HAVI London Borough of Havering ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1965 London Borough of Havering ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1965 HEALTH & WELFARE DEPT., BILLET LANE, HORNCHURCH CONTENTS Page SECTION I — INTRODUCTION Committee Members Staff 2 General Statistics 4 SECTION II — PERSONAL HEALTH SERVICES SECTION MATERNITY AND CHILD HEALTH SERVICE — 7 INTRODUCTION Medical Consultation 8 Health Visiting (and Clinic Nursing) 9 Midwifery 9 Congenital Malformations 11 Unmarried Mothers 12 Home Nursing 12 Sickroom Equipment 13 Clinic Services 14 Child Welfare Clinics (including Dental Treatment) Day Nurseries 16 Nurseries & Child Minders Regulation Act 1948 17 Immunisation and Vaccination 17 PREVENTION OF ILLNESS, CARE & AFTER CARE 18 CHIROPODY 19 NURSING HOMES 21 HOME HELP SERVICE 21 SCHOOL HEALTH SERVICE — INTRODUCTION 22 Medical Inspections 23 Screening Tests 24 Treatment Services 25 Minor Ailment Clinics 25 Orthopaedic and Physiotherapy Clinics 26 Speech Therapy Service 26 Chief Dental Officer's Report 29 Handicapped Pupils 31 Recuperative Holidays 35 Handicapped School Leavers 35 Child Guidance Clinic — Raphael House 36 SECTION III — SOCIAL SERVICES DEPLOYMENT OF SENIOR & FIELDWORK STAFF 46 EMERGENCY SERVICE 47 HANDICAPPED PERSONS — STATISTICS — GENERAL COMMENTS 47 i Page Care of Mentally Handicapped and Statistics 48 Community Care of Mentally Disordered 48 Psychiatric Out-Patient Clinic 51 Social Clubs 51 Admissions to Hospitals 51 Mental Subnormality 52 Training Centres 53 Residential Care of Mentally Disordered 54 Care of Physically Handicapped 57 Domiciliary Services 57 Accommodation 58 (a) Community Care 58 (b) Residential Care 58 Occupation 58 Holidays 60 Transport 61 SERVICES FOR BLIND & PARTIALLY SIGHTED PERSONS 61 Employment 62 Residential Accommodation 62 Partially Sighted 63 SERVICES FOR THE DEAF & HARD OF HEARING 64 CARE OF THE ELDERLY 64 Community Care 65 Holidays 65 Outings 65 Luncheon Centres 65 Meals-on-Wheels 65 Workshop 65 Chiropody 66 Day Centres 66 Accommodation 66 Residential Care 66 Registration of Old People's Homes 67 FAMILIES SERVICE 67 Temporary Accommodation 68 Suttons Hostel 69 Student Training and Visits of Observation 69 SECTION IV — GENERAL ENVIRONMENTAL HEALTH SERVICES Clean Air 72 Public Relations 73 Laundry Service for Incontinent 73 Home Safety 73 Carbon Monoxide Poisoning 73 Swimming Pools 74 Food Hygiene 75 Food and Drugs Administration 75 Meat Inspection 76 Ice Cream 78 Preserved Food 78 Food Hawkers 79 ii Page Milk 79 Liquid Egg (Pasteurisation) Regulations 1963 79 Pesticides and Toxic Chemicals in Food 79 Infectious Diseases 80 Immigrants 80 Training of Student Public Health Inspectors 81 Noise Abatement Act 1960 81 Housing 81 Rent Act 1957 81 Improvement Grants and Areas 82 Underground Rooms 82 Caravans 82 Gypsies 83 Common Lodging Houses 83 Houses in Multiple Occupation 83 Drainage and Sewerage 83 Emptying of Cesspools, etc 84 Factories Act 1961 85 Rodent Control 86 Diseases of Animals Act 1960 87 Diseases of Animals (Waste Food) Order 1957 87 Establishments for Massage or Special Treatment 87 Employment Agencies 87 Pharmacy and Poisons Act 1933 88 Water Supplies 88 Rainfall 89 Refuse Disposal 89 Public Cleansing 89 Scrap Metal Dealers Act 1964 89 Riding Establishments Act 1964 90 Pet Animals Act 1951 90 Animal Boarding Establishments Act 1963 90 Rag, Flock and Other Filling Materials Act 1951 90 Shops Acts, 1950- 1965 90 Consumer Protection Act 1961 91 Offices, Shops and Railway Premises Act 1963 92 iii PREFACE Tel.: HORNCHURCH 52555 Health & Welfare Department, Billet Lane, Hornchurch, Essex. August, 1966. To : The Mayor, Alderman and Councillors of the London Borough of Havering. Mr. Mayor, Ladies and Gentlemen, It is my privilege to present the first Annual Report of the new London Borough of Havering, which came into existence under the provisions of the London Government Act of April 1st, 1965. Combined Department The new Council decided from the outset to amalgamate Health and Welfare in the interests of co-ordination and efficiency of services, and in furtherance of this aim provided the department with accommodation at Billet Lane in close proximity to Housing and Children's Departments. As I had always felt Medical Officers of Health, given the opportunity, had the best prospect of those in social service disciplines of effectively co-ordinating Health and Welfare, this responsibility was gladly undertaken. It was therefore very gratifying to find throughout the year how readily the provisions of the various Health and Welfare legislation fitted into existing patterns of administration, and integration proceeded smoothly from the beginning. Reappraisal of Social Priorities The Department was concerned during the year in developing and extending the services which were transferred to the new Borough, and statistics reflect the increased demand for services which was experienced by various sections during the year. This trend was anticipated, and no doubt will continue as the department becomes established and builds for itself a good reputation. Increasing demand will create problems, because there are limits to resources both in money and manpower, and it may become increasingly necessary in future to make critical evaluation of existing services and practices, and in some respects becoming more selective by concentrating on categories at risk and vulnerable groups. iv The Council was generous during the year in authorising increases in the establishment to meet increased demands for service, but we were in many instances unable to recruit enough staff, and we had shortages of Dentists, Nurses, Medical Auxiliaries, Public Health Inspectors, Social Workers, Hostel Staffs and Domestic Helps, which interfered in varying degree with our plans. Ten-Year Development Plan The Council was required during the year to submit to the Ministry of Health a ten-year development plan of its Health and Welfare Services, and an early survey of the transferred services revealed deficiencies, the most pressing of which was judged to be lack of adequate training facilities for mentally subnormal persons. A new Adult Training Centre is urgently necessary, and it is fortunate that a site already at the Council's disposal on industrially zoned land is available for this purpose. Planning of this major project is proceeding. Urgent priority will also be given to modernising some of the older clinic premises in the area to provide for an increased range of services and also to provide a satisfactory standard of accommodation for clinic based staff. The Ten-Year Development Plan was submitted to the Ministry of Health in November, and the Council is under obligation to review it regularly so that at all times it represents a programme for the next ten years ahead. Staffing The Department was fortunate in retaining the services of most of the personnel who formerly served the area under the Essex County Council and Councils of the two constituent authorities of Hornchurch and Romford, and also in recruiting experienced officers from outside whose help and advice has been invaluable in developing the service, and I would here especially like to acknowledge the assistance given by Dr. J. T. Jones, Deputy Meidical Officer of Health, who joined us from the City of Newcastle-upon-Tyne, Mr. J. F. J. Thomas, Administrative Officer, formerly with the County Borough of East Ham, and Miss K. Wells, a professionally trained Social Worker in the Mental Health Service of the London County Council, who was appointed Principal Welfare Officer to head the Social Worker team. The body of this Report contains details of the many fields of activity in which the department engaged, some of which, I think, are noteworthy, but as it might be invidious to stress certain activities here, I commend the full report in the conviction that perusal will be found most rewarding. v In conclusion, I would like to thank the Chairman and members of the Health and Welfare Committee for their encouragement and support throughout a somewhat difficult year, and also to express gratitude to my staff for their wholehearted co-operation during the year, and their support in maintaining high standards of service. I also wish to acknowledge the help given by my fellow Chief Officers. vi HEALTH AND WELFARE COMMITTEE as at 31st December, 1965 His Worship the Mayor: Councillor S. A. LEGG, J.P. Chairman : Councillor R. W. BLYTHE, J.P. Vice Chairman : Councillor F. J. POWELL Councillor A. V. Winch, J.P. Councillor Mrs. M. P. Hurley (1.4.65 to 31.12.65). Alderman L. W. Carroll, J.P. Councillor F. J. Coffin, J.P. Councillor N. F. Kemble Councillor R. W. E. Manning Councillor F. A. J. Morley Councillor H. Packham Councillor M. J. Ward Councillor J. S. Macy Councillor W. C. Mills Councillor H. F. Moss Councillor W. F. Topp Councillor A. E. Winch Councillor R. M. Carnaby Councillor H. H. Green, J.P. 1 HEALTH AND WELFARE DEPARTMENT MEDICAL, DENTAL AND SENIOR STAFF as at December 31st, 1965 Medical Officer of Health F. L. GROARKE, M.B., L.M., D.C.H., D.P.H Associate Medical Officer of Health J. GORMAN, MB., Ch.B., D.P.H., F.R.S.H. Deputy Medical Officer of Health J. T. JONES, B.Sc. M B., B.Ch., D.P.H. Senior Medical Officer F. W MURPHY, M B., Ch.B., D.P.H., D.T.M.&H. Assistant Medical Officers of Health JILL M. E. CORBETT, M B., Ch.B. J J. DUFFY, M B , B.C.H., B A O.. D.P.H. ELIZABETH M. HAGA, M B., B.S., M.R.C.S., L.R.C.P., D.P.H. L. T. MARSHALL, M B., B.S., L.M.S.S.A. R. M. RITCHIE, L.A.H. (Dublin) DORIS E. WALKER, M.R.C.S., M B., B.S., L.R.C.P., D A. JEAN M. WARE, M B., B.S. MAIR E. WILLIAMS, M.R.C.S., L.R.C.P. Chief Dental Officer E. B. HODGSON, B.D.S. Dental Officers K. ANJAN, B.D.S., L.D.S., R.C.S. (Eng.) Miss M. L. ELL, L.D.S.. R.C.S. (Eng.) J. LUKE, L.D.S., R.C.S. (Eng.) (Part-time) Mrs. 0. SAUNDERS, D.D.S. Administrative Officer Mr. J. F. J. THOMAS, M.R.S.H. Deputy Administrative Officer Mr. E. GOWERS Chief Public Health Inspector Mr. M. F. RANDALL, M.R.S.H., M.A.P.H.I. Associate Chief Public Health Inspector Mr. H. C. Boswell Chief Nursing Officer Miss G. P. THORNHILL, S.R.N., S.C.M., H.V. Chief Chiropodist Mr. L. BOLLAND Principal Welfare Officer Miss K M WELLS Deputy Principal Welfare Officer Mr A. K. HUDDLESTONE Senior Psychiatric Social Worker Mr. J. HORAK Senior Mental Welfare Officer Mr. F. G. DEAR Senior Domestic Help Organiser Mrs. B. BIGNELL Public & Agriculture Analysts HUBERT HAMENCE, Ph.D., M.Sc., F.R.I.C. P. S. HALL. B.Sc , F.R.I.C. 2 REGIONAL HOSPITAL BOARD STAFF Orthopaedic Surgeon G. BARCLAY, F.R.C.S. Consultant Psychiatrist J E. VINCENZI, M.R.C.S., L.R.C.P., D.P.M Chest Physicians S. STEEL, M.D., M.R.C.P. E. WOOLF, M R.C.S., L.R.C.P. (Harold Hill area) Ophthalmologists P DAS GUPTA. M B., B.S. D. J. F. NICOL, D O. Physiotherapist Mrs. A. SLIP 3 GENERAL STATISTICS Area in Acres 29.550 Population (Registrar-General's Estimate for Mid 1965) 250,430 Number of Inhabited Houses as at 31.12.65 75,847 Rateable Value as at 31.12.65 £11,757,920 Estimated product of a penny rate £47,750 EXTRACTS FROM VITAL STATISTICS FOR THE YEAR Live Births—Legitimate Male 2112 Female 2052 Total 4164 Illegitimate „ 98 „ 92 „ 190 Total „ 2210 „ 2144 „ 4354 Birth Rate per 1,000 population 15.99 Illegitimate live births (percentage of total live births) 4.36% Still Births—Legitimate Male 25 Female 36 Total 61 Illegitimate „ 1 „ 2 „ 3 Total „ 26 .. 38 64 Total live and still births 4,418 Still Birth Rate (Per 1,000 Live and Still Births) 14.49 Infant Deaths (under one year)— Legitimate Male 34 Female 25 Total 59 Illegitimate 2 „ 1 „ 3 Total „ 36 „ 26 „ 62 4 Infant Mortality Rates— Total Infant Deaths per 1,000 total live births 14.24 Legitimate Infants per 1,000 legitimate live births 14.17 Illegitimate Infants per 1,000 illegitimate live births 15.68 Neo Natal Mortality Rate— (deaths under 4 weeks of age per 1,000 live births) 10.11 Early Neo Natal Mortality Rate— (deaths under one week of age per 1,000 total live births) 9.41 Perinatal Mortality Rate— (still births and deaths under one week combined per 1,000 live and still births) 23.77 Maternal Mortality (including abortion)— Number of deaths 1 Rate per 1,000 total live and still births 0.23 Deaths — Male 1,153 Female 944 Total 2,097 Death Rate per 1,000 population 10.75 (Note: The crude birth and death rates are 17.38 and 8.33 respectively. The rates given above have been adjusted by the area comparability factors of 0.92 for births and 1.29 for deaths. Comparison with the rates for previous years has not been attempted as the former areas of Romford and Hornchurch had differing area comparability factors. The comparability factors supplied by the Registrar-General make allowances for the way in which the sex and age distribution of the local population differs from that of England and Wales as a whole, and in addition, the death rate factor is adjusted specifically to take account of the presence of any residential institutions in each area. After multiplication by the comparability factors, the local crude birth and death rates are comparable with the crude rate for England and Wales and with the corresponding adjusted rate for any other area.) 5 TABLE No. 1 — REGISTRAR-GENERALS ABRIDGED LIST OF CAUSES OF DEATH IN CERTAIN AGE GROUPS (Corrected for Inward and Outward Transfers) Causes of Death All Ages Age Groups Under Four Weeks Four weeks & under one year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and upwards Total Male Female M. F. M F. M. F. M. F. M. F. M. F. M. F. M F. M. F. M. F. M. F. 1. Tuberculosis, Respiratory 9 8 1 - - - - - - - - - - - - - - 1 - 1 - 3 1 3 - 2. Tuberculosis, Other 3 1 2 - - - - - - - - - - - 1 1 - - - - — - 1 - — 3. Syphilitic Disease 4 4 - - - - - - - - - - - - - - - - 1 - 2 - 1 - 4. Diphtheria - - - - - - - - - - - - - - - - - - - - - - - - — 5. Whooping cough - - - - - - - - - - - - - - - - - - - — — — — — — 6. Meningococcal infections - - - - - - - - - - - - - - - - - - - — — — — — — 7. Acute poliomyelitis - - - - - - - - - - - - - - - - - - — — — — — — 8. Measles - - - - - - - - - - - - - - - - - — — — — — — — 9. Other infective and parasitic diseases 2 2 - - - - - - - - - - - - - - — — — — — — — — 10. Malignant neoplasm, stomach 48 27 21 - - - - - - - - - - - - 3 1 2 - - 1 3 7 11 11 11. Malignant neoplasm, lung, bronchus 153 131 22 - - - - - - - - - - - - 5 1 24 1 4 36 4 25 7 12. Malignant neoplasm, breast 45 1 44 - - - - - - - - - - - - - 4 - 6 - 10 - 5 - 8 13. Malignant neoplasm, uterus 13 - 13 - - - - - - - - - - - - - 1 - 17 - 3 — 2 — 4 14. Other malignant and lymphatic neoplasms 201 104 97 - - - 1 1 - - - - - 3 2 7 9 3 — 22 30 31 35 16 15. Leukaemia, Aleukaemia 20 12 8 - - - - 3 1 1 3 1 - 1 - - - 2 14 25 2- 1 3 3 2 16. Diabetes 17 4 13 - - - - - - - 1 - - - - - 1 - 1 2 — - 4 1 8 17. Vascular Lesions of Nervous System 276 107 169 - - - - - - - - - 1 - - 2 1 5 - 3 12 31 44 61 106 18. Coronary Disease, Angina 446 291 155 - - - - - - - - - - - - 4 3 34 5 8 22 86 52 74 73 19. Hypertension wilh heart disease 30 13 17 - - - - - - - - - - - - - - - 5 93 1 6 7 6 9 20. Other heart disease 164 63 101 - - - - - - - - - - - 1 2 2 1 - 1 7 19 12 32 78 21. Other circulatory disease 104 55 40 - - - - - - - - - - - - 1 - 4 1 9 5 16 9 25 33 22. Influenza 12 2 10 - - - - - - - - - - - - - - - 2 9 - - - 2 10 23. Pneumonia 112 66 46 1 - 3 1 1 - - - - - - - 2 1 1 — — 3 9 7 43 34 24. Bronchitis 124 94 30 - - - 1 - - 1 - - - - - 2 - 5 — 6 4 33 4 29 19 25. Other diseases of respiratory system 18 13 5 - - - - - - - - - - 1 - 1 1 2 2 24 - 3 2 4 2 26. Ulcer of stomach and duodenum 8 5 3 - - - - - - - - - - - - 1 - 3 — - — 1 1 - 2 27. Gastritis, enteritis and diarrhoea 2 1 1 - - - - - - - - - - - - - - - - 1 - - - - 1 28. Nephritis and nephrosis 12 6 6 - - - - - - - - 1 - - - - - 2 - 1 2 1 2 1 2 29. Hyperplasia of prostate 9 9 - - - - - - - - - - - - - - - - - 1 - 3 - 5 - 30. Pregnancy, childbirth, abortion. 1 - 1 - - - - - - - - - 1 - - - - - - - — - — - — 31. Congenital malformations 21 11 10 4 4 5 4 1 - - - - - 1 - - 1 - - — — — — — — 32. Other defined and ill-defined diseases 162 72 90 19 16 1 - 2 1 2 1 - 2 2 - 2 2 5 5 12 6 14 20 13 36 33. Motor vehicle accidents 29 24 5 - - - - 1 2 3 1 8 1 4 - 1 1 4 - 3 - 1 - - 2 34. All other accidents 39 19 20 - - 3 - - - 2 - 1 - 1 - 2 1 2 3 2 1 - 2 5 13 35. Suicide 13 8 - - - - - - - - 2 - 1 1 1 1 1 2 - - 2 1 1 - 36. Homicide and operations of war - - - - - - - - - - - - - - - - - - - - - - - - - TOTAL ALL CAUSES 2097 1153 944 24 20 12 6 9 5 9 6 13 5 11 6 32 29 107 67 256 103 300 221 380 476 SECTION II — PERSONAL HEALTH SERVICES MATERNITY AND CHILD HEALTH SERVICE The aims of this service are to reduce maternal and child mortality and morbidity to the minimum, make provision for childbirth in the home, and encourage the highest standards of care and upbringing in all children, especially those who may be physically, mentally or socially handicapped. To achieve this end, the services of doctors, health visitors, clinic nurses, midwives and district nurses are available, and maternal and child welfare services in clinics, immunisation against infectious disease, skilled care in day nurseries, and education and information on matters of health are provided. The success of these services depend upon close co-ordination with the family doctor and hospital services and with other Health and Welfare Department and Council services, for which I am very grateful. The statistics on pages 4 and 5 compare favourably with average figures for the rest of the country. To maintain this position regular re-examination of services is needed with evaluation in the light of increasing knowledge, and re-allocation of staff time to match changing needs. Notable results of such re-examination during the first year of the new Borough are listed below : (a) Child welfare continued its recent change towards screening of the infant and child population for early handicap or abnormalities of development and away from the traditional emphasis on nutrition and minor treatment, thus displacing the weighing machine from the focus of clinic attention. My intention is that each child should have a complete developmental and medical examination at an early visit to the clinic, repeated as necessary, with special tests at the appropriate age (such as a hearing test at the age of nine months) and that each mother should have an opportunity for a discussion with the Health Visitor at every visit. By this means parents will be reassured of normal progress with the opportunity to discuss any worries, and children will have full investigation and treatment in the rare case of handicap. In some sessional clinics this policy is difficult to implement, because of poor conditions. (b) It has been shown that unfavourable heredity, ante-natal or birth factors, or certain illnesses in early life, can occasionally give rise to handicap or developmental difficulties. Concentration of screening services on these " at risk " children has continued during the year, by encouraging these mothers to attend the clinic and by extra home visits by the Health Visitor with exchange of information with the family doctor. (c) The large variety of foods and nutrients available in the clinics was reduced to those necessary to provide for the full needs of an infant, with at least one alternative in each case. 7 This resulted in saving a considerable amount of staff time and clinic space which was being used in the sale and storage of an excessive number of proprietary products. (d) The number of staff working in attachment or in close liaison to groups of family doctors was increased. At the end of the year one health visitor, seven midwives and four district nurses were fully attached to general practice groups involving nineteen doctors and seven liaison schemes between family doctors and health visitors were in operation. Six requests for attachment were received during the year, and although it was a disappointment to find that few family or hospital doctors really understood a health visitor's training or duties, arrangements for regular liaison visits were made in each case. Further arrangements were made for health visitors to attend paediatric and geriatric consultant ward rounds and clinics at Oldchurch and St. George's Hospitals. Dr. Draper, of Guy's Hospital, visited the Department, as part of his national investigation into this question. (e) The number of children admitted to the day nurseries on medical or social grounds again increased. During the war years day nurseries were opened to enable mothers of young children to help the war effort by going to work, but now the objects of admission are to provide skilled care and assessment of children in need, and to help their parents. (0 Regular meetings of medical and nursing staff were held for informal discussion and in-service training. (g) Arrangements were made with the Children's, Education and Housing Departments of the Borough, and other involved bodies, to hold policy meetings and case conferences whenever the need arose. The various Maternity and Child Health services are described below. During the year many visitors came to the Department to see the clinics and day nurseries, including parties from Japan. Pakistan and Denmark as well as from various parts of the United Kingdom. MEDICAL CONSULTATION The Medical staff consisted of eight full-time doctors with special training and interest in maternity and child welfare. Their duties also include school health work and the medical examination staff. Local general practitioners attended occasionally on a sessional basis. During 1965, a further doctor undertook the course in the ascertainment of mentally handicapped children at Bristol University, increasing the total to six doctors approved for this work, and two Medical Officers continued their special clinics for children with suspected hearing difficulties. During the year, 1,089 medical consultations were held leading to 439 referrals to special clinics or hospital consultants. 8 HEALTH VISITING (AND CLINIC NURSING) A Health Visitor is a State Registered Nurse with midwifery training who is selected for a one-year training course leading to an examination and a Certificate of Health Visiting. The range of her duties includes making a home visit to the mother of each newly born child, with repeat visits as necessary; infant welfare clinic and the school health service work; medico-social work for the families in her community; home visiting of elderly and handicapped persons; promotion of education and information on all matters of health; home visits to cases of infectious disease; and various other duties such as visiting and inspecting registered child minders in her area. Her health education work includes lecturing or leading discussions in schools (at the request of Head Teachers), at ante-natal clinics or mother and baby clubs, and at meetings of voluntary organisations. In 1965 the Borough was staffed with the equivalent of 33 full-time Health Visitors (including five visitors dealing entirely with persons suffering from tuberculosis), against an establishment of 58. This shortage follows national tendencies and it must be accepted that such highly trained workers are likely to be always in short supply. To remedy this situation as far as possible, 12 Clinic Nurses (with S.R.N, qualifications) were employed to undertake clinic and school health work not requiring the Health Visitor's special skills, and each clinic was provided with a full-time Clinic Clerk, to undertake routine administration and to provide clerical assistance. Further staff changes during the year included the appointment of two Health Visitors as Group Advisors, responsible for the work of all the Health Visitors in an area, and another two Health Visitors as Field Work Instructors, selected to undertake the field training of student visitors. One of the Field Work Instructors also lectured on public health nursing services to student nurses at Oldchurch Hospital. One student from the Borough began her training at the South East Essex College of Technology in September 1965 and six students came into the Borough for the practical work part of their studies. Table 2 shows the size of one aspect of Health Visitor's duties. MIDWIFERY A midwife works in close liaison with the family doctor and her duties include the ante-natal care of those patients suitable for home delivery, care at the confinement, and post-natal visiting up to the tenth day following delivery, when she hands over responsibility for assisting the mother and newly born child to the health visitor. The importance in all pregnancies of full and early ante-natal care must again be emphasised. Sometimes mothers of large families are reluctant to have a delivery in hospital, and the midwife and family doctor on occasion need to spend some time in persuading them to accept a hospital confinement. These deliveries 9 Table 2 HOME VISITS BY HEALTH VISITORS Home visits to : Total No. of cases visited Notes Born in 1965 Born in 1964 Born in 1960/63 Children 14,925 3,765 3,532 7,628 Persons under treatment for tuberculosis 1,796 Visited by Tuberculosis Visitors Elderly persons (over 65) 547 Including 88 at special request of hospital or family doctor Patients discharged from hospital 37 Including 19 at special request of hospital or family doctor (excluding maternity cases and mental illness) Mentally ill persons 33 Including 13 at special request of hospital or family doctor Cases of infectious diseases 21 Excluding tuberculosis Total No. of cases visited 17,359 should not be undertaken at home because of the increased risk to mother and baby. The parentcraft and relaxation classes provided in the clinics by health visitors and midwives were particularly appreciated, especially by expectant mothers in the first pregnancy. The number of births, still births, maternal and infant deaths are given on pages 4 and 5. The comparative rates calculated from these figures are given on page 11. The birth rate shows a slight fall from 1964 which confirms national trends. The various still birth and infant mortality rates compare favourably with national figures. Table 3 shows that over two-thirds of all patients delivered in hospital were discharged home, to the care of the midwife, before the tenth post-natal day. This uses available hospital beds to the best advantage, but requires full exchange of information between hospital staff and the midwife. An analysis during the year showed that the scheme for this exchange of information is working well, but that sometimes a mother, on discharge, went to a different address, often to stay with relatives, but omitted to inform either hospital staff or midwife. An amendment of the forms was made to overcome this problem. An Ante-natal Co-operation Card, which is kept by each expectant mother, facilitates the exchange of information between the family doctor, hospital staff and midwife. Too much emphasis cannot be placed upon the need to carefully preserve it. 10 The monthly meetings of the Maternity Liaison Committee, held at Oldchurch Hospital, continued to prove of great value in reviewing and planning the hospital, general practitioners and local authority maternity services and I acknowledge the co-operation of my colleagues in this respect. At the end of the year the staff of 27 full-time and five parttime midwives represented a full establishment so that regular off duty time could be arranged. Several vacancies during the year were fortunately filled without excessive delay. During 1965 one pupil midwife from Havering completed her district training, and twelve pupils from outside the Borough undertook part of their training with one of the five approved teaching midwives on the staff. Table 3—BIRTH STATISTICS Total At home or nursing home In hospital Number of live births 4,318 1,524 2,794 Number of premature live births (i.e. weighing less than 5½ lbs.) 211 24 187 Number of stillbirths 56 5 51 Number of premature stillbirths 25 2 23 Number of infant deaths (under one year) 62 — — Number of maternal deaths 1 — — Number of hospital births discharged to care of midwife before 10th post-natal day 1,935 — — Peri-natal mortality rates : Local N.E.M. R.H.B. Region England/Wales 23.77 24.47 26.85 CONGENITAL MALFORMATIONS The birth notification forms which are sent to the Medical Officer of Health by midwives or hospital staff contain a note on any congenital malformation which may be present. The midwife or member of the hospital staff notifying the birth is then requested to complete a report form, giving further details including the parity and age of the mother. A copy of this report is forwarded to the health visitor concerned for follow-up purposes and a monthly return is made to the Registrar General. During 1965 sixty-nine congenital malformations were notified and reported on in this manner. 11 UNMARRIED MOTHERS Some unmarried mothers were cared for by the normal maternity service, but twenty-four were aided by the Chelmsford Moral Welfare Association. This voluntary organisation acting as the Council's agents undertake care during the ante-natal period and arranges admission to one of several Mother and Baby Homes. HOME NURSING (DISTRICT NURSING) The duties of this group of staff are to provide nursing care in the home, at the request of the family doctor, to maternity cases or to persons with illness or disability. At the end of the year the staff consisted of 25 full-time and 9 part-time State Registered Nurses, including four nurses attached to groups of general practitioners and six male nurses. Employment of the latter enabled the female nurses to be relieved of the lifting and bathing of heavy male patients. During 1965 the Home Nurses, together with the Health Visitors, assisted in the field work training of seventy student nurses from Oldchurch and St. George's hospitals. Statistics on this service are given in Table 4. The especial value of home nursing in the case of the elderly population is clear. Table 4—HOME NURSING Number Ages Under 5 yrs. 5-64 yrs. Over 65 yrs. Total number of persons nursed during the year 2,078 56 767 1,255 Number of visits made during year 49,341 360 15,622 33,359 SICK ROOM EQUIPMENT A large range of sickroom equipment is available on loan to persons being nursed at home. This service, which is supplemented by the issue of disposable pads and a laundry service, is the subject of an ever increasing demand. Table No. 5 shows the number of articles issued during the year. 12 Table 5—SICK ROOM EQUIPMENT Article No. issued Disposable pads 28,000 Bed pans 136 Commodes 112 Wheelchairs 99 Back rests 88 Polythene sheets 80 Foam rings 50 Draw sheets 50 Air rings 50 Bed cradles 41 Urinals (Male) 41 Walking sticks 13 Walking Aids (Tripod) 10 Crutches 10 prs. Bed pans (rubber) 8 Feeding Cups 8 Hydraulic Hoists 8 Mattresses 8 Walking Aids (Quadruped) 8 Bath Mats 4 Bedsteads 4 Urinals (Female) 4 Fracture boards 3 Bed tables 2 Pulleys 1 Enuresis Alarm (for adults) 1 Helping Hands 1 Pillows 1 Walking Machine (frame) 1 CLINIC SERVICES The full-time and sessional clinics in the Borough are listed on pages 43 and 44. MATERNAL WELFARE SERVICES Table 6—ANTE-NATAL AND POST-NATAL CLINICS Ante-Natal Post-Natal Total Number of women attending clinics 1,409 25 1,434 Number of sessions Doctor Midwife 148 725 873 Number of women attending relaxation classes Booked for hospital confinement Booked for home confinement 572 248 820 (a) The Ante-natal and post-natal clinics are held by midwives and doctors, whilst the parentcraft and relaxation clinics are staffed 13 by health visitors who are joined by midwives for sessions on childbirth and analgesia. (b) Free dental treatment is available to expectant and nursing mothers. Every expectant mother should have a dental inspection as part of her preparation for childbirth, because there is an increased risk of infection if carious teeth are present. Appointments can be arranged by calling at (or telephoning) the nearest clinic. Details of inspections made, and treatment given, are shown in Table 8. (c) Women's Welfare Clinics provide free contraceptive advice to women having a medical indication for avoiding childbirth. Sessions were held throughout the year at Westland Avenue, Abbs Cross, Harold Wood and Avon Road Clinics, staffed by female doctors and nurses and a total of 301 women attended. (d) A weekly cervical cytology session was available for women referred by their family doctor, in the Health Centre, Harold Hill. 139 smears were taken, 135 of which were clear; four results indicated the need for further investigation. CHILD WELFARE SERVICES (a) Child Welfare Clinics — these are available for consultation between parents and doctors and health visitors, and for the routine screening tests and medical examinations to detect any deviation from normal development. These include the test for hearing, muscle control and emotional response which are carried out by the Health Visitor upon children at the age of nine or ten months. The purpose of these examinations is to provide early investigation, treatment and advice in any case of handicap, and discussion of anxieties and reassurance to all parents, especially where there is a higher risk of developing handicap because of various unfavourable hereditary, ante-natal, natal or post-natal factors. During 1965, 761 children were considered to be " at risk " and were being carefully followed up. Table 7—CHILD WELFARE CLINICS Born 1965 Born 1964 Born 1960-63 Total Number of children attending 3,403 3,066 2,944 9,413 Sessions held by Doctors Health Visitors Total 1,059 539 1,598 (b) Specialist and treatment clinics — Speech therapy, orthopaedic and ophthalmic advice, chiropody, physiotherapy and orthoptic treatment, and the treatment of minor ailments, were available to children under the age of five as well as through the School Health Service. Details are given on page 45 (chart of clinic services) and on page 24 (School Health Services). 14 15 Table 8—DENTAL SERVICES FOR EXPECTANT AND NURSING MOTHERS AND CHILDREN PART A. DENTAL TREATMENT — NUMBER OF CASES Number of persons examined during the year Number of persons who commenced treatment during the year Number of courses of treatment completed during the year (1) (2) (3) 1. Expectant and nursing mothers 114 84 51 2. Children aged under 5 years and not eligible for school dental service 675 269 226 PART B. DENTAL TREATMENT PROVIDED Scalings and Gum Treatment Fillings Silver Nitrate Treatment Crowns and Inlays Extractions General Anaesthetics Dentures Provided Radiographs Full upper or lower Partial upper or lower (1) (2) (3) (4) (5) (6) (7) (8) (9) 1. Expectant and nursing mothers 49 213 4 2 57 6 5 11 32 2. Children under 5 years and not eligible for school dental service 63 730 135 — 186 97 — — 48 (d) Dental Treatment — Free Dental Inspection and treatment are available, at the clinics listed on pages 43, 44 and 45, for children under school age as well as for school children and expectant and nursing mothers. Details of inspections made and treatment provided are shown in Table 8. (e) Clinic Buildings — By the middle of the year alterations to Hulse Avenue Clinic were complete, providing speech therapy and hearing testing rooms, and improving the minor ailment and clinic room. Programmes of similar improvements were planned for Westland Avenue, Abbs Cross Lane and St. Mary's Lane Clinics. DAY NURSERIES The four nurseries in the Borough provide skilled day care and observation of 190 children under the age of five years. Such skilled and intensive care is primarily required by the handicapped, deprived or isolated children of the Borough and those parents who may be unable, because of illness or other disability, to give their children a normal upbringing. The number of priority admissions on these medical or social grounds has and will continue to increase, as the importance of giving young children a stimulating and satisfying environment becomes more widely understood and the service better known. Staff numbers were maintained despite some difficulty in finding suitable replacements. Six student nursery nurses from the College of Further Education, Ardleigh Green Road, were attached to the Elm Park Nursery. Table No. 9 — DAY NURSERIES Nursery Places Average attendances over the year Waiting list on 31.12.65 Priority Nonpriority Gd. I Gd. II Diban Ave., Elm Park 50 41.76 4 4 80 Western Road, Romford 40 30.87 10 — 51 Clockhouse La., Romford (Hulse Ave., Romford up to Aug. '65) 50 35.17 — — 58 Rush Green, Romford 50 33.33 — — 13 Total 190 141.13 14 4 202 16 The old nursery at Hulse Avenue was closed in August 1965 and the staff and children moved to the new nursery at Clockhouse Lane. Staff and parents were very pleased with the new building which was the result of close co-ordinated planning between the Borough of Romford's Medical Officer of Health and Architect. NURSERIES AND CHILD-MINDERS REGULATION ACT, 1948. Persons undertaking paid child minding or organising nurseries or play groups for children under the age of five years, and the premises being used must, under this Act, be registered by the Council. The organiser must be a fit person to look after children and the premises, which are often church or social halls, must comply with fixed standards of space and amenity. These regulations protect the health and welfare of young children receiving day care away from home. Applications for registration are carefully vetted by the Health Visitors and Public Health Inspectors and once an establishment is registered it is subject to a regular periodic inspection. During 1965, twenty-five premises providing 1067 places and 11 daily minders receiving 117 children were visited and registered. In no case was registration refused. IMMUNISATION AND VACCINATION The total number of children under 16 years of age who received a course of immunisation or vaccination during the year, either at the Authority's clinics or by general practitioners, was as follows :— PRIMARY COURSES Type of antigen Diphtheria/Pertussis/Tetanus/Poliomyelitis 24 Diphtheria/Pertussis/Tetanus 3,392 Diphtheria/Pertussis 2 Diphtheria/Tetanus 334 Diphtheria 40 Pertussis 100 Tetanus 2,034 Poliomyelitis (Salk vaccine) 88 (Sabin vaccine) 4,403 Smallpox vaccination 2,048 The total number of children protected against each disease, including those who were given combined antigens, was as follows: Diphtheria 3,792 Pertussis 3,518 Tetanus 5,784 Poliomyelitis 4,515 Smallpox 2,048 17 The proportion of children under one year of age who have received a primary course of immunisation is estimated to be:— Diphtheria 71% Whooping Cough 68% Tetanus 72% Poliomyelitis 81% RE-INFORCING DOSES Type of antigen Diphtheria/Pertussis/Tetanus/Poliomyelitis 1 Diphtheria/Pertussis/ Tetanus 1,141 Diphtheria/Pertussis 1 Diphtheria/Tetanus 971 Diphtheria 1,589 Pertussis 390 Tetanus 855 Poliomyelitis (Salk vaccine) 30 (Sabin vaccine) 2,983 Smallpox vaccination 618 The total number given re-inforcing doses against each disease, including those who received combined antigens, was as follows :— Diphtheria 3,703 Pertussis 1,533 Tetanus 2,968 Poliomyelitis 3,014 Smallpox 618 PREVENTION OF ILLNESS, CARE AND AFTER CARE Recuperative Holidays 79 recommendations were received for recuperative holidays under the prevention of illness, care and after-care arrangements. 71 of these patients availed themselves of the arrangements made for their admission to various convalescent homes. The normal period in each instance was two weeks, but in one instance the patient returned after one week, and in two other cases, a period of three weeks was recommended. Milk for Tuberculous Patients 90 patients suffering from tuberculosis were supplied with a pint of milk daily, free of charge, on the recommendation of the Chest Physicians. Care of the Tuberculous The former Romford and Hornchurch Tuberculosis Care Association, renamed the Havering Tuberculosis Care Association, continued to provide extra nourishment grants, and other forms 18 of assistance for tuberculosis patients in the same manner as before, the Havering Council continuing the arrangements formerly operated by the Essex County Council, under which an annual grant is made by the Council to the Association and the secretarial work is undertaken by the staff of the Health and Welfare Department. The Association have as their medical advisers, Dr. S. Steel and Dr. E. Woolf, who attend all meetings of the Association, and all assistance is given on their recommendation or advice. B.C.G. VACCINATION AGAINST TUBERCULOSIS B.C.G. vaccination was offered to all children over the age of 13 years, subject to a preliminary tuberculin skin test which detects those children who have already developed a resistance to the disease. The number of children skin tested and vaccinated under this scheme during the year was as follows :— Skin Tested 2,263 Positive result 285 Negative result 1,856 Vaccinated 1,856 All children found to give a positive reaction to the skin test are referred to the Chest Physician for routine chest x-ray as a precautionary measure. B.C.G. vaccination is also provided at the Chest Clinics for known contacts of tuberculous patients. 192 contacts were skin tested during the year and 134 of these who showed a negative reaction to the test were given B.C.G. vaccination. CHIROPODY SERVICE The Chief Chiropodist, Mr. L. T. Bolland, reports as follows:— Persons who have attained pensionable age, handicapped persons, expectant and nursing mothers, and children referred by clinic doctors, are eligible for treatment. A nominal charge is made to expectant and nursing mothers, and to non-registered handicapped persons, but otherwise the service is free. The Council agreed that with effect from the 1st of April, 1965, the attainment of pensionable age was sufficient qualification for free treatment and the assessment forms hitherto required were discontinued. Services in operation (a) Full-time Chiropody Clinics Health Centre, Harold Hill Marks Road Clinic, Romford Hulse Avenue Clinic, Collier Row 19 (b) Part-time Chiropody Clinics Gubbins Lane Clinic, Harold Wood Avon Road Clinic, Cranham St. Mary's Lane Clinic, Upminster Abbs Cross Lane Clinic, Hornchurch Westland Avenue Clinic, Hornchurch Park Lane Community Centre, Hornchurch South Hornchurch Clinic Rainham Clinic (c) Services at Welfare Establishments " Hillside " " The Manor" "The Willows" " Ravenscourt" 61 Main Road (d) Domiciliary Treatment There is a domiciliary service for house-bound patients. This is a limited service as it is operated by full-time chiropodists in addition to their duties or alternatively by part-time personnel. (e) Health Education Talks on foot health, illustrated with films made at the London Foot Hospital were given during the year. Treatments given during the year. Table 10 —CHIROPODY TREATMENT GIVEN DURING THE YEAR Age Group New cases during year Cases being treated at end of year Clinic attendance during the year Domiciliary treatment during the year Treatment at Welfare Establishments Elderly (over 65 years) 853 3,215 13,739 4,080 932 Handicapped 27 112 647 440 89 Expectant mothers 9 1 12 — — Children 52 39 321 — — Others 7 11 96 — — Total 948 3,378 14,815 4,520 1,021 Staffing The establishment of a Chief Chiropodist and ten Senior Chiropodists was one under strength at the end of the year, but the vacancy was being advertised. Three full-time Senior Chiropodists were appointed during the year, and one part-time Senior Chiropodist made successful application for full-time employment. These appointments enabled service to operate full-time at Rainham and South Hornchurch Clinics, and the sessions at Avon Road Clinic to be extended. 20 Despite the increase in staff there has been a steady increase in the number of patients seeking treatment, with an unavoidable increase in waiting lists. Alterations to clinic premises planned for 1966/7 will assist in the expansion of this service. NURSING HOMES There are four nursing homes providing a total of 72 beds for acute and chronic sick persons, registered in accordance with the Public Health Act 1936 (Part VI) and the Nursing Homes Act 1963. These homes are the subject of regular periodic visits. HOME HELP SERVICE This service, which is both preventive and supportive, has generally expanded faster than any of the other local health services and is still a developing service. In assessing the requirements of this service, regard is had to various factors, principally the proportion of elderly in the population (75 per cent. of the service is given to the elderly chronic sick), the extent to which recipients are prepared to provide for their own needs, and the ability and willingness of relatives and friends to help as required. Availability of resources, both in money and personnel, are also important factors. Despite the fact that the proportion of elderly is comparatively low, Havering provided in 1965 Helps at the rate of 0.75 per thousand of the population, which compares favourably with the rate of 0.73 Home Helps per thousand population mentioned in Command Paper 1973. During the year a total of 304,789 hours of service was provided, and on the 31st December, 1965, 381 part-time Helps were being employed. In general there has been no difficulty in recruiting Home Helps, except in certain areas such as Upminster and Rise Park. When this difficulty has occurred, it has necessitated additional travelling by other Helps from various parts of the borough to attend patients in Upminster and Rise Park. It has become increasingly evident that the Home Helps act as sentinels calling in other services as available, and they very often have to act as "Social Workers." For these reasons in-service training is being provided, and will be expanded during 1966. STATISTICS Table 11 NUMBER OF PERSONS RECEIVING HOME HELP DURING YEAR CATEGORY NUMBER Aged (65 -}- years) 1,483 Chronic Sick and Tuberculosis (under 65 years) 256 Mentally Disorded 6 Maternity 307 Others 136 2,188 21 During the year a total of 2,221 recommendations for help were received and of these 33 only were not assisted; during the same period six persons required night attendants and 210 hours of service was provided, all cases being of terminal illness. At the 31st December, 1965, 1,518 persons were still receiving home help. SCHOOL HEALTH SERVICE At the end of 1965 the number of school children in Havering was 42,331, representing 16.9% of the total population of the Borough. They attended 109 schools; 77 primary schools, 28 secondary schools (including grammar schools), 2 technical schools and 2 special schools for educationally sub-normal pupils. The functions of the Borough School Health Service are :— (a) the examination of the school population and the detection and treatment of illness or defect likely to interfere with a child's educational progress. This is carried out in the Borough by:— (i) Medical Inspection (see Table No. 12). Periodic medical examinations by a school doctor, preferably in the presence of the parent, are arranged three times during a child's school career at the approximate ages of five, ten and fifteen. Special inspections and advice are also available at any time and on any of the varied problems of or before a child's school career. (ii) Additional Screening Test (see page 24). Screening tests of vision, hearing and general hygiene are carried out by school nurses. (iii) Treatment Services (see page 25). Treatment of defects detected at a medical inspection or screening test is arranged either at the school clinics or through the family doctor and hospital services. The Borough dental service is described on page 16. (b) The provision for the needs of handicapped children in close co-ordination with the Education Department (see page 32). A child can be referred by the parent, teacher, health visitor or school nurse, educational psychologist or any other person concerned with the child's care to the school doctor for examination and advice. If special educational treatment appears to be necessary the Principal School Medical Officer advises the Chief Education Officer who makes the necessary arrangements for a place to be provided at a suitable special school. In many instances the examination is repeated, after a period of observation, before any recommendation can be made. 22 Between April and December 1965 considerable attention had to be given to administrative problems associated with the formation of the Borough and provision of an integrated service. However, notable events during the year included :— (a) the opening of the new assessment unit at Corbets Tey Special (E.S.N.) School, Upminster. This is a selfcontained unit for the detailed observation and assessment, from medical and social as well as educational aspects, of children who may be in need of some form of special educational treatment. At the end of the year eight children were in attendance and regular visits were being made by medical officers, educational psychologists and child psychiatrists, to observe the children and consult the teachers. (b) provision of five further transistor audiometers. These lightweight machines can easily be hand carried by school nurses, and have made possible the planning of a comprehensive hearing test programme. (c) creation of a liaison committee between the Principal School Medical Officer and representatives of head teachers and teachers. The first meeting of this committee was held in October 1965 and immediately proved of considerable value in discussion of many aspects of the service, and providing a means of exchanging views on proposed changes in the service. (d) provision of fifty extra enuresis (bed-wetting) buzzer treatment sets. This enabled a considerable reduction in the waiting list for treatment of this troublesome condition. (e) regular meetings between head teachers, education officers, educational psychologists and medical officers to select the pupils being offered places in the two special (E.S.N.) schools in the Borough and to review the waiting list. (f) provision of an integrated plan for the exchange of information between the School Health and Youth Employment Services. MEDICAL INSPECTIONS Periodic Medical Inspections The most important of three periodic inspections is the first examination after entering school at the age of five. More conditions which were previously undetected and untreated are found at this inspection, which is well attended by parents, than at the later two inspections. The value of the first or second periodic inspection is considerably reduced when the parent does not attend. A total of 8,756 pupils were examined at periodic medical inspections during the year. 1,452 of these (16.85%) were found to 23 have conditions requiring treatment, but only 12 were judged by the school doctor to be in a generally unsatisfactory state of health. In addition a number of children were found to have defects which, although not requiring immediate treatment, needed to be kept under further observation. Table 12 — DEFECTS FOUND AT ROUTINE SCHOOL MEDICAL INSPECTIONS Condition No. of defects found requiring treatment No. of defects found requiring observation Defective vision 630 366 Orthopaedic (including postural abnormalities) 225 306 Nose and throat abnormalities 187 315 Diseases of the skin 125 147 Developmental abnormality including hernia 72 114 Speech defects 66 73 Squint 57 44 Defective hearing 37 154 Mental development or psychological conditions 33 232 Lung abnormality 29 115 Middle ear infection 28 72 Other 127 308 Re-inspections Certain of the children referred for observation are re-called for a repeat medical inspection. A total of 1,433 re-inspections were carried out during the year. Special Inspections These medical examinations are carried out at the clinics at any time during a child's school career following a request by the parent, teacher, school doctor or nurse, etc. They are not part of the routine inspection programme and are available to help with any problem of a child's physical or mental health, development or educational progress. During 1965 special inspections totalled 1,729. Defects found at these inspections which needed treatment or a period of further observation included 300 skin conditions, 129 vision defects, 94 hearing defects, 89 mental development or psychological conditions, 71 foot defects and 64 speech defects. SCREENING TESTS Vision The periodic medical inspections include a test of vision by the school nurse and an additional test is carried out at the age of seven or eight years. Any deviation from normal is referred to the school doctor who arranges treatment or referral for a 24 specialist opinion. Colour vision is tested at the second or third periodic inspection and if an abnormality is found the child or parent is advised of the possible effects on future occupation. Hearing A programme of routine screening of each child's hearing by school nurses was developed during the year, following the provision of sufficient lightweight transistorised audiometry machines. Children failing the screening tests are referred to a school doctor who arranges any treatment considered necessary or refers the child for a specialist opinion. Hygiene Hygiene inspections, including a check on general cleanliness, examination for the presence of head lice and inspection of feet for plantar warts are carried out at intervals by school nurses. Almost 14,000 children were inspected during 1965. 182 cases of infestation with head lice were discovered, almost all of which were mild infestations quickly responding to treatment. TREATMENT SERVICES Treatment and specialist advice is available at the Council's health service clinics. A table of the services provided at each clinic is shown on page 43. Children are referred by the school doctor except in the case of dental treatment which is available on direct application by parents. (See page 14.) Minor Ailment Clinics Cases treated at these clinics during the year included 757 children with skin disease, 138 with eye disease, 92 with ear, nose or throat conditions and 399 with miscellaneous minor ailments. The number of school children requiring treatment for plantar warts (verrucas) usually increases considerably in the autumn term, and this year proved no exception. Facilities for the treatment of nocturnal enuresis (bed wetting) are available at each of the Council's clinics and waiting lists were reduced during the year by the provision of a further 50 enuresis alarms. The demand for treatment of minor ailments at school clinics has diminished in recent years and these sessions are devoted more to special examinations and consultations with the medical officer. Ophthalmic and Orthoptic Clinics These sessions are attended by arrangements with the Regional Hospital Board by visiting ophthalmic specialists and orthoptists. The ophthalmic specialists advise on treatment, issue prescriptions for spectacles or refer children to the orthoptists who provide nonsurgical treatment for squint and muscle imbalance of the eyes. During 1965 a total of 2,126 children were treated for eye conditions and 1,260 of these were given prescriptions for spectacles. 139 children received orthoptic treatment . 25 Orthopaedic and Physiotherapy Clinics These sessions are attended by arrangements with the Regional Hospital Board by orthopaedic specialists and a physiotherapist. During 1965, 925 pupils attended. 600 examinations were carried out by the orthopaedic specialists and 4,440 physiotherapy treatments were given. Mrs. A. Slip, physiotherapist, reports as follows :— "At the present time there are approximately 1,000 children receiving treatment in the clinics for conditions responding to physical therapy. The greater proportion of these fall under the general classification of postural defects, but other orthopaedic conditions currently undergoing treatment are mainly those affecting the spine and knee. The treatment of these cases is under the direction of the orthopaedic consultant. During the past year there has been a slight increase in the number of children referred by general practitioners and some local hospitals for chest physiotherapy, and a few children have been sent for ultra-violet irradiation. The Hospital for Sick Children, Great Ormond Street, continues to request treatment for a small number of children living locally affected with cerebral palsy, congenital muscular hypotonia and postural defects associated with overweight. (An increasingly large number of children are being advised about weight problems as a causative factor of postural defects and ' hypotonia'.) The number of babies referred suffering suspected birth trauma or congenital abnormality has shown a slight decrease in the past year." Speech Therapy Service In this first report of speech therapy in the Borough of Havering, I feel that I can confidently say that the work has progressed with stability and unity of purpose, which has allowed the merging of the Romford and Hornchurch Districts to take place with a feeling of friendliness and goodwill. In April, 1965, the full compliment of speech therapists for the Borough comprised 1 senior, 3 whole-time and 1 part-time personnel. But we were short of 1 whole-time therapist, to cover Harold Wood. Rainham and South Hornchurch Districts, together with Corbets Tey Special School. This post became vacant at the end of December, 1964, and was not eventually filled until September, 1965. In the meantime some of the most urgent cases were baing treated by the therapists at Harold Hill and Hornchurch. Hornchurch, Upminster and Elm Park Districts In April, 1965, the case load for this area was particularly heavy with long waiting lists at all the Clinics. Previously the 26 speech therapist had only been working for six sessions per week in the area, but from April was able to give full-time service, in conjunction with the duties pertaining to the senior post. Extra sessions were allotted as follows :— April —A clinic was commenced for the first time, for one session per week at Avon Road, Cranham. This relieved the overburdened condition at St. Mary's Lane, Upminster. May—Two sessions per week were given temporarily to Corbets Tey School for educationally sub-normal children, until another therapist was oppointed to take over in September. July —One extra session was held at Westland Avenue, Hornchurch. October—After the appointment of another whole-time therapist in September to fill the vacancy in Harold Wood, Rainham, South Hornchurch and Corbets Tey School, an extra session was commenced at Abbs Cross Lane Clinic. By kind permission of the Headmistress and Headmaster of Hacton Primary School, and after discussion with the Medical Officer of Health, the Chief Education Officer and the School Managers, it was agreed to hold a Clinic in Hacton School, primarily for the children attending the school, who were in need of speech therapy, and possibly at some later date for other children living in the close vicinity. Mrs. Hilton, part-time speech therapist at Collier Row, Romford, was engaged for one extra session per week to undertake this duty. Permission to hold the Clinic was granted on October 6th, and the first session was held at the school on October 13th. Twelve cases were removed from the waiting list for Westland Avenue straight away and transferred for treatment at Hacton School. November—A second session was commenced at Avon Road, Cranham. Between September and December, 1965, the waiting list in the Hornchurch, Upminster and Elm Park area was reduced from 86 to 60. The case-load in this area, however, is still heavy, and there is urgent need for another therapist as soon as there is adequate accommodation. Harold Wood, Rainham, South Hornchurch and Corbets Tey School The Speech Clinics in these districts had been closed for 9 months, with the exception of Corbets Tey School which, as previously stated, was started up again in May. When Miss Buitenhuis took up duties in September, she found fairly heavy case-loads and had a waiting list for all Clinics. There has been a steady flow of new referrals, with an increase in 27 the number of pre-school children now being referred. The sessions allotted are adequate at present at Rainham and South Hornchurch Clinics, and at Corbets Tey School, but Miss Buitenhuis says an extra session could be used advantageously at Harold Wood. Romford Central District A fairly compact area centred chiefly round Marks Road Clinic, where Miss Jones, working full-time, held most of her Clinics. She visits Manor Primary School for one session each week to treat children attending that school who are in need of speech therapy, and in April, 1965, was attending Havering Grange School for educationally sub-normal children for three sessions per week. In October Miss Jones ceased to be employed full-time as she was appointed speech therapist at Harold Wood Hospital for three sessions per week. With one session less at Havering Grange, and two sessions less at Marks Road Clinic, Miss Jones finds the time adequate and has only a small waiting list. Harold Hill Estate Miss Adam holds most of her Clinics for this area at the Health Centre, but also attends Hilldene School Clinic two sessions per week. In September, 1965, speech therapy was commenced at the Junior Training Centre, Gallows Corner. Miss Adam attends for one session per week, and sees on an average eight children each time. Collier Row Mrs. Hilton, part-time speech therapist, attends Hulse Avenue Clinic four sessions per week and spends two more sessions per week visiting four infant schools in order to treat a number of small children whose parents find it difficult to bring them each week to the Clinic. As previously stated she undertook to work for an extra session from October, 1965, at Hacton Infant School, in Hornchurch. School Visits Apart from Clinical sessions held in certain schools, therapists in all districts endeavour to make periodical visits to schools in order to discuss progress, and matters arising from speech therapy, with the Head Teachers and Class Teachers. This often proves very helpful to the speech therapist, and forms another point of contact and a connecting link in the study of the child in relation to his or her environment. If time does not allow for personal contacts to be made as often as is desirable, telephone communications with the Head Teachers are often helpful. Meetings Five staff meetings were held during the year, including three at which senior medical staff were present. 28 There has been much to discuss regarding the administration of the Service in the Borough, and these meetings have been appreciated also for the opportunity they have provided for making social contact with colleagues and officers. I have only to add that the year has been a happy and a busy one for all of us. This we know has come through the co-operation and helpful contacts with all Officers, Staff, Teachers and Parents. This is graciously acknowledged and appreciated by all. Statistics During the year 564 pupils received treatment including 273 new referrals. At the end of the year 364 children were receiving treatment. DENTAL SERVICE The Chief Dental Officer Reports as follows :— 1. Staffing The main problem facing the Dental Service at the present time is that the state of children's teeth continues to deteriorate, and the number of dentists able and willing to devote their energies to this exacting work is insufficient to meet the demand for treatment created. The school population at 31st December, 1965, was 42,331, and to this must be added the large number of pre-school children under 5 years of age who, together with nursing and expectant mothers, form a high priority group of patients. The professional establishment for all the dental services of the Borough is :— 1 Chief Dental Officer 10 Dental Officers After various staff changes during the year, the number in post at 31st December, 1965. was equivalent to six full-time dentists. This figure is arrived at by taking into account the number of sessions that part-time dentists work in addition to full-time staff. 2. Premises and Equipment Altogether there are nine dental clinics in Havering, and all have been in use throughout the year. Of these, the premises at Harold Wood, the Health Centre at Harold Hill, and St. Mary's Lane, Upminster, are purpose built and of recent construction, and the dental surgeries at Hulse Avenue and Marks Road are new additions to existing older clinics. The dental surgeries at Abbs Cross Lane, Westland Avenue and Upminster Road, Rainham, are rooms adapted for the purpose in pre-1939 clinics, and these cannot be regarded as satisfactory by present-day standards. During the period 1st April, 1965, to 31st December, 1965, it was possible to re-distribute some items of dental equipment, so that now all surgeries have achieved a reasonable standard and all are equipped with modern air-turbine drills. 29 3. Orthodontics An increasing public awareness of the benefits of a regular set of teeth, free from unsightly crowding, has led to this branch of dentistry being more widely practised than ever before. The results can be most rewarding, and in addition to the dental benefits, the aesthetic improvement achieved often alters the whole psychological outlook of the child. Only a comparatively small proportion of the cases seen require consultant treatment or advice, but where this is necessary the dental staff have the advantage of the Consultant Service provided by the North East Metropolitan Regional Hospital Board based at Whipps Cross Hospital, and also the Consultant Staff at the London Hospital. Over 200 orthodontic appliances were fitted for patients during the year, and these were constructed at the Dental Laboratory at Barking, where the existing arrangements for all technical work required under the County were continued. 4. General Anaesthetics The administration of general anaesthetics is mostly confined to the younger children for the extraction of deciduous teeth and of the 779 administrations performed during the year, 561 were for children between the ages of 5 and 9 years. Each clinic is equipped with modern anaesthetic machines fitted with the special attachment for delivering Halothane, which is a proved adjuvant in dental anaesthesia. Servicing of all machines is regularly carried out by the British Oxygen Company. 5. School Inspections The inspection of children at all maintained schools has always been fundamental to the school dental service, but the true value of these inspections is only now being fully appreciated. Not only do they provide the means of notifying parents of those children in need of treatment of the facilities that are available, but the information that can be obtained from routine school inspections enables a picture of the condition of teeth in different schools and areas to be compared, and the prevalence of dental disease and the extent to which it is being treated can be assessed. The School Dental Officer is in a unique position to obtain this information. Prevention must be the key-word of the Dental Service, and any information which enables Dental Health Education to be carried out more intelligently and successfully is valuable. 6. Dental Health Education Full education means a way of life and health is part of it— and dental health a significant part. This means that facilities and time for oral hygiene should be part of school life, and it also 30 means that parents and teachers should, with professional advice, look at the content of school meals and the tuck shop. it would be unrealistic to try to suppress the tuck shop out of hand, but items which produce less decay, which are nonetheless attractive and at the same time nutritious, could be offered in their place. Dental Health Education should aim at persuading parents that sound dental health really is worth while—even to the extent of exercising the same sort of resolution and determination that they would devote to ensuring that their child will pass the 11 + examination. And the children themselves must be persuaded that good teeth are worth striving for—not at 14 or 15 when they are becoming conscious of their appearance and when it is so often too late, but much earlier on in life. 7. Treatment of Handicapped Children The plight of the mentally-handicapped child when it comes to obtaining dental treatment can sometimes be an unenviable one, and in this respect the local authority can provide a useful service. During the latter part of the year, all the children attending the Junior Training Centre at Gallows Corner received a dental inspection, and those in need of treatment were offered this at the nearest dental clinic to the centre — that is in Gubbins Lane, Harold Wood. 8. Visits Mr. J. G. Potter. Dental Officer of the Department of Education and Science, paid an introductory visit to the Borough in June. New statistical returns of work which were produced by the Department are now in use, and these are to be extended by the Ministry of Health to include the Maternity and Child Welfare Service next year. 9. Statistics Details of treatment provided for expectant and nursing mothers and pre-school children are given in Table 8 on page 15 and those relating to School Children in Table 13 below:— Table 13 — DENTAL INSPECTION AND TREATMENT OF SCHOOL CHILDREN Inspection (a) First inspection at school. Number of pupils 11,009 (b) First inspection at clinic. Number of pupils 4,208 Number of (a) + (b) found to require treatment 8,815 Number of (a) + (b) offered treatment 7,487 (c) Pupils re-inspected at school clinic 1,760 (Number of (c) found to require treatment 1,093 31 Attendances and Treatment Ages 5 to 9 Ages 10 to 14 Ages 15 and over Total First visit 2,462 1,619 257 4,338 Subsequent visits 4,647 3,678 718 9,043 Total visits 7,109 5,297 975 13,381 Additional courses of treatment commenced 178 102 14 294 Fillings in permanent teeth 1,779 3,537 788 6,104 Fillings in deciduous teeth 3,731 361 — 4,092 Permanent teeth filled 1,491 3,041 651 5,183 Deciduous teeth filled 3,455 312 — 3,767 Permanent teeth extracted 98 441 74 613 Deciduous teeth extracted 1,476 506 — 1,982 General anaesthetics 561 207 11 779 Emergencies 345 172 28 545 Number of Pupils x-rayed 208 Prophylaxis 760 Teeth otherwise conserved 2,198 Number of teeth root filled 141 Inlays 4 Crowns 16 Courses of treatment completed 3,091 Orthodontics Cases remaining from previous year 32 New cases commenced during year 110 Cases completed during year 41 Cases discontinued during year 12 Number of removable appliances fitted 221 Number of fixed appliances fitted 14 Pupils referred to Hospital Consultant 63 Prosthetics Pupils supplied with F.U. or F.L. (first time) – – 2 2 Pupils supplied with other dentures (first time) 3 3 6 Number of dentures supplied — 5 5 10 Health Education in Schools Programmes of talks by health visitors, at the request of head teachers, on mothercraft, personal hygiene and other health matters continued throughout the year. Handicapped Pupils During 1965, 106 pupils were newly assessed as requiring special educational treatment because of physical or intellectual handicaps. The following table shows the position as at 31st December, 1965. 32 TABLE No. 14 Total number of Pupils ascertained as handicapped at end of the year Number of Pupils ascertained during the year Number of Pupils admitted to Special Schools during the year Total Number of Pupils in Special Schools at the end of the year Day Residential Blind 1 — — — 1 Partially sighted 8 2 2 8 — Deaf 9 — 1 6 3 PartiallyHearing 26 7 4 15 2 Physically H'c'd 85 9 5 31 9 Delicate 43 14 10 14 14 Maladjusted 32 7 3 — 19 E.S.N 318 65 33 208 17 Epileptic 11 2 3 — 4 Speech Defects — – — — — Multiple Defects 29 — — 12 10 Totals 562 106 61 294 79 Most handicapped pupils are admitted to special schools, either day or residential, but 103 handicapped children were able to continue to attend normal schools despite their disabilities. The only schools for handicapped pupils situated within the Borough are the two day schools for educationally sub-normal pupils. Other special schools attended by children from Havering include:— Day Schools Ethel Davis School, Goodmayes Branwood School, Grays Joseph Clarke School, Walthamstow William Morris School, Walthamstow West Ham School for the Deaf (Physically handicapped — with special unit for spastic children) (Delicate) (Partially sighted) (Deaf and partially hearing) (Deaf and partially hearing) Residential Schools High View School, Chigwell Ramsden Hall School, Billericay Royal School for the Deaf, Margate East Anglian School, Yarmouth Dorton House School, Sevenoaks Homestead School, Colchester Nazeing Park School, Nazeing Lingfield Hospital School, Lingfield St. Elizabeth's School, Much Hadham Trueloves School, Ingatestone Black Notley Hospital School (Educationally sub-normal) (Educationally sub-normal) (Deaf and partially hearing) (Deaf and partially sighted) (Blind) (Maladjusted) (Maladjusted) (Epileptic) (Epileptic) (Physically Handicapped) (Physically Handicapped) 33 Blind and Partially Sighted Pupils One blind child attended a residential school and eight partially sighted children attended day special school. A further three children who have not yet reached school age are likely to be in need of special educational treatment because of defective vision. At the end of the year twenty-one deaf or partially hearing children were attending day special schools and five were attending residential schools. Two deaf children who are also physically handicapped were attending residential schools where provision is made for their dual handicaps, and two partially hearing children who suffer from other handicapping conditions were attending day special schools. In addition a number of children with hearing defects were attending ordinary schools where they are able to continue their education with the assistance of hearing aids and some special attention from the teaching staff. At the end of the year the Education Committee appointed a peripatetic teacher of the deaf who will carry out a survey of all children with hearing defects in order to assess the need for a possible educational unit for partially hearing children within the Borough. Physically Handicapped Pupils Thirty-one physically handicapped pupils attended day special schools and nine attended residential schools. Thirty-two children in this category are able to continue their education in ordinary schools and five children who are handicapped by other conditions in addition to their physical disabilities attended various special schools. At the end of the year twelve children were awaiting placement. Delicate Pupils Fourteen children were attending residential open-air schools and a further fourteen attended day schools for delicate pupils. One child who has not yet reached school age attended a residential nursery school. At the end of the year two children were awaiting placement in a day special school. Maladjusted Pupils Maladjusted pupils requiring special educational treatment usually attend a residential school or a boarding home. Nineteen children attended such schools or homes for maladjusted pupils and five were awaiting placement at the end of the year. Two nursery classes for pre-school maladjusted children at Parklands and Mead Infants' Schools and a special unit for disturbed children at Manor Primary School are supervised by Dr. J. Vincenzi, Medical Director of Raphael House (Child Guidance Clinic), and information about these units is included in Dr. Vincenzi's report on page 36. 34 Educationally Sub-Normal Pupils This is the largest single category of handicapped pupils. 208 children attended day special schools within the Borough and a further 17 attended residential schools. At the end of the year 55 pupils were awaiting admission to day schools and 2 to residential special schools. Further educational provision for these children is urgently required and a special class for educationally sub-normal pupils is to be established in the near future. Epileptic Pupils Most children suffering from elipepsy are not significantly handicapped and attend school in the normal way. Four pupils needed to attend residential schools during the year, however, and one other was awaiting placement at the end of the year. Pupils with Speech Defects No children were sufficiently affected to require ascertainment for special educational treatment during the year. Multiple Handicaps Children who are handicapped by more than one type of condition can often be suitably placed at a special school dealing with their major handicap. In some instances, however, special treatment is required to deal with a variety of handicaps and a number of residential schools provide facilities for such children. OTHER SERVICES FOR HANDICAPPED PUPILS Transport Transport to and from school, social centres or holiday centres is provided for handicapped children in need of such a service, including those children temporarily disabled as a result of accident or illness. Holidays Recuperative holidays for school children are provided by the Education Committee on the recommendation of the Principal School Medical Officer. In 1965 such holidays were arranged for 42 children. In addition to these facilities special holidays are sometimes arranged by voluntary organisations (e.g. Invalid Children's Aid Association; British Epilepsy Association; Spastics Society, etc.), for handicapped children. It is the usual practice for the Education Committee to meet the cost of these holidays following recommendation from the Principal School Medical Officer. Handicapped School Leavers Handicapped young persons have added difficulties in finding suitable employment and undertaking the transition to adult life. Measures provided during the year to help these school leavers include: 35 (a) the joint appointment between the Education Departments of the London Boroughs of Havering, Redbridge and Barking of a careers officer for handicapped young persons. (b) the attachment of education welfare officers to Corbets Tey and Havering Grange Schools for educationally sub-normal pupils, whose duties include keeping in touch with ex pupils for two years after leaving school. (c) the regular attendance by a welfare officer of the Health and Welfare Department at these two schools to meet parents and children in need of community services. RAPHAEL HOUSE Centre for School and Family Problems Medical Director : Dr. J. Vincenzi 1. Particulars of Staff Responsibilities (a) Medical The Medical Director is a Consultant Psychiatrist who is appointed by the Regional Hospital Board and attends for four sessions (half days) each week. Other Consultant Psychiatrists are similarly appointed to attend for a total of five sessions weekly. Psychiatrists have had full medical training and have worked as General Practitioners and occasionally as School Medical Officers in addition. They have had further training and experience in the field of Mental Health and most of them obtained a Diploma in Psychological Medicine. (b) Psychiatric Social Workers Owing to the shortage of workers of this type it is only possible to hope to fill a limited number of posts and the establishment, therefore, is for two. The Medical Officer of Health is responsible for these appointments. The Psychiatric Social Workers are responsible for liaison with outside agencies and they divide the area between them. These workers have usually had a University background (often leading to a Social Science Diploma rather than a degree). They are required to have considerable experience in social work of other types before being admitted to the Mental Health Course at the London School of Economics or the Universities of Edinburgh or Manchester, which gives them their qualified status. (c) Educational Psychologists The Chief Education Officer is responsible for the appointment of Educational Psychologists who serve on his 36 staff and are responsible for the School Psychological Service in the area as well as forming part of the clinical team. Until ten years ago the supply of Educational Psychologists was reasonably good, especially in the southern half of the country, but there has recently been a serious wastage and it is now very rare for an Authority to be fully staffed. It is therefore likely to become increasingly difficult to maintain a service to schools which would be regarded as adequate by the standard suggested by the British Psychological Society though Havering is fortunate in being nearly fully staffed in this respect at present. There is establishment for two Educational Psychologists who divide their time between visiting schools to undertake work in connection with the School Psychological Service and working as members of a clinical team. They may also undertake some educational treatment under the direction of the Consultant Psychiatrists, and advise heads and remedial teachers in the schools for which they are responsible. The area is divided in order to use the available staff in the most economical way and not necessarily geographical. They work closely with the Tutor Organiser for Remedial Services who is a member of the Chief Inspector of School's Advisory team. Educational Psychologists are normally graduates in Psychology who are also qualified teachers. They have usually followed a teachers' training course, had varied teaching experience over a number of years and have followed a post-graduate course of clinical training. The Senior Educational Psychologist is concerned with the practical administration of the establishment (but not with administrative matters involving decisions about policy, as these are dealt with by the Medical Director after consultation with the whole staff) and also with the organisation of the School Psychological Service, being responsible to the Chief Education Officer for the development of special educational units and the remedial teaching service in Raphael House. (d) Remedial Teachers The remedial teachers, employed at Raphael House for the purpose, work on a part-time basis. They are experienced teachers who are unable to undertake full-time duty and who are interested in working with individual children who need intensive instruction in one or two subjects in a mildly therapeutic setting. The remedial teachers discuss each case with the appropriate Psychologist and sometimes attend relevant sessions of a Case Conference with the fulltime clinical team. 37 (e) Administrative Staff In an establishment of this type the Clerical Staff play a very important role as they are often the first people seen when patients come to the Centre, and the way in which they receive them may have considerable effect on the course of cases in treatment. 2. Area Served The Centre serves the whole of Havering, but special arrangements may be made from time to time for children to attend from adjacent areas of the County of Essex where it would be impossible for them to attend the appropriate Essex establishment. Certain children from the London Borough of Barking who began treatment at Romford or who were referred before psychiatric sessions were allocated by the Regional Hospital Board to the Barking Clinic continue to attend until their treatment is completed. 3. Problems Which Bring Patients to the Centre For record purposes these problems are divided into six categories:— 1. Nervous Disorders. 2. Habit Disorders including physical symptoms. 3. Behaviour Disorders. 4. Organic Disorders. 5. Psychotic Behaviour. 6. Educational and Vocational Difficulties. These categories are fairly wide and some of them cover a variety of symptoms. For example, Group 1 (Nervous Disorders) includes fears, depression, excitability; Group 2 includes bedwetting, feeding difficulties, asthma and other allergic conditions; Group 3 (Behaviour Disorders) which brings nearly half the total number of patients to the Centre is the one where the symptoms are most immediately obvious. It often happens that when children are referred for symptoms which fall into one particular category (particularly Group 3), it is discovered before investigations have gone very far that they have also symptoms of other kinds. These may have persisted for a very long time before the emergence of the obvious one which brought about the referral. 4. Sources of Referral The recognised procedure is for the actual referral to the Centre to be a medical one. coming from a School Medical Officer, family doctor or a consultant at a hospital, but in many cases these people have been asked to make the referral by teachers, educational psychologists (working in the School Psychological Service), probation officers and other social workers, or parents. Parents may refer their children directly to the Centre but they are persuaded, if possible, to discuss the matter with their family doctor first. 38 5. Waiting List The length of the waiting list varies considerably from time to time during each year, but preliminary interviews are usually arranged with a psychiatric social worker and educational psycologist within two or three weeks of referral. The waiting time between these interviews and the first appointment with the psychiatrist is affected by the number of cases referred directly by the magistrates and remanded in custody pending investigation. These cases must have absolute priority. There is a slight tendency for the waiting list for psychiatric interviews to be longest in the winter, but it is seldom possible with the staff available and the heavy pressure of cases to indicate what unavoidable delay there may be in arranging first interviews with the psychiatrist. 6. Procedure Before attending the Centre for interview with a psychiatrist, each child is seen by an educational psychologist to try to assess how well he is able to use his mind in learning situations. During this interview the psychologist may seem to a child to be rather like a teacher but with the difference that the situation is an individual one and the child has the psychologist's undivided attention. This means that the psychologist may be able to discover how a child receives teaching and whether special help is required. If this interview takes place in the Centre the mother is usually interviewed by one of the psychiatric social workers at the same time and a history of the child's development and relationships with people is taken. The Social History indicates the extent to which the child's development might ever have been considered to be normal and how far the emphasis of the problem lies within the personality of the patient, or within an unduly difficult environment with which the child has had to contend. It should, of course, be borne in mind that the attitude of the parent and others close to the child is, in this respect, of greater importance than the material conditions or the traumatic experiences (such as illnesses) which he may have experienced during his lifetime. Sometimes, however, when the child is first seen in school under the School Psychological Service, and then referred to the Centre, the mother may be seen by the Psychiatric Social Worker in her own home. As soon as it can be arranged, an appointment is made for a diagnostic interview with a psychiatrist when both parents are also seen if it is possible. The time reserved for this is quite long, but subsequently treatment interviews are shorter. When a child is taken on for treatment by one of the psychiatrists he is usually seen at fortnightly or monthly intervals and the psychiatric social worker keeps in touch with the family meanwhile, either by visiting the home or by seeing the mother in the Centre. 39 Some children are found to require rather intensive treatment which may be lengthy and these are passed over by the psychiatrist to another member of staff. In a few cases it may be found that the child's emotional problems are caused by falling behind in school work in spite of being of good ability and he may then be given remedial education by one of the educational psychologists or remedial teachers who reports back occasionally to the psychiatrist in charge of the case. All work in the Centre is of a highly confidential nature and parents are informed if it is necessary to send any kind of report outside the Centre. 7. Relationships with Other Workers It is essential for the smooth running of the treatment of children referred to the Centre that the staff should have opportunities to contact other people concerned with their welfare. The Educational Psychologists and the Psychiatric Social Workers, therefore, try to see as many of these people as possible. In the majority of cases the Educational Psychologists discuss problems with Head Teachers, Teachers and members of the Educational Staff, while the Psychiatric Social Workers see Probation Officers and Children's Visiting Officers and other types of Social Workers. This is a fluid arrangement, however, and contacts are made by whichever of the staff can do the work most economically in time and travelling distance. Considerable help is received from the Medical Officer of Health and his staff, from the Head Teachers and staffs of schools, from other Social Workers, and from the Inspectorial and Advisory Staffs of the Educational Department. This is of great assistance in the organisation of the service given to patients and their parents. The house which is provided and maintained by the Local Educational Authority is equipped with specialised materials and apparatus to facilitate the work of each member of the team through the Chief Educational Officer and his staff at the Education Offices, Upminster Court, 133 Hall Lane, Upminster. A suite of consulting rooms is used adjacent to the Teachers' Advisory Centre for adolescent case work to avoid embarrassing older pupils. ANNUAL REPORT OF THE MEDICAL DIRECTOR FOR 1965 From the administrative point of view the first nine months of the Clinic's existence in the Borough of Havering has passed smoothly and uneventfully, and with the addition of three rooms at 90 Eastern Road, which are used at present for teaching purposes, the accommodation has been adequate and well maintained. On the 1st April the number of psychiatric sessions allocated to the establishment was reduced from thirteen to nine because 40 the establishment no longer catered for children from the former Borough of Dagenham, although in practice a certain number of these children have continued to attend until their treatment was completed. The reduction in the number of cases referred from Barking, however, was more than compensated by increased referrals from the half of the Borough of Havering, which was formerly known as the Urban District of Hornchurch and for which this establishment did not formerly provide a complete service as it was officially in the area of the Grays Clinic. In the three quarters of the year 1965 with which this report is concerned, 258 children were referred as against a total of 255 for the comparable period of 1964, the latter figure having been catered for by the larger number of psychiatric sessions. The waiting period for ordinary non-priority cases has, therefore, tended to increase by approximately a fortnight per month since April 1965. Some cases may have to wait as long as four to five months if their needs are constantly over-ridden by priority cases such as Court referrals, psychiatric emergencies and school refusals with emotional basis which have to be dealt with immediately if there is to be any degree of success. As it has not been possible for the whole of this year to fill the post of Psychotherapist, a post indeed which can rarely be filled owing to the national shortage of staff of this type, there is the added pressure that psychiatrists have to carry out all treatment themselves, unless it can be delegated to educational psychologists or remedial teachers, and this can result in serious pressure being put upon the educational psychologists. With only a nine month period to cover, it is not proposed to analyse cases in detail, but the total number of sessions worked was 196 and the total number of out-patients interviewed by psychiatrists was 1,883. The Medical Director is responsible for psychiatric supervision of the two nursery classes for maladjusted pre-school children and also the Observation Unit for severely handicapped children in the Manor School. He should supervise regularly the treatment of Havering children who are placed in independent schools for maladjusted pupils, as well as being available for consultation by headmasters and staff of local authority schools in which maladjusted children are placed. The Observation Unit at Corbets Tey has proved to need psychiatric supervision too, since most of the children admitted are diagnostic problems because of emotional difficulties which are in some cases primary and in some cases secondary to their mental retardation. All these units require visits at least twice a term, but unfortunately this is out of the question with the psychiatric time available and most of them have been visited once a term during the period under review. Parklands Nursery has had an average of eight children on roll during the year, but at one period this was reduced because of the difficulty of containing the aggressive behaviour of one little boy who was subsequently treated by medication and transferred, 41 on reaching school age, to the Observation Unit where he has settled and is doing quite well. Admissions to this nursery are now rather different in type from those at the beginning of its existence, since workers in various fields are bringing forward children for whom differential diagnosis is required in respect of handicaps and these tend to equal the number of children who are placed on psychiatric recommendation after being referred to the Clinic by their parents on account of behaviour problems. It seems likely that some of these more handicapped children will eventually be more appropriately placed for diagnostic purposes in a unit attached to Havering Grange School since the nursery facilities are more suitable for children of average intelligence with nervous or behaviour problems. Mead Nursery has been on its maximum number of ten for most of the year and usually has a small waiting list. The majority of the children here have emotionally disturbed parents, most of whom are under some kind of psychiatric supervision, or have recently been discharged from it. A few who have not actually been referred for treatment have proved to be quite disturbed people in their own right. The children of these parents show quite a range of nervous disorders on entry to the nursery and often tend to look rather unwell, but in most cases there is gradual improvement as the tension between children and parents is lessened by their being apart from each other for some hours of the day. The Senior Psychologist followed up the progress of all the children who have been discharged from Parklands Nursery, which was the first to open, and found that they were all quite well settled in school and only two children out of a total of twenty-five were considered to be in need of psychiatric help at the present time. One of these is a severely handicapped autistic child and the other a non-communicating child who was so old when discovered that there was not time for really adequate treatment in the nursery before he had to enter school. In most of the other cases Headteachers commented that they felt that the children had derived great benefit from nursery attendance and would not have settled so well in school without it. The Observation Unit at Manor School has been visited a little more frequently than the nurseries because of its special problems and also the fact that there was a change of staff in September 1965. There was some concern about the physical condition of one of the children, but this has now been satisfactorily investigated by the Principal School Medical Officer. The two children have become quite accustomed to each other and the staff and the younger one is making satisfactory progress in the unit, but one has reservations about whether day-treatment will eventually prove to be appropriate on a long-term basis since his mother finds things very difficult outside school hours and during weekends. The older child makes less educational progress, but as the responsibility for psychiatric treatment does not lie with this establishment, the position cannot be fully investigated here. 42 43 CLINIC SERVICES OTHER THAN FOR SCHOOL CHILDREN Women's Welfare Cervical Cytology Ante-Natal Relaxation Classes (Number Child Welfare Of Sessions Clinic Midwives' weekly) Other Services Provided Health Services Clinic, Abbs Cross Lane, Hornchurch Twice Monthly Twice Monthly 1 2 1 Dental and Chiropody Health Services Clinic, Avon Road, Cranham Twice Monthly Twice Monthly 2 2 1 Chiropody Bower Hall, Wellingtonia Avenue, Havering-atte-Bower Monthly Church Hall, Chaucer Road, Romford 1 Health Services Clinic, Gubbins Lane, Harold Wood Twice Monthly Twice Monthly 1 2 Twice Monthly Dental-and Chiropody Harold Hill Health Centre, Gooshays Drive, Harold Hill 1 1 3 1 Dental and Health Services Clinic, Hulse Avenue, Collier Row 1 2 Chiropody Dental and Health Services Clinic, Marks Road, Romford Twice 2 2 Chiropody Dental and Church Hall, Nelmes Way, Hornchurch Monthly 1 Chiropody Community Hall, Park Lane, Hornchurch 2 Chiropody Health Services Clinic, Upminster Road, Rainham 1 2 1 Dental and Church Hall, Rush Green. Romford 1 Chiropody CLINIC SERVICES OTHER THAN FOR SCHOOL CHILDREN—(Continued) Women's Welfare Cervical Cytology Ante-Natal Relaxation Classes Child Welfare Midwives' Clinic Other Services Provided St. Michael's Church Hall, Main Road, Gidea Park 1 Health Services Clinic, Southend Road, Sth. Hornchurch 1 2 1 Dental and Chiropody Tweedway Hall, Tweedway, Romford 1 Health Services Clinic, St. Mary's Lane, Upminster 2 2 1 Dental and Chiropody Church Hall, Victoria Road, Romford 1 Health Services Clinic, Westland Avenue, Hornchurch Twice Monthly 2 2 2 1 Dental and Chiropody 45 CLINIC SERVICES FOR SCHOOL CHILDREN Minor Ailment & Medical Consultation Clinic (No. of Sessions Weekly) Other Services Provided Harold Hill Health Centre, Gooshays Drive, Harold Hill 2 Dental Ophthalmic Orthopaedic Physiotherapy Speech Therapy Health Service Clinic, Abbs Cross Lane, Hornchurch 1 Dental Ophthalmic Orthoptic Orthopaedic Physiotherapy Speech Therapy Health Service Clinic, Avon Road, Cranham 1 Physiotherapy Speech Therapy Health Service Clinic, Gubbins Lane, Harold Wood 1 Dental Ophthalmic Orthoptic Speech Therapy Hilldene School Clinic, Straight Road, Romford 1 Speech Therapy Health Service Clinic, Hulse Avenue, Collier Row 2 Dental Speech Therapy Health Service Clinic, Marks Road, Romford 1 Dental Ophthalmic Orthopaedic Physiotherapy Speech Therapy Health Service Clinic, South End Rd.. S. Hornchurch 1 Dental Ophthalmic Orthopaedic Physiotherapy Speech Therapy Health Service Clinic, St. Mary's Lane. Upminster 1 Dental Ophthalmic Orthopaedic Physiotherapy Speech Therapy Health Service Clinic, Westland Avenue, Hornchurch 1 Dental Ophthalmic Speech Therapy Health Service Clinic, Upminster Road, Rainham 1 Dental Ophthalmic Speech Therapy Raphael House, Child Guidance Service—Treatment of behaviour and emotional dis62 Western Road, Romford orders and educational or vocational difficulties SECTION III — SOCIAL SERVICES In April of this year, the Authority became responsible for all aspects of Health and Welfare, including mental health, general welfare provisions, and general social and family case-work. The opportunity for providing an integrated, social work service presented a great challenge, bringing together as it did a variety of disciplines with a blend of experienced and qualified staff. The aim is to provide help of the appropriate kind by and through the appropriate social worker, whether mental welfare or social welfare officer. It is eventually intended to provide a fully integrated service, but this will not be fully possible until all the staff have the now essential social work qualification. It is to this aspect of the department's development that much of the time has been given. Many hours have been spent on discussion within the department by the leaders of the team under the general direction of the Deputy Medical Officer of Health. The policy is to appoint as full welfare officers only those already with social work qualifications. At the 1st April, 1965, the following qualifications were held by members of the staff : 1 Applied Social Studies Certificate 1 Mental Health Certificate 5 Recognition of Experience Certificates of the Council for Social Work Training 1 Occupational Therapy Certificate 2 Home Teacher for the Blind Certificate 1 Diploma in Sociology One Welfare Assistant was already on a two-year full-time Certificate in Social Work Course, and another began a similar course during the year. A Social Welfare Officer started a dayrelease year's course leading to the Home Teacher for the Blind Certificate. Deployment of Senior and Fieldwork Staff Although the policy is to provide an all-purpose social service, because of the variety of officers it was decided to keep the fieldwork staff in the same sections as before 1st April, 1965, to provide continuity of service where possible. Those who had been carrying out work as mental welfare officers before 1st April, 1965, therefore remained under the Senior Psychiatric Social Worker. The social welfare officers, until a senior social welfare officer took up duties, were directed by the Principal Welfare Officer. As more qualified staff are appointed, full integration will be more practicable. The work was carried out in four ways : (a) through home or office interviews by welfare officers, (b) provision of an emergency service, (c) daily care in establishments run by the Department, and (d) through classes, discussion groups, clubs and other gatherings which brought people together under the guidance of members of the staff. 46 Home and Office Interviews Welfare Officers spent nearly all their time on this social work service. Visits were made to people who had contacted the department directly themselves or through their relatives, or at the request of hospitals, general practitioners, other sections of the Department or other Departments, such as Health Visitors, the School Health Service, the Housing Department; or through voluntary agencies such as Old People's Welfare Associations and organisations for the physically handicapped. All these people were brought to the attention of the section because of some social or personal need. Sometimes the work of the officer concerned was arranging services for them; for instance, aids or adaptations to the home for physically handicapped people, a place at the Training Centre and transport there for a mentally subnormal child, accommodation in a welfare home for an elderly person needing care and attention, temporary accommodation for a homeless family. Very often, though, help from the welfare officer was needed over a long period and for complex difficulties arising from, for instance, discharge from psychiatric hospital, or support in coming to terms with the onset of blindness, or family crisis brought on by threat of eviction. Emergency Service In addition to this continuing social work with families and individuals under stress, a 24-hour emergency service was provided for those needing immediate psychiatric hospital treatment, and for families and individuals finding themselves homeless. A mental welfare officer was on call through the local psychiatric hospital, Warley Hospital, at all times. During office hours, a rota system operated so that a mental welfare officer was always available for emergency mental welfare work, and a social welfare officer was available to see unexpected callers with other welfare needs. Other special cases of homelessness from fire, or with unusual property aspects, were investigated by the Deputy Principal Welfare Officer. STATISTICS Handicapped Persons Table 15 REGISTERED HANDICAPPED PERSONS WITHIN THE BOROUGH Children Adults Blind 7 327 Partially sighted 12 85 Deaf 11 83 Partially hearing 30 28 Physically handicapped 140 621 Mentally subnormal 96 300 Mentally ill — 140 Educationally subnormal 333 — Epileptic 13 27 Totals 642 1,611 47 General Comment Table 15 (page 47) shows the number of handicapped persons, including children, who are "registered" with the department. Although it is not traditional to include children in this section of the report, it indicates the way in which the services for the care of handicapped persons are developing in the new Borough. One interesting feature is the high number of persons suffering from a physical handicap. This is undoubtedly one of the great medicalsocial problems of the future. Details of services available for this type of handicapped person are described on page 53. CARE OF HANDICAPPED PERSONS Mentally Disordered It is pleasing to report that progress in this service has been marked, especially on improved liaison with Hospital Service through:— (a) frequent policy meetings with consultants and other staff; (b) attachment of Mental Welfare Officers to Warley Hospital; (c) attachment of a Mental Welfare Officer to Out-Patient Clinics, which resulted in an increase in the number of requests for after-care. To facilitate the essential communications with the catchment area hospitals, Regional Board and other medical agencies the Mental Health Service has been under the supervision and guidance of the Deputy Medical Officer of Health, assisted by a Consultant Psychiatrist who is employed on a sessional basis. Community Care of the Mentally Disordered The Mental Health Act, 1959, reflects a growing recognition of the importance of making medical and social care as fully and as easily available to the patient suffering from a mental disorder as is the case with physically ill. The emphasis of the Act is on informal procedures for hospital admissions and it also underlines the trend away from institutional care—the latter has become increasingly evident in other areas of social policy. MENTALLY ILL The hospitals serving the Borough are Warley Hospital and the Ingrebourne Centre at St. George's Hospital. (a) Links with Warley Hospital In June, 1965, a meeting was held at Warley Hospital, when the Medical Superintendent and his staff discussed with the representatives of the Mental Health services for the hospital's catchment area (Barking, Essex, Havering and Redbridge) ways to develop better liaison between the hospital and the community care services. As a result of this meeting, Mental Welfare Officers from Havering have 48 49 Table No. 16 NUMBER OF PATIENTS UNDER THE CARE OF THE AUTHORITY AS AT 31.12.56 Mentally 111 Psychopathic Subnormal Severely Subnormal Total GRAND TOTAL Un'r 16 Over 16 Un'r 16 Over 16 Un'r 16 Over 16 Un'r 16 Over 16 Un'r 16 Over 16 Attending day training Centre 10 43 54 71 64 114 178 Awaiting entry thereto — — — — 5 — 1 2 6 2 8 Awaiting home training — — — — 3 17 — — 3 17 20 Resident in Local Authority Home/ Hostels — 16 — — — 23 — 7 — 46 46 Awaiting admission thereto — — — — — 10 — — 10 10 Resident at Local Authority expense in other residential Home/Hostels — — — — — 6 1 — 1 6 7 Resident at Local Authority expense by boarding out in private household — — — — 1 — — — 1 — 1 Receiving home visits (1) Suitable to attend a training centre — — — — 1 8 7 17 8 25 33 (2) Others I 123 1 4 5 116 4 38 11 281 292 TOTALS I 139 1 4 25 223 67 135 94 501 595 STATISTICS Table No. 17 PATIENTS REFERRED DURING 1965 REFERRED BY Mentally 111 Psychopathic Subnormal Severely Subnormal Total GRAND TOTAL Un'r 16 Over 16 Un'r 16 Over 16 Un'r 16 Over 16 Un'r 16 Over 16 Un'r 16 Over 16 General Practitioners 112 — — — — 112 112 Hospitals or discharge from inpatient treatment — 136 — 7 — — — — — 143 143 Hospitals, after or during outpatient or day treatment — 2 — — — — — — — 2 2 Local Education Authorities — — — — 7 — 4 — 11 11 Police and Courts 1 — — — — — — — 1 1 Other Sources — 1 — — — — — — — 1 1 TOTALS — 252 — 7 7 — 4 — 11 259 270 been attending the hospital every Monday and Thursday morning, visiting as a matter of routine, admission wards, and going to other wards when a specific request by a Consultant Psychiatrist was made. The Mental Welfare Officers have the use of a room to write notes and see patients, and every facility has been extended to them. Case discussions with the Consultant Psychiatrists are of great value in, order to clarify treatment goals and focus social work help where it is most needed. The after-care referrals, amounting to 96 for last six months of 1965, have been channelled through the Hospital Senior Psychiatric Social Worker, Mr. Hayter, who has introduced improvements into the referral system. A meeting reviewing the liaison and after-care arrangements between the Hospital and the Community Care Services will be held in the hospital in October, 1966. (b) (i) Links with the Ingrebourne Centre at St. George's Hospital In April, 1965, first links with the Centre were established, and since May of that year, the psychiatric social worker and mental welfare officers have been responsible for working with a group of discharged patients from the Centre (see below—Ardleigh Green Group). Also, a number of meetings between the staff of the Centre and the representatives of the M.O.H. were held and in order to effect closer co-operation between the Mental Health Services and the Centre. Two discharged patients were placed into the Council's mental after-care hostel, and regular participation of mental welfare officers in groupwork with the senior citizens at the Centre was planned to start in January 1966. (b) (ii) Ardleigh Green Group Groupwork is directed towards giving people a constructive living experience of membership in a group so that they may develop further and adjust better as individuals, and be better able to contribute to the life of the community. A group, and particularly a group of fellow sufferers, can very effectively help minimise, control, or resolve individual problems in a social setting where expression of strong feelings and open discussion seems easier than in any other setting; often by painful examination, men and women help one another gain insight into their exaggerated feelings, response, etc. The Ardleigh Green Group which meets twice a week (2 p.m. - 4.30 p.m. Tuesdays and Fridays) at the Ardleigh Community Centre, is attended by discharged patients from the Ingrebourne Centre, all suffering from residual deep-seated neuroses. 50 (c) Psychiatric Out-Patient Clinic at Harold Wood Hospital After detailed preliminary discussions and planning (in October and November, 1965) with Drs. Neustatter and Gaitonde and the Group Medical Social Worker, a Mental Welfare Officer, began to attend Out-Patient sessions on Monday afternoons in order to provide social work help and support to newly referred out-patients and to those who are seen by the Consultant Psychiatrist prior to their discharge. Though it is difficult to categorise types of problems from the small number referred before the end of 1965, it would appear that the majority of those persons referred suffer from phobic anxiety states and/or depressive illness, many of whom attempted suicide. Social history and investigations always prove time-consuming, and these patients need a great deal of support and help with their complicated and disturbed inter-relationships. Social Clubs The "THURSDAY CLUB" is a psychiatric social club, which was opened in mid-October, and is run by the Mental Welfare Officers for discharged patients from Warley Hospital and for the residents at Collier Lodge Hostel. Referrals also come from other M.W.O.'s and Social workers in other agencies. Relatives and friends are encouraged to attend as well, in order to provide a balanced group and activities. Those socially isolated because of their condition, need a great deal of help in establishing social contact with others and in joining in club activities. The average attendance has not been high due to lack of new referrals and the most successful social gathering took place on 18th November, 1965, when the attendance was over 30. The club is open for other social workers to visit and liaison with Warley Hospital staff has been established. ADMISSIONS TO HOSPITALS The following Table (No. 18) shows the number of admissions to hospitals during the period 1st April, 1965, to 31st December, 1965. Table 18—ADMISSION TO HOSPITALS BETWEEN 1.4.65 to 31.12.65 Informal admissions 26 Section 29 (72 hours) 101 Section 25 ( 28 days) 10 Section 26 (12 months) 1 Section 60 (Court Order) 1 51 It would appear from the above table that admissions to hospitals appears to be biased towards the use of emergency Section 29, and it should be remembered that some of these figures are concerned, at a later stage, with those persons who are referred to the Health and Welfare Department for after-care. The Health and Welfare Department provided assistance in arrangements of all admissions in Table 19, mostly to Warley Hospital, a few to Goodmayes, Runwell and South Ockendon Hospitals. Since a great majority of admissions to psychiatric hospitals are within informal procedures, i.e., between the G.P. and the hospital, it is expected that a future development of the service will show an increase in the numbers of informal admissions with the assistance of the Health and Welfare Department as well as an increased number of after-care referrals following an informal admission. MENTAL SUBNORMALITY The two categories 'subnormality' and 'severe subnormality' defined in the Mental Health Act 1959, replace the older term of 'mental deficiency' for this type of mental disorder. 'Subnormality' is defined as a state of arrested or incomplete development of the mind (not amounting to severe subnormality) which includes subnormality of intelligence and is of a nature or degree which requires or is susceptible to medical treatment or other special care or training of the patient. Severe subnormality means a state of arrested or incomplete development of the mind, which includes subnormality of intelligence and is of such a nature or degree that the patient is incapable of living an independent life, or of guarding himself against serious exploitation, or will be so incapable when of an age to do so. The Council has the duty of ascertaining subnormal persons in their area and, where necessary, of arranging for their care. Care nowadays is for the most part arranged in the community, and in the majority of cases this is adequately provided for in their own homes, only a small proportion of persons requiring other residential care. As an alternative to residential care hostels are provided by the local authority who can also employ foster parents where advisable. The local authority has the responsibility of providing aftercare facilities for mentally disordered patients and statutory supervision. This necessitates the appointment of social workers to act as welfare officers under the provisions of the Act, and the provision of centres or other facilities for training or occupation. Severity of disability varies considerably in cases of mental retardation, some being very severely handicapped with little appreciation of their surroundings, incontinent and unable to do anything for themselves. Such cases, when living at home, create an inevitably heavy burden for their families, and residential care is not always available even for such severely handicapped cases. 52 The local authority should therefore aim not only at providing training and occupation for the higher grade cases to develop their potential, but should also give support in those homes where the more severe cases reside and provide a day care service and shortterm care to allow parents some respite from the continued strain for periods during the day and for holidays. It will be seen from Table 16 that the number of mentally subnormal children and adults being cared for within the community totalled 450. Training Centres The Borough has a comprehensive Training Centre providing day care which includes social training, education and occupation for 72 junior and 50 adults. It became obvious from early on in the life of the new Health and Welfare Department that this provision was inadequate and, as mentioned in my introductory letter, this problem has been recognised by the Council and the Ministry of Health and plans are going forward for a purpose-built Adult Training Centre providing 200 places. The Junior Training Wing has continued to provide social training and basic education and it is pleasing that there was little difficulty in filling the staff vacancies that occurred. A very close working relationship was built up between the staff at the Centre and the parents. Included in the Junior Centre are ten Special Care cases. It is hoped that the Special Care Unit will be provided during 1966. Adult Training Wing Overcrowding presented a problem at this Centre, but in spite of this great strides were made in increasing industrialisation during the year. Through the efforts of the Supervisor contracts were obtained from various firms in the locality of the Centre and other departments within the Authority have begun to realise the potential of this Centre and have promised to place contracts with the Centre in the future. Parent/Teachers' Association An exciting venture was the formation of a Parent/ Teachers' Association. On my initiative parents of children and adults attending the Centre were invited to an exploratory meeting on 28th July at which it was decided to set up a Parent/ Teachers' Association with Officers of the Health and Welfare Department accepting vital roles for the initial twelve months, with the intention of the parents themselves assuming responsibility after this. Much good will no doubt accrue from this association, and the help of the parents in this direction is greatly appreciated. 53 RESIDENTIAL CARE OF THE MENTALLY DISORDERED Collier Lodge. As a short-stay hostel for 26 persons with history of psychiatric illness, mostly men and women on discharge from Goodmayes and Warley Hospitals. It is a mixed hostel and the age range of the residents is between 16-62 at present. The hostel serves as a half-way house between the hospital and community with emphasis on working and social rehabilitation. The hostel placement offers an opportunity of assessment and support for the patient who is leaving hospital but whose return home is neither possible or desirable. Staffing. Since the hostel was opened for admissions of residents in February 1965, the first Warden and his wife (an Assistant Warden), both trained mental nurses, worked for most of the year without assistance of other staff. Early in December, the couple left, and a female resident Assistant Warden was transferred to the Hostel from one of the Council's Old People's Homes. Selection Criteria. The Warden and the Senior Psychiatric Social Worker/Senior Mental Welfare Officer interview all applicants who are expected to be free from florid and disturbing symptoms, employable and preferably already settled in work to which they can continue to go from the hostel. They are expected to express positive desire to come to the hostel and assessment is made as to their ability to relate to others in a social group; thus social performance of the applicant is more important than his past illness, duration of his illness or number of hospital admissions. The residents have individual interviews with the Psychiatric Social Worker who with the Warden also leads weekly group discussions about the everyday problems as well as problems arising from living in a hostel group. They are also encouraged to attend the "THURSDAY CLUB" which provides "after-care" facilities. The allocation of places in the hostel is determined by the Minister of Health as follows :— To the ESSEX County Council — 13 places, the remaining 13 places to be shared by Barking, Havering, Redbridge and Waltham Forest, Havering being administratively responsible. The experience in regard to hostel placements has been that so far there has been a shortage of suitable applicants for a short-stay care, who are well stabilised. Those who have been interviewed and not accepted, were likely to require indefinite hostel placement, were alcoholics or known to have been socially disruptive and aggressive. (The under-occupation in short-stay hostels for mentally ill has been frequently reported, and it appears that a new hostel begins to enjoy full occupancy after twelve to eighteen months in operation.) There are other factors limiting the full use of hostel places:— 54 (1) board and lodging charges:—patients in psychiatric hospitals who go out to work, pay maximum of £3 15s. p.w. In hostel, charges vary according to earnings: a resident earning £16 p.w. may pay £8 p.w.; another earning £6 pays less than £2. Deductions of two-sevenths from the charge for board/lodging is made when the resident spends weekend away from hostel. (2) Collier Lodge provides a short-stay hostel care and, at first, it was thought that a placement of up to six months duration was desirable. The lack of suitable referrals has led to an alteration in the standards of selection, based also on experience that some residents will take much longer than others to adjust to the responsibilities of living away from hospitals (i.e. adjustment to independence and free choice of action). The duration of short-stay placement is beginning to be interpreted as of up to two year hostel care in appropriate cases, which makes selection of applicants somewhat wider. (3) While in 1965 shortage of Warden staff persisted, the number of residents was advisedly kept constant between 12-16. An Assistant Warden was appointed towards the end of 1965 but the Warden and his wife left shortly after the Assistant's appointment. Admissions and discharges Over the period 7th February, 1965, to 31st March, 1965, two men and one woman were admitted from Barking, one man and one woman from Redbridge and one woman from Waltham Forest, one from Havering and one from Newhani. Between 1st April, 1965, and 31st December, 1965, four admissions were from Barking (three men and one woman), nine from Essex (five men and four women), ten from Havering (five men and five women), three from Redbridge (one man admitted twice, and one woman also a re-admission), three from Waltham Forest (one man and two women), and one man from Haringey. The pattern of discharges is shown in the following table. TABLE 19 Discharged to Men Women Total Hospital 5 5 10 Home 2 4 6 Lodgings 6 5 11 Total 13 14 27 At 31st December, 1965, there were 11 residents in the hostel. In 1965, out of the 58 referrals, 46 were offered a place but only 38 were actually admitted. The remaining 12 were either unsuitable for short-stay hostel care or failed to show interest in coming to the hostel. The average stay was approximately 88 days (three residents completed one year stay). 55 WESTMARSH LODGE Wastmarsh Lodge is a purpose-built hostel offering a permanent placement for 30 mentally subnormal and severely subnormal men and boys in the age group 16 to 60, whose I.Q.'s range from the twenties to the seventies. The residents include those who are also suffering from another handicap, such as speech impairment, epilepsy, incontinence, psychotic overlay and in one boy autistic-like withdrawal. The majority of the residents attend the training centre at Gallows Corner. They are all in receipt of National Assistance Benefit and contribute towards the cost of their maintenance in the hostel. Four residents were able to follow remunerative employment during the year 1965, and two of them were discharged into lodgings and continued in their jobs. The hostel care focused on personal independence, social and emotional development as well as sports and team activities out of doors. The hall at the Training Centre is available for the residents during winter weekends and holidays. Though the hostel is a non-familiar setting, the policy has been to foster favourable features of family life as much as they can be reproduced. Before the hostel opened for admission of residents in November 1963, the administering authority (the Essex County Council) engaged a married couple with a young child, the Warden being a trained mental nurse and his wife (an Assistant Warden) being a qualified teacher of maladjusted children. During the year there were no major staffing problems at the hostel. The allocation of places in the hostel was determined by the Ministry of Health and as in the case of Collier Lodge Hostel, half of the places were allocated to the Essex County Council Health Department, the remaining 15 to be shared "on the basis of need and urgency " by the London Boroughs of Barking, Havering, Redbridge and Waltham Forest. The administrative responsibility for Westmarsh Lodge was transferred on 1st April, 1965, to the London Borough of Havering. Admissions and Discharges During the year 16 admissions and 8 discharges were effected and at the 31st December, 1965, the hostel was fully occupied. The waiting list included 3 from Barking. 2 from Havering, 1 from Essex County Council and 1 from Waltham Forest. Whenever a vacancy occurred, the Warden with the Senior Psychiatric Social Worker or Senior Mental Welfare Officer interviewed the applicant and the urgency and need was carefully assessed. The Hostel has been fully occupied since September, 1965 (21 months after opening). New referrals are expected regularly in July of each year from special residential schools, and at unexpected intervals when the subnormal or severely subnormal person loses his parent(s), or when the parent needs to undergo hospital treatment. Good liaison between the voluntary organisations and the hostel has been maintained. The South Essex Society for Mentally Handicapped Children continued to offer rent-free holidays 56 for the residents at their bungalow at Greatstone-on-Sea, Kent; and the Inner Wheel, Harold Hill and Harold Park, organised an appeal and a Garden Fete in June, 1965, and presented a Mini-bus for the use of the hostel residents. The Mini-bus is used for outings, attendance at a Social Club on Wednesday evenings, and during the holidays. OTHER RESIDENTIAL CARE A. Subnormal children and adults :— (1) 2 boys, one in a residential school at Buntingford (for subnormal epileptic children), second in the Holliwell Lodge Hostel, Colchester (E.C.C.). (2) 5 women, two at a registered private home at Canvey Island, two at Eastwick House Hostel, Colchester (E.C.C.), and one at Fairlop House (N.A.M.H. Hostel), E.ll. (3) 1 man at the N.A.M.H. Hostel, Fairhaven House. B. Mentally disturbed/recovering adults:— (4) 2 women, 1 at the M.A.C.A. Hostel at Ipswich, second at the Richmond Fellowship Hostel at Sth. Darenth, Kent, and (5) 1 man at Richmond Fellowship Hostel at East Moseley. During the year temporary residential care was provided for 22 subnormal/severely subnormal persons as follows:— In Hospitals 4 Local Authority Homes 6 Voluntary Homes 12 22 CARE OF THE PHYSICALLY HANDICAPPED Details of handicapped persons registered with the Borough as at December 31st, 1965, are shown in Table 15. It will be seen that the highest number are those who have some form of physical handicap, and I have no doubt that this section of the handicapped population will require increased attention in the future. The number of persons suffering from some form of physical handicap at 31st December, 1965, was 621. This absolute number is not so important, perhaps, as the fact that the number of such persons being brought to the attention of the department increased, principally because of a greater awareness by the population of the Borough, medical practitioners, hospital services and voluntary organisations, of the community care facilities available. (a) Domiciliary Services The following services are provided by the department:— (i) supportive and review visits by Social Welfare Officers and Health Visitors (ii) nursing care by District Nurses 57 (iii) home care by Domestic Help Service (iv) Meals - on - Wheels, provided in conjunction with the Women's Voluntary Service and HOPWA (v) Night attendants to help in the night care or ill or handicapped persons. (b) Accommodation (i) Community Care The aim is to permit a handicapped person to remain within the community for as long as possible. When the accommodation is unsuitable it can be adapted by, for example, fitting a hand rail or constructing a ramp for a wheelchair. Between April and December, 1965, seventeen adaptations to premises were made. Arrangements have been made with the Borough Architect that where large-scale adaptations are requested on behalf of a handicapped person, members of his staff would scrutinise the plans and advise generally. I am most grateful to the Borough Architect for this. Occasionally the accommodation was totally unsuitable and the Housing Committee agreed to provide five specially constructed homes each year for such cases. These are being planned in consultation with the Borough Architect, who arranges for that member of his staff who is drawing up the plans to visit the handicapped person to familiarise themselves with the problem. I am most grateful to the Housing Manager and his Committee for their help in this respect. (ii) Residential Care A proportion of handicapped persons require residential care, permanent or temporary, and at 31st December, 1965, eleven persons from Havering were accommodated outside the Borough in homes run by voluntary organisations, including the Shaftesbury Society, Cheshire Homes, Salvation Army Homes. (c) Occupation (i) A handicapped person may need special help in finding suitable employment. Up to the age of 18 years this can be provided by the specialist youth employment officer shared between Havering, Redbridge and Barking, but after that age the Disablement Resettlement Officers of the Hornchurch, Romford and Dagenham (for the Rainham area) Labour Offices are responsible for arranging employment, and training or rehabilitation courses. Over 2,000 persons in Havering are on the registers of these officers. The Disabled Persons (Employment) Acts (1944 and 1959) oblige employers to fill at least three per cent, of staff vacancies with persons on these registers. Certain occupations (lift attendant, car park attendant) were virtually confined to persons on these registers. 58 If employment in industry is not possible the handicapped person is provided for in a purpose-built occupation centre at Faringdon Avenue. This sixty-place centre, opened in November, 1965, provides facilities for social contact and occupation of physically handicapped persons and a variety of activities are undertaken: handicraft, light industry contract work, printing, photography, gardening, etc. The period from the opening until December, 1965, was one of settling in, but the number of pensons who could attend was limited by the lack of transport. The Council recognised this and an order was placed for a further larger vehicle which should be available by the middle of 1966. A more comprehensive report of the work of this Centre will be contained in the Annual Report for 1966. (ii) Housebound handicapped persons can undertake outwork through normal commercial channels, or occupational therapy, and the Borough is fortunate in having an Occupational Therapist on their staff, who reports as follows :— (i) Domiciliary Service There were 73 on the register during this period, during which 232 domiciliary visits were made, and 60 other visits. A number of the people were subsequently transferred to the Occupation Centre when it opened. Some people were not eligible for Occupational Therapy at home as they were already attending the Hospital Department. Some were not suitable or did not wish to enter the scheme. Others needed intensive work to prepare them for work at the Centre. (ii) Residential Homes There were 33 on the registers, with weekly classes being held at each of two homes. The numbers at these classes fluctuated at first, but an active group was working in each home. This work would not have been possible to carry out without the assistance of three students from the Ardleigh College of Further Education, who assisted at 'The Willows'. There is a real need for regular assistance in this project. (iii) Occupation Centre Visits were made to help set up looms, to advise and assist in the Handicrafts Section, and to help in any other way possible during the first few months while the centre was getting under way. There is scope for expansion in this O.T. service which could only be undertaken with further regular assistance. 59 Holidays There are eight main holiday centres at which Physically Handicapped persons from this Borough are accommodated. These are:— Maddison's Holiday Camp, Hemsby, Yarmouth, Norfolk Golden Sands Country Club, Dymchurch, Kent Dovercourt Camp, Dovercourt, Essex Grange Farm Holiday Camp, Chigwell, Essex Lulworth Court Holiday Home, Westcliff, Essex Westbourne Lodge Guest House, Clacton, Essex The Bedfont Home for Paralytics, Clacton, Essex Maitland House Convalescent Home, Frinton, Essex In general, Registered physically handicapped persons are recommended for holidays by the visiting Social Welfare Officer who is familiar with the particular homes catering for specific individual needs. Periods of one week, two weeks and in special cases up to two periods of two weeks mainly during the summer season, are used to provide considerable relief and benefit to both handicapped persons and those looking after them. Financial assistance is given by this Borough based on an assessment of financial circumstances and in some cases the full cost of the holiday and transport is borne by this Authority. Maddison's Holiday Camp, Yarmouth Golden Sands Country Club, Dymchurch The Essex Physically Handicapped Association book these two camps for two fortnightly periods at each camp during the summer. These camps provide chalet accommodation for most disabilities, approximately 350 and 200 persons respectively. Last summer 50 persons went to each camp from this Borough and it is hoped to send the same number this year. The Association arrange transport from a central point in the district direct to the camps. The cost per person is £11.5.0 per week including transport. Dovercourt Camp, Dovercourt, Essex The Shaftesbury Society run this camp which is composed of purpose-built chalets accommodating 28 disabled people for fortnightly periods. Last summer approximately 20 people went from this Borough and it is anticipated that the same number will be going this year. The Society charter a special train which runs from Liverpool Street Station, London, to Dovercourt. This Borough arranges with the Hospital Car Service to transport persons from their home address to meet the parties going from Liverpool Street. The cost per person of accommodation is £15.15.0 per fortnight and this includes fares from Liverpool Street Station. Grange Farm, Chigwell, Essex This is a Holiday scheme for the physically handicapped run by the Women's Voluntary Service Winged Fellowship for the Disabled. It is a purpose-built chalet camp providing accommodation for 32 guests. 12 places have been applied for this year for persons 60 from this Borough, and 12 went last year. Transport arranged by this Department is usually carried out by the Hospital Car Service. Fees at the camp are £7.7.0 per person. Lulworth Court, Westcliff This is a holiday home run by Dorincourt Estates for 20 severely paralysed men and women. It is specially adapted for the severely disabled and a number of aids are provided. Approximately 20 persons went from this Borough last year and the same number hope to be accommodated this year. Transport is arranged by this Borough and carried out by Hospital Car Service. Fees £8.8.0 per week. Westbourne Lodge Guest House, Clacton, Essex This Borough has obtained a block booking of all available places at this privately owned guest house for the two weeks August 27th - September 10th. Accommodation is for 20 people and fees are £6 10s. 6d. per week. The Bedfont Hotel, Clacton The Spastic Society own this small home. It caters for eighteen cerebral palsied men and women and is open all the year round. This Borough usually sends five or six pensons from this area during the year. Transport arranged by this Department is by the Hospital Car Service. Maitland House, Frinton, Essex This is a convalescent Guest House run by the Maitland Trust. It accommodates 17 women. Three or four persons from this Borough have holiday periods of up to 14 days. Fees : 8-12 guineas per week. In addition to the above holiday centres individual holidays are arranged for the spring course organised by the Essex Physically Handicapped Association at the Writtle Institute, and the course for young people at Avon Tyrrell run by the National Association of Youth Clubs. Other Services (i) Purpose-built vehicles are provided to transport the handicapped to and from training centres, holiday homes and social centres. (ii) Alterations to premises and the issue of special equipment. (iii) Registration of and issue of badges to Disabled Drivers— at the end of the year some 20 badges had been issued. SERVICES FOR THE BLIND & PARTIALLY SIGHTED Services for the blind and partially sighted are perhaps the most comprehensively developed of all welfare services. Coordination between the senior medical and social welfare officers of the Health and Welfare Department and the head of the Ophthalmic Department at Oldchurch Hospital insure that the standard of service is maintained at a high level. 61 (a) Blind. The Table 20 shows the number of registered blind persons in the Borough as at 31st December, 1965. TABLE No. 20 Sex Age Groups Total 0-4 5-15 16-20 21 -49 50-64 65 + Male 1 3 3 28 15 81 131 Female 2 1 1 17 31 151 203 Total 3 4 4 45 46 232 334 During the period 1st April to 31st December, 1965, there were 25 new registrations as shown in Table 21. TABLE No. 21 Sex Age Groups Total 0-4 5- 15 16-20 21-49 50-64 65 + Male – – – – 2 8 10 Female 1 – – – 1 13 15 Total 1 – – – 3 21 25 40 names were removed from the register; 34 through death and 6 having moved out of the borough. Employment Blind persons in employment totalled 31 (see Table 22), consisting of 2 in special workshops, 3 Home Workers, 26 in open employment. TABLE No. 22 OCCUPATION OF BLIND PERSONS IN EMPLOYMENT Typists, S/Typists, Secretaries 7 Machine Tool Operator 4 Labourers 4 Domestics/Caretaker 4 Telephone Operators 3 Basket Makers 2 Proprietors 2 Working Proprietors, Shop Managers 1 Farmers, etc 1 Boxers, Fillers, Packers 1 Boot and Shoe Repairers 1 Piano Tuners 1 Residential Accommodation The following Table No. 23 gives details of blind persons in residential accommodation as at 31st December, 1965. 62 TABLE No. 23 Residential Accommodation provided under Section 21 of the National Assistance Act, 1948. (1) Homes for the Blind 13 (2) Other Homes 15 28 Residential Homes, other than the above 2 In Hospitals for Mentally 111 3 In Hospitals for Mentally Subnormal 1 Other Hospitals 14 Partially Sighted Table 24 shows the number of registered partially sighted persons as at the 31st December, 1965. TABLE No. 24 Sex Age Groups Total 0-4 5-15 16-20 21 -49 50-64 65 + Male – 8 1 13 5 15 42 Female 1 3 1 4 8 38 55 Total 1 11 2 17 13 53 97 During the period 1st April, 1965, to 31st December, 1965, there were 24 new registrations as shown in Table 25. TABLE No. 25 Sex Age Groups Total 0-4 5-15 16-20 21-49 50-64 65 + Male – 2 – 1 – 6 9 Female – – – – 3 12 15 Total – 2 – 1 3 18 24 10 Names were removed from the register, 8 through death and 2 having moved out of the borough. The Social Welfare Officers dealing with the blind and partially sighted, apart from initial visiting and documentation of new registration, were also concerned in the under-mentioned activities :— Number of visits to blind and partially sighted people 1,494 Number of people taught braille/moon who were not newly registered 4 Number of newly registered who were taught braille/ moon 5 Number of people given handicraft lessons in their homes 6 Number of handwork classes held 75 (2 classes) Number of people who attended handwork classes 40 (2 classes) Industrial rehabilitation 2 male 63 SERVICES FOR THE DEAF AND HARD OF HEARING Table No. 26 shows the number on register as at 31.12.65. TABLE No. 26 Category & Sex Under 16 yrs. 16-29 30-49 50-64 65 + Total Deaf with Speech Male 1 1 5 2 3 12 Female 1 1 9 3 6 20 Total 2 2 14 5 9 32 Hard of Hearing Male – 2 1 – 6 9 Female – 1 2 2 14 19 Total — 3 3 2 20 28 Deaf without Sp'h Male 4 5 11 8 2 30 Female 3 8 9 7 3 30 Total 7 13 20 15 5 60 Grand Totals 9 18 37 22 34 120 In spite of repeated advertisements, we were unable to obtain a suitably-qualified person to fill the post of Welfare Officer for the deaf and dumb, but it was possible to help people on the Deaf Register inherited from Essex County Council in a number of ways. The Principal Welfare Officer attended meetings of the Romford Deaf Club, run by the Royal Association for the Deaf and Dumb, and made sure that members were aware of general departmental facilities. Also, an interpreter for special needs was provided through the Royal Association for the Deaf and Dumb, and help was given to several people in this way. The Register was checked and brought up to date with their help. The local Hard of Hearing Group, another active and welfare club, was also in touch with the Department's welfare facilities directly through the Principal Welfare Officer, and a number of welfare visits were carried out by social welfare officers. CARE OF THE ELDERLY The population over 65 years of age in the London Borough of Havering is approximately 20,000, including 6,000 over 75, of whom approximately 2,000 are housebound. By 1976 the estimated elderly population will be 22,000. The services for the elderly should be developed with as little division as possible between community and residential care, the aim being to enable elderly persons to remain in their own homes as long as possible. 64 COMMUNITY CARE I. FIELD STAFF (a) Visiting Staff This is made up of Health Visitors, Social Welfare Officers, Mental Welfare Officers. (b) Medical Auxiliaries These are District Nurses, an Occupational Therapist, a Physiotherapist. Chiropodists and Home Helps. II. SERVICES (a) Holidays 1,405 old people benefited from the arrangements made by the Department. 787 of these were provided with a holiday at a Holiday Camp at Hopton-on-Sea, 135 at a similar establishment at Dymchurch, and 483 stayed at Boarding Houses, etc., at Ramsgate. In addition to this, the Council provided financial assistance to the Hornchurch Old People's Welfare Association, who arranged a week's holiday for 280 aged persons. (b) Outings for Old People For those old people who did not go on a Council provided holiday, day coach outings were arranged and 1,053 persons availed themselves of this facility. (c) Luncheon Centres The Luncheon Centre scheme for old people was expanded during the year by the opening of five additional Centres; making a total of eight. Over 3,000 meals per week were being served from these centres by the end of the year. (d) Meals on Wheels This service has also expanded during the year. Four vans were engaged on delivering meals at the end of the year and some meals were being delivered by private car. A fifth van is due to be delivered early in 1966. The vans are manned by volunteers in the Romford part of the Borough by the Women's Voluntary Service and in the Hornchurch area by Hornchurch Old People's Welfare Association. The average number of meals-on-wheels delivered weekly was 535. (e) Workshop for the Elderly This was established in 1962 and is sited at 110 Market Place, Romford. It caters for 32 elderly persons (16 at each morning and afternoon session). Various outwork under contract is taking place. 65 (f) Chiropody Details of this service can be seen on pages 19 and 20. During the year 3,215 elderly persons were provided with chiropody service. (g) Day Centres For The Elderly The Council has one purpose-built day centre at King George's Field. During the year, Hopwa House was opened by the Hornchurch Old People's Welfare Association, the Council provide financial assistance to the Association and have opened a Luncheon Centre at this house. III. ACCOMMODATION FOR THE ELDERLY (a) Special Housing Accommodation for the elderly within the community is a specialised service and an important aspect of community care. The Housing Committee are aware of, and sympathetic towards, the problems of providing special housing for elderly persons, including a percentage of new housing for this purpose within their building programme. At December 31st, 1965, the Greater London Council had provided 340 units, mostly bungalows, and the London Borough of Havering 414 units of varying types. (b) Residential Care There are four units of residential accommodation for elderly persons within the Borough at the present time, providing 320 beds, as follows :— Ravenscourt 48 beds Hillside 63 beds The Manor 51 beds The Willows 158 beds There were also 73 elderly Havering residents accommodated in residential establishments provided by other authorities. A further unit of 60 beds at Faringdon Avenue is under construction. The waiting list for residential accommodation is 100. 141 beds are occupied by other authorities — 101 at the Willows, 11 at Hillside, 8 at The Manor, 21 at Ravenscourt. As from April 1st, apart from The Willows, no further beds were available to other Authorities. During the year 50 Havering residents were admitted to residential accommodation on a permanent basis, but in addition to this 35 were admitted for periods varying from one to four weeks, particularly to enable their relatives to go on holiday. 66 (c) Registration of Old People's Homes and Homes for the Mentally Disturbed One new registration in respect of an Old Persons' Home, providing for 20 residents was effected during 1965. At the end of the year there were three homes registered, each for old persons, providing accommodation for a total of 40 persons. FAMILIES SERVICE The social worker dealing particularly with families had been doing this work in the same district before April 1965. After 1st April, 1965, he continued to help families he was in touch with before, so there was no break in the care they received. During the remainder of the year, he gave casework help to all the Havering families in Suttons — 10 families were there on 1st April, 1965, and 13 others came to Suttons between May and December, 1965. He also helped a number of others. These were families who applied for temporary accommodation as they were homeless, or who were put in touch with the Department as they were likely to become homeless, or who were so beset with problems that others — doctors, health visitors, the National Association Board — feared for their future. He was in touch with up to 40 families at any one time. Many of these families first became known to the Department because of accommodation problems. 33 families were referred between 1st April and 30th September, 1965, because of the following:— 11 were in difficulties from living with relatives, usually arising from overcrowding and domestic disputes. 5 had been given notice to quit from furnished accommodation. 4 were illegal sub-tenants in private accommodation. 3 had considerable rent arrears. 3 had matrimonial problems. 2 asked for help in maintaining their rent. 2 were behind with mortgage repayments. 1 had to leave private accommodation as the owner was selling it. 1 had to leave a service tenancy, having given up a job there. 1 had accommodation which was no longer habitable. The aim of this service is to help families work out a satisfactory future for themselves. Some of those seen during 1965 had suffered a series of misfortunes over which they had little or no control, but some were problems in themselves and the task of helping them was bound to be a long one. They suffered perhaps from poor intelligence, mental or physical ill health, low or irregular income, unemployment, more children than they could cope with, general social inadequacy. In some cases those who were parents had themselves been children of 'problem families'. Their own children stand every risk of growing up and forming 'problem 67 families' of their own if they are not helped, as they are so unable to give them the care and control children need for the vital early experience of a stable family life. The difficulties of these families have often gone on for very many years, and social work care and support sometimes has to be given them for very many years too before they can be helped to change sufficiently to break the vicious circle of instability and low standards in one generation leading to instability and low standards in the next. The Department's social work in these cases often took the form of helping the families over the immediate crisis which had often precipitated their referral to the Department. The next stage was to bring some stability into a disturbed situation — help the husband to get back into work, if he was unemployed, ensure a regular income for the family, and guidance on how it might best be spent where many debts were competing for available cash. Help was often needed to resolve bad feeling and bitterness between members of the family, or to work out good plans where it seemed unlikely that both sides would ever come together again. The social worker often found himself contacting many other offices and agencies, or advising the families how to do this, and helping them to use the many medical and social services available for their assistance. The Department has always offered help to families referred to its social workers, even though sometimes those coming to the office asking to be admitted to Suttons Hostel were refused admission there. This was only done when it seemed that they could be helped much more adequately by advising them on another course of action, and when the social worker was convinced the family would be better housed in other ways. In all such cases, the social worker continued to be available to help the family to see them through their pressing difficulties, and to work with them, when they wished, towards a more stable future. This service is extending its scope as more and more families— and individuals — are being referred to the Department who have complicated social problems to contend with. Where they are found to have problems connected with mental illness, physical disability, care of their children or of elderly relatives, a valuable result of the integration of Health and Welfare services in this department is that it is easily possible for a social worker from another section — from the Mental Health service for instance or the service for the Physically Handicapped — to be called in to help the family, and also the appropriate Health Visitor, District Nurse or other person in the Department. Temporary Accommodation Under Section 21 National Assistance Act 1948 the Borough is required to provide temporary accommodation for persons who are in urgent need thereof, being need arising in circumstances which could not reasonably have been foreseen or in such other circumstances as the authority may in any particular case determine. 68 The temporary accommodation unit is Suttons Hostel formerly administered by the County Council of Essex, passed to this new London Borough as of 1st April, 1965. It is operated on a user agreement with the other local London Boroughs of Barking, Redbridge and Waltham Forest. On the inception of this new Authority there were 10 families in Suttons Hostel who had emanated from the former Boroughs of Romford and Hornchurch. A further 13 families were admitted during the year, 10 were discharged leaving 13 families accommodated as at 31st December, 1965. Without the co-operation of the Housing Manager, Children's Officer and the Housing Officer, Greater London Council, who administers the Harold Hill Estate together with the efforts of the various officers of this department the numbers admitted to temporary accommodation would have been considerably increased. By advice, preventive measures and support for families on or under threat of eviction alternative solutions were found. Progress was made during the year in planning a new Reception Centre for Havering families, and in working out with the Housing Department how those on the Havering Housing Waiting List could be rehoused. Two meetings took place with the three other user-Boroughs to plan the running down and ultimate closing of Suttons Hostel which it was hoped would take place by 1st April. 1968. STATISTICS Suttons Hostel — Haverinsg Families Number of Families in Suttons on 1.4.65 10 Number „ Admitted from 1.4.65-31.12.65 13 23 Number „ Discharged from 1.4.65-31.12.65 9 Number „ in Suttons as at 31.12.65 14 23 Of the nine families leaving Suttons during the year:— 6 Made their own arrangements for accommodation. 2 Rehoused by Havering Council. 1 Rehoused by Greater London Council. During the period 1.4.65-31.12.65, 52 applications for Temporary Accommodation were dealt with. STUDENT TRAINING AND VISITS OF OBSERVATION An important aspect of the function of the Health and Welfare Department is providing supervision of the practical work of students undertaking Courses. Although much additional work had to be done during 1965, organising the social work services, and the staff were very fully occupied taking over new duties, it was found possible to continue 69 to help students during their training by welcoming them to the welfare section and introducing them to the work being done there. This is becoming more and more a function for social worker sections in local authorities. Departments which employ professionally qualified workers are frequently approached by Universities and Colleges of Technology to help provide practical work under skilled supervision for their students. A specially close relationship has been built up with the Barking Regional College of Technology, which runs a two-year National Certificate Course in Social Work and has close associations with Local Boroughs including Havering. The following are some examples:— (a) During 1965 a student from the Barking Course stayed for three weeks at Collier Lodge and worked also at Westmarsh Lodge in order to gain experience of residential work with the mentally disordered. The Department was able to arrange for her to have the temporary status of an Assistant Warden during this time. (b) Later in the year the Department provided a supervised placement in casework in the Mental Health Section for a student from this same Course. She stayed five months, attending three days a week and working under the direction of the Senior Psychiatric Social Worker (the other two days a week she spent at Barking College, combining in this way, as is usual on these Courses, both theory and practice). (c) Two students from the Barking Course in social work came to the Department on three separate days to study the work being done for the elderly, the physically handicapped, and the mentally disordered. (d) Twenty-one Student Nurses from Oldchurch Hospital also came to the Welfare Section for half a day each and were introduced to some of the services provided by the social workers. Contact was made with the London Boroughs Training Committee. A close working relationship has now been established, so that the Department is being increasingly used for practical experience by people from other Boroughs taking part in training activities run by the Committee. Senior staff of the Social Work Section are helping with Courses run by the Committee, and Social Workers in the Department are taking part in training opportunities provided by that Committee. 70 SECTION IV GENERAL ENVIRONMENTAL HEALTH SERVICES The Associate Medical Officer of Health, Dr. James Gorman, M.B., Ch.B., D.P.H., F.R.S.H., and the Chief Public Health Inspector, Mr. M. F. G. Randall, M.A.P.H.I., M.R.S.H., report as follows:— The impact of the new Authority upon environmental health was cushioned by the fact that the bulk of the work involved was already being carried out by both Romford and Hornchurch although substantial new responsibilities were added. Under the somewhat difficult conditions which prevailed in the settling down period of the new Authority the general standard of the environmental health services of the district was well maintained during the whole of 1965. A genuine effort was made by the staff to adopt the better features of each Local Authority's administration and this should show beneficial results in due course. The progress by the inclusion of a further 7,000 houses within Smoke Control Areas was noteworthy. In pursuing the policy of making the Borough smoke free as quickly as possible, the pollution from the ever-increasing number of cars must not be forgotten. At present very little can be done by Local Authorities to deal with this problem and all that can be hoped for is that the results of international scientific research will come to fruition and be put into effect very soon. In the meantime, we are concentrating on diminishing drastically the atmospheric pollution which is preventable here and now. It is gratifying to see that the provision for the safety, health and welfare of those employed in shops and offices is improving the existing conditions which for many years have been of a comparatively low order. In spite of the shortage of staff, approximately 28,000 visits or inspections have been made and from this report can be seen the wide scope of all the activities involved. At the end of the year we were five Public Health Inspectors short which meant a reallocation of duties so that essential work— infectious disease enquiries, complaints, meat inspection and smoke control adaptations—was given priority. Routine inspection of houses, factories and food shops was necessarily limited to some extent because of this shortage. The Council has given approval to the appointment of a second Authorised Meat Inspector who will make a considerable contribution to the work of the section as, apart from being able to give the whole of his time to meat inspection, he will to a greater extent release a Public Health Inspector for other work. Three Student Public Health Inspectors were receiving training at the end of the year and the appointment of a fourth student is imminent. 71 CLEAN AIR The Hornchurch (No. 6) Smoke Control Area became operative on the 1st July, 1965, and, at the end of the year some 2,154 claims for grant for works of adaptation had been dealt with. Eighty-five notices under Section 12(2) of the Clean Air Act, 1956, were served in connection with this Area. These notices became necessary because of the large number of applications received near to the operative date and preserved the applicant's entitlement to grant during this time lag. The undermentioned Smoke Control Orders were made by the Council during the year:— Havering (No. 1) Smoke Control Order, 1965. 725 acres. 3,505 dwelling houses: Order made 1.9.65. Confirmed by Minister 21st December, 1965. Operative date 1st July, 1966. Havering (No. 2) Smoke Control Order, 1965. 1,057 acres. 4,960 dwelling houses: Order made 8.12.65. Confirmed by Minister 24th February, 1966. Operative date 1st November, 1966. An area bounded on the north by Collier Row Road; on the west by the Havering/Barking boundary: on the east by the west side of Collier Row Lane and on the south by the north side of Eastern Avenue West. An area bounded on the south side by the Romford/Upminster railway line; on the west by the Romford/ Harold Wood railway line; on the north by the south side of the Southend Arterial Road (A.127) and on the east by the west side of Wingletye Lane. By the end of 1966 approximately half of the total number of houses in the Borough will be within Smoke Control Areas. The considerable effort made to achieve this gratifying result is worthwhile, as a purer atmosphere is of inestimable value to all residents and in particular to the aged and those with respiratory affections. AIR POLLUTION A close liaison was maintained with the Alkali Inspector to ensure that industrial problems of mutual interest received comprehensive attention. INVESTIGATION OF ATMOSPHERIC POLLUTION There are eight volumetric S02 and nine smoke filter stations operating within the Borough. Five of each of these—sited in the northern part of the Borough—are connected with the national survey undertaken by the Department of Scientific and Industrial Research (Warren Spring Laboratory) and the remainder record the amount of certain atmospheric pollution in other parts of the Borough. Daily readings are assessed and recorded and the results passed at the end of each month to the Warren Spring Laboratory at Stevenage. These figures are then integrated with those from other authorities as part of a national survey. 72 It would appear from the graphs kept in the Department that over the last few years the smoke is lessening but the SO2 content remains fairly constant. Four notices of installation or applications for prior approval in accordance with Section 3 of the Clean Air Act, 1956, were submitted to the Council during the year. PUBLIC RELATIONS Talks on subjects of Public Health importance were given to various local organisations of the Borough and to various students by members of the staff. Food Hygiene and Clean Air were the main topics for discussion. Thanks are due to Mr. Glyn Richards, Public Relations Officer, for his ready help and advice and assistance in giving fullest publicity to items affecting the work of the Department. LAUNDRY SERVICE FOR THE INCONTINENT This service was originally started under the provisions of Section 84 of the Public Health Act, 1936. The number of cases receiving the service at the end of the year was 32. The number of garments washed during the year was 12,960 and the number of visits paid to these cases for collection and delivery was 3,052. This service is appreciated very much by those receiving benefit and its importance is in no way reflected merely by the number of cases dealt with. HOME SAFETY Home Safety propaganda through the year was disseminated in Schools, Clinics, Women's organisations, Doctors' waiting rooms. Shops—particularly Chemists and Druggists—and Factories. It mainly took the form of talks and discussions, exhibitions and distribution and display of posters and leaflets and dealt with the various seasons of the year, i.e., fire danger in winter, falls during spring, accidents from fireworks on Guy Fawkes night. CARBON MONOXIDE POISONING At an inquest on an elderly person who died as a result of carbon monoxide poisoning from a kitchen boiler with an external asbestos flue, the Coroner expressed concern regarding other similar boilers which might be potential killers. The Public Health Inspectors sought and checked outside flues and investigated boiler working conditions. Whilst it was not possible to carry out a door to door investigation throughout the whole Borough it appeared that only an insignificant number of houses have kitchen boilers with uninsulated external asbestos flues. Where enquiries elicited the presence of fumes from this type of boiler installation advice was given as to the proper working of the appliance. At the Coroner's request full publicity was given to the dangers involved and a hand-out advising suitable safety precautions was made available to the Press through the Public Relations Officer. 73 The Public Health Inspectors have continued their observations in this connection and investigated any further boilers with external asbestos flues. SWIMMING POOLS There were two indoor public, one indoor school and six outdoor school pools in use during the year. Thirty-five samples of water were taken from these for bacteriological and chemical examination. In general, a high quality was maintained except that two samples, both from one outdoor school pool, were unsatisfactory. This was found to be due to clay being thrown into the pool from the adjoining road. The water in this pool was replaced and a wall was built round the pool to prevent a recurrence of this trouble. The Borough Engineer and Surveyor reports that the following work was carried out during the year:— Hornchurch Baths Re-tiling of foot baths. Improvements to lighting to foyer, etc. Improved drainage in the plant room. Re-decorations of plant room and workshop. Romford Baths Re-decorations of public rooms and provision of new cubicles on bath side. TABLE No. 27 Category (of trade) No. of Premises No. of Premises fitted to comply with *Reg. 16 No. of Premises to which †Reg. 19 applies No. of Premises complying with †Reg. 19 Bakehouses 17 17 17 17 Butchers 153 153 153 153 Cafes 118 118 118 118 Confectioners (Bread, etc.) 52 52 52 52 Confectioners (Sugar) 240 232 212 212 Fish Shops 56 56 56 56 Grocers 303 303 303 303 Greengrocers 164 164 164 164 Ice Cream Manufacturers 2 2 2 2 Clubs 20 20 20 20 Public Houses 73 73 73 73 School Canteens 80 80 80 80 Staff Canteens 79 79 79 79 Off Licences 32 32 20 20 TOTALS 1,389 1,381 1,349 1,349 *Regulation 16 deals with the provision of wash-hand basins. †Regulation 19 deals with facilities for washing food and equipment. 74 FOOD HYGIENE (GENERAL) REGULATIONS, 1960 The level of food hygiene is constantly rising and the Public Health Inspectors have been vigilant in seeing that the Regulations are complied with. The co-operation of the public in bringing to the attention of my Department and to the shopkeepers concerned any causes for complaint would be welcomed in our joint efforts to obtain the highest level of hygiene possible. Ministry of Health Circular 1/66 requests details of food premises grouped in categories of trade and including information for each category as shown in Table No. 27. Court proceedings were taken in respect of the following offences against these regulations:— Alleged Offence Result Smoking while handling open food (Reg. 9) Fined £2 0s. 0d. Smoking while handling open food (Reg. 9) Fined £2 0s. 0d. Smoking while handling open food (Reg. 9) Adjourned Unclean equipment (Reg. 6) Fined £20 0s. 0d. Transportation of meat in driving cab (Reg. 29) Dismissed Transportation of meat in driving cab (Reg. 8) Dismissed Unsound Food During the year a total quantity of 10 tons 14 cwt. 40 lbs. 3 ozs. of food was voluntarily surrendered to the Public Health Inspectors as being unfit for human consumption. FOOD AND DRUGS ADMINISTRATION A total of 597 samples (47 formal and 550 informal) were taken during the year and examined by our Public Analysts. All the formal samples were found to be genuine, but 16 of the informals were found to be either unsatisfactory or incorrectly labelled. No formal action was required in these cases. In addition, 36 samples—the subject of purchasers' complaints—were also referred to the Public Analysts. One prosecution was taken, resulting in a £5 0s. 0d. fine. 112 other food complaints were dealt with, without reference to the Public Analysts. In 6 of these cases, legal proceedings were taken. The 148 food complaints are summarised briefly as follows :— Bread 25 Milk/Milk Products 24 Flour Confectionery 20 Tinned Meat 14 Meat Pies 9 Tinned Vegetables 8 Tinned Fruit 7 Sausages 7 Sugar Confectionery 5 Fresh Fruit 3 75 (Continued from previous page) Meat 3 Poultry 3 Vegetables 3 Bacon 2 Beer 2 Tinned Fish 2 Cereals 1 Crisps 1 Eggs 1 Fish 1 Jam 1 Margarine 1 Nuts 1 Offal 1 Patent Medicines 1 Pickles 1 Soft Drinks 1 The 7 cases in which legal proceedings were taken are listed as follows:— Complaints Result of Proceedings Mouldy Pork Pie Fined £25 0s. 0d. costs £5 5s. 0d. Mouldy cake Fined £5 0s. 0d. Mouldy sausages Fined £5 0s. 0d. Mouldy steak and kidney pie Fined £15 0s. 0d. costs £3 8s. 0d. Mouldy fruit pie Fined £10 0s. 0d. Mouldy sausages Fined £25 0s. 0d. Beetles in cheese puffs Fined £20 0s. 0d. MEAT INSPECTION REGULATIONS 1963 There are five abattoirs in the borough and Table No. 28 shows the number of carcases dealt with during the year. There was no variation in the charges—which are the maximum allowable—made by the Council during the year for meat inspection at the slaughterhouses. They are:—Cattle and horses 2/6d. each, calves and pigs 9d., sheep and goats 6d. Court proceedings were instituted against the owners of one of the slaughterhouses in respect of four contraventions of certain of these Regulations. Fines totalling £40 0s. 0d., were imposed and costs amounting to £5 5s. 0d. awarded to the Council. The Council also took proceedings against a Director of this Company for two offences under Section 105 of the Food and Drugs Act, 1955, for obstructing a Public Health Inspector. He was fined in all, £10 0s. 0d., for these offences. He was also fined £20 0s. 0d. for smoking in the slaughterhouse (Reg. 37) and £5 0s. 0d. for an offence under Section 42 of the Offences against the Person Act, 1861, for Assault. 76 CARCASES INSPECTED AND CONDEMNED The following statement shows the post-mortem inspection of animals at the five slaughterhouses in the Borough licensed by the Council:— TABLE No. 28 Cattle Calves Sheep & Lambs Pigs Horses Goats Total Number Killed (if known) 16,286 3,418 63,362 21,373 81 20 104,540 Number Inspected 16,286 3,418 63,362 21,373 81 20 104,540 All Diseases except Tuberculosis and Cysticercosis Whole Carcases Condemned 15 9 285 143 2 1 455 Carcases of which some part or organ was condemned 5,076 105 7,890 1,139 10 1 14,221 Percentage of number affected 31.25% 3.33% 12.90% 6.00% 14.81% 10% 14.03% Tuberculosis Only Whole Carcases Condemned 1 — — 6 — — 7 Carcases of which some part or organ was condemned 87 – – 280 – – 367 Percentage of number affected 0.54% — — 1.34% — — 0.35% Cysticercosis Only Carcases of which some part or organ was condemned 18 – – – – – 18 Carcases submitted to treatment by refrigeration 17 – – – – – 17 Generalised and totally condemned — – — — – – — 77 FOOD AND DRUGS ACT, 1955 — SECTION 16 The Local Law (North East London Boroughs) Order, 1965, made under Section 84 of the London Government Act, 1963, came into force on the 1st April, 1965. It repealed the local legislation dealing with (a) the registration of ice cream manufacturers and vendors and their premises, and (b) the registration of persons and premises for the manufacture, preparation or storage of preserved meat, and (c) substituted Section 16 of the Food and Drugs Act, 1955, which requires the registration of premises (not persons) used in connection with the manufacture, storage or sale of ice cream or the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale. During the period 1st April-31st December, 1965, sixteen new applications for registration in respect of ice cream and three in respect of preserved food were granted. ICE CREAM SAMPLING During the year, 140 samples of ice cream were taken for bacteriological examination and were classified as follows:— Ministry of Health (Provisional) Grade I (good bacteriological standard) 76 ,, ,, „ „ II (Reasonable „ „ ) 20 ,, ,, ,, „ III (Poor „ „ ) 24 ,, ,, ,, ,, IV (Bad „ „ ) 20 Eighteen ice lollies were also taken for bacteriological examination and found to be satisfactory. Appropriate follow-up action was taken in the case of the lower graded ice cream samples which were mostly confined to "soft" ice cream sold by itinerant vendors. Eleven samples of ice cream and eleven ice lollies were submitted to the Public Analysts for chemical examination and all were found to be genuine. PRESERVED FOOD, ETC., SAMPLING Bacteriological sampling of other food products were carried out in respect of the under-mentioned commodities and in all cases they were found to be free from pathogenic organisms. Fish products 2 Milk Products 5 Other Meat Products 5 Cooked Meats 5 Shellfish 13 Sausages and sausage meat 20 Total 50 78 ESSEX COUNTY COUNCIL ACT, 1952—SECTION 103 This section which deals with the registration of hawkers of food has been in force since 1st April, 1953. During the year under review seven new applications for registration had been granted. MILK DISTRIBUTORS There are ten milk distributors with 18 registered dairy premises in the Borough. In addition, 150 shopkeepers are registered for the sale of milk in sealed containers. MILK (SPECIAL DESIGNATION) REGULATIONS, 1963, AS AMENDED The number of dealer's (pre-packed milk) licences in force at the end of the year was as follows:— Pasteurised 151 Sterilised 128 Ultra-heat Treated 8 Untreated 52 MILK SAMPLING Two hundred and thirty-four samples of milk were taken during the year and submitted to the bacteriologists for testing. Ten of these failed the Methylene Blue Test for keeping quality. Thirtynine of these samples were also examined for the presence of antibiotics and in one case a positive reaction was obtained. Details of this sample were passed to the Milk Production Officer of the Ministry of Agriculture, Fisheries and Food. Twenty-five samples of raw milk were examined (for the presence of Brucella Abortus) all with negative results. Only a small amount of raw milk is sold in the Borough but it must be emphasised that this type of milk is a potential health hazard. In addition to those mentioned above, 40 samples were submitted to the Public Analyst for chemical analyses and found to be satisfactory. THE LIQUID EGG (PASTEURISED) REGULATIONS, 1963 There are no egg pasteurisation plants in the Borough and no samples of liquid egg were submitted for the Alpha-Amylase test during the year. I have no comment to make on the second year's administration of these Regulations. PESTICIDES AND TOXIC CHEMICALS IN FOOD The Council agreed to participate in a national scheme organised by the Association of Municipal Corporations for the sampling and analysing of food to ascertain the presence of pesticides and toxic chemicals from their use in agriculture and food storage. The sampling would form part of our existing routine arrangements but an additional 40 samples would be taken for this purpose only. This action will surely be endorsed by all who are concerned with pollution of food in any form. 79 INFECTIOUS AND OTHER NOTIFIABLE DISEASES The following notifications were received during the year:— TABLE No. 29 Disease Male Female Total Dysentery 13 15 28 Erysipelas 5 4 9 Food Poisoning (or suspected food poisoning) 161 156 317 Infective Hepatitis 15 16 31 Measles 2,363 1,876 4,239 Meningococcal Infection 1 3 4 Ophthalmia Neonatorum 1 1 2 Paratyphoid Fever — 1 1 Pneumonia 3 1 4 Puerperal Pyrexia — 4 4 Scarlet Fever 102 106 208 Tuberculosis: Respiratory 51 10 61 Meninges & C.N.S. 1 — 1 Other 3 1 4 Whooping Cough 25 48 73 Totals 2,744 2,242 4.986 Of the 317 cases of Food Poisoning (or suspected) only 11 (5 males and 6 females) were confirmed bacteriologically. It is pleasing to record that no cases of Poliomyelitis, Diphtheria, Smallpox, Encephalitis, Typhoid Fever or Anthrax were notified during the year. The bulk of the measles cases occurred in the first quarter of the year and this confirmed the expectation that 1965 would be an "epidemic" year. IMMIGRANTS At the beginning of the year, the Ministry of Health communicated with local authorities regarding the special problems in connection with the health and treatment of long-stay immigrants in this country. After consultation with representatives of the medical profession and local authorities the Minister implemented a scheme whereby medical inspectors at Ports obtained destination addresses from immigrants and then forwarded these addresses to the Medical Officer of Health for the areas concerned. Arrangements were then made for a follow-up visit by the Public Health Inspector who gives (a) general information about the health services; (b) advises the immigrants to get themselves and their dependants registered with a Doctor with a view particularly to chest X-ray; (c) a hand-out card printed in six different languages including Hindi and Urdu explaining the medical services available for persons living in the United Kingdom. During the year under review forty-three immigrants were reported to the Medical Officer of Health and follow-up visits made. An annual return is made to the Ministry of Health in order that the national picture can be seen. 80 TRAINING OF STUDENT PUBLIC HEALTH INSPECTORS —MEAT INSPECTION The Council continued the arrangements with the Port of London Authority and with the Tottenham Technical College for the training of their Student Public Health Inspectors in practical meat inspection at our slaughterhouses. Eight students received personal tuition extending up to three months each. NOISE ABATEMENT ACT, 1960 The public is becoming increasingly noise conscious and 122 visits were made in this respect. Complainants were reminded that, irrespective of the Council action, they can take private proceedings and three or more occupiers of premises who are aggrieved by noise or vibration nuisance may lodge a complaint to a Magistrate. HOUSING 1,033 houses were erected during the year as follows:— (1) by the Local Authority 407 (2) by private enterprise 626 HOUSING ACT, 1957—SECTIONS 16 AND 18 Number of Demolition Orders made 6 Number of Closing Orders made 5 RENT ACT, 1957—CERTIFICATES OF DISREPAIR The following is a copy of the return under the Rent Act, 1957, to the Ministry of Housing and Local Government covering the period 1st January to 31st December, 1965: Part I—Applications for Certificates of Disrepair : (1) Number of applications for certificates 10 (2) Number of decisions not to issue certificates 1 (3) Number of decisions to issue certificates:: (a) in respect of some but not all defects 1 (b) in respect of all defects 8 (4) Number of undertakings given by landlords under paragraph 5 of First Schedule 5 (5) Number of undertakings refused 0 (6) Number of Certificates issued 4 Part II—Applications for Cancellation of Certificates: (7) Applications by landlords for cancellation 4 (8) Objections by tenants to cancellation 1 (9) Decision to cancel in spite of tenant's objection 0 (10) Certificates cancelled by Local Authority 3 81 IMPROVEMENT GRANTS AND AREAS In consultation with the Borough Engineer and Surveyor advice has been submitted to the Council in 150 instances during the year. A pilot survey was carried out of Honiton and Cotleigh Road properties in connection with a compulsory improvement area. The information has not yet been published. UNDERGROUND ROOMS The Council approved and submitted to the Minister of Housing and Local Government for confirmation Regulations made under Section 18(2) of the Housing Act, 1957, to control the use of underground rooms for human habitation within the Borough and to close such rooms if thought necessary. These Regulations, if confirmed, will provide a valuable method of tackling the minimal underground room problem (there are probably less than a dozen in the Borough). CARAVANS The control of caravans is now a joint responsibility. The Planning Department undertakes the removal of itinerant caravans and licensing, whilst the Health and Welfare Department deals with all enforcement of byelaws, hygiene control and general environmental problems. (I) The long-term problem of a permanent but unauthorised caravan site in the southern part of the Borough achieved finality with the closure of the site at the beginning of the year following compulsory purchase, the rehousing of the caravan dwellers where necessary and the storage and eventual disposal of certain of the vans. (II) A small privately run site on a farm at Noak Hill which had planning permission for 14 caravans and which permission had been extended for a period of 18 months to expire on 30th June, 1965, was also closed. The bulk of these caravans was transferred to the Council's Broxhill site. (III) The permanent site in the central part of Romford received further planning permission from the Essex County Council in September, 1964, which expires on the 31st December, 1967. The site licence limits the number of vans to 73 and requires that any caravans vacated or removed from the site shall not be replaced by other occupants or vans. Complaints were received regarding the conditions appertaining to this site and the matter is receiving the attention of the Borough Planning Officer in conjunction with this Department. (IV) There is also another privately run residential site on a farm at Noak Hill containing some 135 vans. This site is well maintained and supervised. (V) The Council owns the Broxhill Residential Caravan Site consisting of 66 caravans. This is administered by the Housing Department who maintain day to day control through a Warden who lives in a caravan on the site. 82 GYPSIES The Council agreed in principle to the setting up of a site for about ten local gypsy families. It is envisaged that the site would be self-contained with washing and sanitary blocks and controlled in the same manner as other Council-owned caravan sites within the Borough. Although no decision has been made, Gerpins tip area was thought to be the most likely site when grassed over as it is sufficiently remote from a built-up area, yet within striking distance of shops, schools, etc. It is essential to bring these people into the orbit of the community without delay, particularly as a settled abode will mean that the children concerned can be educated more readily and continuously. COMMON LODGING HOUSES There are no registered common lodging houses in the Borough. HOUSES IN MULTIPLE OCCUPATION The question of houses in multiple occupation received a considerable amount of attention during the year and a comprehensive report on this subject was submitted to the Council. The number of these premises has slowly increased from about 2 in 1960 to at least 18 in 1965 and vigorous action has been taken by the Department to improve conditions in this type of occupation. The Fire Prevention Officer of the London Fire Brigade gave assistance and advice in respect of the provision of means of escape from fire and fireproofing. Apart from the fire hazard the items with which we are mainly concerned, for which standards were adopted by the Council, are cleanliness, repair and decoration, personal and domestic washing facilities, food storage, overcrowding and rent books. Close supervision of these properties is being maintained. The houses with which we have to deal are generally smaller and more modern than the larger type of premises which are the main problem in London and Midland towns. DRAINAGE AND SEWERAGE (a) Extension of Service The Borough Engineer and Surveyor has reported that during the year the following extensions have been made to the main sewers:— 1,085 yards of foul sewers. 3,305 yards of surface water sewer. Twelve premises were re-drained and connected to the sewer during the year. (b) Cleansing of Private Sewers To facilitate the cleansing of private sewers the Council agreed to extend the practice—which applied to the northern 83 part of the Borough—to the whole of the Borough, of undertaking the work of clearing private sewers and as authorised by Section 17(2) of the Public Health Act, 1961, and to remit the payment of any expenses not exceeding £2 0s. 0d. This is a worthwhile public health measure which enables the Local Authority to deal speedily with this problem since lengthy administrative procedures are required if the sewer is privately owned. (c) 1-10, Pantile Cottages, and 1-4, Plaintile Cottages, Bird Lane The question of the inadequacy of the soil drainage serving these premises received the attention of the Council. An extension of the existing soil sewer was agreed so that the necessary conversions can be made in accordance with Section 47 of the Public Health Act, 1936 (at the joint expense of the owners and the Council). Following the service of statutory notices under Section 39 of the Public Health Act, 1936, unanimous agreement was reached with the respective owners requesting the Council to extend the sewer so that these conversions could be carried out. An appropriate sum has been allocated in the 1966/67 estimates for this purpose and the Borough Surveyor is now dealing with the matter. EMPTYING OF CESSPOOLS AND PAIL CLOSETS AND DE-SLUDGING OF SEPTIC TANKS The Council have agreed that, with effect from 1st April, 1966, they will undertake without charge the emptying of cesspools and pail closets and the de-sludging of septic tanks which are in the outlying rural parts of the Borough. To qualify for this service, it is necessary that the apparatus is properly constructed and maintained; that it is of adequate capacity and that main drainage is not readily available. The Borough Engineer and Surveyor will arrange for cesspools to be emptied at approximately six week intervals, pail closets at weekly intervals and septic tanks to be de-sludged at regular intervals (usually six to twelve months) according to their type. The number of properties whose owners have indicated that they wish to avail themselves of the free service is as follows:— Emptying of Cesspools:— Within area of former Hornchurch Urban District 246 Within area of former Romford Borough 23 TOTAL 269 Emptying of Pail Closets:— Within area of former Hornchurch Urban District 66 Within area of former Romford Borough 12 TOTAL 78 84 De -sludging of Septic Tanks:— Within area of former Hornchurch Urban District NIL Within area of former Romford Borough 29 TOTAL 29 FACTORIES ACT, 1961 Prescribed particulars on the administration of the Factories Act, 1961, as required by Section 153(1) and Ministry of Health Circular 1/66. PART I OF THE ACT 1. Inspections for purposes of Provisions as to Health: Premises No. on Register No. of Inspections No. of Written Notices No. of Occupiers Prosecuted (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 41 14 4 – (ii) Factories not included in (i) in which Section 7 is enforced by the local authority 600 358 16 – (iii) Other premises in which Section 7 is enforced by the local authority 38 44 — — TOTAL 679 416 20 — 2. Cases in which Defects were found: Particulars Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Prosecutions Want of cleanliness (s.1) — — — — — Overcrowding (s.2) — — — — — Unreasonable temperature (s.3) – – – – – Inadequate ventilation (s.4) Ineffective drainage of floors (s.6) – – – 1 – Sanitary conveniences (s.7): (a) insufficient 4 2 1 1 — (b) unsuitable or defective 16 3 2 8 — (c) not separate for sexes — — — — — Other offences against the — — — — — Act (excluding Outwork) — — 2 — — TOTAL 20 5 5 10 — PART VIII OF THE ACT OUTWORK—SECTIONS 133 and 134 Nature of work Number of outworkers in August list Wearing apparel — making, etc. 131 Box making 4 There were no instances of work in unwholesome premises. During the year 56 visits were made to outworkers' premises. 85 Rodent Control During the twelve months ended 31st December, 1965, inspections under the Prevention of Damage by Pest Acts, 1949, were dealt with as shown in the following table. TABLE No. 30 Number of complaints received and infestations found— Private Premises Business Premises Agricultural Premises Total Rats 781 123 — 904 Mice 131 30 — 161 Total 912 153 — 1,065 Properties inspected under survey— 903 156 70 1,129 Infestations found— Rats 18 6 — 24 Mice 10 10 — 20 Total 28 16 — 44 Inspections for some other reason- 3,393 3.200 – 6,593 Infestations found— Rats 4 8 — 12 Mice 2 6 — 8 Total 6 14 — 20 The Department is represented on the No. 3 Workable Area Committee, thus enabling a wider view of progress and procedure. Summary of Inspections and Visits by Environmental Health Inspectorate The main headings under which work was done is classified as follows : TABLE No. 31 Subject of Visit or Inspection No. of Visits or Inspections Clear Air Act 7,225 Public Health Acts 5,745 Food & Drugs Act and Regulations 3,898 Incontinent Laundry Service 3,052 Prevention of Damage by Pests Act 2,194 Offices, Shops & Railway Premises Act 1,275 Shops Act 1.206 Infectious Diseases 988 Housing Acts 947 Sampling 608 Factories Act 472 Noise Abatement Act 122 Diseases of Animals Act 82 Miscellaneous 81 Total 27,895 Number of Notices Served: Informal 547 Statutory 91 Total 638 86 Diseases of Animals Act, 1950 The duties under this Act were the responsibility of the Essex Constabulary, but have now been transferred to the department. The object of the legislation is to prevent the spread of animal diseases, such as foot and mouth disease, fowl pest, swine fever. This is accomplished by preventing the movement of any animal suspected to be suffering from any notifiable disease, except under a licence issued by the local Authority or Ministry. Before removing animals from Markets a movement licence must be obtained by the purchaser and a copy sent to the Diseases of Animals Inspector for the area to which the animals are being sent. This enables a constant check to be carried out on all farms and piggeries and assists in tracing the origin of any outbreak. As these diseases are no respecters of routine, staff are on call throughout the 24 hours to cope with any eventuality. In the first year 598 movement licences have been received— most of these have been in respect of animals moved into the slaughterhouses within the Borough. Eighty-two visits have been made to farms and piggeries and 53 movement licences issued. One suspect case of Anthrax was reported, but not subsequently confirmed. In cases where Anthrax or certain other diseases are confirmed it is the responsibility of the Local Authority to dispose of the carcase and/or arrange disinfection precautions. The absence of notifiable diseases in the area is an indication of the success of the long-term policy adopted by the Ministry and of the progress made in stamping out these diseases. Diseases of Animals (Waste Food) Order, 1957 Twenty-two licences to operate plant and equipment for the boiling of waste food for feeding to animals and poultry were in force at the end of the year. Court proceedings were taken against the owner of one piggery under Section 93 of the Public Health Act, 1936. A nuisance order was obtained and costs awarded to the Council. Establishments for Massage or Special Treatment At the end of the year 19 persons had been licensed by the Council to carry on establishments for massage or special treatment as required by Part IV of the Essex County Council Act, 1933. This is one of the functions transferred from the Essex County Council by the London Government Order. Employment Agencies In pursuance of the provisions of Part V of the Essex County Council Act, 1933, nine licences to carry on employment agencies within the Borough were issued during the year. This is another function transferred to the new Borough and previously administered by the County Council. 87 Pharmacy and Poisons Act, 1933 This legislation—previously enforced by the County Council— requires all persons who sell poisons which are included in Part II of the Poisons List to have their name entered in a list maintained by the Council. The requirements applying to the sale of these poisons are laid down in Section 18 of the Act, and in the Poisons Rules, 1964. One hundred and twenty-two sellers involving 189 shops had been listed at the end of the year. Water Supplies Mr. P. Gorden Spencer, Chief Engineer of the South Essex Waterworks Company, has kindly provided the following information regarding the water supply to the district: "(a) The Company's Chigwell Row Works came into operation during 1965 and the construction is completed of a 20 million gallon reservoir at Heaton Grange. (b) Length of mains laid in yards:— 3in. 701. 4in. 3,792. 6in. 1,542. 9in. 99. 12in.715. (c) The water supply of the area and of its several parts have been satisfactory both as to quality and quantity. (d) Bacteriological and chemical examinations are made of the raw water, of the water in its various stages of treatment, of the water supplied from the Company's wells and of the water going into supply. Analyses are also made of samples obtained from consumers' taps in the various parts of the Company's district and all prove to be satisfactory. A total of over 7,867 chemical, bacteriological and biological examinations have been made. In addition samples were examined for radioactivity. (e) We do not make frequent fluorine determinations but on the basis of past results, the fluorine content of the supplies is put at 0.25 p.p.m. (f) The waters are not liable to plumbo-solvent action. (g) No contamination has arisen, therefore no action has been necessary. (h) The number of dwelling houses supplied as at the 31st December. 1965, was 78,521. We are unable to state the number of houses supplied by standpipe, but the total is quite insignificant." Samples of Water In addition to the control maintained by the Water Works Management, the Public Health Inspectors have taken samples from consumers' premises for bacteriological and chemical examination as follows: Main: Thirteen samples were taken during the year from the main supply. Eight were submitted for chemical and bacteriological examination and five for bacteriological examination only. In each case a satisfactory report was received. 88 Well: Six samples were taken from wells in the Borough during the year and as is usually the case with water from shallow wells it could only be considered safe to drink provided it was properly boiled. Boiling Notices were served on the occupiers. The question of the provision of a main water supply to Pinewood Road was under active consideration by the Council at the end of the year. Rainfall The Borough Engineer and Surveyor has supplied details of the annual rainfall recorded at each of six points in the Borough by rain gauge observations, the average of the six gauges being 25.06 inches. The heaviest monthly rainfalls were recorded in July and September. Refuse Disposal The administration of the provisions of Section 146 of the Essex County Council Act, 1933, dealing with deposits of refuse is another of the functions transferred to this Authority from the Essex County Council. Sixteen such refuse dumps were functioning in the Borough at the end of the year, most of them sited in the Rainham Area. Routine visits were made to all the tips and nuisances associated with tipping were minimised. The Council refuse tips are now being controlled by the Officers of the Greater London Council. PUBLIC CLEANSING The Public Cleansing services formerly operated by the Hornchurch Urban District Council and Romford Borough Council have been maintained. A bonus incentive scheme for refuse collection has been extended to cover the whole of the area, and a weekly collection has been operated. The older type resfuse vehicles are gradually being replaced by the modern compression rear loading "Pakamatics" and the changeover should be completed next year. A new type of electric truck has been introduced to the street cleansing services. It is a "rider" type vehicle replacing the pedestrian controlled truck at present in use, and will give greater mobility and range than at present. A new public convenience was opened at Havering Green, and a number of others have been tiled to give a lighter and more easily cleaned surface. Scrap Metal Dealers Act, 1964 This Act came into operation on 1st April, 1965, and required persons carrying on business as scrap metal dealers to be registered by the Council. 89 From that date all the principal provisions of the existing law relating to old metal dealers and marine store dealers including the Old Metal Dealers (Hornchurch) Order, 1956, and the Old Metal Dealers (Romford) Order, 1953, were repealed and replaced by this new legislation. Sixty-eight registrations were made during the year. Riding Establishments Act, 1964 This Act came into operation on 1st April, 1965, and repealed the Riding Establishments Act, 1939. It forbids the keeping of a riding establishment except under the authority of a licence issued by the Council. At the end of the year four such establishments had been licensed and two others were undergoing structural and/or other works to bring them up to the required standard. Six local veterinary surgeons (working in two partnerships) have been appointed in a consultant capacity to act as the Council's authorised veterinary surgeons for the purposes of the Act. The advice of the Fire Prevention Officer, London Fire Brigade, is sought and his recommendations put into effect before a licence is issued. He also supplies notes on the installation and maintenance of small fire-fighting appliances and printed fire instructions for distribution to licensees. I would like to take this opportunity of thanking the Fire Prevention Officer for his valued and ready co-operation. Pet Animals Act, 1951 Twenty licences to keep pet shops were issued during the year. Animal Boarding Establishments Act, 1963 Seven licences to keep Animal Boarding Establishments were issued during the year. Rag, Flock and Other Filling Materials Act, 1951 Two addresses in the Borough are registered under Section 2 of this Act. The Act secures the use of clean filling materials in upholstered articles and is being complied with by the firms concerned. Shops Acts 1950-1965 This Act consolidated a series of measures from 1912-1938 and includes conditions of employment for adult and young persons employed in the retail trade and in certain wholesale premises; early closing days, hours that shops are required to close in the evening and restrictions on Sunday trading. A shopkeeper is now required to fix the early closing day of his choice and to exhibit a notice at his shop to that effect. The weekly half holiday for shop assistants still applies. Shop trading hours including Sunday have been in the "public eye" for many years. Some wish to retain its principles, others suggest it be abandoned altogether. The Home Office has 90 lished proposals to amend the Shops Acts 1950-1965 and organisations have been invited to submit their comments by the 28th February, 1966. In the introduction to these proposals it states : " Her Majesty's Government desire to make two things clear. They regard retail distribution as a key sector of the economy, in which if the national objectives for faster economic growth and rising living standards are to be achieved there will need to be, as in other sectors, greater efficiency in the use of resources and in particular greater productivity. There is also the obvious need to ensure that retail distribution provides maximum service to the community, consistent with efficient use of resources and reasonable working conditions for its employees." The results of the Home Office enquiry will be of great interest locally. A total of 1,206 visits and observations were made under the above Acts and the following contraventions were noted :— (1) Early Closing Day Failing to exhibit Notices 72 Failing to observe the Regulations 6 (2) Evening Closing Hours Failing to close shop for serving of customers 5 (3) Sunday Trading Failing to close shop on Sunday for serving of customers 15 Failing to observe the Regulations 13 (4) Conditions of Employment Failing to exhibit Notice as to Assistant's weekly half-holiday 11 Failing to allow assistant's half-holiday 5 Failing to allow proper intervals for meals and rest 1 Failing to exhibit abstract of Act and keep records of young persons 14 Failing to keep record of Sunday employment 4 Failing to allow holiday in lieu of Sunday employment 1 There were eight prosecutions for contravening the Sunday Provisions of the Act and fines of £36 were imposed ranging from £3 for a first offence to £10 for a second offence. The Council were awarded 9 guineas costs. Consumer Protection Act, 1961 This Act gives power for regulations to be made on safety requirements and construction of certain goods likely to cause death or personal injury. Many visits and inspections were made and under the Oil Heaters Regulations, 1963, a market stallholder was prosecuted and fined £3 and with 3 guineas costs for selling an unsuitably guarded appliance. 91 Offices, Sh&ps and Railway Premises Act, 1963 The main provisions under this Act came into force on the 1st August, 1964. It provides for the safety, health and welfare of those employed in shops or offices and follows closely the provisions of the Factories Act(s). Every employer has to register his premises either with the Local Authority or Her Majesty's Inspector of Factories. At the end of the year only 1,920 had registered. 315 premises were inspected fully with the following results :— TABLE No. 32 SUMMARY OF INFRINGEMENTS Section Details Number Section 4 Cleanliness 95 5 Overcrowding 17 6 Temperature 158 7 Ventilation 61 8 Lighting 24 9 Sanitary Conveniences 117 „ 10 Washing Facilities 133 .. 11 Drinking Water 16 „ 12 Clothing Accommodation 23 „ 13 Seating Facilities 7 „ 14 Seating (Sedentary) 3 15 Eating Facilities 7 „ 16 Floors, Passages & Stairs 112 „ 17 Fencing Machinery 24 22 Dangerous Conditions & Practices 11 „ 24 First Aid Provisions 144 „ 49 Registration 10 „ 50 Abstracts 99 TOTAL 1,061 Cleanliness Approximately one-third of the premises were in need of some form of cleansing — generally walls and ceilings, and some warranted the removal of accumulations of rubbish. Notices were served for the contraventions to be remedied. Overcrowding A small number of the overcrowded conditions ascertained required immediate action as they were thought likely to cause risk of injury to health. Heating In most offices heating appeared to be adequate but in shops and warehouses the position was not so satisfactory. Just over half the premises displayed a thermometer. Ventilation Problems concerning ventilation were found mostly in small shops where ventilation facilities had not been incorporated in the shop front design. 92 Lighting A survey of lighting of premises was carried out and information was submitted to the Ministry. la. Offices Lighting was found to be of a good standard in office premises as the majority had adequate natural lighting which only had to be supplemented by artificial as outside conditions demanded. 1 b. Shops In the majority of cases use was made of artificial lighting during trading hours and found to be in the main, high in the public areas. 2. Butcher's Shops were considered to be the best lit throughout with large stores a close second. Grocery and provision shops were well lit in the public areas, but other parts of the premises were poor in comparison. In small non-food premises there was little difference between the selling areas and other parts of the premises, none of which were found to be of a high standard. 3. Where poor lighting was found no specific standards were recommended to occupiers in view of the proposed regulations, although considerable reference was made to the Illuminating Engineering Society's Code as this was thought to be a suitable minimum standard. Occupiers, when asked, were agreeable to bring their premises up to that standard. 4. Glare was experienced in various instances; being unable to assess glare value, general advice only was given regarding background decor and the siting of lighting sources. Sanitary Accommodation and Washing Facilities Unclean sanitary accommodation and the lack of hot-water facilities were the main points noted. Drinking Water In a few instances the siting of the drinking water supply was unsatisfactory as it was in the water closet department as distinct from being in a separate intervening ventilated space which normally contains the washing facilities. Seating Facilities Generally were found to be good although defective chairs rarely got repaired. Floors, Passages and Stairs A considerable number of the premises visited were such as to warrant immediate action. There was an absence of handrails and guards to open sides of staircases, worn steps, defective and loose floorboards, badly worn carpets and other floor coverings. There were serious obstructions of exitways, passageways and staircases. Appropriate notices wen served to remedy the defects. 93 Dangerous Conditions and Practices Matters dealt with included electric and oil fires not adequately guarded; rickety step ladders, defective electrical wiring and fittings and badly stacked goods. The Ministry are making regulations as to ladder construction and it will be an offence to use a ladder with a step or rung missing. Accidents Local Authorities have to notify the Ministry of Labour on the number of accidents reported and these have been investigated. Table 33 gives the type of workplace and Table 34 an analysis of the accident. It will be observed in Table 34 that falls of persons are the major cause of injuries and this is the pattern throughout the country in shop or office. TABLE No. 33 ACCIDENTS — ANALYSED BY WORKPLACE Workplace Number Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Inf. Advice Offices 7 7 — 7 Retail Shops 39 32 — — 32 7 Wholesale Shops, Warehouses 3 2 — l 1 1 Catering Estabs. open to public, canteens 1 1 — — 1 — Fuel Storage Depots — — — — — — TOTAL 50 42 — l 41 8 TABLE No. 34 ANALYSIS OF REPORTED ACCIDENTS Offices Shops Retail Wholesale Warehouses Catering establishments open to public, canteens Fuel Storage Depots Machinery — l 2 — — Transport — l 1 — — Falls of Persons 10 13 — — — Stepping on or striking against Object or Person 1 4 — — — Handling Goods — 5 — — — Struck by Falling Object 5 _ Fires and Explosions — — — — — Electricity — — — — _ Use of Hand Tools — 5 — 1 — not otherwise specified — 1 — — — TOTALS 11 35 3 1 — 94 A notice was published in the local press drawing the attention of occupiers to their obligations to notify accidents. Upon general inspection where accident books were kept in the majority of cases the occupier thought this to be the extent of his liability. Many firms had no knowledge that an accident book should be kept where more than ten persons were employed as required by the National Insurance Act. Occupiers are warned that these contraventions are a serious matter and can lead to legal proceedings being instituted. Annual Report—Offices Shops & Railway Premises Act, 1963 A copy of the 1965 report may be seen by the public at the Town Hall, Romford, and is reproduced below:— TABLE No. 35 REGISTRATIONS AND GENERAL INSPECTIONS (1) (2) (3) (4) Class of Premises Number of Premises Registered during the year Total Number of Registered Premises at the end of year Number of Registered Premises receiving a General Inspection during the year Offices 24 418 62 Retail Shops 21 1,327 241 Wholesale Shops, Warehouses 3 42 3 Catering Estabs. Open to Public, Canteens 3 125 9 Fuel Storage Depots 1 8 — TOTAL 52 1,920 315 TABLE B.—Number of Visits of all kinds by Inspectors to Registered Premises= 1,275. 95 TABLE No. 36 ANALYSIS OF PERSONS EMPLOYED IN REGISTERED PREMISES BY WORKPLACE (1) (2) Class of Workplace Number of Persons Employed Offices 3.139 Retail Shops 7,698 Wholesale Departments, Warehouses 821 Catering Estabs. open to the Public 959 Canteens 15 Fuel Storage Depots 44 Total 12,676 Total Males 4,784 Total Females 7,892 Exemptions Nil Prosecutions Nil Inspectors Number of Inspectors appointed under Section 52 (1) or (5) of the Act 19 Number of other staff employed for most of their time on work in connection with the Act 1 Summary There is a lack of knowledge both by employers and employees as to the provision of the Act. There has been little response regarding implementation and the majority seem content to await the visit of the Inspector. Only two complaints were received. 96