping them must work together as a united force towards a common goal. Many old people are difficult, and peevishness and irritability are faults of character and not of age, and these people are excusable to some extent, particularly those who fancy that they are being neglected, despised and ridiculed. Whatever organised bodies may be doing—and it is gratifying to see the increasing interest they are taking—it is the public themselves, the relatives, friends, neighbours and fellow citizens—young and middle-aged who can accomplish most. They are in the best position to counteract the mental and physical hazards which result from a feeling of being "neglected, despised and ridiculed". When they themselves pass into old age, they will thereby be better prepared to meet it, and live with it with satisfaction, than many of the present generation of pensioners who have not learned to do so. Practical aid can now be given to those whose working days are over, especially those who live alone. Help that was almost non-existent ten years ago, when the word "Geriatrics" first came into use. The principle that the majority of old folk are best off at home, has been firmly established, and great efforts have been made to make the home more suitable. Old People's Welfare Committees, the Meals on Wheels Service, the Old People's Clubs, the employment schemes for the elderly are supplying long-felt needs. More is being done to prevent accidents in the home, which take a heavy toll of the aged, here again health education and the co-operation of everybody, as well as the elimination of material causes in the homes (the unprotected fire, defective gas appliance, dark staircase or worn carpet) are important. 47 Old age is wretched if it has to defend itself with an apology, and its worst feature is that it makes those at that season of life feel that they are troublesome to others. Home Safety From January to December 1967, a total of 6,856 home accident cases were reported at Farnborough, Orpington and Beckenham Hospitals. Of these 3,844 were adults, and 3,012 children. This shows a pronounced increase, as compared with the same period in 1966, when the overall figures were 6,440. Of these 3,703 were adults and 2,737 children. Since the formation of Bromley Home Safety Committee in November 1967, statistics of home accidents from Bromley Hospital were obtained for the month of December, which shows that during that month, a total of 135 adults and 114 children were treated for injuries sustained in their homes. The three most prominent causes of these accidents, according to the hospital authorities are as follow:— 1. FALLS, being the chief danger to the older person. 2. BURNS/SCALDS effect both the very young and old people. 3. POISONING. Being the danger to adults, particularly in relation to gas, medicinal substances through overdoses, mistakes, etc., and also to the very young child who finds drugs/tablets loose in cupboards, drawers, etc. Those members of the Home Safety Committees within the Borough, who work for the cause of Home Safety, know well that accidents are "caused" and therefore can "be prevented". For these people, study of many cases has proved that these accidents are not "bolts from the blue", or sudden acts of unkind fate, but a chain of events starting from a cause and leading to a result, a tragic result which could have been prevented by action somewhere along the line. The aspirin bottle "could" have been put away after the last use, the mat could have had a non-slip backing, the handle of the saucepan "could" have been turned away from the front of the cooker. If these simple acts had been carried out, a small child could have been saved a trip to hospital, an old person could have avoided a fall, and the scalding accident need not have happened. The Press, Radio and Television play their part in reaching the public with help and advice on the causes and prevention of these accidents. Health and Welfare and Home Safety Committees, Health Visitors, Nurses, Teachers and Voluntary Workers all play their part in trying to reduce these unnecessary accidents, but the 48 accident rate still remains too high, and "I didn't know" or "I never realised" continues to be the cry, when these accidents occur. Local Campaigns With the co-operation and approval of the West Kent Pharmaceutical Society, the Home Safety Committees have arranged for posters to be printed and displayed in all Chemists' shops within the Borough, notifying members of the public that all unwanted drugs/tablets/medicines, etc. could be returned to the chemist for ultimate disposal. Copies of these posters have been given the widest publicity, in Libraries, Clinics, Old People's Clubs, General Practitioners' Surgeries, and the local and national press. During the past year, the Home Safety Committees have supported the National Campaign on general preventive measures, particularly with regard to the Fire Protection Campaign, sponsored by the Home Office, R.o.S.P.A. and the Fire Protection Associations. Many lectures, displays of material, film shows, etc., have been carried out during the year, with the wonderful co-operation of many Head Teachers, Health Visitors, Council of Social Services, and many voluntary organisations. INFECTIOUS AND OTHER DISEASES 51 INFECTIOUS AND OTHER DISEASES General Although a total of 4,772 notifications of Infectious Disease were received during 1967, the vast majority of these (4,299) were in respect of cases of measles, and the Borough continued to enjoy the freedom from the more serious infections which has been such a gratifying feature of its health experience so far. Once again, both diphtheria and poliomyelitis were noteworthy by their absence, a tribute to the good sense of parents in the Borough in continuing to take full advantage of the immunisation facilities provided for their families by the Local Authority and General Practitioner services. It is anticipated that before the next biennial epidemic of measles occurs a safe and effective vaccine will be available to give protection against this common, but sometimes unpleasant, illness. It is hoped that the public response will be sufficient to make some impact on the epidemic prevalence of this infection. Cases of whooping cough showed a sharp increase compared with the previous year and there was also a small increase in the number of cases of food poisoning reported, the latter reemphasizing the need for continued and continual vigilance in the field of food hygiene. In other respects, however, the notifications compared favourably with the preceding year. Cases of dysentery were fewer and isolated and this infection did not occur in epidemic form during the year. Finally, it is encouraging to be able to record again a further diminution in the number of new cases of tuberculosis reported during the year, the total number of new notifications being 44 as compared with 60 in 1966, and there was again a further small reduction in the total number of patients on the Register. Statistical details of the various infectious diseases are given below under separate headings and unless otherwise stated, no deaths from these infections occurred. Diphtheria No cases were notified in 1967. Dysentery Twenty-nine cases were notified, all of them being of the mild sonnei type. These were all isolated cases and the infection did not occur in epidemic form. Forty-three notifications were received in 1966. Erysipelas Eleven cases were notified as against eight in the previous year. 52 Food Poisoning Thirteen cases were notified during the year, compared with seven in the previous year. All of these affected single families, or individuals, and there were no general outbreaks of the disease. FOOD POISONING Incidents and Cases Causative Agent GENERAL OUTBREAKS FAMILY OUTBREAKS SPORADIC CASES notified or ascertained TOTAL No. of outbreaks and sporadic cases cols. (1+3+5) TOTAL No. of cases columns (2+4+5) No. of separate outbreaks No. of cases notified or ascertained No. of separate outbreaks No. of cases notified or ascertained 1 2 3 4 5 6 7 1. S. typhimurium — — — — 3 3 3 2. Other Salmonellae (a) - - - - 2 2 2 3. CI. welchii — — 1 8 — 1 8 4. Staph, aureus — — — — — — — 5. Other causes (b) — — — — — — — 6. Cause unknown — — — — — — — 7. TOTAL — — 1 8 5 6 13 DETAILS OF FOOD POISONING DUE TO SALMONELLAE OTHER THAN S. TYPHIMURIUM Type of Salmonellae INDIANA — — - — 1 1 1 ENTERITIDES - - - - 1 1 ' — - — — — — - — — — - - — — — - - - - - Measles 4,299 notifications were received in 1967, as against 1,236 in 1966. One death from this disease was recorded. Meningococcal Infections No cases were notified in 1967. There were two cases in the previous year. Ophthalmia Neonatorum Three notifications of this disease were received. 53 Pneumonia Thirty notifications in respect of cases of pneumonia were received. 223 deaths were attributed to this disease. This figure includes the people who are normally resident in the area, but who died in premises outside the Borough boundaries. Poliomyelitis No cases of this disease were notified during the year. Puerperal Pyrexia Twenty-nine cases were notified in 1967, compared with twenty-four in 1966. Scarlet Fever Ninety-five cases were notified, compared with 111 in the previous year. Once again the infection continued to occur in a generally mild form. No deaths from this disease were recorded. Smallpox No cases occurred during 1967, but once again it was necessary for a number of suspected contacts to be kept under surveillance at various times during the year. The Department was called upon to authenticate the signature of the doctor on 5,093 International Certificates of vaccination. The figure for the previous year was 20,991. Tuberculosis Forty-four new cases were notified during 1967, and, in addition, two cases came to knowledge after death and three previously known cases were restored to the register. This compares with sixty notifications received in the previous year. Eleven deaths were attributed to this disease. There were nine deaths in 1966. The following are details of the recordings in the register for the year ended 31st December, 1967. TUBERCULOSIS The following are details of the recordings in the register for the year ended 31st December, 1967:— Respiratory Other forms Total No. of Cases M F M F No. on Register at 1.1.67 1,597 1,261 148 175 3,181 No. of cases notified during 1967 21 18 1 4 44 No. of cases coming to knowledge after death 1 1 — — 2 Restored to Register 2 — — 1 3 Inward Transfers 26 21 - 1 48 1,647 1,301 149 181 3,278 Deletions-deaths, removals recoveries, etc., 126 84 5 5 220 Number of cases on Register at 31.12.67. 1,521 1,217 144 176 3,058 54 Age Groups New cases notified or otherwise revealed. (Not including Inward Transfers). Deaths Pulmonary Non-Pulmonary Pulmonary Non-Pulmonary M F M F M F M F Under 1 year 1 year 2-4 years 1 5-9 years 1 10-14 years 1 15-19 years 2 1 20-24 years 1 25-34 years 3 5 1 35-44 years 3 2 2 1 45-54 years 3 3 4 55-64 years 4 2 7 2 65-74 years 3 1 1 7 3 75 years and over 2 1 1 3 3 Age Unknown 1 Inward Transfers 21 18 1 4 23 8 — — 26 21 — 1 Totals 47 39 1 5 Public Health Prevention of Tuberculosis Regulations 1925. Section 172, Public Health Act, 1936. No action was taken by the Local Authority under these regulations during 1967. Typhoid Fever One case of Typhoid Fever in a male in the 35/45 years age group was notified during the year. This man had been in contact with a large number of persons who travelled in the course of their employment in many different countries and it was concluded the infection had been acquired by this means. Whooping Cough Notifications of this disease showed a sharp increase in 1967, two hundred and eighteen cases being notified compared with one hundred and thirteen in the previous year. 55 INFECTIOUS DISEASES 1967 Notifiable Disease Number of Cases Notified in Age Groups Under 1 year 1 and under 5 5 and under 15 15 and under 25 25 and under 35 35 and under 45 45 and under 65 65 and Upwards Age unknown Total All ages M F M F M F M F M F M F M F M F M F M F Scarlet Fever 23 9 17 43 2 1 41 54 Whooping Cough 4 5 64 56 43 44 1 1 112 106 Measles 43 34 1,274 1,159 868 862 4 10 1 8 2 4 3 1 15 11 2,207 2,092 Pneumonia 1 1 1 5 2 1 2 7 2 2 5 1 16 14 Dysentery 1 1 5 4 1 2 1 7 4 1 1 1 10 19 Erysipelas 1 6 2 2 9 2 Puerperal Pyrexia 16 10 3 — 29 Food Poisoning 1 1 7 1 1 2 2 11 Typhoid Fever 1 1 — Ophthalmia Neonatorum 3 3 — Tuberculosis (Pul.) 1 1 1 2 2 3 5 3 2 7 5 5 2 21 18 Tuberculosis (N.Pul.) 1 2 2 1 4 Totals 52 40 1,368 1,230 936 954 8 46 6 30 8 12 21 15 9 10 15 12 2,423 2,349 4,772 SERVICES UNDER THE MENTAL HEALTH ACT, 1959 59 MENTAL HEALTH SERVICE Sara Syrop, m.d.(warsaw), d.p.h., d.c.h„ d.t.m. &h., Senior Medical Officer H. J. Vagg, a.r.s.h., a.i.s.w., Principal Mental Welfare Officer It would be valid to compare year 1967 to year 1966 only, the latter being the first full calendar year in the service's existence. The lay-out of this report follows on the previous one as closely as possible so that the reader can evaluate for himself the analysis and comments made 12 months ago. TABLE I CASES IN COMMUNITY CARE SUPERVISED BY THE MENTAL HEALTH SECTION IN 1967 (Corresponding numbers for 1966 in brackets) Mental Illness Elderly Mentally Infirm Psychopathic Disorder Subnormality Severe Subnormality Totals New Referrals 296(259) 26(29) 7(1) 72(114) 24(18) 425(421) Total Cases 31.12.1967 328(313) 27(40) 2(1) 317(292) 180(183) 854(829) The upward trend has continued for all types of mental disorder with the exception of elderly mentally infirm. This category is perhaps the worst defined and the small number involved would make speculations as to the reason for the decline unprofitable. MENTAL HEALTH SECTION STAFF General Comments Recruitment continued within the limits imposed by financial stringency; and the policy of appointing only academically qualified persons, or those considered capable of so qualifying was strictly adhered to. The list of mental health social workers by post and qualification is given on page 62. The division into three areas each with the office situated at: 11 Homefield Rise, Orpington. 17 Palace Grove, Bromley. 69 Croydon Road, Penge, S.E.20. with the Senior Mental Welfare Officer in charge, has continued, and so has the duty roster providing round the clock service, weekends and public holidays included. Because of the sheer size of the Borough and inadequate public transport from the southern 20 square miles of the Borough, much thought is given in connection with the projected move of 60 the Health Department to the new offices near Bromley North, since it seems inevitable that an area office in one form or another would have to remain as a permanent feature of the service. ATTACHMENT OF MENTAL WELFARE OFFICERS TO FAMILY PRACTICES In August, 1967, a pilot scheme was launched by attaching five Mental Welfare Officers to five family practices in the Penge and Beckenham areas. To ensure as far as possible the success of the scheme, the practices were carefully selected. All Doctors were community orientated and were already working on the team approach lines through previously existing attachments of Health Visitors. None expressed anxiety about "outsiders" breaking into the doctor/patient relationship. Before the scheme had the official approval, good working relationships existed between the Doctors and the Mental Welfare Officers involved and every G.P. expressed willingness and even enthusiasm to take part in the scheme. The Authority and the G.P.s were from the start in agreement as to why the attachments would be advantageous to them and to the community as a whole. Firstly, it was felt that the team approach already referred to above, could with advantage, be extended. Not only emotional and social difficulties of the patients whether primary cause of the illness or secondary to the illness, were more likely to be diagnosed and/or high-lighted by this member of the team whose training and routine work makes him most sensitive to this area of human functioning. To investigate this side of the complex nature of illness is very time consuming, and the notoriously overworked G.P. is seldom able to afford the time needed. The time factor would even more be involved in therapeutic situations where general support, explanations and reassurance has to be given unhurriedly and more than once. Secondly, a well established kindly family doctor is often the first post of call in marriage difficulties, transient depressions or social inadequacy. Whilst the frankly psychotic patient presents no medical problem to the G.P. as long as the services of the Consultant Psychiatrist are available, the number of those suffering from vague mental ill health is steadily growing. This is the group where a substantial number of G.P.s feel the M.W.O. should be the main therapist. When our basic mental health services are truly adequate and we turn to apply ourselves to a primary prevention programme, we envisage that the M.W.O. will be called in as a 61 consultant in a case where the individual, in spite of the support from the usual caretaker agencies like neighbours, clergy and doctors, does not satisfactorily cope with a crisis situation. Lastly, both the G.P.s and the M.W.O.s can contribute much to the concept of illness as a family symptom. The G.P. with his knowledge of the other members of the family often extending several generations back, and the M.W.O. understanding the complex workings of the Welfare State and its resources, the locality and scope of voluntary agencies, can together offer "total" treatment of the situation and support not only the overtly sick in the community, but its vulnerable members as well. At the time of writing this report the scheme has operated for seven months and no real difficulties were encountered. It involves no more than one hour per week spent by the family doctor and M.W.O. in discussing their "joint patients". The doctors concede that the prejudice against the M.W.O. employed for "constabulary" duties only, is dying out rapidly. At the same time, the Mental Welfare Officer is abandoning the concept of the General Practitioner working in isolation with the surgery doors opened to patients only. Statutory Functions The importance of statutory duties performed by the M.W.O. must never be under-estimated. For performing these, the M.W.O. is vested with legal powers under the Mental Health Act, 1959. The table below gives the number of admissions where the M.W.O. was involved either formally or informally. TABLE II HOSPITAL ADMISSIONS EFFECTED BY M.W.O.s IN 1967 (Corresponding numbers for 1966 in brackets) Mental Health Act, 1959 Mentally Ill and Psychopaths Mentally Subnormal and Severely Subnormal Section 25 44(33) -(-) Section 26 10(11) -(-) Section 29 140(115) -(-) Section 60 4(4) -(-) Total Compulsory Admissions 198(163) -(-) Informal Admissions 76(73) 9(2) Total: all admissions 274(236) 9(2) Here, too, a steady upward trend adds weight to the argument against the wishful thinking still indulged in by enthusiasts and professionals alike, namely, that the higher the standard of 62 community care, the lower the number of hospital admissions. With the standard of L.H.A. services rising, the number of hospital admissions persistently remain on the increase. Mental Welfare Officer as Specialised Social Worker The concept of deploying the M.W.O.'s skills in three general directions—statutory duties, general support and intense case work—has proved a sound one and the service has been fortunate in the stability of the staff. There were no resignations in 1967. The personalities and qualifications of new staff are very good. We appointed two officers with P.S.W. qualifications, one with C.S.W. qualifications and a trainee with an excellent school record. The list of officers (staffs of mental health establishments is considered separately), is given below by listing posts in the left hand column and qualifications in the column opposite. Principal Mental Welfare A.A.P.S.W. 3 Officer 1 Certificate in Social Work 3 Deputy Principal Mental Diploma in Social Studies 1 Welfare Officer 1 Declaration of Recognition Senior Mental Welfare of Experience in Social Officers 3 Work 1 Mental Welfare Officers 10 Undergoing full time Training *1 Trainee, Mental Welfare Officers *2 Others 8 17 17 *1 seconded on to C.S.W. Course in September, 1967. The In-Service training, or rather staff development, continues on lines described in the report for 1966. The figures below do not include training of Training Centre staff nor the many case conferences held throughout the year. The M.W.O.s attended 135 (92 in 1966) seminars and conferences, making an average of 9.7 sessions per officer (8.5 in 1966). Towards a Comprehensive Mental Health Service The attachment of two M.W.O.s both academically qualified, to two Consultant Psychiatrists in the Borough, has worked smoothly and harmoniously. Similarly, a third M.W.O. "loaned" to the Child Psychiatrist to work at the L.A. Child Guidance Clinic, The Willows, Chislehurst, has continued throughout the year pending the appointment of a full-time P.S.W. The new officer will work for over half of the time at the Clinic and for the remainder in a consultative capacity within the rest of the community Mental Health Service. As previously, all the M.W.O.s have retained their own case loads and have continued to take their turn on the duty roster. 63 New Development in the Hospital Services for the Borough There has been a further extension of psychiatric outpatient facilities. The table below differs from the corresponding table for 1966 by the number of adult psychiatry sessions at Stepping Stones being increased from six to nine sessions. TABLE III NUMBER OF OUT-PATIENT CONSULTANT SESSIONS IN THE BOROUGH PER WEEK Name of Hospital Adult Psychiatry Child Psychiatry / Guidance Bromley (Stepping Stones) 9 3 Beckenham 2 0 Farnborough 3 2* Orpington 1 0 Queen Mary's** 2 0 Sydenham** 0 2 The Willows, Chislehurst*** 0 4 TOTAL 17 11 * referrals through Paediatricians only. ** hospital situated just outside Borough boundaries. *** local authority clinic. The Farnborough Day Hospital opened early in 1967, is satisfactorily meeting the demand for the day care of the mentally ill, and as envisaged, has become a focal point of contact between the hospital and L.H.A. services. ORPINGTON TRAINING CENTRE 143 Chislehurst Road, Orpington Supervisor: Mrs. D. W. Hodgman Senior Assistant Supervisor: Mrs. S. I. Walton The Centre has had yet another successful year, the staff continuing with devotion their hard work in unsuitable premises. One Assistant Supervisor resigned and one qualified officer was appointed. The second new appointment was that of the Trainee, who was fortunate enough to secure a place on the N.A.M.H. two year Diploma Course in Bristol, beginning in September, 1967, with her placement sponsored by the Council. The third new appointment was that of a part-time pianist and the "children" are already showing benefit from participating in 64 the many activities associated with music which were hitherto denied to them. The provision of an extra classroom at the Centre completed just before Easter, 1967, enabled us to reduce the waiting list to Special Care cases only and to relieve pressure in the rest of the Centre. Now one classroom is au par with the modern educational establishments. The attendance rate remains good. The annual medical inspection carried out for children and adults confirmed good general health, the defects being only in the sensory (visual) and dental areas. The facilities of School Clinics are often used by the trainees. Where the parents are either unable or unwilling to take the child for treatment, the M.W.O. provides transport or acts in loco parentis. The Centre aims to help the child in reaching his full potential. The three Rs, physical education, social graces, awareness of the outside world are taught. For the older trainees, simple skills, e.g. home making for girls and light industrial work for boys are given due emphasis. The latter group are now increasingly involved in contract work while the girls are getting very proficient in sewing, needlework and cooking. To enhance the awareness of the outside world, the "children" continue to shop in the locality in small groups and the whole Centre visited the Maritime Museum, Greenwich, Horniman Museum and the Orpington General Post Office. The Authority is acutely aware of the need to employ staff, who, in addition to experience and personal qualities, are also suitably academically qualified. The formal training of existing staff is hampered on one hand by the scarcity of Diploma Course placements, and on the other by the fact that the majority of officers are not, because of family commitments, able to apply for such placements. The In-service training referred to in the previous report has been intensified in 1967. The two One-day Conferences for all staffs, including Hospital Schools, organised in conjunction with Bexley L.B. took place in 1967. The Spring Conference had Orpington Training Centre as its venue, where the emphasis was on the 3R work and Speech Therapy. For the Autumn Conference, Goldie Leigh Hospital, Abbey Wood, S.E.2 acted as host and the subjects covered were the application of music in the Training Centres, also special teaching methods and equipment needed for cerebral palsied children. In addition, two Assistant Supervisors attended day release seminars. In all, in-service training occupied 110 officer/sessions (57 in 1966) making an average of 10 sessions per officer (5.7 in 1966). The secondment of one trainee on a Diploma Course was already referred to. 65 The relationships with the neighbourhood remain excellent and the Garden Fete held in September gave pleasure to children, parents and friends, and doubled the Amenities Fund. Child Psychiatry and Child Guidance The appointment of one Child Psychiatrist to cover not only Local Authority Child Guidance sessions but also to work in the Hospital Service, and thus be responsible for all the children presenting behaviour or educational problems, has, as envisaged, gone a long way to establishing a comprehensive service. The demand for the service is still in excess of the amount of Consultant time available—a temporary remedy was provided by appointing an Assistant Psychiatrist to cover two sessions at Stepping Stones. The work of the Child Guidance Clinic is dealt with in ihe section on the School Health Service. SUBNORMALITY Size of the Problem As seen from Table I there have been small variations only in the total numbers of subnormal and severely subnormal cases in the community. These variations are in the main due to movement of families in and out of the Borough. The Young Mentally Handicapped Child The prediction that Bromley can, according to the national average (incidence rate for severely subnormals 3.7 per 1,000 births) expect 18.5 such cases to be born each year, has proved correct. The Table IV below includes 97 severely subnormal children, all in their first five years of life, giving an average of 19.6 children born each year. Assessment and Parent Counselling The Health Visitor carries out general support and family counselling where there is a young mentally handicapped child. When the child reaches his fifth birthday, the casework is taken over by the Mental Welfare Officer, or in the event of the child coming within the orbit of the Education Department, his wellbeing becomes the responsibility of the Education Welfare Officer. The instances when the Mental Welfare Officer becomes involved before the child is 5, have been on the increase—with the quality of the M.W.O.s work constantly improving, more and more cases have emerged where the M.W.O. became the key figure. The formal and informal links either inter-Departmental (e.g. Children's or Housing Department) or with other agencies, 66 statutory and voluntary (e.g. Probation Service, N.S.P.C.C.) have been strengthened. A considerable proportion of mentally handicapped children come from the multiple problems families, and the team approach practised by the Mental Health Service is now accepted throughout the whole range of Social Services. The medical and psychological assessment of young children continues to be carried out in the child's home by the Senior Medical Officer, Mental Health. Even if an Assessment Clinic, mentioned in last year's report, is established, it is generally felt that a home visit has so many advantages that it may well be retained—for instance, for the first contact between the family and the Senior Medical Officer. Link with Hospital Paediatric Service The liaison with Paediatricians working from local hospitals has worked extremely well. With the efficient two-way traffic in information, the knowledge of the child and his family can be pooled, duplication avoided and delay in dealing with social problems minimised. The Assessment Centre (Newcomen at Guy's Hospital) is very prompt in sending their findings to the Medical Officer of Health, often with the request for providing a particular service, be it home help for the mother or play group for the child. Clinical Types of Subnormalsy The Table below gives groupings by diagnosis of young subnormal children. TABLE IV CHILDREN IN COMMUNITY THOUGHT TO BE MENTALLY HANDICAPPED—BORN AFTER 31.12.1961 (Corresponding number for 1966—children born after 31.12.1960—in brackets) Subnormality (various causes) 45 (32) Mongolism 26 (28) Severe Subnormality (non-specific defects) 21 (18) Cerebral Palsy 20 (18) Spina bifida with hydrocephaly 8 (6) Hydrocephaly 7 (6) Microcephaly 6 (5) Spina bifida 4 (3) Microcephaly with cerebral palsy 3 (3) Autism 3* (0) Deaf 3** (0) Rubella Syndrome 2*** (0) Patan's Syndrome j *** (0) Lowe's Syndrome 1*** (0) Hypercalcaemia 0 (1) Total: 150 (120) 67 *One child was referred in 1967, two children were previously included in the severely subnormal group. **The final diagnosis in all cases made in 1967. ***A11 these are new referrals in 1967. The Table is of some interest. The right hand side columns relate to mentally handicapped children, and in spite of the turnover of "population" amounting to one fifth of the total (children born in 1961 left the register, the new referrals took their place), the size of specific groups remain practically identical. Nearly half of the total increase in numbers is due to a larger first group (subnormality from various causes) and this undoubtedly reflects the wider terms of reference adopted by the hospitals in notifying the child to the Health Department. This in turn, we feel is due to the enhanced awareness on the part of the Consultants and their staffs of the relevant L.H.A. service available. The number of "self referrals", i.e. the mother approaching the Medical Officer of Health directly to ask for her child to be assessed, although marginal, has been on the increase. Clearly, everybody is taking note of the developing services. TABLE V CHILDREN BORN AFTER 31.12.1961 REMOVED FROM THE MENTALLY HANDICAPPED REGISTER DURING 1967 (Corresponding numbers for 1966 in brackets) Left District (3 severely subnormal, 3 subnormal, 2 mongols (with cerebral palsy) 8 (14) Found on assessment to have deafness as main handicap 3 (4) Admitted to subnormality hospital for long term care (1 mongol, 1 severely subnormal) 2* (2) *This severely subnormal child was subsequently removed by parent. Found on assessment to be below average 1 (5) Died 1 (6) Total: 15 (31) The numbers involved are too small to make valid comparisons, but it is of note how small is the fraction admitted to hospitals on long term basis (1 % to 2%). The reasons are two-fold—on the one hand the parents are more reluctant than ever to part with their child, and the reluctance is rationalised by pointing out the shortcomings of subnormality hospitals. Whilst gearing the community care to 68 lightening the burden the family has to bear, the staff cannot but feel how much further all the supportive services would have to develop before this help is anything like adequate. On the other hand, the national shortage of hospital beds remains as acute as ever. The developments on the hospital side are covered under the heading below. THE SUBNORMALITY HOSPITALS AND THE BOROUGH Long Term Care In 1967 there was a marked tightening up of criteria for admission to hospital on a long term basis. Only cases requiring skilled medical treatment or intense nursing care are being considered. This ruling is very strictly adhered to, but further difficulty is created by the fact that even when a case is accepted for admission, the hospital authority is not able to give any indication as to the length of time to be spent on the waiting list. This situation, where the parents already told that their child ought to be in hospital, have to continue to care for him with the uncertainty whether or when the relief will come, increasingly adds to the burden. The increase in the number of mentally subnormals provided with long term residential accommodation other than hospital accommodation (Table VI) is due to these trends. TABLE VI PERSONS PROVIDED WITH LONG TERM RESIDENTIAL ACCOMMODATION DURING 1967 Mentally 111 Mentally Subnormal In residence on 1.1.1967 13(9) 9(5) Admitted during the year —(7) 6(5) Discharged during the year 1(3) 3(1) In residence on 31.12.1967 12(13) 12(9) In order to implement the policy that subnormality hospitals will contain the most severe cases only, a move started to discharge from the hospitals cases admitted there as long as 50 years ago. Whilst the local authority files on the patients coming out into the community after half a century in an institution would undoubtedly be of interest to the sociai historian, one may well question the humanity of such a step. If, on the other hand, such policy is aimed primarily at pressuring the local health authorities into providing adequate residential accommodation of their own, the timing (present economic climate) may well render the pressure ineffective. 69 Short Term Care Over and above restricting the long term admissions referred to above, the hospital authority found itself unable to meet the commitments under the Mental Health Act, 1959. Ministry Circular 5/52 suggests that short term care will be available to meet social emergencies and/or to provide temporary relief for the family. Summer 1967 brought disappointment to many families who had already arranged a holiday on the understanding that their handicapped member would for that period be admitted to hospital. The representations to the hospital authority were met with reiterations of their own difficulties and little promise of improvement. It was up to the Borough to secure suitable vacancies and to meet the cost in voluntary homes. Table VII below gives appropriate figures from which it would be noted that the Council provided short term care placements for 36 cases, against 29 provided by the hospital authority. TABLE VII CASES PROVIDED WITH SHORT TERM CARE IN 1967. Hospital Placements Other Placements Category Under 16 Over 16 Total Hospital Placements Under 16 Over 16 Total Other Placements Total all Placements Subnormal 2(4) 3(3) 5(7) -(-) 1(-) 1(-) 6(7) Severely Subnormal 16(13) 8(14) 24(27) 5(3) 1(1) 6(4) 30(31) TOTALS: 18(17) 11(17) 29(34) 5(3) 2(1) 7(4) 36(38) At the same time, work started to put forward a scheme for an organised "School Holiday" to take place in the Spring of 1968. With the subnormality hospitals gradually assuming a marginal role in the whole spectrum of the services, the community services were bound to expand. Play Groups The St. Mary's Centre, Hayes, has flourished and as from the Autumn Term has functioned every day of the week, accommodating 24 children in all. Its success from the start is due primarily to the professionalism of the staff involved. The Centre accommodates every degree of handicap, providing relief to the mother in cases of the most severely and often multiple affected child, stimulation and nursery education to the children awaiting Special School and Training Centre placements. The Centre admits children from the whole of the Borough, and transport is arranged by the parishioners. The Centre is an excellent example of a smooth partnership between voluntary and 70 statutory bodies. The Hayes Parish Church is responsible for the service. The Bromley Society for Mentally Handicapped Children assists by meeting the fees in necessitous cases. The local authority provides the services of its senior officer to act as medical adviser, puts forward the children for admission and meets the deficit incurred by the Church in running the Centre. The Beckenham Play Group, organised by the Beckenham Red Cross, started early in 1967 and has developed well. Up to 12 children attend once a week. The modest premises stood in the way of further expansion, but this will be put right in 1968, when an extension to the British Red Cross Headquarters will be completed and the Play Group will be operational twice a week. Although the Play Group admits children from Beckenham and Penge areas only, the pressure on places continues. The Group is run entirely on voluntary lines, no payment is made to the staff and no financial support has been sought from the Council. Problems of Training Centre Placements With the knowledge that shortage of Training Centre places, especially on the adult side will continue, much thought and care has to be given to each individual case. Tribute was already paid in last year's report to the help received from the contiguous authorities, especially Kent County Council. This help was generously given in 1967, and half of our adult trainees continue to attend the Swanley Training Centre. Table VIII again shows no material change since last year, when it was pointed out that all the Centres involved have reached saturation point. TABLE VIII RESIDENTS ATTENDING TRAINING CENTRES AT 31.12.67 JUNIORS AND ADULTS Name of Centre and responsible Authority AGE GROUP TOTALS 5 years- 16 years- M F M F Scads Hill(Bromley) 30(28) 22(22) 23(16) 22(21) 97(87) Swanley(Kent) -(-) -(-) 25(27) 18(16) 43(43) Sidcup(Bexley) 2(3) 2(2) -(1) -(-) 4( 6) Perry Rise(Lewisham) 1(0) -(-) -(-) -(-) 1( 1) Thanet(Kent) 1(1) 1(1) -(-) -(-) 2( 2) Slough(N.S.M.H.C.) -(-) -(-) 1(1) -(-) 1(1) 34(33) 25(25) 49(45) 40(37) 148(140) 71 Club Activities for the Mentally Subnormal The Borough has now two Gateway Clubs, one in Penge and one in Orpington (January, 1967). Both Clubs have had a most successful year, having gained the support from local communities. The field officers of the Section provided advice. The Council meets the cost of renting the premises and the Clubs are run by Committees elected by parents. The Peter Pan Club established in Bromley 10 years ago, has the distinction of being one of the first of its sort in the country. In spite of cramped premises, the Club has a large membership and a wide range of activities of which the youngsters take full advantage. The progress with the new Junior Training Centre will be referred to at the end of the report. Headquarters of the Mental Health Section The work of the senior officers working from headquarters at the Health and Welfare Department has been covered in some detail in the Annual Report 1966. It will suffice to say that the financial restrictions coming at a period of rapid natural growth of the service has greatly added to the pressures and stresses. In September, 1967, the first Day Centre, Stembridge Hall, was opened. STEMBRIDGE HALL DAY CENTRE 9a Stembridge Road, Penge, S.E.20 Supervisor: Mr. S. J. Hall Deputy Supervisor: Mrs. E. G. A. Fathers This report is the exception to the rule, since it covers the period 18th September, 1967 to 5th May, 1968. The Centre opened on the first date and was, by design, filled very gradually. To limit the report to the first three and a half months of the Centre's existence would, therefore, not present a true picture. The Centre occupies a Council owned Hall which was acquired by the Health Department early in 1967. It was subsequently redecorated and adapted for the purpose. A store and a small Supervisor's office were added at the rear of the building. The Centre provides rehabilitation for young adults of either sex handicapped by mental disorder, for work in semi-sheltered or open employment. A free midday meal is served at the Centre and each trainee, or "member" to use the official designation, is paid a nominal sum in respect of work done. When more experience has been gained consideration will be given to introducing a scale of payments related to output and effort, on the lines of Ministry of Health Circular L.H.A.L. 21/67 which deals with incentive payments to mentally handicapped adults in Local Authority Training Centres. The Centre can accommodate up to 24 members. 72 At the time of writing this report 20 members were attending. Out of a total of successful referrals of 34: 5 left to take up open employment 6 left after a short stay—a week on average 2 relapsed and were readmitted to hospital 1 moved away from the area. 14 The source of successful referrals were as follows: 9 Psychiatric hospital 16 Mental Welfare Officers 5 Disablement Resettlement Officers 1 Family Doctor 3 Stepping Stones Club 34 The attendance record has been excellent throughout and so has the time keeping. The Mental Welfare Officers involved in the community care of individual members and other social agencies, keep in close touch with the Supervisor. Nine local firms carrying out light industrial work, have, through the personal efforts of the Supervisor, become and remain regular suppliers of contracts. It is envisaged that once such a supply of work can be counted upon, the surplus will be re-routed to the adult workshop at the Training Centre. This was the first new project established in the Borough. However modest in its aims and size, its success has been a source of satisfaction and pride to all concerned. When by the end of 1967, the authority was providing the ex-mentally ill with a place to work—Rydal Mount, Beckenham, a 15 place short-stay hostel was still awaiting completion. The Warden and Matron, however, had already taken up their posts and were engaged in getting the hostel ready for occupation early in 1968. PROJECTS ON MENTAL SUBNORMALITY SIDE Adult Industrial I Rehabilitation I Training Centre, Bromley As soon as negotiations to purchase a large industrial property for the above purpose fell through, every effort was made to acquire a suitable site for purpose building. These efforts were successful, and at the time of writing, the purchase is nearing completion and the Architects' work in progress. 73 Junior Training Centre, "Woodbrook" This long awaited Centre in Beckenham, which will incorporate a Kindergarten and a Special Care Unit and accommodate 80 children, is in the "builders on the site" stage, and the opening is anticipated for Summer, 1969. Closing Comments The Annual Report has by its very nature to be factual with the facts speaking for themselves. The staff, field officers and seniors alike, have given of their best and were rewarded by the show of confidence from the community, the voluntary organisations, the general practitioners and the hospital service. The supportive community services and the Training Centre have successfully completed yet another year's work. However, in writing this report one kept one's thoughts on the problems which will follow in the wake of the facts reported. The reader will by now appreciate that many items are missing. The trends away from hospital care cannot be reversed and the need for local authority establishments, day and residential, is bound to get even more acute. Missing from the Report are hostels for subnormal children and subnormal adults, a long-stay hostel for mentally ill, all envisaged in the Council's Three Year Plan. The short-term hostel will lose its function unless long-term placements are available to absorb its "failures". A sheltered workshop as a place of work for people not capable to enter or re-enter open employment is also missing. The Day Centre does not cater for these needs. In a sentence, the Report on the Mental Health Services in 1967 is saying, "Well done—but a great deal more will have to be done." REPORT OF THE CHIEF WELFARE OFFICER 77 REPORT OF THE CHIEF WELFARE OFFICER WELFARE SERVICES STAFF Chief Welfare Officer: J. Hanson, o.b.e., d.m.a., f.i.s.w. Deputy Chief Welfare Officer: J. Gill, d.m.a., a.i.s.w. Casework Supervisor: Mrs. E. K. M. Lemare-Long, a.i.m.s.w. Senior Social Welfare Officers: D. Hilditch. C.s.w. R. P. Messer, c.s.w., a.i.s.w. Miss J Turner, c.s.w. Senior Social Welfare Officer for the Blind: A. A. R. Clay, a.i.s.w. Specialist Welfare Officer for the Deaf: P. Coward, d.d.w. Mr. Chairman, Ladies and Gentlemen, I am pleased to submit my third annual report upon the development of the Welfare Services in the Borough. I have endeavoured to outline the main objectives, and to make an appraisal of some of the services in order to highlight their deficiencies. It is as important, I feel, to indicate what remains to be done as well as what has been accomplished. Reference was made in last year's report to the limitations imposed on the development of the Welfare Services in the Borough as a result of the Government's economic policy. This stringency continued throughout the year now under review and the general picture has been one of development within strict limits. A significant event was the appointment of the Specialist Welfare Officer for the Deaf in December, 1967. Previous attempts to make an appointment to this post had been unsuccessful, so that I had to report both in 1965 and 1966 that virtually no welfare service was provided in the Borough for the adult deaf and hard of hearing. This Report only covers the first few months of this officer's service with the authority, but many contacts with clients have been made already and the foundations for a comprehensive welfare service for the deaf and hard of hearing have been laid. Another development was the setting up of a Work Centre for the Physically Handicapped in the Penge area. This Centre was started in July, 1967, in co-operation with the Penge Round Table, in premises provided by the Education Department at the Alexandra Infants School. The appointment of an Industrial Work Organiser enabled contracts for work to be negotiated with commercial firms and public bodies to the benefit of those attending the Work Centre. Transport has been provided by the department in the two special vehicles purchased in June, 1966, and in October, 1967, respectively. It soon became clear that these two vehicles were inadequate to meet the needs of the physically handicapped in the Borough and several more vehicles of this type 78 fitted with mechanical hoists are required. It was particularly disappointing, therefore, that the two further vehicles I felt were needed were not included in the priorities approved for inclusion in the revenue estimates for 1968/69. The implication of this limitation on the provision of transport for physically handicapped people has been felt in all parts of the Borough. Facilities have increased considerably in the voluntary and local authority spheres and the disabled have become more anxious to avail themselves of the services. Consequently, the demand for transport has increased considerably—it is often the key to giving adequate support to the seriously disabled. The training programme for social welfare personnel has now entered its third year. Four students commenced the two year course leading to the Certificate in Social Work in September, 1967, and two welfare assistants were recruited for in-service training prior to their making application for places in colleges of further education for the course starting in September, 1968. One of these, and one other experienced officer, have been offered places on courses starting in September, 1968. There were two students due to complete their course in June, 1968, but one withdrew during the second year. The North-Western Polytechnic has used the department as a placement agency for first and second year students, and in the past year four students have been placed. Advantage has been taken of courses arranged for experienced social welfare officers, residential homes staff, and administrative staff within the limits of approved expenditure. The programme of the London Boroughs Training Committee has been especially helpful in meeting these training needs. The first in-service training course for attendant staff in Homes was organised in the early part of 1968. Certificates of attendance were presented by the then Mayor, Aid. Mrs. A. L. Gunn, J.P., to eleven attendants. Courses of this nature were commended by the Report of the Williams Committee (of which I was a member) and are likely to be repeated at frequent intervals. It was of some regret to me, however, that the local authority did not feel able to appoint a Homes Adviser. The new pattern of training for social workers with the deaf agreed between the College of Deaf Welfare and the Council for Training in Social Work required a placement agency in the London area which could set up a student training unit for those on recognised courses for social work with the deaf. This authority agreed to set up the student training unit which will also provide facilities for the continuance of the existing placement arrangements with colleges of further education providing Certificate in Social Work courses. My appointment to the Ministry of Labour (now the Department of Employment and Productivity) Committee on the needs 79 of the severely disabled in the Greater London area south of the Thames provides an opportunity both to assess the needs of individuals who, through disability, cannot compete in industry, and to influence the ways in which these needs may be satisfied. This survey is intended to assess the needs of the physically and mentally handicapped for sheltered employment. Throughout the year, I have continued to serve as an Adviser to the Welfare Committee of the Association of Municipal Corporations. This involves the submission of views about policies proposed by the Government, as well as discussions with numerous bodies including the Ministry of Health (now the Department of Health and Social Security) and national voluntary organisations. It is also relevant to indicate that, for several years now, I have represented the Association of Municipal Corporations on the Council for Training in Social Work and have served on a number of its committees or panels. This link is most useful as far as the Borough is concerned as it enables me to apply the knowledge gained nationally to the local situation. Similar considerations apply to my membership of the committees of the National Old People's Welfare Council which are concerned with the needs of the elderly, and training in its broadest aspect. I hope that the data which is now produced will give some indication of the importance attached to client and community needs, and T would like to thank all members of the welfare services team for their contribution to the advances achieved in 1967/68. Residential A ccommodation Soon after 1st April, 1967, the residential accommodation provided under joint user arrangements with the Regional Hospital Board at Orpington Hospital was closed and the 23 men in the ward concerned were transferred to accommodation in the residential homes. The Local Authority accommodation available remained at 394 places throughout the year and no further accommodation will be ready until the new purpose-built home for 46 residents is occupied in late 1969 or 1970. The capital building programme for residential homes provides for one home in each of the years 1970/71 and 1971/72 but sites for these have not yet been determined. I reported last year that the waiting list of persons requiring residential accommodation urgently stood at 68, of whom 24 were in hospital. The social workers were in touch with 107 people (31 in hospital) at 31st March, 1968, who needed care and attention urgently. This increase of 57% in the waiting list over a period of one year bears out my comment last year that a drastic revision 80 of the building programme will be required to provide enough places for the increasing number of elderly people who require residential care. More suitable (including sheltered) housing for the elderly and extended domiciliary services would help to reduce this demand. But, even with developments in community services which at the moment seem beyond the nation's resources, the demand for residential care is likely to exceed supply for many years. The very limited mobility of an increasing number of residents presents a problem in filling vacancies in homes without lifts. Lubbock House was provided with a lift during the year but Durham House and Selwood are without. The Borough Architect is looking into the structural problems of providing lifts in these two homes. If suitable schemes can be prepared the installation of lifts will be included in my proposals for the next three year capital programme. There was a reduction in the number of new admissions to homes compared with the previous year (115 as against 174) but the percentage of admissions from hospital rose from 36.8% in 1966/67 to 39.1% in 1967/68. The next highest group of admissions were of persons living alone, amounting to 45 residents or 25.8%, (the corresponding figures for 1966/67 were 34 or 29.5%), whilst only 49 or 22% were living with relatives, (the corresponding figures for 1966/67 were 24 or 20.8%). There is a tendency for admissions from hospital and from persons living alone to rise in comparison with those admitted from homes where they were living with relatives. The pressure on local authority accommodation is so great from persons living alone or awaiting admission from hospital, that this trend is likely to continue. This means that support for relatives caring for the aged must come increasingly from the domiciliary services and the use of day and short term care. The average age of new admissions remained at 82 years. An analysis of the ages of those admitted shows that 101 of the 115 new admissions were over 75 years of age, and 42 (i.e. over 36%) were over 85 years of age. This compares with the national figures as shown in the Ministry of Health Annual Report for 1967, which indicates that of persons over 65 years of age admitted into residential accommodation 27.5% were over the age of 85 years. There were 134 discharges from homes during the year. This figure does not include those who went into hospital for treatment and returned to the home subsequently. 73 persons (or 54.5% of the total) were discharged to hospital and had not returned at 31st March, 1968. Deaths in homes numbered 48 during the year (35.8% of all discharges). Only 4 persons returned to their homes during the year, excluding those admitted for short term only. 81 A meeting was held at Farnborough Hospital in November, 1967, with the Group Secretary, Consultant Geriatrician, and other officers of the Bromley Group Hospital Management Committee to discuss the problems arising from the shortage of beds in residential homes which makes it difficult for patients to be moved from hospital into residential accommodation when they are no longer in need of hospital treatment but are unable to care for themselves in their own homes. The discussion took place on the agreed understanding that the one-for-one exchange system, which is used in some areas, is not acceptable. The hospital officers accepted the view that residents were entitled to know that, when admitted to hospital for treatment, their bed in the residential home would be retained for their return. It was agreed that patients requiring recuperative care before returning home after hospital treatment could go to residential homes for short term care rather than to a convalescent home too far away from their home area. Very few have, however, come into homes so far but the hospital social workers are aware of the arrangements which can be made to meet a particular individual need. Short term care in residential homes is now firmly established as a supporting service for the elderly and their families. The number who received such care during the year was 134—a small increase of 11 over the previous year but representing maximum use throughout the year, summer and winter, of the beds available for this purpose. The average age of those admitted was again 81 years: of the 5 who did not return home, 1 died, 1 went into hospital, 2 went to voluntary homes and only 1 stayed in a local authority home. Day Care Extensive use has been made of the facilities at the residential homes for receiving day care visitors. The number of individuals attending during the year was 40. This number could have been exceeded had more transport facilities been available to bring the elderly to the Homes. The value of this service lies in its long term preventive aspect, as well as in the positive help given at a particular time. Those who come to the Homes, as well as relatives who care for them, are given encouragement and support to remain in their own homes and the pressure on permanent accommodation is eased. An interesting feature of the new home planned to open in 1969 at St. Paul's Cray, is the day centre provision which will enable 15 to 20 elderly to participate in various activities, including further education classes, in the additional rooms provided. Accommodation provided by Voluntary Homes There were 55 elderly people admitted to voluntary homes during the year whilst 54 were discharged. The average age of 82 discharge was 78 years compared to 84 years in the previous year— whereas the average age of discharge in local authority homes was 84 years compared with 82 years in the previous year. It follows that comparisons of this nature need to be made over a long term rather than a short term to ascertain whether there is any validity in drawing conclusions about the effect on residents of the earlier age of admission to voluntary homes. The expanding domiciliary services, including day centres, seem to be limiting the demand for full residential care to those of very advanced years. Voluntary homes in adapted premises without lifts find increasing difficulty in filling vacancies with residents fit enough to negotiate stairs. Charges for Accommodation The standard charge for accommodation provided in the Borough's eight homes was raised from £10 0s. Id. to £11 9s. 3d. per week on the 30th October, 1967. Only 33 residents were assessed to pay this amount for their accommodation; the cost to the local authority increased from £11 17s. 3d. per resident per week in 1966/67 to £11 18s. 7d. in 1967/68. This compares with an average of £11 16s. 5d. for London boroughs. Registration and Inspection of Homes The local authority has a duty to register and inspect homes run for profit or administered by voluntary committees. With three new registrations approved during the year the total number in the Borough is now 29 homes, with applications for three more registrations under consideration. A fire occurred in one private home, which placed an elderlv lady in grave danger. The Chief Fire Officer agreed to review the arrangements at all the registered homes as a matter of ureency to ensure that they complied fully with fire prevention reauirements. The advice of the department was sought to an increased extent bv those proposing to set up new homes or deciding to improve the facilities. It is vital that the department's role should be seen as a constructive one aimed at ensuring the best available care for the elderly, rather than as a negative one of "red taoe" control. The broadening contacts with proprietors indicates that there is an acceptance of this viewpoint. There have been difficulties in one or two cases where registration had not been sought before residents were admitted. In order to bring these establishments in to the standard reauired before registration could be recommended delicate negotiations had to be conducted, bearing in mind the vulnerability of the elderly residents in such situations. I acknowledge the verv willing co-operation of the Fire Prevention Officers of the London Fire Brigade in examining premises with an understanding of the problems involved and making recommendations so promptly. The Chief Public Health Inspector has advised on matters of hygiene 83 in homes and 1 extend my thanks to him for his assistance. The Borough Planning Officer, too, has been most helpful where problems involving building regulations have arisen. Social Work in the Community The three teams under their Senior Social Welfare Officers in the three areas of the Borough have been working under intense pressure during the year—the statistics showing the number of persons placed in residential homes, the number of families provided with temporary accommodation, and the amount of assistance provided for handicapped people, do not in themselves illustrate the demanding nature of the work. Indeed, the successes of the work of the social workers cannot be measured in statistics— advice, sympathetic guidance, and help at the right time can prevent the need for an elderly person to be placed in a home or can prevent the eviction of a family. Effective social work support depends upon the co-operation of different agencies. As the department has become established within the Borough, co-operation with hospitals, general practitioners, and voluntary agencies, and other departments of the local authority, has developed. A system of referral from hospital medical social workers of patients discharged home after treatment who may need the help of the social welfare officers was set up during the year—65 such referrals were made up to 31st March, 1967. Further developments along these lines will help to avoid emergencies arising through lack of contact between clients in need of help and the social welfare officers in the area. The Ministry of Social Security (now the Department of Health and Social Security) have for some time been enclosing a prepaid card with award notices sent to newly retired pensioners. The recipients are encouraged to send these cards to the central office at Orpington, indicating in what way they would like advice or assistance. The response to this service has not been as great as might have been expected but those who have used it during the year have been provided with help or advice which might otherwise not have been given. Meals and Recreation for the Elderly The close link between the Council and the voluntary agencies in the field of community care has continued. The number of meals on wheels provided during the year by the Womens' Royal Voluntary Service, the British Red Cross Society and the Old People's Welfare Committee in the Borough has increased from 93,000 to 120,000. During the year the Day Centre at the William Morris Hall, Bromley was opened and plans were well advanced for the small Civic Hall, Crofton Pound, Orpington, to be used for a similar purpose. Consultations have been held on several occasions during the year with the Borough Architect on the detailed planning of the 84 large new Day Centre at Masons Hill, Bromley, and close liaison was maintained with the Bromley Old People's Welfare Committee. This project is planned to proceed along with the adjoining building of a block of flats for the elderly by the Housing Committee and the necessary loan sanction has been approved by the Department of Health and Social Security. The improvements and extensions to the Beckenham Day Centre have also been agreed in principle, but it may not be possible to carry out this work in 1968/69 in view of the economic situation. A booklet was produced during the year in conjunction with the Bromley Old People's Joint Committee entitled "Services for the Elderly". This booklet contains information of all services available in the Borough provided by the statutory and voluntary organisations and 25,000 copies were distributed. Temporary Accommodation A further four properties were acquired during the year in pursuance of the Council's policy to provide separate family units for the temporary accommodation of homeless families, and there were 15 units available at 31st March, 1968. It was necessary to provide accommodation for 16 families during the year (this was the same number as in the previous year). The Housing Committee accepted 12 families as permanent Council tenants from among families in temporary accommodation during the year. At 31st March, 1968, 14 families were still accommodated. Prevention The skills of social workers are most used in working together with other agencies to prevent families becoming homeless and thus requiring temporary accommodation. Case conferences are arranged from time to time by the co-ordinating secretary on the staff of the Medical Officer of Health. Social workers discuss with representatives of other agencies the problems of families at risk of becoming homeless. Solutions are very often found which prevent the need for eviction. Support on a long term basis is arranged in certain cases, with one officer acting on behalf of the various agencies concerned. During 1967/68 the social welfare officers dealt with 63 families but, as indicated above, only 16 families needed to be admitted. These figures reflect some success in the measure taken locally to prevent homelessness. WELFARE SERVICES FOR THE PHYSICALLY HANDICAPPED (GENERAL CLASSES) The Register The Ministry of Health requires local welfare authorities to maintain a register of persons assisted under their scheme for the 85 provision of Welfare Services under Sections 29 and 30 of the National Assistance Act, 1948. The grouping of disabilities in the Register is in accordance with the Medical Research Council Code of diseases and disabilities. The number of persons registered increased by 297 compared with an increase of 102 the previous year. This increased number of new registrations reflects the growing awareness of the public of the various services which are available to handicapped people. It is an indication that a continuing expansion of these services will be required for some time to come if resources are to be available to meet the needs of all handicapped persons in the Borough. A total of 925 persons were registered as at 31st March, 1968. Of the 297 new registrations the majority (203) fell within the categories denoting organic nervous diseases or arthritis and rheumatism. Social welfare officers made 2,245 visits to the homes of handicapped persons during the year, an increase of 23%. The pressures on social welfare officers' time are such that routine visits are not generally possible—the increased number of visits, therefore, were largely made for specific purposes. Adaptation to Property The homes of 54 handicapped persons were adapted to help them overcome the effects of their disabilities. The cost of the adaptations varied from £3 for the installation of a handrail on a staircase to £348 for building an outside toilet and enclosed loggia. This extensive adaptation was carried out for the benefit of a young girl with spina bifida who had extreme difficulty in climbing the stairs to get to the toilet in the house. At the home of a client suffering from terminal renal failure adaptations were carried out so that haemodialysis equipment (kidney machine) could be installed. This enables the individual to have treatment at home and so continue to do a full week's work and lead a normal family life. In the case of a severely paralysed person, co-operation with the Department of Health and Social Security led to the installation of a "Possum" (patient operated selector mechanism) device. This equipment, costing several hundred pounds, is provided under the National Health Service and enables a severely disabled person to operate a range of electrical equipment by mouth or other small physical movements. The unit gives an on/off control over a number of electrical functions, including an alarm (bell and buzzer), an intercom link to the front door coupled with a door lock (to allow the "Possum" user to interrogate and if necessary let in visitors), heat, telephone, radio and light. The installation is designed to give the client an increased degree of independence. 86 Another example of a large adaptation was that in the home of a young man paralysed below the waist as the result of a road accident. His bungalow was adapted to permit him to use his wheel chair in all rooms. Access was made to the bathroom and toilet, and steps were replaced by ramps. These adaptations helped this young man to lead an independent life and return to his previous employment. Assessments on the financial ability of clients to contribute to the cost of adaptations are made. Considerable benefit to clients has resulted from the decision of the Committee (August, 1967) to provide the first £50 of adaptations free of cost. Adaptations to the homes of persons who are permanently and substantially disabled cannot be considered as a solution to the special housing needs of this section of the community. Housing policy in regard to new building needs to take account of the special requirements of wheel chair users. Housing authorities are including flatlets for the elderly in their development schemes, and as considerable numbers of the elderly have physical handicaps a high proportion of such flatlets could be constructed with the needs of wheel chair users in mind, so that ramps, wide doorways, special toilet facilities, etc. could be incorporated in new constructions at ground floor level. Personal Aids The number of aids to daily living supplied to handicapped people totalled 553 at a cost of £1,562. Included in this figure is the cost of supplying nursing aids at the request of district nurses on the advice of hospital consultants or general practitioners. The "Ripple" bed, which is used as a nursing aid to prevent bed sores, has placed an additional burden on the financial resources available for the supply of aids. "Ripple" beds cost £48 and during the year 14 were supplied. Requests for lifting aids such as the "Penryn" hoist and the "Easi-Carri" hoist have also been considerable. But the principle requirements continue to be bathing aids and walking aids which together account for over 65% of aids supplied. No charge is made to persons supplied with these aids which are returnable when no longer required. The increasing attention being applied to improving nursing techniques in the field of geriatric care is likely to increase the demand for such aids. The British Red Cross Society were given a grant of £150 to assist them to supply nursing aids and wheel chairs on temporary loan. Transport In the year under review the need for special transport facilities for people too disabled to get about by public transport exceeded the resources available. A second vehicle, specially adapted with 87 a tail lift and equipped to carry passengers in wheel chairs, was brought into service. The two vehicles travelled over 21,000 miles providing 8,400 passenger journeys for disabled persons during the year. If the vehicles and drivers were available, more could be done to meet the needs of the home-bound disabled. For example, the Work Centre at Alexandra Road School could have been used by more people if the transport facilities to get them to and from home had been available. Occupational Work The interest shown by the Penge Round Table in the welfare of the handicapped in the Penge area resulted in a joint enterprise commencing in June, 1967, between the department and a group of Round Table members, whereby the Penge Work Centre opened in an out-building at the Alexandra Road School. The premises were used by the Drum Youth Centre and the Youth Officer of the Education Department agreed that the two groups could share the premises. The local authority had no financial provision to set up such a Centre and it was due entirely to the enthusiastic co-operation shown by the Penge Round Table and the staff of the two departments that this Centre was able to open. The Industrial Work Organiser obtained work from several firms and the clients were conveyed to the Centre. The Centre was administered by a joint committee of Round Tablers and members of my staff. Pressure to expand the facilities to permit more disabled to attend the Centre is already evident but without the resources to provide more transport any expansion is limited to the very few who can make their own travelling arrangements. The Occupations Officers have played an important part in introducing the disabled to the Centre and in supervising the work. There has been unavoidable diminution in the amount of handicraft instruction in the homes of disabled but, even so, 3,123 visits were made during the year. A proportion of these were solely for the supply of outwork materials and the collection of finished products. Holidays Financial restrictions prevented any expansion in the number of holidays during 1967/68. Holidays were provided for 58 handicapped persons between May and July, 1967—the largest group going to Caister Holiday Camp in Norfolk. Getting away from home for a holiday presents so many problems involving travelling arrangements, special accommodation, mobility in strange surroundings, etc., that only by joining an organised holiday group arranged by the local authority will many severely disabled people venture to go away. The British Red Cross Society arrange a holiday every year at California Lakeside camp in Berkshire and I value highly the co-operation between the Society and the department in the provision of support to the disabled. 88 Club Activities In addition to the valuable work done by the British Red Cross Society in running clubs for the disabled, I am pleased to record that two clubs have been initiated by social welfare officers of the department. The good Companions Club at Penge has been active for two years and in May, 1967, the Orpington Younger Handicapped Persons Club was started. Here, young disabled people meet to enjoy the social activities and are assisted by the social workers. WELFARE SERVICES FOR THE BLIND AND PARTIALLY SIGHTED Certification Consultant ophthalmologists carried out 156 examinations during the 12 months ended 31st March, 1968. 122 persons were examined for the first time and 34 were re-examined. Fees paid amounted to £622 6s. 6d.; first examinations accounted for £518 10s. 6d. of this amount and the remaining £103 16s. Od. was for re-examinations. As a result, 78 persons were added to the blind register, 46 persons placed on the partially sighted register and 9 persons had their names included on the observation list . Approximately, one quarter of the persons examined suffered from cataract. Register of the Blind After making adjustments for new registrations, transfers and deletions from the register, there were 490 persons on the register at 31st March 1968, an increase of 16 on the previous year. The number of registered blind men rose from 157 at 31st March, 1967, to 164 on 31st March, 1968, whilst the number of registered blind women increased from 317 to 326 during the same period. Distribution in Age Groups (Blind Persons) At 31st March, 1968, there were five children under the age of fifteen registered as blind. 13 persons were in the age group 16 to 20; 51 persons in the group 21 to 49 and the remaining 421 came in the 50 and over age group. The three older age groups show slight increases on last year's figures. The national statistics indicate that there will be a temporary increase in the number of blind teenagers. This is due to the children suffering from rentrolental fibroplasia (blindness caused by excessive oxygen) moving into a higher age group. As far as the elderly are concerned there will be an increase in the number of persons over 70 who are registered as blind if present trends continue. 89 Classification of Blind Persons Children at School Of the five children who are of school age, three girls and one boy are mentally retarded and unable to benefit from education. The remaining boy receives secondary education at Linden Lodge School, Wimbledon. Two blind teenagers were still at school on 31st March, 1968; one boy was at Worcester College for the Blind and one girl at Dorton House School, Seal, Kent. Employed On the 31st March, 1968, two male home workers were employed as piano tuners and one blind female was employed at home as a machine knitter. 37 men and 14 women were employed in open industry, working with sighted colleagues and holding down jobs which, in the main, require a high degree of skill. Examples of their ability are illustrated by a blind physiotherapist who is employed in a local hospital and a former bank manager who has been retained by his bank to lecture on banking. Unemployed The majority (352) of the 429 unemployed blind persons were over the age of 65. Of the remaining 77, 27 were housewives, 7 employable with or without training, 7 not available for employment, 15 mentally ill and 21 physically disabled. Register of the Partially Sighted After adjustments for new registrations, transfers, and deletions from the register, there were 197 persons on the register as at 31st March, 1968, a net increase of 13 on the previous year. There was a reduction of the number of registered partially-sighted males from 63 at 31st March 1967, to 57 at 31st March, 1968. In the same period the partially-sighted females increased from 121 to 140. The increase in the partially-sighted register will probably be reflected in a corresponding increase of the blind register at a later date. Distribution in Age Groups (Partially-sighted) Increases occurred in the age groups 5 to 15 (10 to 15), 16 to 20 (7 to 8), 21 to 49 ( 29 to 31), 50 to 64 (16 to 21) and there was no change in the two extreme age groups 1 to 4 (2) and 65 and over (120). It is interesting to note that the trend of the older age group to increase was not maintained in the year under review. Nationally, there were increases in the age groups 16 to 64 and 65 and over. Classification of Partially-sighted Persons At 31st March, 1968, there were 17 partially-sighted children under the age of 15. Two were babies, one child was mentally 90 retarded and unsuitable for education at school, two had not started school, 10 attended special schools for the partially-sighted, and two were capable of benefiting from education in an ordinary school. Employed At 31st March, 1968, 36 partially-sighted persons were in gainful employment. Considering the rising unemployment figures during the winter of 1968 the partially-sighted persons at that time fared reasonably well in the labour market. The exception was a partially-sighted man who had mobility problems which resulted in him losing two jobs. These problems were resolved eventually and he was placed successfully in employment. Unemployed Of the total of 144 unemployed, 20 males and 100 females were over the age of 65. Three males and three females were available for and capable of work, four males and 13 females were not available for work and one man was undergoing training. Visitation by Social Welfare Officers Social Welfare Officers made 2,112 visits during the year to the homes of blind and partially-sighted persons to give advice on the most appropriate methods of overcoming the disability of defective vision. The number of visits made increased by 29% over the previous year. Home Teaching of Crafts and Embossed Types During the twelve months ended 31st March, 1968, 141 lessons were given by social welfare officers in a person's own home, viz. (a) Braille 103; (b) Moon 25; (c) Handicrafts 13. Of those learning to read on embossed type, three persons completed Grade II Braille, one person reached Grade I Braille standard, one person achieved Grade II Moon, and one person completed Grade I Moon. Deaf /Blind The number of deaf/blind persons has increased to three due to the transfer-in of a totally deaf/blind man and his deaf/partiallysighted wife. With the support of the social welfare officer the couple have adjusted reasonably well to their new environment. They have attended several meetings of the Deaf/Blind Luncheon and Social Club at Swanley which is organised by the London Borough of Bexley to enable deaf/blind persons who live within easy travelling distance of Swanley to gather for a group activity. The deaf/blind man and his wife, together with a deaf/blind lady were guests at the Deaf/Blind Christmas Luncheon organised by 91 the Kent Association for the Blind. An innovation this year was that the menu was transcribed into Braille for the benefit of the deaf/blind persons who read Braille. Handicraft Classes Handicraft classes for blind and partially-sighted persons are held at Beckenham, Bromley, Chislehurst and Orpington. Throughout the year the classes have been well attended. The good attendance record is achieved mainly because transport is provided by either voluntary drivers or taxis paid for by Kent Association for the Blind. Apart from their therapeutic value, the classes provide an incentive for blind persons to move outside their home environment. Sheltered Employment The female blind worker employed as a flat machine knitter in the London Workshops for the Blind became redundant as a result of the knitting department being closed. The total augmentation, supplementation, and travelling expenses, for the period 1st April to 25th September, 1967, amounted to £329 4s. 8d. Home Workers Scheme At 31st March, 1968, there were two blind male piano tuners and one female machine knitter employed under the Home Workers Scheme. The total augmentation for these workers amounted to £817 12s. 2d. The Borough also paid a fee of £60 per worker towards administrative costs. 75% of expenditure of administrative costs of Homeworkers Schemes is payable by the Department of Employment and Productivity up to a maximum of £40. Residential Accommodation The number of registered blind and partially-sighted persons resident in homes as at 31st March, 1968, was as follows: — Blind—In Special Homes 1 Male 6 Females In other Homes 144 „ Partially-sighted— 5 „ 22 „ National Library for the Blind Membership of the library is open to any blind person who is able to read Braille or Moon. The cost of membership is £3 per person per annum and this is met by the local authority. At 31st March, 1968, 31 blind persons were members of the library. Nuffield Talking Book Library 145 blind and partially-sighted persons had talking book machines at 31st March, 1968. An annual rental charge of £3 is 92 made for borrowing a machine. Special headphones can be purchased from the library for those who have defective hearing. 109 persons meet the rental charge themselves; 24 who have limited means have all or part of their rental paid by Kent Association for the Blind; 7 are St. Dunstaners who are not required to pay the rental; and 5 are not yet on a rental basis as they use the older disc machine. During 1967 the library introduced a smaller lightweight talking book machine, which has tapes that can be sent direct to a person without involving the Post Office in a special delivery service. The new machines are being issued in conjunction with a policy of converting the existing tape machines. Social Rehabilitation Social rehabilitation facilities which are provided by the Royal National Institute for the Blind at Oldbury Grange, Bridgnorth were not used during 1967/68. A blind housewife continued to attend the Warwick Row Rehabilitation Centre in the City of Westminster. A charge of 3s. per day is made plus the cost of travelling expenses, the cost to this authority being £49 17s. 6d. for the year. Kent Association for the Blind The variety of services provided by this Association continued to give support to blind and partially-sighted persons either in groups or individually. The Annual Exhibition and Sale of Work, together with the quiz, domino and cribbage competitions enabled blind and partially-sighted persons from all over Kent to meet. Many friendships have been formed through attending these functions. Although blind persons have a comprehensive list of holiday homes to choose from, the majority of those living in the London Borough of Bromley took their holiday in the Kent Association for the Blind Home at Cliftonville. In November, the Association organised a residential course on jewellery for social welfare officers for the blind. It is hoped that as a result, blind and partially-sighted persons will become interested in this different form of craftwork. A member of my staff attended the course. A nominal grant of £10 per annum was made to the Association by the London Borough of Bromley. Social Activities In April, 1967, a group of blind and partially-sighted persons had a week's holiday at the Kent Association for the Blind Home at Cliftonville. A social welfare officer, together with two trainee welfare officers accompanied the group. During the summer various social clubs and handicraft classes had outings to South Coast holiday resorts. The clubs participated in the activities organised by the Kent Association for the Blind, including the Annual Church Service held at Margate. 93 As the evening pottery classes held at Raglan Hayesford School for Boys, Bromley had been successful, a second class was organised on Thursday evenings at Burnt Ash Junior School. This met the need of blind persons wishing to learn pottery who live in the Beckenham area. The blind persons attending Burnt Ash Lane School share a room with sighted members of another group. At first it was feared that difficulties would arise out of having two groups in the same room. The fear was unfounded as the people concerned have worked together harmoniously. In October, the Kent Association for the Blind held their Annual Exhibition and Sale of Work at Maidstone. Parties of blind and partially-sighted persons from the Borough visited the Exhibition to see what prizes had been won by local people in the competition and also to give their support to the sale of work On 21st October the Combined Charities Fair was held in the Congregational Church, Bromley. Members of my staff manned a stall from which handwork made by the blind and physically handicapped persons was sold. At the end of November the Council staff supported joint Sales of Work arranged at the Bromley and Orpington Offices. In December the social clubs for the blind organised Christmas parties for the elderly blind and partially-sighted and in early January club members were guests at the Kent Association for the Blind's New Year Party held in Maidstone. Department of Employment and Productivity The Department of Employment and Productivity made arrangements for four newly-registered blind men and one partiallysighted man to attend a three months' course of industrial rehabilitation at Torquay. One blind man has been re-instated with his former employer, a second has gained employment in open industry, another man finished his rehabilitation course in March, 1968, and the fourth person was not placed in employment due to ill health. The partially-sighted man has not yet been placed in suitable employment. St. Dunstaners The number of St. Dunstaners registered in the Borough at 31st March, 1968, was 12, 10 of whom were in employment and two over 65 years of age. British Wireless for the Blind Fund The Kent Association for the Blind continued to act as agents for the British Wireless for the Blind Fund providing both mains and battery wireless sets to blind persons resident within the Borough who do not have access to a radio. The number of wireless sets issued during the year ended 31st March 1968, was seven. 94 Guide Dogs for the Blind Association There were no applications for a Guide Dog by persons on the blind register. Two men and two women living in the Borough have Guide Dogs. Holidays During the holiday season of 1967 the Department arranged holidays for those who wished to take a holiday at the Merrell House Holiday Home for the Blind at Cliftonville and also at homes in Hastings and Weston-Super-Mare. For the first time blind and partially-sighted persons participated in the Borough's scheme for giving financial assistance to handicapped persons who wish to take a holiday. The total amount spent on this service in 1967/68 was £401 14s. Od. Integration Due to the appointment of an additional social worker to the Orpington team, a limited scheme of integration was introduced into the Orpington district office on 1st January, 1968. It was designed to give each social welfare officer a mixed caseload which would include blind, elderly and physically handicapped persons. Social workers who had little or no experience of dealing with the problems of blindness attended an induction course conducted by the Senior Social Welfare Officer for the Blind. A result of integrating the social welfare officers for the blind fully into the team has been a closer liaison between colleagues, and a reduction of the caseloads to a more manageable level. Initial visits to persons suffering from defective vision are carried out by the Senior Social Welfare Officer of the Blind and the client's needs assessed in order that the most appropriate worker can be allocated. Long Cane Technique Over the years many attempts have been made to overcome the problems of mobility which blind persons face. White sticks, guide dogs and sonic torches are among the methods used and for some blind persons have proved successful. 1967 saw the introduction into this country of the Long Cane Technique which is based on a system taught in America originally to war blinded persons. The Royal National Institute for the Blind and St. Dunstans carried out an evaluation of the technique at their rehabilitation centres and proved that for some blind persons their mobility was vastly improved by using long cane. Instruction in the Long Cane Technique has since become part of the training received at the Royal National Institute for the Blind centres at Torquay and Bridgnorth. The Midlands Mobility Centre at 95 Birmingham provides courses for sighted instructors in Orientation and Mobility. As more instructors are trained it will be possible for instruction in this new technique to be made available to all blind persons. On 14th March, 1968, I submitted a Comprehensive Report on the Long Cane Technique to the Welfare Services SubCommittee. This Report traced the development of the use of the ordinary white stick by blind persons in this country; outlined the training given in the Long Cane Technique; and included an appraisal of the mobility experiment carried out by the Royal National Institute for the Blind. The Report referred to the conferences on mobility and orientation arranged by the Royal National Institute for the Blind in February and September, 1967. Future training of blind persons in this new technique will either take place at a residential centre or in a person's own home by a locally employed instructor and I trust this authority will find it possible to recruit a Mobility Instructor in the not too distant future. REPORT OF THE CHIEF PUBLIC HEALTH INSPECTOR 99 WORK OF THE PUBLIC HEALTH INSPECTORS J. C. Kermode, m.a.p.h.i., m.r.s.h. Chief Public Health Inspector. Again the work of the Section has been seriously affected by the shortage of professional staff. The number of District Public Health Inspectors falling well below the establishment. This constant understaffing is giving rise to unfortunate conditions. Generally, the Inspector's work may be divided into three categories. Firstly, he has to deal with urgent matters which arise from day to day, such as notified cases of infectious diseases, complaints concerning food, drains, insanitary conditions in houses and the like. The investigation of such matters is urgent and in any case cannot be delayed for more than a day or so. The second category includes work which, for a variety of reasons, has to be carried out in accordance with a particular schedule or timetable. This including the establishment of Smoke Control Areas, food sampling, inspection of premises for registration and so on. The final category relates to the routine inspection of premises such as offices, shops, caravans, and factories. The duties involved in this last mentioned group are of equal importance to the others, but perforce are the ones neglected when pressure of work is greater than existing staff can manage. The state of affairs has been aggravated in the past year by the necessity for detaching staff from other work in order to carry out unforeseen housing surveys, especially in Penge and North West Beckenham. This was followed by the detailed inspections of slum property preparatory to the declaration of Clearance Areas over and above the work set out in the five year Slum Clearance Programme. This failure to maintain adequate routine supervision of the premises mentioned in category three, especially those 2,272 in which food is prepared, sold or stored is having an unfortunate effect and the consequent lowering of standards is of great concern to the staff. It is the general consensus of opinion that the best means of ensuring good clean practices in food premises is by frequent visiting and the education of food handlers in good hygienic principles and practices. Unfortunately many of these workers do not remain long and often need to be replaced after a short period of employment. If standards are not to be allowed to fall further it may be that a different policy will have to be pursued entailing the reporting of offences found followed bv summary prosecution. Unfortunately, the institution of proceedings is in itself a time consuming practice and it destroys the spirit of co-operation with traders which has been built up over the course of years. 100 Had it not been for the employment of three technical assistants as from August, 1967, it would hardly have been possible to establish the three Smoke Control Areas which were undertaken and it would have been improbable if much housing inspection could have been undertaken in Penge. One casualty arising from the staff position and the consequent very slow progress made was the Cumpulsory Improvement Area being set up in Bromley. The two year period allowed for by the Act for the completion of the work expired and it was necessary to declare two new areas to incorporate those where it had not been possible to initiate the necessary procedures. This is disturbing as the Government has indicated that future legislation will concentrate on the rehabilitation of these older houses. Similarly, although the Committee approved new standards for the several thousands of houses let in multiple occupation in the Borough, it has not been possible to apply them except in a cursory fashion. The year, however, has not been without its compensations. The total number of visits to premises in the area by Inspectors for all purposes is recorded as 29,800 compared with 31.327 in 1966. The previously mentioned survey of Penge and North West Beckenham was carried out in conjunction with the Borough Planning Officers' staff. My Inspectors undertook to survey the properties most likely to be substandard and 474 dwellings were surveyed and the results were passed to the Planning Officer for analysis. Partly as a result of this survey it was decided to expedite the Clearance of certain properties in Penge not included in the 1967 schedule of Slum Clearance. This necessitated the detailed inspection of many properties of which 51 were represented and Housing Act proceedings commenced in order to secure demolition. Perhaps the major achievement of 1967 was the establishment of three Smoke Control Areas totalling no fewer than 9,023 prooerties. The absence of serious fog in the past two winters is undoubtedly due to this cumulative work combined with similar action in neighbouring boroughs. INSPECTION AND SUPERVISION OF FOODS There is considerable legislation governing the standards, quality, methods of production, sale and storage of foodstuffs intended for human consumption. Public Health Inspectors therefore, of necessity, spend a considerable proportion of their available time visiting and inspecting shops, manufactories, stores, markets, etc., and in giving advice and guidance where this is found necessary. This educative work could with advantage be increased. 101 Generally, personnel involved in the food trade are co-operative. However, when required, written notices to remedy conditions are issued and a reasonable period is given for compliance. It was not found necessary to resort to legal action for the non-compliance of such notices. Samples of food and drugs are regularly taken and are submitted to the Public Analyst for examination. No instances of wilful adulteration were found; there were, however, cases of technical infringements, details of the resultant action being given in the tables on pages 104-112. The sampling of foodstuffs for the presence of residual pesticides was again carried out as part of a survey in collaboration with other London Boroughs; these samples all proving to be satisfactory. FOOD AND DRUGS ACT, 1955 FOOD SAMPLING Letters in parenthesis are referred to on page 104. Article No. Examined No. Unsatisfactory Formal Informal Formal Informal Baby Food - 1 - - Baking Powder - 1 - - Batter Mixture - 1 - - (t) Beer - 2 - 1 Biscuits - 1 - - Blancmange Powder - 2 - - Brandy 2 - - - (f) Bread and Bread Rolls - 22 - 18 (c) Butter 1 20 - 1 (d) Buttered Roll - 3 - 2 (w) Cake Decorations - 3 - 2 (‡) Cereal and Cheese products - 7 - 1 (o) Cheese and Cheese Products - 17 - 1 Chocolate Syrup - 1 - - Coffee - 1 - - Coffee and Chicory Essence - 1 - - Cream - 18 - - (j) Cream Cakes, Cakes & Tarts - 20 - 3 (1) Cream of Tartar - 3 - 1 Curry Powder - 2 - - Custard Powder - 2 - - (z) Dehydrated Vegetables - 3 - 1 Dessert Powder and Mixture - 3 . - - Dessicated Coconut - 2 - - Drink Powder - 2 - - (V) Drinking Chocolate - 2 - 1 (m] Drugs - 53 - 1 Fish and Fish Products - 18 - - Flake Albumen - 1 - - 102 Article No. Examined No. Unsatisfactory Formal Informal Formal Informal Flavourings - 5 - - Flavouring Essence - 3 - - Flour (including Self-Raising - 3 - - Food Colouring - 3 - - (q) Frozen Vegetables - 1 - 1 (y) Fruit and Fruit Products - 21 - 1 Gelatine - 1 - - Gin 2 - - - Ground Almonds - 5 - - Ground Ginger - 1 - - (s) Honey - 2 - 1 Ice Cream - 29 - - Ice Cream Powder - 2 - - (p) Jam and Preserves - 12 - 2 Jelly - 6 - - lard - 7 - - (x) Margarine - 14 - 1 Marzipan - 1 - - (a) Meat and Meat Products - 85 - 8 (b) Milk and Milk Bottles 4 96 2 14 Milk Drinks - 1 - - Milk Pudding - 2 - - Mousse - 2 - - Oils and Fats - 8 - - Parsley, Thyme and Lemon Stuffing - 1 - - Pastes - 29 - - Peanut Butter - 4 - - Pickles and Sauces - 12 - - (n) Poultry and Poultry Products - 14 - 2 Pudding and Cake Mixture - 5 - - Raw Vegetables - 1 - - Saccharin Tablets - 2 - - Salad Cream and Dressing - 4 - - (i) Sausages and Sausage Meat - 61 - 4 (k) Soft Drinks - 52 - 2 (u) Soups - 3 - 1 (h) Spices 1 19 1 3 Stufffed Olives - 1 - - Suet - 2 - - (r) Sugar and Sugar Products - 5 - 1 (g) Sweets - 24 - 3 Tea - 5 - - Tomato Juice - 1 - - Tomato Puree - 2 - - (*) Vinegar (Malt) - 3 - 1 (e) Vegetables (Tinned) - 8 - 1 Whisky 2 - - - Yoghourt - 1 - - TOTALS 12 781 3 79 103 The undermentioned food stuffs were examined for the presence of residual pesticides:- Article No. Examined No. Unsatisfactory Forma Informal Formal Informal Beef Dripping - 1 - - Cereals - 2 - - Dairy Products - 2 - - Fruit Products - 3 - - Infant Food - 1 - - Meat Products - 5 - - Poultry Products - 2 - - Vegetable Products - 3 - - TOTALS - 19 - - 104 Nature of Unsatisfactory Sample Remarks (a) Serial No. 1053. Corned Beef. Composition: Embedded in the corned beef was a dipterous fly which had undergone heat treatment. Reported to Committee. Matter drawn to attention of Importers. Serial No. 1115. Untreated Milk. (b) Composition: Contained approximately 1% added water. Formal sample taken, see Serial No. 116. Serial No. 1116. Untreated Milk. (b) Composition: Contained approximately 2% added water. Investigation of production. Producer warned. (b) Serial No. F.C. 164. Milk containing foreign matter. Composition: Contained a pipe cleaner which, although rusty, did not appear to have been used in a pipe. Reported to Committee. Dairy Company warned. (b) Serial No. 1050. Milk containing foreign matter. Composition: Contained a sand cement residue in the base of the bottle. Reported to Committee. Bottlers warned. (b) Serial No. 1084. Milk containing foreign matter. Composition: The bottle had adhering to the inner surface of the glass eight pupae of a phorid fly. Legal proceedings Vendor fined £50 with £6 19s. 6d. costs. Serial No. 1055. Butter. (c) Composition: Moisture 16.4%. Slightly above the allowable maximum (16%). Correspondence with Importers - Satisfactory. Serial No. 1051. Buttered Roll. (d) Composition: Not more than 10% of the fat spread on the roll consisted of butter fat. Repeat formal sampleSatisfactory. Serial No. 1102. Garden Peas. (e) Composition: Contained a small snailTrichia Striolata, common on cultivated land in Britain. Reported to Committee. Packers warned. Serial No. 1085. Bread. (f) Composition: Contained a living full grown larva of the Mediterranean Flour Moth, Ephestia. Reported to Committee. Distributor warned. Serial No. 1052. Bread. (f) Composition: Contained a small fragment of die casting alloy (zinc with small amounts of aluminium and copper). Reported to Committee. Baker warned. 105 Nature of Unsatisfactory Sample Remarks Serial No. 0989. Sandwich Chocolate. (g) Composition: Contained a larva of the moth Ephestia. The presence of frass and webbing on the chocolate surface indicated that it had been living on the bar. Reported to Committee. Retailer warned. Serial No. 1046. Ground Cinnamon. (h) Composition: Contained 0.45% V/W of essential oil. (Reasonable standard not less than 0.7% V/W). Repeat formal sample. Analyst advises against Statutory action. Serial No. 1213. Pork Sausagemeat. (i) Composition: Meat 60% including 21% fat. The lean meat content is satisfactory but the fat should be increased to give a total meat content of not less than 65%. The sample contained 200 p.p.m., sulphite preservative which should have been declared. Repeat samples satisfactory. Serial No. 1134. Untreated Milk. (b) Composition: Fat 4.15%, solids not fat 8.05%. The FPD indicated the presence of a minimum of 2% added water. Repeat samples satisfactory. Serial No. 1132. Bottle of Milk. (b) Composition: Free in the pint bottle of milk was a piece of fused mineral matter of the nature of clinker (approx. 1 in. x i in.). There was also a number of relatively small particles of this material present. The milk passed the Methylene Blue Test. Matter drawn to attention of Dairy Company. Serial No. F.C. 180. Unopened pint bottle of Milk. (b) Composition: No foreign matter was detected in the milk but there was a slight soiling of the inner surface of the bottle due to the presence of adherent mould growths. Reported to Committee. Dairy Company warned. Serial No. 1242. Buttered Roll. (d) Composition: Contained a piece of string 14 in. long composed of cotton fibres which had been baked in the roll. Legal proceedings. Baker fined £20 with £14 lis. 1d. costs. Serial No. 1189. Bread. (f) Composition: The crumb of the loaf was soiled by iron and mineral oil which had probably derived from the bakehouse machinery. Legal proceedings. Manufacturer fined £15 with £9 3s. Od. costs. 106 Nature of Unsatisfactory Sample Remarks Serial No. F.C. 179. Portion of Hot Cross Bun. (j) Composition: Contained a stone (0.7 in. x 0.4 in.). Adherent to the stone was sand and cement as well as farinaceous matter. Legal proceedings. Manufacturer fined £10 with £9 6s. 1d. costs. Serial No. F.C. 176. Bun. (j) Composition: The glass splinter associated with the bun measured approximately 6 mm. long and 2 mm. wide. There were traces of food residues adhering to it and these contained wheat structures. No action. Unable positively to ascertain origin of glass. Serial No. 1206. Non-Alcoholic Rum Flavour. (k) Composition: The drink complied with the requirements of the Soft Drink Regulations as regards composition but the labelling requires consideration in that grapes are depicted on it, suggesting the presence of a product of the grape and Non-Alcoholic Rum Flavour suggests a flavour rather than a drink. The word "Drink" could be added after "Flavour". Manufacturers have gone into voluntary liquidation. Serial No. 1241. Cream of Tartar B.P. (1) Composition: Complies with the B.P.C. requirements as to composition and purity. The article is no longer B P. Manufacturers reprinting label to comply. Serial No. 1146. Aspirin Tablets- (m) Composition: Aspirin 322 mg. tablet. B.P. limits for 300 mg. tablets which replaces the 5 grain tablet, 185-315 mg. Probably old stock. Stock withdrawn from sale. Serial No. 1346. Corned Beef. (a) Composition: Dark areas of tion on the surface of the meat due to slight corrosion of the inner surface of the can. Matter drawn to tion of Embassy of porting country. Serial No. 1538. Pork Sausages. (i) Composition: Contained preservative Vendor now exhibiting (240 p.p.m.) which had not been declared. permanent preservative notice. Serial No. 1536. Beef Sausages. (i) Composition: Meat 44%. Should contain not less than 50% meat. Correspondence with Manufacturers. Repeat formal sample-Satisfactory. 107 Nature of Unsatisfactory Sample Remarks Serial No. 1535. Sausages-Beef Chipolatas. (i) Composition: Contained preservative (250 p.p.m.) which had not been declared. Vendor now exhibiting permanent preservative notice. Serial No. 1435. Sausage Roll. (a) Composition: Showed an area of mould growth on the meat filling. Legal proceedings. Vendors fined £20 with £12 9s. Od. costs. Serial No. 1531. Lancashire Hot Pot. (a) Composition: Meat content 8%. Acceptable minimum 12.5%. Correspondence with Manufacturers. Recipe altered to give 12.5% meat content. Serial No. 1349. Boned Chicken in Chicken Jelly. (n) Composition: Chicken 76%. Acceptable minimum 80%. Correspondence with Importers. Order given to overseas supplier to increase meat content to 80%. Serial No. 1479. Boned Chicken in Chicken Jelly. (n) Composition: Chicken 76%. Acceptable minimum 80%. Manufacturer has now increased meat content to 84%. Serial No. 1421. Pasteurised Milk. (b) Composition: Small areas of discolouration on the inner surface of the bottle due to the presence of mould, denatured milk and general debris. Legal proceedings. Bottlers fined £80 with £7 0s. lOd. costs. Serial No. 1384. Untreated Milk. (b) Composition: Foreign matter consisting of decayed wood fragments. Reported to Committee. Bottlers warned. Serial No. 1400. Pasteurised Milk. (b) Composition: Foreign matter consisting of denatured milk. Reported to Committee. Dairy Company warned. Serial No. 1522. School Milk Bottle with residue of Milk and foreign matter. (b) Composition: Contained crystals of magnesium sulphate (Epsom Salts) adhering to the inner surface of the glass. The Salts had been added subsequent to delivery of the milk and the Suppliers were in this matter blameless. 108 Nature of Unsatisfactory Sample Remarks Serial No. 1355. Thicker Topping. (b) Composition: Butter fat 19.6%. This article could not be whipped to a stiff consistency in the laboratory in spite of the pictorial suggestion on the label that it could. Labels reprinted to satisfactory standard. Serial No. 1269. Instant Low Fat Milk. (b) Composition: The moisture content (5.2%) was slightly in excess of the 5% maximum permitted by the Dried Milk Regulations. Correspondence with Manufacturers - Satisfactory. Serial No. 1324. Processed Cheddar Cheese. (o) Composition: Moisture 43.4%, Fat on the dry matter 46.8%. The Cheese Regulations require not more than 43% water and not less than 48% fat in the dry matter. Correspondence with Manufacturers. Repeat sample satisfactory. Serial No. 1399. Blackcurrant New Jam. (p) Composition: Contained a snail which had undergone a heating process. Proceedings. Conditional discharge for 12 months. Costs of £12 9s. Od. awarded to Council. Serial No. 1381. Frozen Peas. (q) Composition: The dark material associated with the peas consisted of composted vegetable matter. Matter drawn to attention of Packer and reported to Committee. Serial No. F.C. 187. Bread. (f) Composition: Fragments of grey cardboard were embedded in the crumb. Reported to Committee. Baker warned. Serial No. F.C. 219. Bread. (f) Composition: Lengths of string; one 9 cm. and the other 7.5 cm. long were found in the loaf. Reported to Committee. Baker warned. Serial No. F.C. 201. Bread. (f) Composition: Short lengths of string were present in four slices. Legal proceedings Baker fined £30 with £12 9s.Od. costs. Serial No. F.C. 185. Bread. (f) Composition: The dough had become soiled with iron and mineral oil. Legal proceedings. Baker fined £15 with £9 6s. 1. costs. Serial No. F.C. 206. Bread. (f) Composition: The dough had become soiled with iron and mineral oil. Reported to Committee. Baker warned. 109 Nature of Unsatisfactory Sample Remarks (f) Serial No. F.C. 193. Bread. Composition: The dough had become soiled with iron and mineral oil. Legal proceedings. Baker fined £10 with Serial No. F.C. 192. £9 6s. 1. costs. (f) Bread. Composition: Dark foreign matter between the slices of the cut loaf consisted of particles of the outer crus't of the loaf. Reported to Committee. Matter drawn to the attention of Baker - no further action. Serial No. F.C. 200. (f) Bread. Composition: The dark object embedded in the crust proved to be bakehouse char and not a rodent dropping as suspected. Reported to Committee. No further action. Serial No. F.C. 205. Bread. (f) Composition: Embedded in the crumb was a mixture of dough, bakehouse char and a little oil. Reported to Committee. Baker and Vendor warned. Serial No. F.C. 203. Bread. (f) Composition: A fragment of zinc 13mm. long and 5 mm. wide was present in the crumb. Legal proceedings. Manufacturer fined £20 with £12 9s. Od. costs. Serial No. F.C. 191. Cream Doughnut. (j) Composition: A small amount of mould was detected in the cream filling. Reported to Committee. No further action. Serial No. F.C. 221. Icing Sugar. (r) Composition: The foreign matter consisted of a mixture of sugar, calcium phosphate, mineral oil and iron. Reported to Committee. Refiners warned. Serial No. 1503. Honey. (s) Composition: Embedded in the sample of honey was an unused medical dressing. Attention of Canadian Embassy drawn to occurrence. Serial No. 1433. Lemonade. (k) Composition: The plastic stopper of the bottle was contaminated by a disinfectant of the Dettol type which had tainted the drink. Legal proceedings. Manufacturer fined £10 with £10 7s. 1d. costs. Serial No. 1382. Stout. (t) Composition: The stout was sour when received and had a high acidity figure indicating that the stout had turned to vinegar. Reported to Committee. Distributor and Manufacturer warned. 110 Nature of Unsatisfactory Sample Remarks Serial No. 1394. Barley Beef Soup. (u) Composition: Description considered to be ambiguous. A preferable description would have been Barley and Beef Soup. Serial No. F.C. 184. Drinking Chocolate. No action. (V) Composition: Contained coconut fibres. Legal proceedings. Manufacturers fined £15 with £9 6s. 1. costs. Serial No. 1426. (w Chili Powder. Composition: This was a compound article being a mixture of spices and should therefore have been described as such. Correspondence with Manufacturers. Re-labelling to satisfactory standard. Serial No. 1276. Ground Cinnamon. (h) Composition: The volatile oil content 0.63 v/w) was below the acceptable minimum of 0.7 v.w. Correspondence with Manufacturers Satisfactory. Serial No. 1544. Angelica. (w ) Composition: Contained the colour Blue VRS which is no longer permitted, this dye having been withdrawn from the permitted list this year. Re-exporting this product to overseas supplier. Serial No. 1619. Foreign body in Luncheon Meat. (a) Composition: Contained a spiral of iron wire 1mm. in diameter and 11 mm. in length. Reported to Committee. Embassy of exporting country notified. Serial No. 1689. Pork Pie. (a) Composition: Contained a fragment of aluminium alloy 0.5 cm. x 0.3 cm. overall which appeared to have been in the dough before baking. Legal proceedings. Manufacturer fined £30 with £7 7s. Od. costs. Serial No. 1671. Cornish Pasty. (a] i Composition: Contained a single hair 7 cm. long having the characters of a wool fibre. Reported to Committee. Baker warned. Serial No. 1713. Steak Pie. (a) 1= Composition: The meat content was 13.5% as opposed to the required standard of 25%. Correspondence with Manufacturers - Repeat sample - satisfactory. Serial No. 1661. Milk containing foreign matter. (b) Composition: On the inner surface of the bottle were small areas of discolouration due to mould growths in denatured milk. Some of the mould was free in the milk. Reported to Committee. Dairy Company warned. 111 Nature of Unsatisfactory Sample Remarks Serial No. 1711. Pasteurised Milk. (b) Composition: The foreign body in the capped milk bottle consists of a horse chestnut approximately 3 cm. in diameter. Legal proceedings. Dairy Company fined £10 with £9 19s. Od. costs. Serial No. 1752. Margarine. (x) Composition: Embedded in the margarine was a small fragment (0.5 cm. x 0.2 cm.) of mineral matter coated with a substance of the nature of tar; it may have derived from a road surface. Reported to Committee. Origin of foreign matter not ascertained. No further action. Serial No. 1600. An opened can of Pineapple Cubes. (y) Composition: The can was badly dented resulting in the development of a small slit in one end plate which allowed the entrance of mould spores. The growths were extensive and of the Penicillium type- Reported to Committee. Vendor warned. Serial No. 1567. Marmalade. (p) Composition: A complaint of mould growths. The soluble solids of this sample at 72% were satisfactory. The growths were limited to the surface where at some stage condensation of water had occurred allowing such growths to occur. Reported to Committee. Manufacturers warned. Serial No. 1629. Garden Peas. (z) Composition: Contained the food colour Blue VRS which is no longer permitted in Britain. Correspondence with Manufacturers. Withdrawn from sale. Serial No. F.C. 248. Bread. (f) Composition: Contained a glass fragment. It was not possible to confirm whether or not it had been baked in the bread. Reported to Committee. Origin of foreign matter not ascertained. No further action. Serial No. 1691. Bread. (f) Composition: Embedded in the loaf was the upper part of a No. 10 1¾ in. wood screw which showed signs of considerable usage. Reported to Committee. Baker warned. Serial No. 1568. This case was taken into account by the Court at the hearing of case Serial No. F.C. 185 Total fines £15 with £9 6s. 1d. costs. Bread. (f) Composition: The crumb had become soiled with iron and mineral oil. 112 Nature of Unsatisfactory Sample Remarks Serial No. 1569. Bread. (f) Composition: Fragments removed from the crumb of the loaf were soiled with iron and mineral oil. Reported to Committee. Baker warned. Serial No. 1602. Bread. (f) Composition: Embedded in the crumb was the head and thorax of a beetle which had undergone heat treatment. Bakers warned. Serial No. 1678. Cereal. (t) Composition: The material found in the cereal consisted of a number of fragments of paraffin wax, 13 mm. x 20 mm. similar to that used to prepare the inner surface of wrapping. Reported to Committee. Manufacturer warned. Serial No. 1735. Lollipop. (g) Composition: Included in the colours identified was the colour Blue VRS which is no longer permitted in Britain. Correspondence with Manufacturer. Withdrawn from sale. Serial No. 1690. Chocolates. (g) Composition: The chocolates were infested bv the larvae of the Mediterranean Flour Moth. Legal proceedings. Retailer fined £25 with £10 10s. Od. costs. Serial No. 1632. Malt Vinegar. (*) Composition: The analysis of the sample indicated that it was of abnormal composition being exceptionally low in those "secondary" substances which give the aroma to malt vinegar. Correspondence with Manufacturers. Analyst agrees this vinegar is genuine. Serial No. 1694. Ground Cinnamon. (h) Composition: Low in volatile oil. The sample contained 0.60% as opposed to an acceptable minimum of 0.7%. Correspondence with Manufacturers. Formal repeat sample satisfactory. Serial No. 1685. A ngelica. (w) Composition: Contained the colour Blue VRS which is no longer permitted in Britain. Correspondence with Importers. Re-exported to France. 113 Unsound Food A total of 17 tons 16 cwts. 11 lbs. of food unfit for human consumption was surrendered to Public Health Inspectors during the year. Details of the various items are given below: Tons Cwts. Lbs. Meat and Offal at slaughterhouse 3 18 70 Meat and Offal at wholesale and retail premises 2 - 100 Cooked meat and meat products - - 91 Canned meat - 15 93 Fish (fresh and tinned) - 5 78 Fruit and Vegetables (fresh and tinned) 5 14 84 Frozen Foods 3 9 6 Other Foods 1 10 49 114 BACTERIOLOGICAL SAMPLES OF MILK Samples of designated milks were taken and submitted for examination with the following results:- Satisfied Failed Phosphatase Test 72 Methylene Blue Test 150 10 Turbidity Test 3 *Ring Test 102 1 VOID TESTS-48 i.e. Atmospheric (shade) temperature at Laboratory prevented carrying out of tests. The tests shown in the above table were applied for the following purposes:- Phosphatase Tests-Applied to "Pasteurised" Milk to determine that the milk was satisfactorily pasteurised. Methylene Blue Tests-Applied to "Untreated" and "Pasteurised" milks to indicate that the bacterial content was within the prescribed standard. Turbidity Tests-Applied to "Sterilised Milk" to determine that the milk was satisfactorily sterilised. Ring Test-Applied to untreated milk to determine the presence of "Brucellus abortus". Where samples failed to satisfy the prescribed tests investigations were undertaken and further samples obtained, the tests of which proved to be satisfactory. *In the case of one Ring Test failure the reacting cow was detected and removed. Repeat samples from the remainder of the herd proved negative. The Animal Health Division of the Ministry of Agriculture, Fisheries and Food was informed at all stages of the investigation. BACTERIOLOGICAL SAMPLES OF ICE CREAM 103 samples were taken during the year with the following results:- Grade I- 83 Grade II - 16 Grade III- 3 Grade IV- 1 Further samples were obtained from the suppliers whose products had given Grade III or Grade IV results. These further samples were found to be satisfactory and were classified as Grade I 115 OTHER SAMPLES AND SPECIMENS SUBMITTED TO PATHOLOGICAL LABORATORY FOR BACTERIOLOGICAL EXAMINATION 60 empty milk bottles were submitted at intervals during the year for bacteriological examination directly following their treatment by the bottle washing machine of a local milk bottling plant-all were found to be satisfactory. 35 empty beer bottles were similarly examined following their treatment by the bottle washing machine of a local beer bottling plant-all were found to be satisfactory. 9 samples of Frozen Egg were examined and were found satisfactory-no pathogenic organisms being isolated. Samples of foodstuffs, as listed below, were submitted to the Pathological Laboratory in connection with suspected cases of Food Poisoning, Typhoid, Paratyphoid and Dysentery. With the exception of the three specimens of sausagemeat, where the presence of CI. Welchii was indicated, all samples were found to be free of pathogenic organisms. Apple Crumble 1 Butter 1 Chicken 3 Cockles 1 Coleslaw1 Cream 1 Custard 2 Dried Peas1 Fruit Salad 1 Greens 1 Ham 2 Home Made Sponge Cake 1 Ice Cream 1 Jelly 1 Meat 3 Dried Milk 1 Pork Dripping 1 Potatoes 2 Sausagemeat 3 Steak and Kidney Pudding 1 Stewed Plums 1 Stuffing 1 Sugar 1 Water 6 415 specimens of faeces and 2 specimens of urine were submitted from persons suspected to be suffering from infectious disease or food poisoning, or to be contacts of persons suffering 116 from infectious disease. The results are listed below: - Faeces specimens Positive Negative Suspected Dysentery 277 20 257 Suspected Food Poisoning 107 14 93 Suspected Paratyphoid, etc 31 Nil 31 Urine specimens Positive Negative Suspected Paratyphoid, etc 2 Nil 2 MEAT INSPECTION Annual licences were granted to five slaughtermen and the licence for one private slaughterhouse was also renewed during the year. The carcases of all animals slaughtered within the Borough were inspected and regular routine visits and inspections were made to distributing depots and retail butchers' shops. CARCASES INSPECTED AND CONDEMNED Cattle, excluding Cows Cows Calves Sheep and Lambs Pigs Goats Number killed 50 10 2387 3743 1037 18 Number not inspected NIL NIL NIL NIL NIL NIL All diseases except Tuberculosis and Cysticerci Whole carcases condemned - - 6 59 1 - Carcases of which some part or organ was condemned 11 2 13 1279 127 Tuberculosis only Whole carcases condemned - - - - - - Carcases of which some part or organ was condemned 4 Cysticerci Carcases of which some part or organ was condemned Carcases submitted to refrigeration - - - - - - Generalised and totally condemned - - - - - - Approved charges totalling £229 18s. 6d. were made for the inspection by Public Health Inspectors of the carcases shown in the above table. 117 FOOD COMPLAINTS Complaints regarding the sale of foodstuffs, alleged to be unsound or to contain extraneous matter, were made on 97 occasions. These complaints were all very fully investigated by the Public Health Inspectors and, except for a few found to be unjustified, were individually reported to the Environmental Health Sub-Committee for the determination of appropriate action. The investigation of these complaints involves very careful enquiries in order to present a fair and accurate report particularly in view of the fact that the findings may lead to prosecution of the vendor or manufacturer. Specimens of extraneous matter are submitted to the Public Analyst to determine their nature and substance, and shopkeepers and food manufacturers are interviewed and their stocks and premises inspected to discover, if possible, the point of origin. Where the articles complained of have been manufactured outside the London Borough of Bromley the co-operation and assistance of the Public Health Inspectors acting in the area concerned is called upon. The complaints may be classified as under: — Alleged condition Foreign Bodies, Dirty, etc. Mouldy Other Conditions Bread and flour confectionery 25 12 2 Tinned foodstuffs 3 1 3 Perishable articles (pies, sausages, etc.) 2 8 — Milk and milk bottles 11 — 2 Chocolate confectionery 2 — 2 Cereals 1 — — Miscellaneous 14 3 6 The most frequent cause of complaint concerned bread and flour confectionery. Extraneous matter found consisted of grease from machinery, small pieces of metal, metal screws, a piece of string, pieces of hessian and glass, and portions of bakehouse char. Mould was mainly found in sliced loaves. Complaints concerning milk and milk bottles were largely in respect pf the internal staining of bottles from various causes and with the presence of foreign bodies such as glass and insect larvae. From the point of view of the store owner "self service" may have much to commend it. However, the practice deprives shop assistants of full control over stock rotation and the order in which perishable goods are sold. It has resulted in an increase in the 118 number of complaints relating to moulds and decomposition which arises from overlong and possibly unsuitable storage. Where such instances occur a careful investigation is made into the history of the article, from manufacture to sale, in an endeavour to find, and remedy, the circumstances giving rise to the unsound condition. Every opportunity is taken to impress on manufacturers and shopkeepers the need of maintaining a strict system of inspection and rapid turnover of perishable articles. The "coding" of these foodstuffs is a very important factor. Most manufacturers of such items as sausages and meat pies stamp a code on the wrapper indicating the day and place of manufacture. Normally this cannot be deciphered by the shopkeeper, although it is the practice of reputable manufacturers to issue firm instructions as to the "shelf life" of the product and the conditions under which it must be stored. Shop managers are advised to apply a simple code of their own to all perishable goods. Thus when a daily examination of the stock is made there can be no misunderstanding as to the date of receipt of particular items. I am pleased to note that this practice is on the increase, although by no means universally employed. It is not the general practice in the trade to code such quick selling lines as bread which, especially when wrapped and sliced, is very susceptible to mould growth under appropriate atmospheric conditions. The only safe precaution here would be rejection of all stock not sold on the day of receipt thus precluding any mixing with the following day's delivery. It has also to be borne in mind that insects or foreign bodies may enter the foodstuff after purchase or mould develop whilst the food is stored in the home. An inspection of the kitchen is made in all cases, and conditions under which food is prepared or kept in the domestic kitchen are not always found to be ideal. During 1967 it was found necessary to issue 32 warning letters and in addition to institute proceedings as shown below: — Fined Costs Milk Bottle (Contained insects) Dairyman £50 £6 19s. 6d. Bread (Foreign matter) Manufacturer £15 £9 3s. Od. Hot Cross Bun (Foreign matter) Manufacturer £10 £9 6s. Id. Bread Roll (Foreign matter) Manufacturer £20 £14 lis. Id. Drinking Chocolate Powder (Foreign matter) Manufacturer £15 £9 6s. 1d. * Bread (Foreign matter) Manufacturer £15 £9 6s. 1d. Bread (Foreign matter) Manufacturer £10 £9 6s. 1d. Pot of Jam (Foreign matter) Manufacturer — £12 9s. 0d. Jar of Coffee (Foreign matter) Manufacturer £15 £5 5s. 0d. Bread (Foreign matter) Manufacturer £30 £12 9s. 0d. Bread (Foreign matter) Manufacturer £20 £12 9s. 0d. Milk Bottle (Internal stain and mould) Dairyman £80 £7 0s. 10d. 119 Bottled Mineral Fined Costs Water (Tainted) Manufacturer £10 £10 7s. 1d. Sausage Roll (Mould) Vendor £20 £12 9s. 0d. Gingerbread (Mould) Retailer £20 £10 10s. 0d. *Bread (Foreign matter) See * above Pork and Egg Pie (Mould) Retailer £12 £5 5s. 0d. Pork Pie (Foreign matter) Manufacturer £30 £7 7s. 0d. Chocolate (Maggots) Retailer £25 £10 10s. 0d. Bottle of Milk (Foreign matter) Dairyman £10 £9 19s. 0d. Shelled Walnuts (Rat droppings) Packers £20 £11 0s. 6d. Bread (Foreign matter) Baker £25 £22 4s. 6d. FOOD PREMISES Food Hygiene (General) Regulations 1960. There are some 2,272 food premises in the area, made up a; follows: - Premises Total No. Premises to which Reg. 19 applies No. Premises Pitted to Comply with Reg. 19 No. Premises Fitted to Comply with Reg. 16 Bakers and Bakehouses 112 112 112 111 Butchers 184 184 181 181 Confectioners 276 97 97 274 Milk Dealers 246 - - 246 Clubs and Hotels 140 140 139 139 Chemists 76 76 76 76 Fishmongers (Wet, Dried and Fried) 75 75 75 74 Greengrocers 130 130 129 128 Grocers 307 307 306 304 Hospitals, Nursing Homes and Old People's Homes 121 121 121 121 Industrial Canteens 102 102 102 102 Public Houses 162 162 159 157 School Canteens and Serveries 104 104 104 104 Cafes and Restaurants 189 189 188 181 FOOD AND DRUGS ACT, SECTION 16 Number of Food Premises registered under the abovementioned Act for :- (a) Sale or manufacture for purposes of sale of ice-cream or the storage of ice-cream intended for sale 865 (b) The preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 279 120 MILK (SPECIAL DESIGNATIONS) REGULATIONS Licences to deal in specially designated milks were currently held as under:- Dealers (Pasteurisers) Licences 1 Pasteurised 150 Sterilised 103 Ultra Heat Treated 40 Untreated 65 RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Standards for the cleanliness of specified materials used in filling upholstery, soft furnishings, bedding, toys, etc., are provided by this Act. Premises where such materials are used and/or stored must be licensed by the Local Authority and provision is made for sampling the materials. Samples may be taken from stocks and also from finished articles which may be opened up for this purpose. Samples of the undermentioned materials were taken and proved to be satisfactory: - Rag flock, dyed fibre, coir fibre, kapok and feathers. HOUSING AND SLUM CLEARANCE PROGRESS SINCE 1st JANUARY, 1965 In presenting this report the opportunity is taken to review the progress of slum clearance and housing from the formation of the London Borough of Bromley on 1st April, 1965, to the end of 1967. At the beginning of 1965 there were still parts of the "Groves Area" in Penge which had been represented in Clearance Areas, Compulsory Purchase Orders had been made, and houses not demolished. Since 1965, the following houses have been demolished in these Areas: - 1965. Hawthorne Grove-Nos. 28, 32, 34, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 64, 64a, 66, 68, 74, 74a, 76. Limetree Avenue-Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. Hamilton Place-Nos. 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. Jasmine Grove-Nos. 19, 21, 23, 25, 27, 29, 31, 33, 35, 37, 39, 41, 43, 45. Hartfield Grove-Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12. 121 1966. Hawthorne Grove-Nos. 2, 4, 6, 8, 10, 12, 14, 16, 18, 20, 22, 24, 26. 1967. Hawthorne Grove-Nos. 70, 72, 74. The demolition of the houses listed above completed the demolition of all the houses in the "Groves Area" which had been represented for Slum Clearance by the former Penge Urban District Council. Other Areas in Penge (outside the "Groves Area") for Slum Clearance Action by the former Penge Urban District Council. Hadlow Place C.A. 1964-Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, Hadlow Place. Represented 1964. C.P.O., 1964. Local Public Enquiry, 1965. C.P.O., confirmed, 1965. Nos. 4 and 5 (unoccupied) not yet demolished. Nos. 1, 2, 3, 6, 7, 8, 9-demolished in 1967. Anerley Vale C.A. 1964-Nos. 5-47 (odd), Nos. 22-44 (even). Represented 1964. C.P.O., 1964. Local Public Enquiry, 1965. C.P.O., confirmed, 1965. All houses demolished. St. Hugh's Road, C.A. 1964-Nos. 15, 17, 19, 21, 23, 25. Represented 1964. C.P.O., 1965. All houses demolished 1967. Since the formation of the Borough, the following Clearance Areas have been represented: - 1965. St. Hugh's Road C.A. 1965-Nos. 7, 9, 11, 13, St. Hugh's Road. Represented 1965. C.P.O., 1966. C.P.O., confirmed, 1966. All houses demolished 1967. 1966. Woodbine Grove No. 1 C.A. 1966-Nos. 8, 10, Woodbine Grove. Woodbine Grove No. 2 C.A. 1966-Nos. 37, 39, 41, 43, Woodbine Grove. Woodbine Grove No. 3 C.A. 1966-Nos. 49, 51, Woodbine Grove. Woodbine Grove No. 4 C.A. 1966-Nos. 55, 57, Woodbine Grove. 122 These four areas, represented in 1966, were dealt with in tne Bromley (Groves Area No. 1) C.P.O., 1966. Local Public Enquiry, 1967. C.P.O., confirmed, 1967. No houses yet demolished. Thicket Grove C.A.-Nos. 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, Thicket Grove. Represented 1966. C.P.O., 1966. Local Public Enquiry, 1967. C.P.O., confirmed, 1967. Houses not yet demolished. (Note: Thicket Wood Chambers, Nos. 1-28, owned by the Council, were not represented. They were demolished in 1967.) Arpley Road C.A.-Nos. 16, 18, 20, 22, 24, 26, 28, 30, 32, 34, 36, 38, 40, 42, 44, 46, 48, 50, 52, 54, 56, 58, 60, 62. 31, 33, 51, 53, 55, 57, Arpley Road. Represented 1966. C.P.O., 1967. C.P.O., confirmed, 1967. (Note: Nos. 64, 66, 68, 70, 72, 74. 35, 37, 39, 41, 43, 45, 47, 49, already owned by the Council.) No houses yet demolished. In addition to Clearance Areas represented in 1966, the Bromley (Groves Areas Nos. 2 and 3) C.P.O., 1966, were made in respect of: Nos. 14-20, 26-48, 52-64 Laurel Grove. Nos. 1, 3, Woodbine Terrace. Nos. 5-19, 23-35, 45, 47, 53. 2, 4, 6, Woodbine Grove. Nos. 48-84, 92-100, Oakfield Road. C.P.O., 1966. Local Public Enquiry, 1967. C.P.O., confirmed, 1967. 1967. Farwig Lane, Bromley No. 1 C.A.-Nos. 17, 19, 21, 23, 25, 27, 29, 31, Farwig Lane. Represented, 1967. C.P.O., 1967. Local Public Enquiry to be held in 1968. Farwig Lane, Bromley No. 2 C.A.-Nos. 45, 47, 49, 51, 53, 55, 57, 59, 61, Farwig Lane. Represented, 1967. C.P.O., 1967. Local Public Enquiry to be held in 1968. 1967. Farwig Lane, Bromley No. 3 C.A.-Nos. 81, 83, 85, Farwig Lane. 123 Represented, 1967. C.P.O., 1967. Local Public Enquiry to be held in 1968. No houses yet demolished. Victoria Place, St. Paul's Cray C.A.-Nos. 4, 5, 6, Victoria Place. Represented, 1967. C.P.O., not yet confirmed. Lancaster Place, St. Paul's Cray C.A.-Nos. 2, 3, 4, 5, 6, 7, 8, 9, Lancaster Place. Represented, 1967. C.P.O., 1967. Local Public Enquiry to be held in 1968. Fordcroft Road, St. Mary Cray C.A.-Nos. 10, 12, 14, 16, 18, 20, 22, 24, 26, 28, Fordcroft Road. Represented, 1967. C.P.O., not yet confirmed. Evelina Road, Penge, C.A.-Nos. 1, 3, 5, 7, 9, 11, 13, 15, Evelina Road. Nos.. 8, 10, 11, 12, 14, Clarina Road. Represented, 1967. C.P.O., not yet made. Penge Lane, Penge, C.A.-Nos. 1, 2, 3, 4, 5, 6, Penge Lane. Represented, 1967. C.P.O., not yet made. Bellefields Road, St. Mary Cray C.A.-Nos. 1, 2, Bellefields Road. Represented, 1967. C.P.O., not yet confirmed. Heath and Clifford Groves, Penge C.A.-Nos. 4, 6, 7, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, Heath Grove. Nos. 1, 2, 4, 5, 6, 7, 9, 10, 11, 12, 13, 14, 16, 17, 18, Clifford Grove. Represented 1967. Evelina Road No. 2 C.A.-Nos. 19, 20, 21, Evelina Road. Represented 1967. Croydon, Road, Penge C.A.-Nos. 12, 14, Croydon Road. Represented 1967. Pawleyne Road, Penge C.A.-Nos. 100, 102, 104, Pawleyne Road. Represented 1967. INDIVIDUAL UNFIT HOUSES Action taken in respect of individual unfit houses or parts of houses is as follows: Demolition Orders made. 1965. 10, Versailles Road, Anerley, S.E.20. Demolished, 1967. 47, Jasmine Grove, Penge, S.E.20. Demolished, 1966. 124 1 & 2, Tapsells Cottages, St. Mary Cray. Demolished, 1965. 5 & 7, Lower Road, St. Mary Cray. Demolished, 1966. 1966. 20, 22 and 24. Cherry Orchard Road. Bromley. Not yet demolished. 1967. 1 & 2, Sunnybank, Pratts Bottom. Demolished, 1967. 93, Farwig Lane, Bromley. Not yet demolished. Two Wooden Dwellings: "Stride Field" and "Leaves Green" Not yet demolished (unoccupied). 4, Fordcroft Road, St. Mary Cray. Not yet demolished. Parts of Buildings represented for Closure. 1965. 8, Mosslea Road, Penge, S.E.20. (Basement). 2, Palace Square, Upper Norwood, S.E.19. (Basement). 1966. 17, Derwent Road, Anerley, S.E.20. (Basement). 19, Derwent Road, Anerley, S.E.20. (Basement). 1967. 61, Selby Road, Anerley, S.E.20. (Basement). 67, Anerley Road, Anerley, S.E.20. (Basement). 90, Belvedere Road, Upper Norwood, S.E.19. (Basement). 17, Mosslea Road, Penge, S.E.20. (Basement). 10, Mosslea Road, Penge, S.E.20. (Basement). 79, Thicket Road, Anerley, S.E.20. (Basement). Closing Orders made in all cases, occupants re-housed, and basement closed. Closing Orders Determined. The following Closing Orders were determined, work having been satisfactorily completed to render premises fit for occupation: 1965. 38, Palace Square, Upper Norwood, S.E.19. (Basement). 1966. 69a, Church Road, Upper Norwood, S.E.19. (House). 1967. 3, Thicket Road, Anerley, S.E.20. (Basement). In addition to the Housing work set out above, serious consideration has been given in the past three years to the special problems in Penge and North-West Beckenham. This area contains many houses of considerable age (up to 100 years), many of which are in various stages of disrepair. There are a considerable number capable of improvement, and many in multiple occupation in which amenities fall short of modern standards. 125 Under the direction of the Borough Planning Officer a comprehensive survey is being carried out of approximately 8,000 houses and in this work the Health and Welfare Department is assisting by surveying the areas which are likely to be affected by slum clearance. During the year three small areas, containing 474 houses, were surveyed and the information transmitted to the Borough Planning Officer. The Survey will proceed into 1968, and uoon its comoletion the Council will consider the general question of the redevelopment of this part of the Borough and the need for demolition, reconditioning and improvement of the houses. In addition to the comprehensive survey of Penge and NorthWest Beckenham, a Housing Survey was carried out by the Greater London Council in which 1 in 25 houses were surveyed throughout the Greater London Area. Part 1 of this survey was undertaken by the London Borouehs, and in Bromlev the Health and Welfare Department assisted the Borough Planning Officer by surveying the houses which were thought to be below modern standards. Finally, the London Borough of Bromley was selected as an area for random samoling by the Ministry of Housing and Local Government for the National Housing Condition Survey. Thirtyfour houses in the Borough were inspected by an Officer of the Ministry, who was accompanied by one of the Public Health Inspectors. Overcrowding At the commencement of 1967 there were 14 known cases of statutory overcrowding; during the year a further 27 instances were recorded. Of this total 11 families had, by the end of the year, ceased to be overcrowded by virtue of being rehoused. RE-HOUSING The following information has been supplied by the Housing Manager:— Prior to 1967 During 1967 Houses Families in occup. Houses Families in occup. Permanent dwellings built 9,336 9,336 520 520 Prefabricated dwellings built by Local Authority 875 875 Nil Nil During 1967 there were 272 vacancies. During 1967, 529 families were housed from the waiting list in permanent accommodation. The total number of families on the waiting list as at 31st December, 1967, was 4,097. During the same period 84 temporary bungalows were demolished and the tenants were transferred to permanent accommodation. 126 HOUSING (A) Repair—Housing and Public Health Acts Number of houses rendered fit after service of notices:— Housing Act, 1957, Public Health and similar Local Acts. Informal Formal By owner 503 31 (B) Beyond repair—Housing Act, 1957 1. No. of undertakings accepted (section 16) Nil 2. „ closing orders made (section 17) Nil 3. „ demolition orders made (section 17) 5 4. „ closing orders made (section 18) 5 5. „ closing orders determined (section 27) 1 6. „ closing orders revoked and demolition orders substituted (section 28) Nil 7. „ houses demolished following demolition orders 3 (C) Clearance Areas (1) Represented during Year: 1. Number of Areas 13 2. Houses unfit for human habitation 99 3. Houses included by reason of bad arrangement, etc. . Nil 4. Houses on land acquired under 43(2) Nil 5. Numbers of people to be displaced: (a) Individuals 272 (b) Families 106 (2) Action taken during the Year: 1. Houses demolished by Local Authorities or Owners: (a) Unfit 81 (b) Others Nil 2. Number of people displaced: (a) Individuals 347 (b) Families 98 COMPULSORY IMPROVEMENT OF DWELLINGS The Housing Act, 1964, gives a local authority power to require the compulsory improvement of tenanted dwellings which lack one or more of the standard amenities defined in the Act. The amenities are a bath, wash-hand basin and sink, each with a hot and cold water supply, an internal water closet and a ventilated food store. Two areas containing 142 dwellings, approximately 68 of which lacked one or more of the standard amenities, were declared to be 127 improvement areas during 1967. These areas contained a part of the former Borough of Bromley No. 1 Compulsory Improvement Area which the department was unable to deal with during the statutory two-year period prescribed by the Act. During the year improvement works were completed at approximately 29 dwellings as a result of action taken by the Council. Opposition to improvement is encountered from some elderly tenants who have no desire to have their houses improved by the provision of modern amenities. RENT ACT, 1957 Applications under the Rent Act have reached a very low level. Certificates of Disrepair and other documents specified in the Act have been issued as follows:— Applications for Certificate of Disrepair 5 Number of decisions not to issue certificate — Number of certificates issued 2 Number of undertakings given by landlords under Paragraph 5, First Schedule 1 Number of undertakings refused by L/A — Applications for Cancellation of Certificate By Landlords to L/A for cancellation 2 Objections by tenants to cancellation — Certificates cancelled by L/A 3 HOUSING INSPECTIONS Defects Remedied, Nuisances Abated by Informal Action Drainage Drains: Constructed or Reconstructed 47 Repaired 191 Cleansed 1,244 Cesspools: Provided — Overflowing 9 Leaking — Abolished 2 Sanitary Appliances Sinks, etc., provided 15 Sinks, etc., repaired 56 W.C.s provided 13 W.C.s repaired 79 128 Dampness Roofs and rainwater fittings 340 Walls and stacks 357 Damp-proof courses and floors 66 Water Supply Provided - Installations repaired 27 General Items Wallplaster 289 Ceiling plaster 109 Floors 105 Rooms cleansed or redecorated 32 Windows and doors 253 Lighting 8 Ventilation 19 Staircases 40 Fireplaces, etc (ex. Clean Air) 30 Yard paving and drainage 12 Dustbins 35 Food storage and preparation 14 Nuisances from animals abated 8 Accumulations removed 82 Premises disinfested 56 Premises disinfected 20 NOTICES Infringements found, either as a result of routine inspections, or following the investigations of complaints, are dealt with by informally requesting the owners or agents to apply a suitable remedy. If these requests are not acceded to after an appropriate interval Committee sanction is sought for the service of Statutory Notices. 730 Informal Notices were issued of which 475 had been complied with by the end of the year. 136 Statutory Notices were served, and in 5 instances Court Orders were obtained. During the year 130 Statutory Notices were fully complied with. COMMON LODGING HOUSES The Ministry of Health has requested that this report should contain specific reference to Common Lodging Houses in the area. Common Lodging Houses are to a considerable extent an 129 anachronism from the past and provide accommodation of a type hardly commensurate with the year 1967. Years ago they could be found much more frequently, especially in industrial areas, to which itinerant labour was attracted. The accommodation although generally of a communal and minimal character has nevertheless to be in accordance with Byelaws, and the premises must be registered under Section 238, Public Health Act, 1936. It is, perhaps, surprising to find 2 such establishments within the London Borough of Bromley. One at Arpley Road, Penge, accommodating 33 persons and the other at Poverest Road, St. Mary Cray, with 24 persons—all men. They are contained in old premises and have been registered for many years. Neither is likely to continue for long as one has already been declared unfit and is part of a Clearance Area under the Housing Act. The other is in a district scheduled for redevelopment. Some of the men living in these two Lodging Houses are itinerant workers but in both cases several of them have lived there for many years and the accommodation affords the only home they know. The lodgings furnish a type of accommodation suited to the needs of these particular men and for that reason can be said to serve a useful purpose. Regular inspections are made to ensure that the Byelaws are being observed and, having regard to the nature of the structures, the premises appear to be adequately run. MOVEABLE DWELLINGS The Caravan Sites and Control of Development Act, 1960, prohibits the use of land as a caravan site without a site licence. Licences are issued by Local Authorities who may attach conditions to them to enforce a high standard of environment for the caravan dwellers. At the end of the year there were five licences in force. In addition, one site licence was being considered for renewal and an application for another was receiving attention. One licence, for one caravan, expired on the 31st July, 1967. as the temporary planning permission was not renewed. In another case enforcement action was considered because certain conditions attached to a new licence had not been complied with within the time specified. Negotiations were continuing at 130 the end of the year. Particulars of the five licensed sites are appended below:— Location of Licensed Sites No. of Vans permitted The Paddock, Downe Road, Keston 12 Lower Hockenden Farm, Hockenden, Swanley 1 Crittenden Caravan Park, Pond Lane, High Street, West Wickham 30 11 Heathfield Road, Keston 23 Restavon, Berry's Green Road, Cudham, Nr. Biggin Hill 60 The difficulty of dealing with itinerant caravanners using the grass verges of the Orpington By-Pass and the A.21 was referred to in my last report. Throughout the year this nuisance became progressively worse until Orders for their removal were obtained ultimately in the Magistrate's Court under provisions of the Orpington Urban District Council Act, 1954. Both of these Metropolitan roads were practically clear on the 31st December, 1967, but many of the caravans had moved to Council owned housing land at Chislehurst Road, Orpington, so that proceedings for their removal had to be re-instituted. The permanent caravan site provided by the Council at Star Lane, St. Mary Cray, for twelve gipsy families was completed and occupied in the Autumn. A Warden was appointed from their number to secure compliance with the rules governing the running of the site and general management was exercised by the Housing Manager, DRAINAGE AND SEWERAGE The Council accepts as a legal responsibility the clearance of certain types of public sewers and the work is undertaken by Disinfector/Handymen employed by the Department. In addition, private drains are cleared, but a charge is made in these cases. Of the 1,294 instances of choked drains dealt with, 874 related to private drainage. The trunk soil seweraee system is under the control of the West Kent Main Sewerage Board and the Greater London Council. The Borough Engineer states that foul sewers and surface 131 .vater sewers have been provided within the Borough during 1967 as under:— PRIVATE ESTATE DEVELOPMENTS: Foul Sewers Yards 6 in. Diameter 1,452 9 in. Diameter 576 Surface Water Sewers 6 in. Diameter 216 9 in. Diameter 1,762 12 in. Diameter 440 PRIVATE STREET WORKS: Foul Sewer 6 in. Diameter 678 Surface Water Sewers 6 in. Diameter 633 9 in. Diameter 469 12 in. Diameter 260 15 in. Diameter 22 SEWERAGE AUTHORITY: (a) New Sewers: Foul Sewers 6 in. Diameter 1,322 9 in. Diameter 666 Surface Water Sewers 9 in. Diameter 137 12 in. Diameter 66 15 in. Diameter 363 18 in. Diameter 599 21 in. Diameter 212 (b) Replacement of Old Sewers: Foul Sewers 9 in. Diameter 55 12 in. Diameter 165 (c) By Declaration under Section of Public Health Act, 1936: Foul Sewer 6 in. Diameter 255 During the year 10 new houses were connected to cesspools and 20 cesspools were abolished, the properties being connected to main drainage. There are now 2,199 cesspools in use in the Borough. 132 DISINFECTION Articles of clothing, bedding, etc., requiring disinfection following cases of infectious disease were collected and delivered in specially constructed metal lined vehicles and taken to the depots where disinfection was carried out by experienced operators. Steam disinfecting plants are situated at the Council's Depots at Waldo Road, Bromley, and Crofton Road, Orpington. Articles unsuitable for treatment by steam disinfection were disinfected by chemical means. In appropriate cases, premises, where infectious diseases occurred, were disinfected by suitable chemical sprays and fumigants. Disinfection of bedding was carried out on request for hospitals in the area. Where notifiable infectious diseases are involved, these services are free of charge. Similar provisions exist for disinfection on request where nonnotifiable illness has occurred. In such cases an approved nominal charge was made. DISINFESTATION Premises and articles infested by vermin and insects are also treated by the disinfecting operators. Sixty-seven requests were received for this service and the necessary work was carried out on payment of the approved charges. WASP NEST DESTRUCTION Preparations were made early in the year to cope with calls for help in disposing of wasp nests. Based on the experience gained in 1966 additional and improved equipment was obtained and additional members of the existing staff were instructed in methods of disposal. The season started early—the first request for assistance being received on 1st May and thereafter calls were received with increasing frequency during June, July, August and September. There was a sharp drop in activity in October, the season then being virtually over. A total of 439 nests were destroyed—a charge of £1 per clearance being made. CLEAN AIR ACT, 1956 Smoke Control Areas Continued progress was made during the year in the unspectacular but rewarding work of surveying and establishing smoke control areas. The smoke control programmes as originally approved by the 133 Council had the year 1975 as the target date for bringing the whole of the Borough under smoke control. Curtailment of the programme during 1967 on economy grounds has had the effect of deferring this date until 1976 and this will be achieved only if present progress is maintained and there are no further "cutbacks". Three technical assistants were appointed in the late summer of 1967 to assist with the survey work, thus reducing the amount of time which the public health inspectors had been devoting to this work and enabling them to be employed on other urgent duties. At the commencement of 1967, sixteen smoke control areas were in operation, covering a total area of some 4,778 acres and containing approximately 23,601 premises. During the year the Minister of Housing and Local Government confirmed three Smoke Control Orders in respect of the following areas:— Area No. Area Acreage Premises 4 Petts Wood Ward (part) 685 3,423 5 Martins Hill and Town Ward (part) 268 3,164 Plaistow and Sundridge Ward (part) 6 Anerley Ward 346 2,436 The three Orders became operative on 1st December, thus at the end of the year 6,077 acres of the Borough and 32,624 premises were under smoke control. 2,477 applications for financial assistance under the Clean Air Act were received from owners and occupiers of houses in the three areas towards the cost of adapting or replacing fireplaces in order to comply with the Orders. The preliminary surveys of the areas indicated that approximately 5,363 dwellings would require adaptation ranking for grant. It would appear, therefore, that a large number of the residents are not applying for grants, or are carrying out work such as the installation of electric radiant fires which at present do not rank for grant. The surveys in Petts Wood Ward and Plaistow and Sundridge Ward of further areas, which it is anticipated will be brought under smoke control in 1968, were completed during the year. No particular problems have been encountered during the year in connection with smoke control areas. Financial assistance under the Clean Air Act is considered to be reasonably generous and residents are given the choice of converting to solid smokeless fuel, gas or oil fired appliances. Electric storage radiators using off-peak electricity also rank for grant but not electric convector or radiant fires. Supplies of fuel have been adequate and no shortages have been reported. Fuel merchants have cooperated well with the Health and Welfare Department to ensure that only smokeless fuels are delivered in the controlled areas. 134 No contravention of the Smoke Control Orders was reported or detected. Numerous complaints of nuisance from smoke from lighting of bonfires in smoke control areas, as in other parts of the Borough were received. A Smoke Control Order does not prohibit the lighting of bonfires but if the smoke emitted is a nuisance to the inhabitants of the neighbourhood action can be taken under the Public Health Act. Normally complaints concerning bonfires are dealt with by informal action. The disposal of garden refuse, even when composting is practised, does present a problem and, therefore, bonfires have to be accepted as a necessary evil. Atmospheric Pollution Under Section 3 of the Act, all new furnaces must be capable of being operated without emitting smoke and, except in the case of small domestic boilers, notification of proposals to install new furnaces has to be given to the local authority. The majority of notifications received by the Department during the year related to the installation of oil fired central heating boiler plant. When considering such notifications, regard is had to the Memorandum on Chimney Heights issued by the Ministry of Housing and Local Government, which gives guidance on the calculation of chimney heights for effective dispersal of flue gases in order to avoid excessive ground level concentration of S02. It was not found necessary to take any formal action under the Clean Air Act in connection with the emission of dark smoke or grit. There are, of course, relatively few major sources of industrial pollution within the Borough. A number of complaints were received of atmospheric pollution from paint spraying of motor vehicles and grit emission from mechanical plant handling solid fuel at a coal depot. Informal action resulted in an abatement or amelioration of the nuisance. Perhaps the most common complaint investigated during the year concerned the burning of refuse by traders in the yards at the rear of their premises. In a number of instances, warning letters had to be sent to the offenders. Many traders feel that the collection of trade refuse should be a free service and resent having to pay the charge levied by the Council for the service. Measurement of Atmospheric Pollution Instruments for measuring the concentration of smoke and sulphur dioxide—the two main pollutants of the atmosphere resultant from the combustion of solid and liquid fuel—are maintained by the Department at four selected sites within the Borough. The sites are visited daily, readings taken and the data obtained 135 are forwarded to the Warren Spring Laboratory of the Ministry of Technology, who are conducting a five-year survey of air pollution on a national basis. The object of the survey is to enable valid conclusions to be drawn concerning the level and distribution of air pollution. It has already been reported that there has been a marked reduction in the concentration of smoke in the Greater London Area, which is directly attributable to the establishment of smoke control areas throughout the area. RADIOACTIVE SUBSTANCES ACT Although the main burden of the supervision of premises at which radioactive isotopes are stored or used falls upon the staff of the Ministry of Housing and Local Government certain duties devolve on the Local Authority. The premises concerned are mainly places where scientific research is undertaken but senior schools may also use sealed sources of radiation. During the year the use of luminous paint which was applied to the skin on the back of the hands of patrons at a certain dance establishment as a "check out" system was investigated. This substance was found to possess carcinogenic properties and might have presented danger particularly to those applying the paint. The proprietors undertook to cease using the paint. PREVENTION OF DAMAGE BY PESTS ACT, 1949 RODENT CONTROL The problem of rat and mouse infestation is a continuing one. Theoretically, if all sources of infestation were reported immeddiately and we were able to cope with the huge initial volume of work expeditiously the rodent population could be practically eliminated by the use of modern methods and poisons. In practice, however, notification is rarely given at the first sign of infestation and a mating pair can very quickly become a large family. A doe can become a mother at three months and as the gestation period tor a rat is approximately three weeks it is not difficult to appreciate how this happens. Compared with last year there was a fall of almost 17% in the number of notifications of rat infestation but the factors likely to influence this number are too numerous to attempt to suggest a reason for the reduction. One hopes, however, that it was due mainly to our efforts in the previous year! Considering the vast network of soil sewers in the borough our problem with rat infestation is very slight indeed. Two poison 136 treatments are carried out each year, the one in the spring being immediately preceded by test baiting to discover the location of infestation. The results for the year under review indicated a reduction in the rat population. The figures relating to surface infestations, as submitted to the Ministry of Agriculture, Fisheries and Food, are shown below:— PROPERTIES OTHER THAN SEWERS Properties other than sewers Type of Property NonAgricultural Agricultural 1. Number of properties in district 115,080 374 2. (a) Total number of properties (including nearby premises) inspected following notification 6,879 62 (b) Number infested by (i) Rats 2,451 10 (ii) Mice 187 1 3. (a) Total number of properties inspected for rats and/or mice for reasons other than notification 128 - (b) Number infested by (i) Rats 7 - (ii) Mice — - PIGEON DESTRUCTION Routine work to reduce the number of pigeons congregating at various sites has continued throughout the year. It is rarely possible to completely exterminate flocks of pigeons and reinfestation can occur quite quickly if regular visits are not made to deal with the new arrivals. Trapping and shooting are the methods usually employed. During the year 63 complaints were received and a total of 2,819 pigeons were destroyed. Pigeons roosting on the supporting girders of the railway bridge over Crofton Road have caused fouling of the public footpath beneath, and annoyance to persons using the footpath. A solution to this problem would be the proofing of the underside of the bridge. British Railways repudiate liability and although estimates were obtained for proofing, the work was not proceeded with in the interests of general economy. Special attention, however, continues to be given to the destruction of the birds, and by the Highways Department by daily cleansing of the footpath. 137 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 The object of this Act is to raise the standard of working conditions in shops, offices and railway premises. In the majority of the premises affected the Local Authority is responsible for enforcing the general requirements which relate to cleanliness, overcrowding, temperature, ventilation, lighting, sanitary conveniences, washing facilities, drinking water, seats, safety of machinery and first-aid and for investigating the cause of accidents. As in previous years inspections have had to be somewhat restricted owing to shortage of staff. It was, however, possible to make 943 detailed inspections, the total number of visits for all purposes being 1,554. 360 contraventions were found, these being mostly of a minor character. The most common types of contraventions found were the failure to provide thermometers to register room temperatures and first-aid equipment with inadequate or defective washing facilities and inadequate ventilation running a close second. With few exceptions employers have shown a readiness to comply with the requirements of the Act and in no case was it necessary to resort to legal action. Accidents reported numbered 69, fifteen of which were investigated because it seemed likely that advice could be given to the employer to prevent a recurrence of a similar accident. For the most part the injuries were of a minor character but in one case, involving a service lift in a restaurant kitchen, an employee sustained a badly cut forehead and nose. The lift shaft opening was not fitted with gates having an interlocking device to ensure that the lift could not be operated whilst the gates were open but the Company rectified this matter immediately. At the time there was no direct contravention of the Act but special legislation is being introduced next year to meet these circumstances by way of a Statutory Instrument. 138 OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 (A) Registrations and General Inspections Class of premises No. of premises registered during the year No. of registered premises at end of year No. of registered premises receiving a General Inspection Offices 41 685 161 Retail shops 36 1,468 674 Wholesale shops, warehouses 3 45 32 Catering establishments open to the public, canteens 14 162 64 Fuel storage depots — 12 12 Totals 94 2,372 943 Total Number of Visits of all kinds by Inspectors to registered premises under the Act 1,554 (B) Analysis of Contraventions Section No. of Contraventions found Section No. of Contraventions found 4 Cleanliness 39 15 Eating facilities 6 5 Overcrowding 6 16 Floors, passage and stairs 23 6 Temperature 49 7 Ventilation 39 17 Fencing exposed machinery 20 8 Lighting 11 18 Protection of young persons from dangerous machinery — 9 Sanitary Conveniences 26 10 Washing facilities 55 19 Training of young persons working at dangerous machinery — 11 Supply of Drinking Water 12 12 Clothing Accommodation 5 23 Prohibition of heavy work - 13 Sitting facilities 1 14 Seats (Sedentary Workers) 1 24 First Aid General Provisions 67 Total 360 139 (C) Exemptions No. of applications received Nil (D) Prosecutions Number instituted Nil Number of complaints (or summary applications made under Section 22) Nil Number of interim orders granted Nil (E) Reported Accidents Workplace Number Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Informal Advice Offices 10 — — — — 10 Retail Shops 44 8 — — 8 36 Wholesale Shops, Warehouses 9 2 - - 2 7 Catering Establishments open to public. canteens 6 5 - - 5 1 Fuel Storage Depots - - - - - - TOTALS 69 15 — — 15 54 Analysis of reported accidents Offices Retail Shop Wholesale Warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery — 2 1 1 — Transport — 1 2 — — Falls of persons 4 10 1 4 — Stepping on or striking against object or person 2 4 1 — — Handling goods 3 15 3 — — Struck by falling object — — 1 1 — Fires and Explosions — — - - - Electricity — — — — — Use of hand tools — 8 — — — Not otherwise specified 1 4 - — — 140 Prescribed Particulars on the Administration of the Factories Act, 1961 PART I OF THE ACT 1. INSPECTIONS for purposes of provisions as to health (including inspections made by Public Health Inspectors). Premises Number on Register Number of Inspections Written Notices Occupiers prosecuted (1) (2) (3) (4) (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by Local Authorities 83 19 - Nil (ii) Factories not included in (i) in which Section 7 is enforced by the Local Authority 563 251 9 Nil (iii) Other Premises in which Section 7 is enforced by the Local Authority (excluding outworkers' premises) 76 77 2 Nil Total 722 417 11 Nil 2. Cases in which DEFECTS were found. Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness (S.l) - - - - - Overcrowding (S.2) — — — — Unreasonable temperature (S.3) — — — — Inadequate ventilation (S.4) — — — — - Ineffective drainage of floors (S.6) - - - - - Sanitary Conveniences (S.7) — — — 5 - (a) Insufficient 5 5 — — - (b) Unsuitable or defective 5 5 — - - (c) Not separate for sexes 1 1 — —. - Other offences against the Act (not including offences relating to Outwork) - - - - - Total 11 11 — 5 - 141 PART VIII OF THE ACT OUTWORK (Sections 133 and 134) No. of out-workers in August list required by Section 133(1)(c) Wearing Apparel—making, etc. 89 Household linen 1 Lace, lace curtains and nets 1 Curtains and furniture hangings 1 Paper bags 2 Making of boxes or other receptacles or parts thereof made wholly or partially of paper 3 Carding, etc., of buttons, etc. 1 Stuffed Toys 12 MORTUARIES There are two mortuaries operated by the London Borough of Bromley, one in the Town Hall grounds at Beckenham and the other at Beaverwood Road Depot, Chislehurst. The plans made in 1966 for improvements and increased facilities at the Beckenham Mortuary were virtually completed by the end of the present year. These included the following items:— Provision of six additional refrigeration spaces. Provision of an electric hoist. Provision of one new post-mortem table. Re-surfacing of one post-mortem table. Refurbishing of Viewing Room. Provision of new electric space-heaters in post-mortem room. Provision of new gas water heater for post-mortem room. Internal decoration. 142 During 1967, 549 bodies were brought to the Mortuaries where post-mortem examinations were conducted by a Home Office Pathologist as shown below:— Mortuary Address No. of bodies brought to the Mortuary and post-mortem examinations conducted (1) (2) (1) Town Hall, Beckenham 380 (2) Beaverwood Road, Chislehurst 169 WATER SUPPLY There are only 24 dwellings not provided with a main piped water supply. These are mainly situated in isolated parts of the district and are generally dependent upon rainwater collected from roofs and stored in underground tanks; three premises, however, obtain their source of supply from a private well. The main water supply in the Borough is provided by the Metropolitan Water Board, and I am indebted to the Director of Water Examination of that Authority for the following information: — "(1) (a) The supply was satisfactory both as to quality and quantity throughout 1967. (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 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 sign of contamination or any other abnormality is immediately investigated. (c) (i) The Board has no record of the number of structurally separate dwellings supplied in your area, but the population supplied direct according to the Registrar-General's estimates at 30th June, 1967, was 302,483. (ii) No houses were permanently supplied by standpipe. 143 (d) No fluoride was 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 via Surbiton and Walton, Hampton, Kempton Park via Honor Oak and Shortlands Wells Shortlands, West Wickham, Orpington, Sundridge, Lullingstone, Eynsford, Horton Kirby and Jewels Wood. No new sources of supply were instituted and there were no changes to the general scheme of supply in your area. The number of samples collected and the bacteriological and chemical analyses of the supply from the above sources after treatment are shown on the attached sheets, (b) The Board's river and well sources have not yet been considered to have a plumbo-solvent action, on account of their hardness content and alkaline reaction. It should, however, be appreciated that all types of water pick up varying amounts of metal from piping, particularly when it is newly installed; this applies to copper, zince, iron and also lead. Tests for lead have been carried out in connection with chemical analyses of samples of running water collected from premises in the distribution system and I set out below the information obtained over the period 1st January to 31st December, 1967: — Lead content (mg/1 Pb) water from main taps in consumers' premises Number of samples Per cent. Less than 0.0 64 66.7 0.01 22 22.9 0.02 3 3.1 0.03 4 4.2 0.04 2 2.1 0.05 0 - 0.06 1 1.0 96 100.0 The above figures apply to the whole of the Board's area but it should be pointed out that the general characteristics of the water are similar throughout the area so that the findings are applicable to individual Boroughs. The regular system of examination for lead in water in domestic premises will continue during 1968." 144 BACTERIOLOGICAL RESULTS — YEARLY AVERAGES, 1967 OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY Source of supply Number of samples BEFORE TREATMENT Number of samples AFTER TREATMENT 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. 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. All Thames-derived 3,578 12.2 99.75 99.97 Eynsford No. 1(a) 132 0.3 9 100.0 — 100.0 - 247 0.0 1 100.1 100.0 Eynsford No. 2(b) 188 0.0 5 100.0 — 100.0 - Horton Kirby No. 1(a) 180 0.8 25 91.67 0.8 93.33 0.5 242 0.1 203 100.0 100.0 Horton Kirby No. 2(b) 215 0.1 5 93.49 0.4 04.42 0.3 Jewels Wood 45 0.8 61 100.0 - 100.0 - 45 2.2 19 100.0 100.0 Lullingstone No. 1(a) 146 0.0 1 100.0 — 100.0 - 254 0.1 6 100.0 100.0 Lullingstone No. 2(b) 153 0.0 13 100.0 — 100.0 - North Orpington No. 1(a) 172 3.2 52 30.23 11.0 41.86 6.6 255 0.6 7 99.22 99.61 North Orpington No. 2(b) 231 1.7 27 37.66 4.2 49.35 2.3 Orpington 249 0.0 166 99.20 - 99.60 - 254 0.0 6 100.0 100.0 Shortlands No. 1(a) 168 0.0 10 100.0 - 100.0 — 219 0.0 7 100.0 100.0 Shortlands No. 2(b) 190 0.2 12 100.0 - 100.0 — Shortlands No. 3(c) 65 0.0 1 100.0 - 100.0 — Sundridge No. 1(a) 59 0.0 0 100.0 — 100.0 — 255 0.0 1 100.0 100.0 Sundridge No. 2(b) 60 0.0 3 100.0 — 100.0 — Sundridge No. 3(c) 104 0.0 205 100.0 — 100.0 — Sundridge No. 4(d) 103 0.0 0 100.0 — 100.0 — West Wickham 209 0.0 404 97.61 - 98.56 - 212 0.0 4 100.0 100.0 AVERAGE RESULTS OF THE CHEMICAL EXAMINATION OF WATER SUPPLIED TO THE LONDON BOROUGH OF BROMLEY, 1967 Milligrammes per litre (unless otherwise stated) Description of the Sample No. of Samples Day of the month Ammoniacal Nitrogen Albuminoid Nitrogen Nitrate Nitrogen Oxygen abs. from KMnO4 4 hrs. at 27°C. B.O.D. 5 days at 20°C Hardness (total) CaCO3 Hardness (non-carbonate) CaCO3 Magnesium as Mg Sodium as Na Potassium as K Chloride as Cl Phosphate as PO4 Silicate as SiO2 Sulphate as S04 Natural Fluoride as F Surface-active material as Manoxol OT co2 Turbidity units Colour (Burgess units) ph value Electrical Conductivity (micromhos) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) 13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) All Thames derived 363 0.024 0.089 4.1 1.12 282 73 5 22.5 5.1 30 1.9 10 64 0.30 0.01 0.1 12 7.9 590 Eynsford 8 0.009 0.030 4.0 0.08 265 37 2 9.0 1.4 15 14 0.10 31 0.0 1 7.3 500 Horton Kirby 8 0.004 0.031 4.8 0.08 268 44 2 10.0 1.9 19 25 0.15 34 0.0 1 7.2 520 Jewels Wood 4 0.010 0.030 3.0 0.06 235 33 2 7.5 1.4 13 22 0.10 22 1.9 5 7.4 400 Lullingstone 8 0.004 0.025 4.0 0.14 259 33 3 9.0 1.1 15 16 0.10 29 0.1 1 7.3 500 Orpington 4 0.006 0.023 6.5 0.14 296 51 3 10.5 1.8 16 20 0.10 33 0.0 1 7.2 570 Shortlands 8 0.007 0.030 4.8 0.08 291 67 4 11.5 1.6 18 50 0.15 30 0.2 1 7.3 550 Sundridge 15 0.008 0 025 3.3 0.06 221 52 3 9.0 2.1 18 32 0.15 15 0.0 1 7.5 430 West Wickham 3 0.008 0.029 5 4 0.04 282 44 2 9.5 1.4 13 24 0.10 33 0.0 1 7.3 530 146 SWIMMING BATHS The Department is responsible for the general supervision of swimming baths within the Borough so far as conditions which might give rise to health hazards are concerned. The Baths Manager and Engineer provides the day-to-day oversight of Public Baths and those situated at schools under the control of the Council. There are a number of other pools to which the public has access in addition to the large Bath provided by the Greater London Council at Crystal Palace. Specimens are obtained from these pools regularly in order to confirm that the continuous steps taken to purify the water are working effectively. During the year it became necessary to ban the use of the chemical ORTHOTOLUDINE. used for testing for the presence of residual chlorine in the bath water. This chemical has been pronounced as carcinogenic. Other suitable substances are available for the purpose. Care has also to be taken at swimming pools to ensure that certain other chemicals employed there are not used simultaneously as eases dangerous to bathers and staff may be evolved and one incident of this type was reported. THE DISEASES OF ANIMALS ACT, 1951 The City of London's Veterinary Department operates a service to undertake duties under the above-mentioned Act on behalf of Local Authorities. This service has been in operation throughout 1967 in the London Borough of Bromley and I am indebted to the Veterinary Officer, Mr. G. S. Wiggins, M.R.C.V.S., for the co-operation of his Department and for much of the following particulars:— FOOT & MOUTH DISEASE The Ministry of Agriculture, Fisheries and Food declared the whole of England and Wales to be a controlled area (as from 18th November) under the terms of the Foot and Mouth Disease (Controlled Areas Restrictions) General Order, 1938. This meant that the movement of all cloven hoofed animals had to be licensed by the Local Authority. During the period 146 such licences were issued; most of these were for the movement of animals to a slaughterhouse in the Borough for immediate slaughter. As part of a local campaign to minimise the risk of contamination of premises where animals were kept the Officers of all Departments of the Council were asked to restrict as far as possible 147 visits to such premises and a supply of suitable disinfectant, brushes, receptacles and water was made available to enable the boots and vehicles of Officers making unavoidable visits, to be effectively disinfected. Advice and assistance was also given, where required, to animal keepers in the Borough. REGULATION OF MOVEMENT OF SWINE ORDER, 1959 Under this Order 175 Movement Licences were verified and no irregularities were found. ANTHRAX ORDER, 1938 Information was received from the Ministry of Agriculture, Fisheries and Food that a heifer had been found dead at a local farm in Keston on 29th February, the cause of death being suspected as anthrax. Notices were served declaring the premises to be an infected place and notice was given requiring the disinfecting and cleansing of the infected place. All in-contact stock was protected with vaccine or antibiotic. The carcase was disposed of by burning on the site. The Ministry of Agriculture, Fisheries and Food's Officers subsequently confirmed that smears taken from the dead animal confirmed the presence of anthrax. Further inspections having proved that all the required measures had been carried out, the notice defining the infected place was withdrawn on 1st March. ORDERS—MINISTRY OF AGRICULTURE, FISHERIES & FOOD From time to time Orders are received from the Ministry which require publication. Eight such Orders were advertised in the National Press. ANIMAL KEEPERS, ETC The following premises are situated within the Borough and were regularly visited and inspected — no infringements or irregularities were found. Number of existing premises Stock Keepers 33 Farms (more than one type of animal) 45 Pig Keepers 49 Horses only 1 Poultry Keepers 26 Slaughterhouse ] Riding Establishments 12 Animal Boarding Establishments 15 148 RIDING ESTABLISHMENTS ACT, 1964 Twelve applications were received for the grant of licences to keep Riding Establishments. The premises were inspected and were referred to, and reported upon, by a Veterinary Surgeon and a Fire Prevention Officer. All animals available to be hired from the premises were also examined by Veterinary Surgeons. Conditions were satisfactory and the licences were issued. PET ANIMALS ACT, 1951 Licences to deal in "Pet Animals" as defined by the Act were issued to 25 applicants. The majority of the businesses were on a small scale selling fish, tortoises, birds and small animals. A total of 37 visits were made to the premises, no contraventions of the terms of the licences being found. ANIMAL BOARDING ESTABLISHMENTS Fifteen licences were granted to persons to keep Boarding Establishments for Animals. Provision is made at the premises for boarding 268 dogs and 96 cats. Sixty-nine visits were made to these premises during the year —no contraventions of the terms of the licences being found. SUMMARY OF PUBLIC HEALTH INSPECTORS' VISITS General Sanitation Animal Boarding Establishments 69 Caravans 277 Cesspools 53 Common Lodging Houses 66 Drainage 2,570 Filthy Premises 26 Fouling of Footpaths 39 Hairdressers 90 Keeping of Animals 29 Noxious Accumulations 160 Piggeries 16 Public Conveniences 110 Rivers, etc 101 Schools 44 Swimming Baths — Public 7 Swimming Baths — Private 22 Theatres, etc. 4 Verminous Premises 104 149 Housing Housing Acts (Clearance) 965 Housing Acts (Improvement) 1,108 Overcrowding 43 Public Health Acts 5,369 Rent Act 48 Factories, etc. Factories with power 251 Factories without power 19 Building Sites 77 Outworkers 33 Offices, Shops and Railway Premises General Inspections—Offices 161 Retail Shops 674 Wholesale Shops and Warehouses 32 Catering Establishments and Canteens 68 Fuel Storage Depots 12 Visits of all kinds (including above) 1,554 Food Premises—Food Hygiene Regulations Bakers' Shops 150 Bakehouses 112 Butchers 298 Dairies 37 Fishmongers 140 Greengrocers 145 Grocers 606 Ice Cream 107 Restaurants 283 Slaughterhouses 161 Stalls 437 Food Complaints 97 Inspection of Foodstuffs Meat—Slaughterhouse 455 Meat—Wholesale Depots 78 Meat—Retail Shops 24 Other Foods 353 Merchandise Marks Act—Food only 12 150 Rodent Control Agricultural premises 24 Non-agricultural premises 385 Water Supply 84 Noise Abatement 187 Pharmacy and Medicines 12 Rag Flock and Other Fillings Act 4 Riding Establishments Act 18 Pet Animals Act 37 Clean Air Act Nuisances 210 Industrial premises 170 Smoke Control Areas 8,616 Pigeons Infestations 11 Infectious Diseases General 354 Food Poisoning 161 Disinfection supervision 23 Surveillance of Infectious Diseases Contacts, etc 149 Nursing Homes and Child Minders 9 Sampling Egg Products 12 Fertilisers and Feeding Stuffs 1 Food and Drugs 513 Ice Cream (Bacteriological) 123 Milk (Bacteriological) 292 Water—Drinking 11 Rivers, etc 13 Swimming Baths 46 Rag Flock Act 4 Miscellaneous 344 Total 29,800 151 NUMBER OF DEFECTS OR CONTRAVENTIONS FOUND Housing: Defects and Nuisances 1,682 Filthy and verminous conditions 48 Water supply 29 Cesspools 2 Drainage 863 Overcrowding 7 Rent Act 3 Infectious Diseases and Food Poisoning 68 Food Premises: Bakers and Bakehouses 64 Meat Depots and Stalls 9 Butchers 99 Fishmongers and Poulterers 41 Grocers 128 Greengrocers 59 Dairies and Milk Shops 28 Ice Cream Premises 44 Food Preparing and Manufacturing Premises 41 Restaurants, Hotels, Canteens, etc. 92 Street Vendors, Hawkers' Carts and Markets 27 Trade Premises: Caravan Sites 1 Theatres, etc., Places of entertainment - Common Lodging Houses 2 Factories 88 Hairdressers 29 Offices, Shops and Railway Premises Act 451 Miscellaneous: Rodent Control—Agricultural Property 3 Non-Agricultural Property 34 Keeping of Animals 2 Noxious Accumulations 88 Smoke and Clean Air Act 120 Noise Abatement Act 24 Rivers, Streams, etc. 4 152 NOTICES SERVED Informal Notices: Public Health and Housing 465 Others 270 Complied with at end of year: Public Health and Housing 313 Others 144 Statutory Notices: Public Health Act 130 Clean Air Act 1 Complied with at end of year: Public Health Act 95 SCHOOL HEALTH SERVICE 154 SCHOOL HEALTH SERVICE INDEX Page B.C.G. Vaccination 167 Child Guidance 169 Cleanliness Inspections 161 Clinics 190 Defects—Periodic and Special Medical Examinations 162 Diseases of Ear, Nose and Throat 166 Diseases of Skin 167 Employment of Young Children 184 Follow-up Examinations 161 Handicapped Pupils 175 Health Education and Home Safety 187 Health Visiting 186 Hearing Impaired Children 174 Independent Schools 163 Infectious Diseases in Schools 168 Page Members of Education Committee 155 Minor Ailments 165 Ophthalmic Clinics 165 Orthopaedic Clinic 167 Orthoptic Clinic 165 Other Inspections 160 Other Medical Examinations 184 Periodic Medical Inspections 160 Physical Education 184 Physiotherapy Clinic 167 Prefatory Letter 156 School Health 159 School Meals and Milk Service 186 School Psychological Service 172 Speech Therapy 168 Special Inspections 160 Special Schools 180 155 MEMBERS OF THE EDUCATION COMMITTEE (as at 31st December, 1967 *Alderman C. H. E. Pratt (Chairman) *Councillor Mrs. D. E. L. West, M.B.E. (Vice-Chairman) Alderman Mrs. A. L. Gunn, J.P. (Mayor) Alderman Miss B. James, J.P. Alderman E. C. H. Jones, C.B.E., B.Sc. Alderman R. A. Sanderson, J.P. Alderman A. W. Waller *Councillor P. A. R. Allwood *Councillor R. R. Baker Councillor J. F. David *Councillor R. G. Foster Councillor E. J. Lovell *Councillor Mrs. M. C. McClure, B.Sc. *Councillor P. McNally Councillor Miss K. A. Moore *Councillor Miss B. G. Oldham Councillor F. J. Packer, F.C.I.S. Councillor Mrs. L. M. Prince Councillor A. E. Read *Councillor Mrs. M. Read *Councillor Mrs. O. L. Roberts, J.P. Councillor J. P. Sheridan, A.M.I.E.I. *Councillor W. H. Stephenson Councillor J. D. Vergette, F.I.M.I. *Councillor Mrs. A. M. White Councillor A. W. Wright Co-opted Members: H. Anderson, M.A., A.Inst.P. J. H. Atkins, J.P. N. K. H. Bailey, B.A., B.Sc. J. Davies The Rev. Canon T. C. Hammond, M.A., LL.B. Miss E. M. Huxstep, C.B.E., B.A. *G. R. Lloyd *W. Marsden C. E. Wiltshire, J.P. (One vacancy) *Denotes members of Primary Education and Welfare Sub-Committee. CHIEF EDUCATION OFFICER—G. V. Welboume, M A. 156 TO THE CHAIRMAN AND MEMBERS OF THE EDUCATION COMMITTEE Ladies and Gentlemen, I have the honour to present the third Annual Report on the School Health Service of the London Borough of Bromley. Health of School Children The School Health Service has continued to screen, medically and fully, pupils in the three age groups, entrants, 10 years and 14 years old, and though approximately 700 fewer of these routine health checks have been carried out, the results have remained satisfactory. Less than 20% of pupils were referred for treatment. Details of these examinations are shown later in the report. The fact that there is even this percentage indicates the value of these examinations because in the main, these defects were discovered for the first time. In only one child was the general nutritional and physical condition reported as unsatisfactory. Co-operation with other Services The main objective of routine and special examinations is to find pupils who, by virtue of handicap, are in need of special educational provision. Continuity with the Child Welfare Clinics is essential as it is generally estimated that only 80% of children continue to attend Child Welfare Clinics after the age of two years. The report indicates how this continuity is provided by allocation of Medical Officers and Nursing Staff to linked groups of schools and clinics, thus enabling exchange of information and contact between colleagues known to each other in the schools, clinics and general medical practices. References for medical treatment are made to the medical practitioner except in certain defined categories where the emphasis is mainly educational or the Authority provides its specialist service as for speech therapy or supplementary ophthalmic treatment. An exception to this applies to the orthopaedic referrals. During the year, there was an extension of the scheme introduced the previous year to enable the Assistant Medical Officers to be designated Medical Liaison Officers and, as such, to visit Wards and to attend at Hospital Paediatric Clinics by appointment for detailed discussions with specialist and medical practitioners on handicapped children also likely to be in need of special educational treatment. School Psychological Service The report indicates the stresses which financial stringencies and a national shortage of staff are placing on this growing local 157 service. A greater awareness of the relationship of emotional and developmental factors on learning difficulties is prompting investigation at an earlier age than the statutory age of two years. The report underlines the co-operation between remedial teachers, assistant medical officers and heads of schools and educational psychologists on the slow learners' needs in infant and junior schools and that reading difficulties at secondary level are now under investigation. At the same time, it is to be expected because of the inter-relationship that classes for maladjustment and for partially hearing children will also benefit from advice on learning difficulties for some of the pupils in attendance. More satisfactory premises will be found in 1968 as a base for this service. Child Guidance Again a report indicates the struggle that must take place for time between consultation and therapy when a service is rapidly expanding due to the popularity and expert knowledge of the physician in charge. It is hoped in 1968 to appoint a Psychiatric Social Worker to this clinic and to seek more suitable premises. Speech Therapy A common defect of speech today is the stammer and nationally there is evidence that this defect is becoming less common. In our own service, there was a reduction from 49 to 48 children treated in the clinics. That the waiting list at the end of the year was reduced from 175 to 157 is a tribute to the work of the Therapists as there were for both years approximately the same number of removals from the area and ceased attendances. Nationally, this service for some years has suffered from the loss of therapists through marriage but now recruitment of staff and opening of new clinics has also been delayed by financial stringencies. Service for Hearing Impaired Children The development of this service has been one of the most encouraging features of the year. The objectives of this service are to ascertain hearing loss at an age that will enable the child to exploit to the full his residual hearing and diagnosis has to be made in infancy so that the child can listen to sounds and speech. Screening tests for infants and young children which are carried out in the Infant Welfare Service are continued in the School Health Service by audiometry. At present this is conducted by school medical officers and the possibility of transferring these 158 examinations to the school nurses is not considered feasible because of their increasing other commitments. A number of physically handicapped children are partially hearing as well as physically disabled so that this service will be vital to any special school for the physically handicapped. The reports show that a survey this year has indicated the ages and educational provision for 130 hearing impaired children in the Borough, and that nursery and infant units ihave been established in two primary schools. The appointment of additional Teachers of the Deaf will enable more visits to be paid to schools where there are children with defective hearing, as well as to support the new unit which, it is hoped, will open in September, 1968. Close liaison is being maintained with Hospital Audiology Clinics in the Greater London area. Physically Handicapped Pupils Although categories of children with handicaps and disabilities are recognised for administrative convenience, many pupils have more than one disability. A number attend ordinary schools but for most special educational provision is necessary. Parent counselling is very necessary and close co-operation between the medical and education services. The majority are likely to need community care for the rest of their lives and in an Authority with a comprehensive Welfare Service, close liaison between this Service and the School Medical Service is essential tp provide for these young persons when they return to home adequate community care. It is hoped that in the near future, by joint arrangement, plans for a special school for physically handicapped will be developed. Educationally Subnormal Children The reports of the activities of the three Special Schools show developments of great interest, including increased swimming facilities, the setting up of an adventure playground, and the use of a minibus provided by the Variety Club of Great Britain to enable pupils to visit factories, firms and places of interest. I wish to pay tribute to the wonderful assistance I have had from Dr. Carter-Locke in these formative years of the new Borough. He has established permanent links of co-operation with the Head Teachers and with the Education Department and has been responsible for the detailed day-to-day administration of the School Health Service. My thanks are also due to the Chief Administrative Officer and to the staff of the School Health Sectionand to the many who have contributed to this report. In conclusion, I would again thank the Chairman and members of the Committee for their sympathetic consideration and suDoort to schemes for the betterment of the School Health Service, and in particular Mr. Welbourne, the Chief Education Officer, his 159 staff and the Heads of Schools for their constant encouragement and ready co-operation throughout the year. L. R. L. Edwards, Principal School Medical Officer. SCHOOL HEALTH There are 36 secondary (including 2 direct grant) and 86 primary schools in the Borough; also 3 special day schools for educationally subnormal children. In January, there were 43,722 pupils on the registers of the maintained primary, secondary and special schools. Routine medical inspections have continued to be carried out in schools on all pupils in the following age groups: Entrants to Infants' Schools: at 10 years of age and at 14 years old. At 8 years of age all pupils are given routine tests of vision and hearing only. A full medical examination is, however, undertaken at this stage if for any reason it appears necessary. In addition, special examinations are carried out at any time during a child's school career if the Head Teacher, Parent or Doctor is concerned about the health of a particular child. The total number of children attending both maintained and private schools, who were examined in the routine age groups was 12,023. As a result of these examinations the physical condition of only one pupil (.01%) was found to be unsatisfactory, and 2.291 pupils (19.1%) were found to require treatment. A further 3,714 children were given routine tests of vision and hearing. As a result of which 86 pupils (2.31%) were referred for treatment because of visual defects, and 33 pupils (.89%) were referred for treatment because of hearing defects. Further details of these examinations will be found later in the Report. A staff of ten Assistant Medical Officers devote approximately 50% of their time to work within the School Health Service. Each Medical Officer is responsible for a particular group of schools so that regular contact between the Head Teachers and their own School Medical Officer is possible. The schools allocated to each Medical Officer are grouped, as far as possible, around the Child Welfare Clinics which the particular Medical Officer also attends. This enables the Medical Officer to see both the child and its parent at the Child Welfare Clinic until the child becomes eligible for school, and then to continue seeing them both at school. This continuing care is valuable as it helps to build up a good relationship between the parent, child and doctor. 160 MEDICAL INSPECTION OF PUPILS ATTENDING MAINTAINED PRIMARY AND SECONDARY SCHOOLS (including Nursery and Special Schools) PERIODIC MEDICAL INSPECTIONS Age Groups inspected (By year of Birth) No. of Pupils who have received a full medical examination Physical Condition of Pupils Inspected No. of Pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) Satisfactory No. Unsatisfactory No. for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils (1) (2) (3) (4) (5) (6) (7) (8) 1963 and later 6 6 — — — 1 1 1962 1,502 1,501 1 — 59 175 234 1961 1,490 1,490 — - 76 187 256 1960 326 326 — — 28 28 56 1959 238 238 — 3,367* 14 33 46 1958 138 138 — 178* 5 14 19 1957 3,436 3,436 — — 329 392 701 1956 368 368 — - 37 55 88 1955 106 106 - — 12 21 32 1954 53 53 - — 13 6 19 1953 2,952 2,952 - — 376 270 621 1952 and earlier 279 279 — — 44 25 67 TOTAL 10,894 10,893 1 3,545* 993 1,207 2,140 Col. (3) total as a percentage of Col. (2) total 99 99% Col. (4) total as a percentage of Col. (2) total .01 % *Test of vision and hearing only at the age of eight years. 81 pupils referred for treatment because of visual defects. 31 pupils referred for treatment because of hearing defects. OTHER INSPECTIONS Number of Special Inspections 938 Number of Re-inspections 2,555 Total 3,493 Special Inspections Special inspections are carried out at any time during a child's school career if the head teacher, family doctor, parent or health visitor is concerned about the health of a particular child. A total of 938 special inspections were carried out during the year, and the principal defects discovered concerned vision and hearing. 161 Re-lnspections A re-inspection is an inspection arising out of one of the periodic medical inspections or out of a special inspection. A total of 2,555 re-inspections was carried out during the year. Follow-up Examinations Follow-up examinations, referrals to General Practitioners, Specialist Clinics, and to Hospital Consultants are arranged as and when necessary. Cleanliness Inspections These inspections are carried out by the Health Visitors. Children in the Infants Departments are inspected during the first six weeks of each term. Inspections in the junior and secondary schools are also carried out each term unless clear inspections are reported for three consecutive terms. In addition to the above, inspections are carried out at any time if and when necessary. (a) Total number of individual examinations of pupils in schools by Health Visitors 40,068 (b) Total number of individual pupils found to be infested 204 (c) Number of individual pupils in respect of whom cleansing notices were issued (Section 54(2), Education Act, 1944) 42 (d) Number of individual pupils in respect of whom cleansing orders were issued (Section 54(3), Education Act, 1944) Nil 162 DEFECTS FOUND BY PERIODIC AND SPECIAL MEDICAL INSPECTIONS—MAINTAINED SCHOOLS Defect Code No. (1) Defect or Disease (2) PERIODIC INSPECTIONS Special Inspection Entrants Leavers Others Total 4 Skin T 80 96 167 343 - O 34 26 30 90 - 5 Eyes — a. Vision T 163 420 410 993 57 O 413 184 256 853 10 b. Squint T 40 11 23 74 - O 7 1 5 13 — c. Other T 6 4 21 31 1 O 9 6 31 46 — 6 Ears— a. Hearing T 25 4 19 48 8 O 117 14 44 175 5 b. Otitis T 19 3 2 24 1 Media O 22 2 4 28 — c. Other T 2 2 3 7 - O 3 1 3 7 — 7 Nose and Throat T 68 21 35 124 1 O 120 11 45 176 2 8 Speech T 38 2 26 66 4 O 59 2 11 72 1 9 Lymphatic Glands T 2 1 3 6 - O 47 5 9 61 — 10 Heart T 10 4 5 19 1 O 22 3 21 46 — 11 Lungs T 35 16 35 86 3 O 62 21 50 133 — 12 Developmental— T 7 3 5 15 - a. Hernia O 10 3 5 18 1 b. Other T 3 15 22 40 - O 63 20 57 140 1 13 Orthopaedic— T - 29 6 35 2 a. Posture O 14 61 60 135 — b. Feet T 20 33 61 114 5 O 48 37 39 124 — c. Other T 13 18 22 53 1 O 63 43 39 145 1 14 Nervous System— T 3 4 5 12 - a. Epilepsy O 4 1 2 7 — b. Other T 3 11 13 27 1 O 21 7 16 44 — 15 Psychological— T 4 1 6 11 3 a. Development O 26 2 27 55 3 b. Stability T 6 3 19 28 2 O 117 68 156 341 3 16 Abdomen T 12 3 17 32 1 O 23 8 15 46 — 17 Other T - 11 3 14 1 O 27 24 63 114 2 T = TREATMENT O = OBSERVATION 163 INDEPENDENT SCHOOLS Independent Schools, which so desire, have continued to participate in the School Health Service. At present 18 such schools take advantage of the facilities provided by the Service. Subject to their parents' consent pupils attending these schools receive routine medical inspections (at the same ages as children attending maintained schools), and also have the advantage of access, where necessary, to the specialist clinics. Arrangements are also made as an when necessary for the special examination of any child. During the year 1,129 children were medically inspected, and a further 169 children received tests of vision and hearing only. In addition, a total of 15 special inspections and 84 re-inspections were carried out. PERIODIC MEDICAL INSPECTIONS Age Groups inspected (By year of Birth) No. of Pupils who have received a full medical examination Physical Condition of Pupils Inspected No. of Pupils found not to warrant a medical examination Pupils found to require treatment (excluding dental diseases and infestation with vermin) for defective vision (excluding squint) for any other condition recorded at Part II Total individual pupils Satisfactory Unsatisfactory (1) (2) (3) (4) (5) (6) (7) (8) 1963 and later 3 3 — — — — — 1962 165 165 - - 9 19 28 1961 82 82 - - 4 5 9 1960 47 47 - - - - - 1959 60 60 - 165* 2 - 2 1958 18 18 - 4* 1 - 1 1957 172 172 - - 14 19 33 1956 83 83 - - 6 3 9 1955 72 72 - - 9 4 13 1954 18 18 — - 1 - 1 1953 263 263 - - 20 10 30 1952 and earlier 146 146 — 1 14 11 25 TOTAL 1129 1129 - 169* 80 71 151 The physical condition of all the children inspected was satisfactory. *Tests of vision and hearing only at age of eight years. 5 pupils referred for treatment because of visual defect. 2 pupils referred for treatment because of hearing defect. OTHER INSPECTIONS. Number of Special Inspections 15 Number of Re-inspections 84 99 164 DEFECTS FOUND BY PERIODIC AND SPECIAL INSPECTIONS — INDEPENDENT SCHOOLS Defect Code No. (1) Defect or Disease (2) PERIODIC INSPECTIONS Special Inspection Entrants Leavers Others Total 4 Skin T 6 9 6 21 - O 7 14 9 30 — 5 Eyes- a. Vision T 13 34 33 80 1 O 50 33 34 117 1 b. Squint T - 1 - 1 - O 1 6 3 10 — c. Other T - - 1 1 - O 1 1 3 5 — 6 Ears— a. Hearing T - 1 - 1 1 O 18 8 7 33 b. Otitis Media T - - 1 1 - O 2 1 1 4 — c. Other T - - 1 1 - O 3 — - 3 — 7 Nose and Throat T 5 1 3 9 - O 16 7 13 36 - 8 Speech T 2 - 5 7 - O 7 1 4 12 — 9 Lymphatic Glands T 1 1 - 2 - O 1 — — 1 — 10 Heart T - - - - - O 3 1 3 7 — 11 Lungs T 1 1 4 6 - O 4 9 7 20 — 12 Developmental— T - - - - - a. Hernia O 1 — 3 4 — b. Other T - 1 - 1 - O 3 1 7 11 2 13 Orthopaedic— T - - 1 1 1 a. Posture O 1 13 7 21 - b. Feet T 2 - 5 7 1 O 5 10 13 28 — c. Other T - 4 2 6 1 O 7 3 8 18 1 14 Nervous System- T - - - - - a. Epilepsy O 1 — 3 4 — b. Other T - - - - - O — 1 4 5 — 15 Psychological— T 2 - - 2 - a. Development O 2 1 5 8 — b. Stability T - - - - - O 5 2 3 10 — 16 Abdomen T 3 - - 3 - O 7 3 1 11 — 17 Other T - 9 - 9 - O — 1 5 6 2 T—TREATMENT O—OBSERVATION 165 Minor Ailments Minor ailments are treated by the Health Visitors at the Clinics, or at school if requested by the Head Teacher. These arrangements are found to avoid loss of school time which would otherwise be inevitable. During the year a total of 308 pupils was treated. Treatment of Pupils EYE DISEASES, DEFECTIVE VISION AND SQUINT Number of cases known to have been dealt with:— External and other, excluding errors of refraction arid squint 14 Errors of refraction (including squint) 4,517 Total 4,531 Number of pupils for whom spectacles were prescribed 1,791 Ophthalmic Clinics These Clinics are situated at Beckenham. Bromley, Chislehurst, Orpington, Penge and St. Paul's Cray. A total of 9 weekly sessions is held at these centres. In addition a session is held every other week at Bromley. A total of 720 new cases and 3,811 re-examinations was seen at the Clinics. The attendance at these Clinics continued to be very good on the whole, and it was again possible for both new cases and reexaminations to be seen without any undue delay. The importance of the Ophthalmic Clinics cannot be overstressed as unchecked defects of vision can have serious effects on a child's scholastic achievements. It is with regret that we record the death at the beginning of the year of Mr. Oliver Walker, who, since the inception of the Borough on the 1st April, 1965, had been one of the Ophthalmic Consultants at the Chislehurst Clinic, and who had previously worked for many years for the Kent County Council. We were fortunate in being able to amalgamate successfully this session with one already in being, thus reducing the weekly sessions at Chislehurst from two to one. Orthoptic Clinic Patients seen at this Clinic are always referred by an Ophthalmologist. Three weekly sessions are held at the Bromley North Clinic, and one session per week at The Willows Clinic, Chislehurst. The latter clinic was only started in August in order to reduce the travelling distance for some patients and thus to 166 encourage their attendance. As this innovation has proved worthwhile it is anticipated that it will be continued. Patients not living in the areas served by these two clinics are seen at the nearest local hospital. The following types of cases are referred:— (a) Cases of obvious strabismus or squint. (b) Patients suspected of having a strabismus. (c) Amblyopic patients. (d) Patients with any ocular muscle imbalance. (e) Patients who are complaining of ocular symptoms, the cause of which is not obvious to the Ophthalmologist. Details of treatments and attendances are as follow:- Number of new cases 58 Number on treatment 103 Number on occlusion 87 Number of treatments given 167 Number of cures with operation 5 Number of cures without operation 19 Cases discharged—cured— (a) Functional for binocular single vision 12 (b) Cosmetic 11 Total number of attendances 665 Transferred or left the District 3 Number of sessions 181 Number on waiting list at 31.12.67 5 Diseases and Dejects of Ear, Nose and Throat Number of cases known to have been dealt with: Received operative treatment:— (a) for diseases of the ear - (b) for adenoids and chronic tonsilitis 749 (c) for other nose and throat conditions 208 Received other forms of treatment — Total 957 Total number of pupils in schools who are known to have been provided with hearing aids:— (a) during 1967 6 (b) in previous years 44 Orthopaedic and Postural Defects Number known to have been treated: (a) Pupils treated at clinics or out-patients 233 167 (b) Pupils treated at school for postural defects 12 Total 245 Orthopaedic Clinic The Clinic is situated at Bromley North and caters for the surrounding population. Other parts of the area are covered by various Hospital Out-patient Departments. The main defects seen at these Clinics were minor deformities of the feet, back and knock knees. The attendances continued to be good and the Clinic is held according to need, which is approximately once a month. Physiotherapy Clinic Cases are treated at the Bromley North and Beckenham Town Hall Clinics, and at Hospital Out-patient Departments. The majority of cases attending for treatment were referred direct from the Orthopaedic Consultant. Cases of general debility were referred to the Clinics for a course of sunlight. A total of 706 attendances were made at the two Clinics, and of these 482 were for remedial exercises, etc., and 224 for sunlight. Diseases of the Skin (excluding uncleanliness) Number of pupils known to have been treated: Ringworm—(a) Scalp - (b) Body — Scabies 5 Impetigo — Other skin diseases 479 Total 484 B.C.G. Vaccination In the effort to eradicate tuberculosis, B.C.G. vaccination was again undertaken with parental consent, on children in the 13-14 year age group, who are found to need this form of protection following upon a skin test. In addition, those who are shown by the skin test to need further investigation are referred, with the approval of the family doctor, to the appropriate Chest Clinic. During the year 3,192 children received a skin test and the 2,581 negative reactors received B.C.G. vaccination. Of the 430 children who were found to have a positive reaction to the skin test, 197 were referred to the appropriate Chest Clinic for further investigation. No further action was necessary in the case of the remaining 233 children who gave a positive reaction because of previous B.C.G. vaccination. 168 Infectious Diseases 1,890 notifications of infectious diseases in children of school age were received during the year. Details of the notifications received are as below:— Disease Total No. of Cases 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter Scarlet Fever 60 23 18 4 15 *Measles 1,730 1,519 173 37 1 Whooping Cough 87 19 26 16 26 Dysentery 3 — 1 — 2 Pneumonia 7 1 2 1 3 Food Poisoning 1 — — 1 — T.B. (Pul.) 2 — 1 1 — Totals 1,890 1,562 221 60 47 *Measles increase (1966—440 cases) Speech Therapy This year we were unfortunate in losing a full-time therapist through her marriage and subsequent removal from the area, and as yet have only been able to replace her with a part-time therapist. This persistent and unfortunate shortage of staff creates in itself more problems. The present staff have worked hard to keep the Service moving but it is an uphill struggle. The waiting list grows and the therapists are acutely aware of the many children whom they have interviewed who are in desperate need of help, but through necessity can only be marked as urgent cases and placed on the waiting list. This unnecessary wait may result in a worsening of their condition and in a deterioration in their school work. The therapists are continually having to compromise, parents, teachers and medical officers complain of the long waiting list and at the same time expect the children to have more frequent appointments. With such pressures it is extremely difficult for the therapists to maintain the necessary school and home visits—clinic time being so limited that outside visits are reduced to a minimum. That the liaison is so good is due to the high sense of responsibility of all the therapists concerned. The figures for 1967 are as follow:— Number of referrals to the service 300 Number of children seen— (a) in clinics 336 (b) in Special Schools inc. Cheyne Hospital 87 (c) in Training Centre 25 169 The children seen in the Special Schools, Cheyne Hospital and the Training Centre were predominantly cases of delayed language development and defective articulation. Of the 336 children seen in the clinics the case distribution was as follows:- Stammering 48 Dyslalia 137 Retarded speech and language development 68 Cleft Palate repaired 8 Dysarthria 2 Aphasia 1 Dysphonia 1 Partial Hearing 13 Interdental speech 45 Lateral speech 12 Inadequate naso-pharyngeal closure 1 275 cases were closed:— Improved 175 Transferred 22 Removed from area 25 Ceased attendance 28 Refused appointments 15 Left school 10 The number of attendances was as follows:— Clinics 2,541 Special Schools and Cheyene Hospital 695 Scads Hill Training Centre 600 In all 31 school visits and 47 home visits were made. At 31st December, 1967. the waiting list stood at 157 including 55 priority cases. Child Guidance Through various sources, cases of psychological disturbances come to light and are referred, if necessary, to the appropriate Child Guidance Clinic. These Clinics which are spaced throughout the District are held in Hospital premises except at "The Willows", Red Hill, Chislehurst, which is held in the Council's own premises. The remaining Child Guidance Clinic sessions are held at Farnborough Hospital, Stepping Stones, Bromley Hospital and at Sydenham Hospital, which serves the Borough of Bromley although it is outside its geographical limits. A number of psychiatrists have in the past been concerned at the different clinics, but in March the Regional Hospital Board appointed one Consultant, Dr. R. Rodriguez, to be responsible for the Child Guidance work at the local hospitals and at our own Clinic at Chislehurst. The appointment of one Consultant has helped to co-ordinate this Service. 170 I am grateful to Dr. Rodriguez for the following report in respect of the Chislehurst Child Guidance Clinic, where he carries out 4 sessions per week. During 1967 the demands on the Clinic have continued to increase (60 referrals in 1965, 81 in 1966, 112 in 1967), but without increased staff and better accommodation, it has been impossible to prevent an undesirable lengthening of the waiting list. With the available present resources it is not possible to take more new children for treatment. It is considered desirable to increase the treatment facilities by asking for the appointment of a Child Psychotherapist to the staff. Also, it has been very difficult, due to the great pressure of clinical work, to maintain as close contact as needed with outside agents. The Educational Psychologists have continued their work as in previous years. Mrs. O'Kelly, who had been working here for many years, left on 31st August, 1967, to take up a post with the Surrey County Council Education Department. Mr. A. Bennett was appointed on 1.9.1967 and during the summer months we had the help of Mr. Good. Apart from psychological assessment in the Clinic, numerous visits were paid to schools covering the children attending the Clinic. The extramural activities of the Educational Psychologists in schools are not included in this report. No Psychiatric Social Worker has yet been appointed to the Clinic, but Mrs. Cameron, the Social Worker, increased her number of sessions from 4 to 6 in May; she still carried on her duties as Mental Welfare Officer. Some urgent repairs were carried out during the year; as a result the Clinic was closed for several days. The inadequacy of the premises has become progressively more evident. Some of the play material was replaced; the Clinic was also provided with a Grundig Stenorette and a new Enurex machine. Sixty-two new children from the borough have been investigated and taken on for treatment during the year. A total of 112 referrals was received during 1967 (81 in 1966). There was an increase in the number of referrals from General Practitioners, Paediatricians and other Psychiatrists. The total number of psychiatric interviews with children was 630 as against 469 in 1966. As in the past, co-operation with outside agents has been a regular part of the responsibilities of the Unit. Contact was maintained with Head Teachers, Education Welfare Officers, Assistant Medical Officers, Children's Officers, Probation Officers and Health Visitors. The staff has attended meetings organised, amongst others, by the Education Department and Mental Welfare Department. Two students of the Institute of Education visited the Clinic. 171 Details of referrals and attendances during the year are as follow:— Waiting List: (a) Awaiting first interview 53 (b) Interview and awaiting treatment Nil In attendance: (a) Active 90 (b) Periodic Review (holiday cases) 16 Number of cases closed 78 Number of applications withdrawn 10 (Failed repeatedly to attend for diagnostic interview) 247 Sources of referral: Probation Officers 2 Court 2 Head Teachers 10 School Medical Officers 22 General Medical Practitioners 12 Parents 13 Children Officers 5 Hospitals (Paediatricians and Psychiatrists 13 Chief Education Officer 6 School Psychological Service 27 Others — 112 Number of new patients taken on for treatment during each month:— January 10; February 6; March 5; April 2; May 7; June 7; July 4; August 3; September 2; October 9; November 4; December 5. Number of Psychiatric interviews: Quarter to 31st March, 1967 163 Quarter to 30th June, 1967 191 Quarter to 30th September, 1967 125 Quarter to 31st December, 1967 151 Number of Home Visits: Psychiatric Social Worker 45 Educational Psychologists 1 Other Staff — Social Worker made 7 visits to different outside agencies. 172 Number of School visits: Psychiatric Social Worker 2 Educational Psychologists (for Clinic cases) 14 Other Staff - School Psychological Service I am grateful to Mrs. P. Preston, Senior Educational Psychologist, for the following report:— This year the Psychological Service has investigated 937 children, carried out counselling duties in the schools, and completed two educational surveys. The work of the School Psychological Service relates to most agencies concerned with the care, welfare and education of children, and may be best presented in terms of the areas of service it covers, thus:— I. In the Schools. Total available Educational Psychologists time—14 sessions per week—637 children (age range 4+ years-16+ years) were investigated individually and reported on by the Educational Psychologists and the following additional work carried out:— (a) Infant Schools. (1) A Report on the large scale experimental screening for slow learners was compiled last April and the second year phase is nearing completion. (2) Advisory service was given to the special opportunity classes and inter disciplinary group discussions and educational visits were arranged. (b) Junior Schools. (1) Regular monthly meetings have taken place with the remedial teachers—Mrs. Waite. Mr. Rogers, Mrs. Carter and Mrs. Hooper. (2) Consideration given to the slow learners' needs—a follow on of the infant screening programme. In this connection Educational Psychologists have attended 17 Panel meetings at which approximately 160 slow learners were discussed with Assistant Medical Officers and Heads of Schools. (c) Secondary Schools. A survey into the reading difficulties at secondary level was completed showing the need for some remedial reading provision in schools. This is now being discussed with Mr. Thomas, Assistant Education Officer for Secondary Education, Mr. Warren, Senior Adviser, and Miss Jenkins, the Adviser for Secondary Schools. 173 (d) Day Special Schools. The Educational Psychologists have visited fortnightly the three Special Schools and joined in the staff conferences. (e) Maladjusted Classes. Only a very casual and occasional contact was possible, but a closer liaison is planned for in future. (f) Deaf and Partially Hearing Children. There has been newly formed Junior and Nursery school units. Demands on the School Psychological Service have begun and are now co-ordinated through the Assistant Medical Officer administratively responsible for the Deaf. II. At the Local Education Authority Child Guidance Clinic, The Willows, Chislehurst. Total available Educational Psychologist time: 4 sessions reduced to 2 sessions per week since September. 74 children (age range 4 years-16+ years) were seen. Dr. Rodriguez Consultant Psychiatrist, has reported in greater detail on the work of this clinic. III. At the Bromley Hospital Child Guidance Clinic. Total available Educational Psychologist time: 2 sessions per week. 90 children (age range 3 years-16+ years) were seen. These are referred mainly from School Medical Officers, General Practitioners and Hospital Consultants. There were also a few School Psychological Service referrals. IV At the Farnborough Hospital Paediatric Department. Total available Educational Psychologist time: 2 sessions per week. 136 children (age range 6 months -18 years) were seen as follows:— 26 children referred by Dr. Rodriguez, Consultant Psychiatrist. 2 sessions per week. 67 children referred by the Consultant Paediatricians. 10 children seen at Cheyne Hospital (physically handicapped). 33 children seen at the Phoenix (Spastic) Centre. Working within a Paediatric Department enables the Educational Psychologists to engage in developmental studies, essential in the case of handicapped children, and to diagnose at an early age their possible educational needs. More than half of the children in the Special Opportunity classes (infants) have come via this Department. 174 Staffing There are still only 2 full time Educational Psychologists. We welcomed Mr. A. Bennett in September, 1967. He was to be our third Psychologist, but Mrs. O'Kelly left for Surrey in August, 1967. We were able to secure the services of Mr. B. R. Good as a temporary part-time Psychologist during the summer term and hope that he may give us more of his limited but valuable assistance in the future. Regrettably it has as yet been impossible to remedy the inadequacies of clerical assistance and housing. Clerical Provisions The School Psychological Service has no separate establishment for secretarial staff. Mrs. Lynn and her staff at the Education Sub-Office, Beckenham, have helped regularly with typing and we have appreciated their efficient service. The Typing Pool at Sunnymead has also been called upon to help in emergencies and for major duplicating work and we are indeed grateful for their willingness. We learn with interest of plans to provide the School Psychological Service with adequate premises at St. Paul's Wood Hill in 1968. 1967 is chiefly remembered for the stress and frustrations experienced, and now with a waiting list of 205 children in schools alone, and an increasing volume of work in the clinics, we face 1968 with some concern. Service for Hearing Impaired Children During the year liaison between the visiting Teachers of the Deaf, who are on the Chief Education Officer's establishment, and the School Health Service staff, has enabled the early detection and assessment of the hearing impaired child to be made. It is hoped that this liaison will ensure that every possible assistance regarding treatment and education will be made available to every child with a hearing defect. It is hoped that when financial provision permits it will be possible to appoint an Audiometrician to the staff of the School Health Service. The Audiometrician would have time to test the hearing of children more frequently and perhaps more important to start testing at an earlier age than is possible at the moment. I am grateful to Mr. G. V. Welbourne, Chief Education Officer, for the following report on the Service for hearing impaired children :— At the beginning of the year, the Borough had the services of one permanent Visiting Teacher of the Deaf, plus temporary help 175 from a second. This provision was wholly inadequate but by stages, the situation was improved, first by the part-time employment of two qualified teachers who, although not specialists in teaching the deaf, had experience with hearing impaired children of their own, and later by the additional appointment of two qualified Teachers of the Deaf. One of the Borough's primary teachers entered the Manchester course during the year and is expected to be available to take up duty in September, 1968. There were 130 hearing impaired children in the Borough during the year, as follows :— Children under five years of age 17 Children at Ordinary School— with hearing aids 37 without hearing aids 41 Children at Residential Schools 13 Children at Day Schools for the Deaf and Partially Hearing Units 22 Nursery and Infant Units were established at two primary schools and 14 of the children named above were in attendance. The remaining children in special schools and units attended outside the Borough. A small number attended private nursery classes within the boundary. A new three classroom unit for partially hearing children is expected to be open in September, 1968, at one of the Borough's new schools. Two additional Teachers of the Deaf have been appointed to take up duty at that time. A room at the former Beckenham Town Hall was adapted as an Audiology Clinic for the use by Teachers of the Deaf and School Medical Officers. In addition, the Visiting Teacher of the Deaf was given access to the Clinic at Sydenham Children's Hospital for the testing of Bromley children. A total of ten Speech Trainers was purchased during the year, for use in classes, in the children's own homes, and by the Peripatetic Staff. A service of spare parts and batteries for individual aids was also begun. A number of commercial aids for individual children were bought during the year. Handicapped Pupils Every effort is made to ascertain the handicapped child at as early an age as possible. Many of these children come to the attention of the School Health Service through the Health Visitors, the Chief Education Officer, Parents, Teachers, or some other person or organisation. Handicapped children from the age of 2 years become the responsibility of the School Health Service. 176 The officially recognised types of handicaps are: Blind, Partially Sighted, Deaf, Partially Hearing, Physically Handicapped, Delicate, Maladjusted, Educationally Sub-Normal, Epileptic and Speech Defects. Once a child has been ascertained as handicapped it is kept under supervision, and any recommendations for special educational treatment are forwarded to the Chief Education Officer for his consideration and action. Special appointments are arranged for the Assistant Medical Officers to see these children, either at a Clinic or at the child's home depending, usually, on the degree of handicap. Before a recommendation is made the advice of the various appropriate Hospital Consultants, with whom there is a very close liaison, is obtained. During the year 59 boys and 37 girls were assessed as needing special educational treatment at special schools. Details of the various handicaps are included in the following table. The Borough is fortunate in possessing three day schools for educationally sub-normal pupils, and a report on each of these schools will be found later in this Report. The field of handicap is a very wide one; for instance a large range of different conditions is included under the heading of "Physically Handicapped" and similarly "Delicate" can cover a number of different conditions. Obtaining the best possible arrangements for the education of the handicapped child often requires time and patience, but the effort involved is fully justified by the results obtained. -J PART I RETURN OF HANDICAPPED CHILDREN New assessments and placements During the calendar year ended 31st December, 1967:— Blind P.S. Deaf Pt.Hg. PH. Del. Mai. E.S.N. Epil. Sp. Def. TOT. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) A How many handicapped children were newly assessed as needing special educational treatment at special schools or in boarding homes? boys - - 2 - 7 9 10 29 2 - 59 girls — 1 1 — 3 2 8 22 — — 37 B How many children were newly placed in special schools (other than hospital special schools) or boarding homes? (i) of those included at A above boys - - - - - 6 4 17 - - 33 girls — 1 1 — 3 1 4 15 — — 25 (ii) of those assessed prior to January, 1967 boys - - 2 - 1 3 11 25 - - 42 girls — — — — 1 2 — 11 — — 14 (iii) TOTAL newly placed—B (i) and (ii) boys - - 2 - 7 9 15 42 - - 75 girls — 1 1 — 4 3 4 26 - — 39 PART II Children found unsuitable for education at school During the calendar year ended 31st December, 1967:— (i) How many children were the subject of new decisions recorded under Section 57 of the Education Act, 1944? 17 (ii) How many reviews were carried out under the provisions of Section 57A of the Education Act, 1944? 1 iii) How many decisions were cancelled under Section 57A(2) of the Education Act, 1944? — ^4 00 PART III HANDICAPPED PUPILS AWAITING PLACES IN SPECIAL SCHOOLS OR RECEIVING EDUCATION IN SPECIAL SCHOOLS: INDEPENDENT SCHOOLS: IN SPECIAL CLASSES AND UNITS: UNDER SECTION 56 OF THE EDUCATION ACT, 1944: AND BOARDED IN HOMES. As at 18th January, 1968:— Blind P.S. Deaf Pt.Hg. P.H. Del. Mai. E.S.N. Epil. Sp. Def. TOT. (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) How many children from the Authority's area were awaiting places in special schools other than hospital special schools? (i) waiting before 1st (a) day places January. 1967:- - - - - - - - - - - — (1) Under 5 years of age (ii) newly assessed since 1st January, 1967:— (b) boarding places - - - - - - - - - - - (a) day places - - - - - - - - - - - (b) boarding places - - - - - - - - - - - (i) waiting before 1st January, (a) whose parents had refused consent to their admission to a special school 1967:— (a) day places - - - - - - - - - - - (b) boarding places - - - - - - - - - - - (a) day places boys - - - - - - - - - - - girls - - - - - - - - - - - (2) Aged 5 years and over (b) others (b) boarding places boys - - - - - - - - - - - girls - - - - - - - - - - - (ii) newly assessed since 1st Jaruary,1967 (a) whose parents refused consent to their admission to a special school (a) day places - - - - - - - - - - - (b) boarding places - - - - - - - - - - - (b) others (a) day places boys - - - - - - - 12 - - 12 girls - - - - - 1 - 6 — — 7 (b) boarding places boys - — - — 2 3 6 - — — 11 girls - - - - - - 3 - - - 3 (a) day places boys - - - - - - - 12 - - 12 (3) Total number of children awaiting admission to special schools other than hospital special schools—total of (1) and (2) above girls — — — — — 1 - 6 — - 7 (b) boarding places boys — — — — 2 3 6 - - — 11 girls - - - - - - 3 - - - 3 v£3 EDUCATION IN SPECIAL SCHOOLS: INDEPENDENT SCHOOLS: IN SPECIAL CLASSES AND UNITS UNDER SECTION 56 OF THE EDUCATION ACT, 1944; AND BOARDED IN HOMES As at 18th January, 1968:— Bind P.S Def. Pt.Hg. P.H Del. Mal. E.S.N. Epil. Sp. Def. Tot (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (i) Maintained special schools (other than hospital special schools and special units and classes not forming part of a special school) regardless by what authority they are maintained day boys - 3 2 — 18 13 - 155 - — 191 girls - 5 — — 9 7 - 112 — — 133 boarding boys 1 - — — 6 10 1 6 — — 24 girls — - — — 5 7 1 2 - — 15 How many pupils from the Authority's area were on the registers of:— (ii) Non-maintained special schools (other than hospital special schools and special units and classes not forming part of a special school) wherever situated day boys — — — — 2 - - - - - 2 girls — — — — 2 — — — — — 2 boarding boys 2 1 3 1 2 6 10 4 2 — 31 girls 2 — 1 1 2 - - - - - 6 (iii) Independent schools under arrangements made by the authority day boys — — 2 4 1 - 1 — - - 8 girls — — — 1 — — 1 — - — 2 boarding boys — - 1 1 2 - 36 2 — — 42 girls — — 2 — 1 — 9 1 — — 13 (iv) Special classes and units not forming part of a special school. boys — — — 8 — — — — — — 8 girls — — — 7 — — — — — — 7 How many children from the Authority's area were boarded in homes and not already included in B above. boys - - - - - - - - - - - girls - - - - - - - - - - - How many handicapped pupils (irrespective of the area to which they belong) were being educated under arrangements made by the authority in accordance with Section 56 of the Education Act, 1944. (1)hospitals boys - - - - 11 - - - - - 11 girls - - - - 6 - - - - - 6 (ii)in other groups, e.g.unlits for spastics, etc. boys - - - - 15 - - - - - 15 girls - - - - 14 - - - - - 14 (iii) at home boys 1 — — - 2 — 2 - — — 5 girls — — - — 3 — 1 - — — 4 Total number of handicapped children requiring places in special schools; receiving education in special schools; independeni schools; special classes and units; under Section 56 of the Education Act 1944; and boarded in Homes. Totals of A(3); B(i) to (iv); C and D(i) to (iii) above boys 4 4 8 14 61 32 56 179 2 — 360 girls 2 5 3 9 42 15 15 121 - - 212 180 SPECIAL DAY SCHOOLS FOR EDUCATIONALLY SUB-NORMAL CHILDREN Goddington School, Orpington. This, the fourth year in the life of the School, has been one when the School can be said to have reached maturity. The number of children on the roll stands at 132. 5 children left to take up employment in the area. There are now 10 boys and girls who left the school with this end in view, and all continue to be gainfully employed. 2 children (one boy and one girl) were transferred to an ordinary Secondary School. Their marked progress while at Goddington has been a souce of great satisfaction to all concerned. The medical work at the school continued on the lines accepted from the very beginning. The School Medical Officer is part of the team, fully aware that the medical problems are an important part of the child's learning difficulty and at no time in the child's life can these be separated out. The Medical Officer attends regularly once a week and often between the set sessions for informal discussion. The routine medical inspections are carried out as laid down in the Education Act, but the tendency is more towards Special Examinations at the request of the Head Teacher or parents. In the course of 1967, such examinations included 36 children who had full psychometric re-assessment. Whilst the general health of the children has remained good, the many open air activities greatly contributed to the almost proverbial buoyancy of Goddington. Much specialised attention is constantly reauired for those with additional handicaps, e.g. epilepsy and cerebral palsy. The services of the school nurse who has full nursing qualifications and extensive hospital experience, have been invaluable. Great concern is felt about the small amount of time devoted to Speech Therapy. This is due to the shortage of Speech Therapists on the local authority staff, and it is hoped that this deficiency will be remedied as soon as possible. The overall improvement in the school performance of most of the children noted last year, is due to the fact that many children are now admitted to Goddington at an age younger than hitherto. The Otis screening test carried out in the whole of the Borough for the past year and a half, has brought to the notice of the Authority many slow learners and has had a verv welcome effect of giving an opportunity to Head Teachers of Infants and Junior Schools to take a positive attitude in transferring "their" child to a Special School. The screening programme, however, brought additional pressure on the places at Goddington, and it became 181 necessary to run down the Diagnostic Unit and thus provide an additional classroom for the "School Proper". The few children who would remain at the Unit for the Spring Term 1968, would transfer to the new unit to be opened at Midfield Junior School after Easter, 1968. The School now runs a full range of social activities in order to prepare the children to merge with the community, and many visits to factories and other firms, also places of general interest were made. In this, the offer of a minibus by the Variety Club of Great Britain, due to arrive shortly after Easter, 1968, will be a great asset. The adventure playground built with the help of the Headmaster and boys of the Ramsden Secondary School is now a feature of which the Authority will take notice. Swimming takes place regularly at Beckenham Baths by the senior children and at Warren Road School by the courtesy of the Headmaster. These activities resulted in 37 of the children now being proficient swimmers. One Goddington boy has the rare distinction of being the first child in Bromley to win the Borough of Bromley's Swimming Award. The staff rightly feel that if the broad aims of education are to prepare the child to take its rightful place in the community, such striving must be re-enforced when the child's intellectual capacity is below par. Whilst the child is in school, the school he/she attends must gain full acceptance by the local community so that the acceptance on leaving school is taken as a matter of course. Such an acceptance, Goddington has enjoyed from the start and many of the neighbours are members of the Friends of Goddington School Association Three members serve on the Association's Committee and have come in in a big way on the fund raising programme. The target of the fund is a Swimming Pool for the school and the project is expected to come to fruition in 1968. The Headmaster is most helpful in allowing the related services to hold professional meetings at the school. The Kent Paediatric Society often meet at the school. Individual visitors are also welcome at the school and invariably comment on the atmosphere of bustle and enjoyment prevailing at Goddington St. Nicholas School, West Wickham Number of children on roll: — Boys 67 Girls 42 109 182 Staff Headmaster Deputy Head 7 Assistant Teachers (full-time) 1 House-Craft Teacher (part-time) 3 House Mothers (1 full-time and 2 part-time) Twelve girls and five boys left the school during the year (7 at Easter, 10 in the Summer) and an interesting variety of jobs was obtained: as assistants in stores, canteens and super-markets, assembly work in factories, a trainee machinist, a trainee nurseryman and an apprentice hairdresser. Every child is medically examined annually as a routine and there are special examinations for all school leavers and for those referred by the Staff for a number of reasons. Routine skin tests were carried out on fourteen pupils. Of these, 5 were positive, 3 having received previous vaccination and 2 were referred and followed up by the Chest Clinic. The remaining 9 received B.C.G. vaccination. The Speech Therapist attends weekly and guides the Staff in therapeutic work and in language development in the class-rooms. Three more autistic children have been admitted to the school and now there are nine of these spread throughout the school gaining confidence and becoming increasingly aware of what is happening around them. For this pioneer scheme of integrating the autistic children, an observation unit would be a great asset and a step forward in learning about their activities. The heated swimming pool at the school is used for nearly 7 months in the year and all the children have the opportunity of at least one swimming period each week. Six children learned to swim during 1967 and five girls improved their strokes and ability to swim by doing one length (25 feet). Many are now able to visit public swimming baths as the result of learning or nearly learning to swim in the school pool. Confidence gained in the water is reflected in their other activities and self-reliance and self-confidence are increased. To extend the length of the swimming season, a special effort to raise money for a cover building took the form of an exhibition and rally of veteran and vintage cars in the school playground. Through the activities of the St. Nicholas Association, the St. Nicholas Club (for seniors and ex-pupils) enjoy ballroom dancing in school, and the members make friends and learn to adjust socially as well as in the fields of learning and achievement. 183 Grovelands School, St. Paul's Cray At the beginning of the year there were 116 pupils at Grovelands, with 33 admissions and 29 leaving during the following 12 months. Much sadness was felt following the death of two small girl pupils during the year. Of those leaving, eight were transferred to Training Centres, one to a Private School and one to a Residential School. Three left the district, two were taken into care by the Kent County Council, two pupils are undergoing training at Wadden Hall and one is awaiting admission. Seven are in suitable employment; three in factories, one in dry-cleaning, one as a machinist, one in a supermarket and one in horticultural work. One child was admitted to hospital. Three members of the teaching staff left during the year. Mrs. P. Moniz emigrated to Canada, Mrs. P. Johannessen left the district and Mr. A. Stevens left to take up an appointment as Deputy-Head. The school was pleased to welcome two new members to the fulltime teaching staff. There have been the usual routine medical inspections as conducted throughout the Borough and in addition all new entrants have been seen during their first term, regardless of their age-group. Various special examinations were undertaken at the request of staff and parents, including I.Q. checks with full leaving medicals and mid-school I.Q. assessments for re-appraisal. There was a small group for B.C.G. The Welfare Assistants have conducted their usual parties to Dental and Ophthalmic clinics and a few children were taken to hospital. The Speech Therapist has seen the children more regularly recently and the Educational Psychologist has made frequent visits. There were the usual varied activities with more frequent outings made possible following the presentation of the mini-coach by The Variety Club of Great Britain. The Zoo, London Airport, Greenwich Museum and Bromley Town Hall were visited as well as various short trips into the country. The seniors were shown round several factories and a G.P.O. sorting office to give them ideas of possible means of employment. A Puppet Show at St. Nicholas School, West Wickham, was much enjoyed as was the annual Sports Day held at Grovelands. Activities within the school included the annual Harvest Festival and Christmas Fair, a Folk Dance followed by the annual Christmas festivities—the junior Christmas party was also attended by a class from Ifield School, Gravesend. The school was pleased to welcome a variety of visitors. The Theatre Centre Co. gave an excellent performance of "The Clown", and the Wilfred Smith Quartet gave a recital which the children 184 and staff thoroughly enjoyed. There was a lecture on the Prevention of Cruelty to Animals and a film on Road Safety. There were also visits from the Youth Employment Officers who interviewed all the leavers. During the year students from various Training Colleges visited the school. Generally it has been a year of progress, pupils and staff working together to create the happy atmosphere which is evident throughout the school. Employment of Young Children 574 children were examined by the Assistant Medical Officers during the year. Certificates were issued in 573 cases, and in only one case was the certificate not issued. Boys Girls Delivery of Newspapers and Milk, etc. 353 101 Errands and light shop duties, etc 52 16 Shop Assistant 26 Junior Clerk 2 5 Waitress 9 Entertainment 3 6 410 163 Other Medical Examinations The following examinations were carried out by Medical Officers during the year: — Training College Candidates 359 Teachers (including six for other Authorities) 146 Total 505 I am grateful to Mr. G. V. Welbourne, Chief Education Officer, for the following reports on Physical Education, the School milk and the School Meals Service: — Physical Education Physical education patterns within the schools are changing rapidly. Great efforts are being made to include as many activities as possible into the curriculum. This requires a new look at the staffing of the P.E. Departments in the not too distant future. Instead of a person who now tries to have a good working knowledge of very many sports, there will be a director of sporting activities who will allocate activities looked after by part-time specialists who will be experts in their particular sport. A scheme attempting to bring about these conditions has been started this year at the Crystal Palace National Recreation Centre 185 in order to work out the manner in which young men and women will receive instruction in physical education when the school leaving age is raised to 16 years. Fifty boys and fifty girls from four secondary schools attend the Crystal Palace on Wednesdays in order to take courses of their choice from a group of sixteen sports. The hundred pupils are divided into groups of twelve or thirteen and allocated to skilled instructors in this activity and are given a basic course of skill training in which the emphasis is on the enjoyment of the exercise rather than aiming at the polished performance which will come later. So far the scheme has proved very successful and, even though the instruction takes place outside school hours, the attendance, keenness and performance continue to be very good. In the primary schools, there has been a significant development in the provision of school pools which have been purchased by parent-teacher associations. The results achieved by the teachers in these schools have been remarkable. When it is remembered that the national average of being able to swim at all is about 30% and that the nine schools having their own pool average 85%, the value of having this amenity is obvious. Very shortly about a quarter of the Junior Schools in the Borough will have pools. This is laying the foundations of future excellence in swimming. It is well here to observe how much is done by the Borough's three special schools to teach swimming. Two of them have their own pools and the results show how worthwhile the possession of this facility is in preparing young handicapped children for their recreation in larger public pools. The emphasis of the Borough's physical education policy is not in providing the best opportunities for the gifted few but in giving to all the young people an opportunity to take part and enjoy the richness and fullness of a brisk, varied and stimulating physical programme. Nevertheless, some of the highest honours in sport are coming to young enthusiasts resident in this part of Kent. One young man is to be given a trial for the England water polo team, another will cycle in the Olympic Games in Mexico, another won the London Schools Gymnastics Championship, a young woman is the British Gymnastic Champion, a very young girl has won diving honours in Kent, and many others have reached county standards in the traditional games. There has been a great increase in the interest shown in outdoor activities, especially canoeing and mountaineering. This has necessitated the special training of teachers, and courses have been organised and planned to enable them to reach a standard which will guarantee the safe instruction of all young people placed in their care. To help with this work, the Authority found a place just outside the Snowdon National Park which would have been 186 exceedingly good as a base for expedition training, sailing, canoeing and Duke of Edinburgh activities. Unfortunately, the financial situation made it impossible to go ahead with this scheme. The exercise has not, however, been totally wasted. It has clarified much thinking about the value of having such a place within the educational purlieu of this Borough. School Milk Service A return for a day in September, 1967, showed that the daily number of pupils drinking one-third pints of milk was 30,780 in maintained schools, and 4,185 in non-maintained schools—approximately 1,460 gallons daily. School Meals Service The daily average of meals served during the year 1967 was approximately 34,500. New school kitchens opened during the year were as follows: — January, 1967 Blenheim Junior School January, 1967 Blenheim Infants' School September, 1967 Crofton Junior (new premises) September, 1967 Oaklands (Biggin Hill) During the year the School Meals Service was asked to supply meals for two Work Centres, one at Stembridge Hall, 16 meals daily, and the other Beckenham Work Centre, 16 meals daily. The Health Visitor in the School Health Service The policy of the assistance of the Health Visitor at all Medical Inspections in Primary Schools has continued providing the necessary link with the home, and during 1967 the Health Visitors prepared and attended 1,152 sessions. In addition the visions have been tested of all senior school children due for a Medical Inspection, and all children of 8 years old who have vision and hearing tests only. 40,068 Hygiene Inspections have been carried out and 204 of these children's parents have been advised on treatment, necessitating 483 re-inspections. 630 school clinic sessions have been arranged including Dental Sessions where the Health Visitor's assistance has been necessary. 308 children have been treated for minor ailments for which the other services do not provide. 187 HEALTH EDUCATION AND HOME SAFETY THE AIMS OF HEALTH EDUCATION Recent discoveries in Science and Medicine have given mankind mastery over so many factors in his environment that the man-in-the-street just does not realise the vast regions of nature which simply have not been explored, and when some tragic epidemic occurs is staggered, feels that "somebody" is to blame, and so a scapegoat must be found, preferably amongst those shadowy but powerful people, the "Scientists", the "Authorities" or the "Government". People forget how much we do not know about human illness even with our present knowledge, and fail to realise that "public health" is a "public concern". Hygiene is a communal activity which concerns all of us, not just some of us, and prevention of disease will not be achieved by casting responsibility on the shoulders of the few. Progress in controlling infection is truly a team effort, is not confined to the work of medical men, but needs the conscious attention of Education Authorities, Commerce, Industry, and, in fact the whole community. Until the public generally and in particular those in positions of responsibility, feel this way, progress will remain slow. The improvement in health of the British public over the last 100 years has been a combined exercise. Essential roles were played firstly by the visionaries and pioneers and later by other dedicated workers in the Public Health Service, by bacteriologists, engineers, public health inspectors and others. There must also be added to this team, the people who have developed and provided weapons for the medical man, and the industrial organisations, whose own research staff have produced chemotherapeutic substances and antibiotics for the cure of illness, and disinfectants and detergents all of which have done so much to prevent the spread of infection and to help control outbreaks of communicable disease. It has been learned that one of the objects of health education must be to inform people; to give them facts so that they may better understand the reasons behind modern health principles and precepts. The three aims of health education, as defined by an expert committee of the World Health Organisation are:— (1) To ensure that the community regards health as an asset. (2) To equip the individual with skills, knowledge and attitudes to help him solve his own health problems. (3) To promote the development of the health services. But, most important, the application of this knowledge is no easy task when ingrained habits and customs have to be broken 188 down, and personal likes and dislikes, as well as prejudices and emotions, counteracted. Success depends not only on expert teaching, but on sympathy, patience and the correct approach appropriate to the age, sex, personality and the social and educational background of those to whom it is directed. Advice, guidance and practical help go shoulder to shoulder with teaching. The maximum effort must be directed towards children ana young people so that good habits may be formed earlier. As has been said, there is an important place for indirect instruction— "Teach them. Knowing not, they learn it". The foundations are laid in the HOME. Wise parents seek every opportunity of improving their health knowledge. Older children who practise at home habits they have learned at school or youth centres often stimulate indifferent parents to follow suit. Good health habits cannot be formed too early in life. Parents and others who have children and young people under their care have heavy teaching responsibilities. Children are imitators. They copy the acts of their elders, the bad as well as the good. The simple principles of cleanliness of the body, hands, hair and teeth and of health should gradually become automatic. HOME SAFETY From January to December, 1967, a total of 6,856 home accident cases were reported at Farnborough, Orpington and Beckenham Hospitals. Of these 3,844 were adult and 3,012 children. This shows a pronounced increase, as compared with the same period in 1966, when the figures overall were 6.440. Of these, 3,703 were adults and 2,737 children. Since the formation of Bromley Home Safety Committee in November, 1967, the statistics of home accidents from Bromley Hospital were obtained for the month of December which shows that during that monthly period, a total of 135 adults and 114 children were admitted for treatment. The three most prominent causes of these accidents, according to the records shown at the hospital, were as follow: 1. FALLS. Are the chief danger to old people. 2. BURNS/SCALDS. Affect both the young and old people. 3. POISONING. Is the danger to adults especially in relation to gas, medicinal substances (through overdoses, mistakes, etc.) and also to the very young child who finds drugs/tablets, etc., loose in cupboards, drawers, etc. 189 Accidents in the home are therefore a particular hazard to children and to old people. Prevention has a very personal aspect —parents need to teach to the young the dangers of fires and naked lights, and the risk of eating tablets or drinking liquids they may find lying about. Parents should beware of inflammable clothing material, fires unprotected by fireguards, and medicines and disinfectants left lying within easy reach of the young. Those who work for the cause of home safety, know well that accidents are CAUSED and can, therefore, be prevented. Study of many cases has proved that "accidents" are not "bolts from the blue" or sudden acts of unkind fate, but a chain of events, starting from a cause and leading to a result, and a tragic result which could have been prevented by action somewhere along the line. The aspirin bottle "could" have been put away after its last use, the mat "could" have a a non-slip backing, the handle of the saucepan "could" have been turned away from the front of the cooker. If these simple acts had been carried out a small child could have been saved a trip to hospital, an old person could have avoided a fall, and a scalding accident need not have happened. These simple truths "must" be put across to those who have not yet taken them in. The Press, radio and television play their part in reaching the public, with help and advice on the causes and prevention of accidents. Health & Welfare and Home Safety Committees, Health Visitors and Nurses, Teachers and Voluntary Workers all play their part, but the accident rate remains still too high. "I didn't know" or "I never realised" continues to be the cry of a victim of an unnecessary home accident. Local Campaigns National figures reveal that 12,000 children each year were the victims of accidental poisoning in the home. In 1966, 29 children died from poisoning in this manner and the main causes were a failure of parents to lock up drugs or to store toxic household substance} out of the reach of children. In an effort to tiy to reduce these appalling figures the Home Safety Conmittees within the Borough submitted proposals to the West Kent Branch of the Pharmaceutical Society, asking for approval, that a poster be displayed in the chemist establishment, to notify members of the public, that all unwanted drugs, medicines, etc., could be returned to the chemist for disposal. This approval has been granted, and full publicity is being given on this matter at Schools, Clinics, Old People's Clubs, General Practitioners' Surgeries, Libraries, etc., throughout the Borough. 190 DETAILS OF CLINICS CLINIC AND ADDRESS WEEKLY SESSIONS held as follow: (By appointment only) OPHTHALMIC: School Clinic, The Willows, Monday—a.m. Red Hill, Chislehurst. School House, 55 Chislehurst Monday—All day Road, Orpington. Mickleham Road Clinic, Monday—a.m. St. Paul's Cray. North Clinic, Monday—a.m. Station Road, Bromley. Wednesday—a.m. Friday—p.m. Saturday—a.m. (Alternate) School Clinic, Friday—a.m. Town Hall, Beckenham. School Clinic, Friday—a.m. Oakfield Road, Penge. ORTHOPTIC: North Clinic, Monday—p.m. Station Road, Bromley. Tuesday—All day School Clinic, The Willows, Thursday—a.m. Red Hill, Chislehurst. *ORTHOPAEDIC: North Clinic, Friday—p.m. Station Road, Bromley. (Monthly) *PHYSIOTHERAPY: School Clinic, Monday—p.m. Town Hall, Beckenham. Thursday—a.m. North Clinic, Tuesday—a.m. Station Road, Bromley. Friday—a.m. *Children living in Beckenham and Bromley are referred to these Clinics. Children living in the remainder of the Borough are referred to: Orpington Hospital; Farnborough Hospital; Queen Mary's Hospital, Sidcup; or to The Children's Hospital, Sydenham. SPEECH: School Clinic, The Willows, Monday—All day Red Hill, Chislehurst. Wednesday—a.m. Assemblies of God Church Rooms, Monday—All day Masons Hill, Bromley. Tuesday Wednesday—a.m. 191 CLINIC AND ADDRESS WEEKLY SESSIONS held as follows: (By appointment only) School Clinic, Monday—All day Town Hall, Beckenham. Wednesday „ Friday „ „ Tuesday—a.m. †CHILD GUIDANCE The Willows, Tuesday—All day Red Hill, Chislehurst. Friday „ „ †Cases are also referred to the Child Guidance Clinics at Bromley Hospital, and the Children's Hospital, Sydenham. Cases may also be seen at the Child Guidance Clinic at Farnborough Hospital, having been referred via the Paediatricians. DENTAL: School Clinic, The Willows, Monday—All day Red Hill, Chislehurst. Wednesday„ „ School House, 55 Chislehurst Monday—All day Road, Orpington. Tuesday„ „ Wednesday „ „ Thursday „ „ Friday „ „ Mickleham Road Clinic, Monday—All day St. Paul's Cray. Tuesday „ „ Wednesday „ „ Thursday „ „ Friday „ „ Kimmeridge Road, Tuesday—All day Mottingham. Thursday „ „ Friday „ „ North Clinic, Monday—All day Station Road, Bromley. Tuesday „ „ Wednesday „ „ Thursday „ „ Friday „ „ South Clinic, Monday—All day Princes Plain, Bromley. Tuesday „ „ Wednesday „ „ Thursday „ „ The Pavilion, Recreation Ground, Friday—All day Church Road, Biggin Hill. 192 CLINIC AND ADDRESS WEEKLY SESSIONS held as follows: (By appointment only) School Clinic, Wednesday—All day Town Hall, Beckenham. Friday „ „ Thursday—p.m. Hawes Down Clinic, Wednesday—All day Hawes Lane, West Wickham. Thursday „ „ Friday—a.m. School Clinic, Monday—a.m. Oakfield Road, Penge. Wednesday—a.m. Tuesday—All day Thursday „ „ Friday „ „ tSPECIAL EXAMINATION CLINICS: School Clinic, Thursday— Oakfield Road, Penge. 9.30-11 a.m. The Willows, 2nd and 4th Thursday Red Hill, Chislehurst. in month, 4 - 5 p.m. Mickleham Road Clinic, 1st, 3rd and 5th St. Paul's Cray. Friday in month, 9 -10 a.m. Jin addition to these fixed times, appointments are arranged as and when necessary at other clinics for the purpose of carrying out special examinations, etc. MINOR AILMENT FACILITIES—see page 165. Bromley Office Supplies, 39/41 East Street. Bromley, Kent, BR1 1QT