I HAV 2 London Borough of Havering ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1966 London Borough of Havering ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1966 HEALTH & WELFARE DEPT., BILLET LANE, HORNCHURCH LONDON BOROUGH OF HAVERING BILLET LANE, Telephone: HORNCHURCH, HORNCHURCH 52555 ESSEX. With the Compliments of the Medical Officer of Health and Principal School Medical Officer CONTENTS Page SECTION I - INTRODUCTION Committee Members 3 Staff 4 General Statistics 6 SECTION II - PERSONAL HEALTH SERVICES MATERNITY AND CHILD HEALTH SERVICE Maternity Services 11 Midwifery 12 Dental Treatment — Expectant and Nursing Mothers 13 Women's Welfare 13 Cervical Cytology 13 Mothercraft and Relaxation Classes 14 Ante-Natal and Post-Natal Clinics 14 Un- Married Mothers 15 Congenital Malformations 15 Clinic Services 15 Medical Consultation 15 Child Welfare Services 16 At Risk Register 16 Specialist and Treatment Clinics 18 Dental Treatment — Children Under 5 Years 18 Child Welfare Clinics 19 Health Visiting (and Clinic Nursing) 19 Day Nurseries 20 HOME NURSING 21 SICK ROOM EQUIPMENT 22 NURSERIES AND CHILD MINDERS REGULATION ACT 1948 23 NURSING HOMES 23 HOME HELP SERVICE 23 NIGHT ATTENDANTS 25 RECUPERATIVE HOLIDAYS 25 PREVENTION OF TUBERCULOSIS 25 CARE OF THE TUBERCULOUS 26 CHIROPODY 27 IMMUNISATION AND VACCINATION 29 VENERAL DISEASE 31 SCHOOL HEALTH SERVICE - INTRODUCTION 32 Medical Inspections 32 Screening Tests 33 Hygiene Inspections 33 Treatment Services 34 i Page SCHOOL HEALTH SERVICE - Continued Minor Ailment Clinics 34 Ophthalmic and Orthoptic Clinics 34 Orthopaedic and Physiotherapy Clinics 34 Speech Clinics 35 Dental Clinics 35 Child Guidance and School Psychological Service 35 Health Education in Schools 36 Handicapped Pupils 37 School Dental Service 41 SECTION III - SOCIAL SERVICES INTRODUCTION 44 COMMUNITY CARE OF THE MENTALLY DISORDERED 45 RESIDENTIAL CARE OF THE MENTALLY DISORDERED 49 COMMUNITY CARE - WELFARE SERVICES 49 RESIDENTIAL CARE 53 REGISTRATION OF OLD PEOPLE'S HOMES AND HOMES . FOR THE MENTALLY DISTURBED 54 TEMPORARY ACCOMMODATION 54 SERVICES FOR THE BLIND AND PARTIALLY SIGHTED 55 CARE OF THE PHYSICALLY HANDICAPPED 58 SECTION IV-GENERAL ENVIRONMENTAL HEALTH SERVICE Introduction 61 Food and Drugs Administration 61 Unsound Food 63 Ice Cream Sampling 64 Preserved Food 64 Milk Sampling 64 Liquid Egg (Pasteurisation) Regulations 1963 65 Poultry Processing Plants 65 Food Hawkers 66 Milk Distribution 66 Food Hygiene (General) Regulations 1960 66 Meat Inspection 68 Water Supplies 70 Rainfall 71 Swimming Pools 72 Paddling Pools 73 Clean Air 73 Atmospheric Pollution 76 Radio Active Substances Act 1960 80 Sewerage and Sewage Disposal 80 Street Works 83 Underground Rooms 83 Gipsies 83 Picture Windows 84 Condensation in Homes 85 ii Page Rent Office 86 Improvement Grants 86 Houses Erected 88 Demolition and Closing Orders 88 Certificates of Disrepair 88 Establishments for Massage and Special Treatment 89 Laundry Service for the Incontinent 89 Infectious Diseases 89 Noise Abatement 90 Medical Arrangements for Long-Stay Immigrants 91 Diseases of Animals Act, 1950 92 Diseases of Animals (Waste Food) Order, 1957 92 Animal Boarding Establishments Act, 1963 92 Riding Establishments Act, 1964 93 Pet Animals Act, 1951 93 Rag, Flock and Other Filling Materials Act, 1951 93 Scrap Metal Dealers Act, 1964 93 Employment Agencies 93 Pharmacies and Poisons Act, 1933 93 Pigeons 93 Litter 93 Inspections and Visits 94 Rodent Control 95 Factories Act, 1961 96 Shops Act, 1950 97 Consumer Protection Act, 1961 99 Offices, Shops and Railway Premises Act, 1963 100 iii Health & Welfare Department Billet Lane Telephone: Hornchurch Hornchurch 52555 To: The Mayor, Aldermen and Councillors of the London Borough of Havering. Mr. Mayor, Ladies and Gentlemen, I present my report on the health and welfare of the Borough for the year 1966. This is the Second Annual Report since the formation of the Borough, but the first to cover a full twelve month's work of the Health and Welfare Department. For this report statistics relating to the year 1965 are available for purposes of comparison and have been referred to in certain of the statistical information. Descriptions of the various services provided by the combined Health & Welfare Department were given in my report for 1965, and the present report therefore deals mainly with the statistics relating to these services for the year under review with comments thereon, together with details of any extensions or variations in the services provided. It is pleasing to record that the initial difficulties, unavoidable in setting up a large department, have now been overcome. Staff transferred mainly from the three constituent authorities but with others recruited from other authorities, combining for the first time in a Department covering both health and welfare, settled down well together, and by 1966 were functioning smoothly as a team and providing an expanding and improving service. Dr. J. Gorman, Associate Medical Officer of Health, formerly Medical Officer of Health for the Urban District of Hornchurch from 1st October, 1946 to 31st March, 1965, retired on 31st December, 1966, and I take this opportunity of recording my appreciation of the help and assistance he afforded me in dealing with the many problems which arose during the difficult period which proceded and followed the inauguration of the new Borough on 1st April, 1965. I wish to express my thanks to the Members of the Council 1 and my colleagues in other Departments for the help they have given during the year, and also to all members of the staff of the Health & Welfare Department for work carried out during the year, of which this report gives a summary. I am Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F. GROARKE Medical Officer of Health. 2 HEALTH AND WELFARE COMMITTEE as at 31st December, 1966 His Worship the Mayor Councillor R.S.C. Dix (ex officio) Chairman Councillor F.J. Powell Vice-Chairman Councillor F.A.J. Morley Councillor R.W. Blythe, J.P. Councillor R.M. Carnaby Councillor F.J. Coffin, J.P. Councillor H.H. Green, J.P. Councillor N.F. Kemble Councillor R.W.E. Manning Councillor H.F. Moss Councillor H. Packham Councillor S.E. Shute Councillor M.J. Ware Councillor A.E. Winch Councillor Mrs. A.V.Winch, J.P. Non-voting Members: Councillor R.C. Baker, J.P. Councillor L.F.P. Eley 3 HEALTH AND WELFARE DEPARTMENT STAFF as at DECEMBER 1966. Medical Officer of Health F.L. GROARKE, M.B . L.M., D.C.H., D.P.H. Associate Medical Officer of Health J. GORMAN, M.B., D.P.H., Retired 31.12.66. Deputy Medical Officer of Health J. T. JONES, B.Sc., M.B., B.Ch., D.P.H. Principal 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.Ch., B.A.O., D.P.H. ELIZABETH M. HAGA, M.B., B.S., M.R.C.S , L.R.C.P , D.P.H. EVELYN B. KILSBY, B.Sc., B.A., L.R.C.P., M.R.C.S. L. J. MARSHALL, M.B., B.S., L.M.S.S.A. R. M. RITCHIE, L.A.H. (Dublin) H. C. GUPTA, M.B., B.S., D.P.H. 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) D. RAMSAY, L.D.S., R.C.S., B.D.S. MRS. O. SAUNDERS, D.D.S. K. WRIGHT, L.D.S., R.C.S., B.D.S. Administrative Officer J. F. T. THOMAS, M.R.S.H. Deputy Administrative Officer E. W. GOWERS, A.R.S.H. Chief Public Health Inspector M. F. RANDALL, M.R.S.H., M.A.P.H.I. Associate Chief Public Health Inspector H.C. BOSWELL, F.R.S.H., F A.P.H.I. Chief Nursing Officer MISS G.P. THORNHILL, S.R.N., S.C.M., H.V. Chief Chiropodist L. BOLLAND, M.Ch.S., S.R.Ch. Principal Welfare Officer MISS K.M. WELLS, A.I.M.S.W., M.S.M.W.O. Deputy Principal Welfare Officer A.K. HUDDLESTONE Senior Psychiatric Social Worker J. HORAK, R.M.N., A.A.P.S.W. Senior Mental Welfare Officer F. G. DEAR, M.S.M.W.O. Senior Social Welfare Officer MISS E.M. TURNER SMITH, A.I.M.S.W. 4 STAFF Contd. Senior Domestic Help Organiser MRS. B. BIGNELL Public and Agriculture Analysts J. HUBERT HAMENCE. Ph.D., M.Sc., F.R.I.C. P.S. HALL, B.Sc., F.R.I.C. 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 E. 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. P. LANCER, M.R.C.S., L.R.C.P., M.B., B.S. Physiotherapist MRS, A. SLIP, M.C.S.P. 5 GENERAL STATISTICS Area in Acres 29,550 Population (Registrar-General's Estimate for Mid 1966) 250,190 Number of inhabited houses as at 31.12.66 76,520 Rateable value as at 31.12.66 £11,900,403 Estimated product of a Penny Rate £48,400 During the year, the natural increase (4224 live births, minus 2277 deaths) would have resulted in an increase in population of 1947, but the Registrar-Generals mid year estimate of 250,190 is 240 less than the comparative figure for 1965. It follows therefore that the number of people moving away from this Borough exceeded by 2187 the number of those who came to live in Havering. The number of inhabited dwellings increased by 673 during the year, which, allied to the slight fall on total population, resulted in the average number of people per dwelling falling from 3.30 in 1965 to 3.27 in 1966. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR (Figures for 1965 are given in parenthesis) Live Births Male Female Total Legitimate 2072 1941 4013 (4164) Illegitimate 120 91 211 (190) Total 2192 2032 4224 (4354) Birth Rate per 1000 population 15.53 (15.99) Illegitimate live births (percentage of total live births) 5.% (4.4) Still Births Male Female Total Legitimate 33 24 57 (61) Illegitimate 1 2 3 (3) Total 34 26 60 (64) Total live and still births 4284 (4418) Still birth rate (per 1000 live and still births) 14.0 (14.5) 6 Infant Deaths (under 1 year) Male Female Total Legitimate 31 23 54 (59) Illegitimate 2 2 4 (3) Total 33 25 58 (62) Infant Mortality Rates — Total infant deaths per 1000 total live births 13.7 (14.2) Legitimate infants per 1000 legitimate live births 13.5 (14.2) Illegitimate infants per 1000 illegitimate live births 18.9 (15.7) Neo Natal Mortality Rate (deaths under 4 weeks' of age per 1000 live births) 9.7 (10.1) Early Neo Natal Mortality Rate (deaths under one week of age per 1000 total live births) 8.8 (9.4) Perinatal Mortality Rate (Stillbirths and deaths under one week of age combined per 1000 live and still births) 22.6 (23.8) Maternal Mortality (including abortion) Number of deaths 1 (1) Rate per 1000 live and still births 0.23 (0.23) Comparison of above rates with those of London, England and Wales is shown on the following table. TABLE - 1 Havering London England & Wales Birth Rate 15.5 17.7 17.7 Illegitimate Live Births (percentage of total live births) 0.5 10.3 Not available Still birthrate 14.0 14.2 15.4 Infant Mortality rate 13.7 17.8 19.0 Neonatal Mortality rate 9.7 12.4 12.9 Early Neonatal Mortality rate 8 8 11.0 11.1 Perinatal Mortality rate 22.6 25.1 26.3 Maternal Mortality rate 0.23 0.33 0.26 Death Rate 11.4 11.1 11.7 7 The birth rate of 15.53 again shows a decrease compared with the previous year when the rate was 15.99 per 1000 population but is in tune with the national trend. The death rate of 11.4 is higher than the 1965 rate of 10.8 but compares favourably with the rate of 11.7 for England and Wales. Illegitimate Births increased from 190 to 211, the percentage in relation to total live births rising from 4.4 to 5.0. The Infant, Neonatal, Early-Neonatal and Perinatal Mortality rates all decreased slightly, only the infant mortality rate for illegitimate live births showing an increase. This is due to the small number of deaths involved, the increase being due to one death more than in the previous year. Infant Mortality The infant mortality rate for England and Wales has fallen over the past ten years from 23.8 per thousand in 1956 to 19.0 per thousand in 1966. If related to the number of births in the country in 1966, this difference in rate means that 3980 less children died under the age of 1 year, than would have been the case if no improvement in the 1956 rate had occured. The 1961 perinatal mortality rate (still births and deaths in first week of life) of 32 per thousand live and still births for England and Wales was considered by the Ministry of Health to be too high. It was then estimated that the numbers of such deaths could be reduced by 5,000 per annum by raising the general standard of care of the premature baby, and by adopting all possible measures to prevent the onset of premature labour. Since 1961 the perinatal mortality rate for England and Wales has dropped by 5.7 to 26.3. In numbers this means that had there been no improvement in the 1961 rate of 32 per thousand, the total number of still births and deaths under 1 week of age in 1966 would have been approximately 4,900 greater. Similarly had the 1966 rate been achieved by 1961, the figure for that year would have been approximately 4,580 less. A similar improvement in the perinatal death rate has occured in Havering. In 1961 the rates in the two constituent areas were Hornchurch 32.0, Romford 31.9 as compared with 22.6 for 1966. The special baby care unit attached to Oldchurch Hospital serves the district adequately. In addition a "flying squad" service is based at this Hospital to provide specialised help immediately should an unexpected emergency arise at a domiciliary confinement. The causes of infant deaths and of neonatal deaths together with the age at death are given in Tables 2 and 3. 8 TABLE - 2 Infant Deaths Cause of Death 0 - 1 month 1 - 3 months 3-6 months 6-12 months Total Anencephalus 1 — — — 1 Atelectasis 3 — — — 3 Bronchitis — 1 — — 1 Bronchopneumonia — 1 1 — 2 Cerebral Anoxia 1 — — — 1 Cerebral Degeneration — — 1 — 1 Cerebral Tumor — — 1 — 1 Congenital Heart Disease 6 3 1 — 10 Congenital Malformations 2 1 — — 3 Enteritis — 1 — — 1 Hepatoblastoma 1 — — — 1 Influenza — 1 — — 1 Inhalation of Vomit — — 1 — 1 Intra-uterine Asphyxia 3 — — — 3 Meningomyelocele — 1 1 — 3 Pneumonia of new-born 1 — — — 1 Prematurity 22 — — — 22 Sclerema 1 — — — 1 Uraemia — 1 — — 1 TOTAL 41 10 7 — 58 TABLE - 3 Neonatal Deaths Cause of Death Under 1 week 1 - 2 weeks 2-3 weeks 3-4 weeks Total Anencephalus 1 — — — 1 Atelectasis 3 — — — 3 Cerebral Anoxia 1 — — — 1 Congenital Heart Disease 3 2 — 1 6 Congenital Malformations 1 1 — — 2 Hepatoblastoma — — — 1 1 Intra-Uterine Asphyxia 3 — — — 3 Pneumonia of new-born 1 — — — 1 Prematurity 22 — — — 22 Sclerema 1 — — — 1 TOTAL 36 3 — 2 41 9 TABLE - 4. REGISTRAR-GENERAL'S ABRIDGED LIST OF CAUSES OF DEATH IN CERTAIN AGE GROUPS (Corrected for Inward and Outward Transfers) Cause of Death All Ages Age Groups Under 4 weeks 4 weeks and under 1 year 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and upwards 1 Tuberculosis, Respiratory 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. 16 4 2 — — — — — — — — — — — — — 1 1 — 2 1 — — 1 — 2 Tuberculosis, Other 1 1 — — — — — — — — — — — — — — — — — 1 — — — — — 3 Syphilitic Disease 3 2 1 — — — — — — — — — — — — — — — — 1 — 1 1 — — 4.Diphtheria — — — — — — — — — — — — — — — — — — — — — — — — — 5 Whooping Cough — — — — — — — — — — — — — — — — — — — — — — — — — 6 Meningococcal infections — — — — — — — — — — — — — — — — — — — — — — — — — 7 Acute Poliomyelitis — — — — — — — — — — — — — — — — — — — — — — — — — 8 Measles — — — — — — — — — — — — — — — — — — — — — — — — — 9 Other infective fit parasitic diseases 2 1 1 — — — — — — — — — — — — — — — — — — — — — — 10 Malignant neoplasm, stomach 53 28 25 — — — — — — — — — — — — 1 1 5 3 4 2 9 8 9 11 11 Malignant neoplasm, lung, bronchus 130 112 18 — — — — — — — — — — — — 2 2 11 1 40 7 39 5 20 3 12 Malignant neoplasm, breast 39 1 38 — — — — — — — — — — — — — 2 — 5 1 6 — 9 — 16 13 Malignant neoplasm, uterus 11 — 11 — — — — — — — — — — — 1 — 3 — 2 — 2 — 1 — 2 14 Other malignant & lymphatic neoplasms 210 124 86 — — — — — — 1 1 2 — 2 3 8 1 12 7 25 19 41 24 31 3J 15 Leukaemia, Aleukaemia 17 7 10 — — — — — 1 1 — — — — — — 2 1 2 2 1 2 3 1 1 16 Diabetes 12 3 9 — — — — — — — — — — — — — — — — — 2 2 4 — 3 17 Vasculty Lesions of Nervous System 301 110 191 — — — — — — 1 — — 1 — — 2 2 10 3 14 15 26 48 57 122 18 Coronary Disease, Angina 491 302 189 — — — — — — — — — 1 4 — 10 3 42 8 69 22 97 52 80 103 19 Hypertension with heart disease 20 8 12 — — — — — — — — — — — — — 1 1 — 1 1 5 4 1 b 20 Other heart disease 155 73 82 — — — — 1 — — — — — 2 — 2 4 5 5 17 6 13 7 33 60 21 Other circulatory disease 92 49 43 — — — — — — — — — — — — — — 3 2 7 3 12 10 27 28 22 Influenza 7 1 6 — — — 1 — — — — — — — 1 — — — 1 — — — — 1 3 23 Pneumonia 153 64 89 1 — 2 — 1 — — — — — — 1 1 2 3 3 3 1 12 11 41 71 24 Bronchitis 133 94 39 — — 1 — — — — — — 1 — — — — 2 — 17 4 32 8 42 26 25 Other diseases of respiratory system 13 7 6 — — — — — — — — — — — — 1 — — — 1 2 4 1 1 3 26 Ulcer of stomach and duodenum 11 10 1 — — — — — — — — — — 1 — — — — — 1 — 5 1 3 — 27 Gastritis, enteritis fit Diarrhoea 9 4 5 — — 1 — 1 — — — — — — — — — 1 — — 2 — 1 1 2 28 Nephritis and nephrosis 10 7 3 — — — — — — — — — 1 — — — — — — — — 2 — 2 2 29 Hyperplasia of prostate 5 5 — — — — — — — — — — — — — — — — — — — 1 — 4 — 30 Pregnancy, childbirth, abortion 1 — 1 — — — — — — — — — — — 1 — — — — — — — — — — 31 Congenital malformations 26 15 11 6 3 5 3 — 1 2 — — — 1 — — — 1 2 — 2 — — — — 32 Other defined fit ill-defined diseases 186 68 118 12 18 2 — — — 1 1 4 3 — 2 3 2 6 6 10 9 14 21 16 56 33 Motor vehicle accidents 32 27 5 — — — — 1 — 1 1 8 — 2 — 2 — 3 1 1 1 5 — 4 2 34 All other accidents 23 14 9 — — 1 — 1 — — — — — 2 — 1 — 1 — 1 — 1 2 6 7 35 Suicide 24 14 10 — — — — — — — — 2 1 — 3 2 — 2 3 7 2 1 1 — — 36 Homicide & operations of war 1 — 1 — — — — — — — — — — — — — 1 — — — — — — — — Total All Causes 2177 1155 1022 20 21 13 4 5 2 7 3 16 9 14 12 35 27 111 54 228 110 325 222 381 558 10 SECTION II PERSONAL HEALTH SERVICES SECTION MATERNITY AND CHILD HEALTH SERVICE In the 1965 Report I mentioned that one of the aims of this Service was to reduce maternal and child mortality and morbidity to the minimum. Reference to the rates under the heading Vital Statistics reveals that, in common with the national figures, a further reduction was achieved in the figures for the infant mortality rates. The close co-ordination with the family doctors and hospital services and with other Health & Welfare Departments and Ambulance Services continued. The number of Health Visitors working in close liason with groups of family doctors increased from seven to nine. These were in addition to the Health Visitor fully attached to a group practice. Screening of the infant and child population for early handicap or abnormalities was continued, and this has particularly applied to the "At Risk" children. Maternity Services Statistics relating to the Ante-Natal and Post-Natal Clinics, and also the Mothercraft and Relaxation Classes are given in Table 9. All expectant mothers are encouraged to book a general practitioner on the obstetric list, and therefore the need for the local authority to provide Ante-Natal and Post-Natal Clinics has declined considerably over the last few years. In consequence both ante-natal and post-natalcare are almost entirely undertaken by general practitioners or clinics attached to Hospitals, dependent upon whether the expectant mother is booked for home or hospital confinement. The Local Authority Midwives carry out regular ante-natal care of all patients booked by them, examining patients between the regular examinations by the general practitioner and for this purpose paid 8847 ante-natal visits to patients' homes in addition to making 3471 ante-natal examinations at general practitioners clinics and 4784 at Midwives Ante-Natal Clinics. The local Authority provides mothercraft and relaxation classes for all expectant mothers who wish to attend irrespective of whether booked for hospital or home confinement. These classes are staffed by health visitors, but midwives also attend for the sessions on childbirth and analgesia. Ante-natal co-operation cards provide a necessary interchange of information between doctors, midwife and hospital, and as 11 two thirds of all patients delivered in hospital were again discharged home to the care of the midwife before the tenth post-natal day, hospitals provide full information for the midwife prior to mother and baby being discharged. Midwifery Details of the number of births and maternal and infant deaths together with the rates, and comments thereon are given earlier in this report under Vital Statistics. The following table gives details of the midwifery work undertaken by the Midwifery Staff, which at the end of 1966 comprised 28 Full-time and 3 Part-time Midwives and two District Nurse Midwives - equivalent to 31 Full-time Midwives compared with an establishment of 33. TABLE - 5 No of domiciliary confinements attended by Midwives Number of cases delivered in Hospital and other institutions but discharged and attended by domiciliary midwives before 10th day Doctor not booked Doctor booked Total 53 1298 1351 1899 In 1965, the midwives attended 1471 domiciliary confinements. A comparison between the two years reveals that the number of domiciliary births in relation to the total fell from 34.9% to 32.0% in 1966. This is shown in the following comparative table of births notified during the two years. TABLE - 6 Place of Birth Total Adjusted by any notifications transferred in or out of the area 1966 1965 D omiciliarv 1352 1529 Institutional 2864 2845 Percentage of Domiciliary Births 32.0 34.9 From the above table it will be seen that the number of births in hospital remained practically constant, and that the fall in the number of births allowed a higher percentage of 12 mothers to have their confinements in Hospital. As 70-75 per cent of all expectant mothers fall within one or other of the priority groups for hospital confinement, these figures indicate that the number of priority cases confined at home has been reduced. Dental Treatment for Expectant and Nursing Mothers Dental treatment is provided free of charge for expectant and nursing mothers at the Authority's Clinics, and details of the number of persons treated, and of treatment provided are given in Table—7 below, with the equivalent figures of 1965 for comparison. TABLE - 7 Dental Treatment for Expectant and Nursing Mothers Year No. Examined No Treated F illings Inlays & Crowns Extractions General Anaes thetics Denture 1965 114 84 213 2 57 6 16 1966 97 96 194 2 49 3 11 Womens' Welfare Womens' Welfare Clinics were held throughout the year at the Hornchurch, Elm Park, Harold Wood and Cranham Clinics, at which pre contraceptive advice was available to women having a medical indication for avoiding childbirth. A total of 321 women attended the Clinics during the year. Ministry of Health Circular 5/66 urged local health authorities to assist the work of the Family Planning Association by providing clinic premises free of charge, and bearing the cost of heating, lighting and cleaning etc. Arising out of this Circular the Council agreed to allow the Family Planning Association free use of premises at 49 Eastern Road, Romford, to maintain the premises in good condition, and to make a grant of £600 per year towards the cost of heating, lighting and cleaning. The Council has agreed to accept financial responsibility for treatment provided by the Association on medical grounds to any woman resident in this Borough, and to make an annual contribution in conjunction with other London Boroughs towards the rent of the Association's new head-quarters at Wanstead. Cervical Cytology In 1964 a weekly cervical cytology session was commenced at Harold Hill Health Centre. This had been inaugurated as a pilot scheme for the detection of early uterine cancer, but an 13 early expansion of the service was not possible due to difficulties in recruiting technicians in the Hospital Laboratory Service. These difficulties were resolved early in 1966 and in consequence, sessions were commenced at the Cranham, Elm Park, Harold Wood, Romford and Upminster Clinics between April and May. The number of smears taken increased from 139-in 1965 to2520 in 1966. The results are as set out in the following table. TABLE - 8 Results of Cytological Examinations 1 Absence of Atypical Cells 2465 11 Atypical Cells, but no evidence of malignancy 45 11+ Atypical Cells, early repeat desirable 3 111 Cytology Suggestive of, but not conclusive for, malignancy 7 Mothercraft and Relaxation Classes The importance of full and early ante-natal care was stressed in my last report, and reference was also made to the Mothercraft and Relaxation Classes. During the year 822 expectant mothers attended these classes for the first time, the total attendances at the 497 classes held being 4110. Of the 822 women who attended for the first time 638 were booked for a hospital confinement and 184 for domiciliary confinement. The classes, staffed by Health Visitors aided by Midwives who attend for the sessions dealing with analgesia, are greatly appreciated by the mothers, most of whom are young women expecting their first babies, and the instruction given encourages then to ensure that they co-operate to the full in receiving proper ante-natal care, both in their first and subsequent pregnancies. The classes also enable the mothers attending to meet others with the same problems and to establish a friendly relationship both with the Health Visitors and between themselves, which continues after the birth of their babies when they subsequently attend the Child Welfare Clinics. TABLE - 9 Ante-natal and post-natal clinics and mothercraft and relaxation classes Number of Women attending Clinics Ante-Natal Post-Natal Total 906 30 935 14 TABLE -9 contd. Number of Sessions Doctor Midwife Total 48 749 797 Number of Women attending Relaxation C lasses Booked for Hospital Confinement Booked for Home Confinement 638 184 822 Un-Married Mothers The Council continued the arrangement whereby, on an agency basis, the Chelmsford Diocesan Moral Welfare Association provides care during the ante-natal period for unmarried mothers and arranges subsequent admission to Mother and Baby Homes. The total number of unmarried mothers from Havering dealt with by the outdoor worker of the Association was 87, and approximately one-third of these were admitted to Mother and Baby Homes. Congenital Malformations During 1966 , 69 congenital malformations observed at birth were reported on the notifications of births received from hospitals and midwives. These were notified to the Registrar General, and the details were also transferred to the Health Visitors for following-up. Clinic Services In September 1966, the Child Welfare Session held weekly at the Jubilee Hall in Victoria Road, Romford was discontinued as the Hall was sold by the owners. Apart from this, clinic services continued to operate throughout the year in the premises listed in my last report. Plans for the extension of three existing clinics were well advanced by the end of the year. It is hoped that the works involved will be carried out in each instance during 1967, providing much needed additional accommodation for services which at present are functioning under very crowded conditions. Medical Consultation The medical staff is maintained at eight full-time doctors, whose duties also include school health work and medical examination of staff. In addition local general practitioners 15 attend occasionally on a sessional basis. During 1966 resignations and appointments resulted in the number of doctors approved for the ascertainment of mentally handicapped children decreasing from six to five but a further medical officer undertook a course in this work at London University which restored the number to six, when the necessary period of practical work had been completed. During the year 76 children attending child welfare clinics were referred by medical officers to special clinics or hospital consultants. Child Welfare Services The total number of children attending the Clinics decreased slightly from 9413 in 1965 to 8921 in 1966. 75.8% of children born in 1966 attended the clinics as compared with an equivalent figure of 78.1% in 1965. In my last report, attention was drawn to the changing function of the child welfare clinics in that consultation between parents and doctors and health visitors and routine screening tests and medical examinations to detect any deviation from normal development now take precedence over the assessment of a baby's progress by means of the weighing scales. This factor and the reduction in 1965 in the wide range of proprietory milk and other foods previously available in clinics may have caused this slight reduction in the attendance figures. The routine screening tests and medical consultations enabled early ascertainment of possible handicaps with the necessary investigation and treatment, and also referral for specialist advice and treatment of any other matters affecting the well being and future development of the infants attending. These routine screening tests and medical examinations also provide the majority of mothers with the assurance that their child is healthy and developing normally. At Risk Register At the end of the year 304 children were considered to be "at risk" because of various unfavourable hereditary, ante-natal natal or post-natal factors, and these children were being carefully followed up. All premature infants, had of course, been included on the "at risk" register but the majority of these had made favourable progress by the end of the year, and were removed from the register as nolonger being in this category. The following table sets out the number of premature births as adjusted by any notifications transferred in or out of the area. For 16 this purpose all infants weighing 5½lbs. and less at birth are regarded as premature. TABLE - 10 Weight at birth Premature live births Born in hospital Born at home or in a nursing home Premature stillbirths Nursed, entirely at home or in a nursing home Transferred to hospital on or before 28th day Died Died Died Born Total births within 24 hours of birth in 1 and under 7 days in 7 and under 2 8 days Total births within 2 4 hours of birth in 1 and under 7 days in 7 and under 2 8 days Total births within 24 hours of birth in 1 and under 7 days in 7 and under 2 8 days in hospital at home 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. 21b. 3oz. or less 10 5 2 — — — — — — — — — 9 — 2. Over 21b. 3oz. up to and including 31b. 4oz. 15 2 3 — — — — — — — — — 7 — 3. Over 31b. 4oz. up to and including 41b. 6oz. 44 3 2 — — — — — 3 — — — 9 2 4. Over 41b. 6oz. up to and including 41b. 15oz. 47 — 3 — 3 — — — 1 — — — 4 1 5. Over 41b. 15oz. up to and including 51b. 8oz. 76 3 1 — 16 — — — 2 1 — — 6 1 6. TOTAL 192 13 11 — 19 — — — 7 l — — 35 4 17 Babies and young children who were found to be handicapped were included in the handicapped children register and kept under regular observation. Those who would be likely to require special education treatment as handicapped pupils were brought forward for ascertainment at the appropriate time, but in the majority of cases, the need for classification as handicapped pupils does not arise, provided the child is capable of receiving education in a normal school. At the end of the year 153 children under the age of 5 years were recorded as handicapped or under investigation for potential handicap. Specialist and treatment clinics Orthopeadic, ophthalmic, speech therapy, chiropody, physiotherapy and orthoptic sessions are held at the clinics and are available to children under the age of five as well as for children attending school. Similarly children requiring specialist advice or treatment are referred to Hospital Consultants in the same manner as in the School Health Service. During the year 439 children under five were referred for special treatment or advice. Dental Treatment Dental treatment is provided free of charge at the Authority's Clinics for children under 5 years of age. Table 11 below gives particulars of treatment provided during 1966 compared with the previous year: TABLE 11 Dental Treatment for Children under 5 years of age Year Teeth Filled Teeth otherwise conserved Prophylaxis Teeth extracted Ratio of fillings to extractions 1965 730 135 63 186 3.9 1966 888 218 231 185 4.8 It is important that a child's first set of teeth are well cared for and that dental inspection should be commenced at an early age so that appropriate treatment can be provided at the first signs of dental decay. 7% of the dentist's time during 1966 was devoted to treatment of mothers and young children, compared with 6% during the previous year (the major contribution being to the School Dental Service). A Ministry report on the dental services in the Borough during the year commented favourably on the ratio of fillings to teeth extracted, which was better than average and has been further improved by the efforts of all members of the staff. 18 Child Welfare Clinics Total attendances at the Clinics fell from 62991 in 1965 to 51628 in 1966, the average number of attendances for all children falling from 6.7 to 5.8 per annum. This may possibly be due to the recent changes, described above, in reducing the emphasis on regular weighing of children, the reduction in the number of nutrients available in the clinics, and also to the fact that separate immunisation sessions were held in the Clinics in the Romford area in 1966, instead of vaccination and immunisations being given at child welfare clinic sessions. Details of the sessions held and number of children attending are given in Table 12 below. TABLE - 12 Child Welfare Clinics ]No of children attending Born in 1966 Born in 1965 Born in 1961-64 TOTAL Sessions held by 3202 2928 2871 8921 Doctors Health Visitors TOTAL 1011 478 1489 Health Visiting (and Clinic Nursing) Reference was made in the 1965 report to the wide range of duties undertaken by the Health Visitor. These duties, which many years ago were primarily concerned with the routine visiting of mothers and young children, have now widened to cover school health and medico social work and home visiting of the elderly. Closer liason with general practitioners during the past two years has accentuated this widening range of duties as will be seen by comparison of the statistics relating to visits paid during 1965 and 1966. See table 13 below. At December 1966, out of an establishment of 58 the equivalent of 32.5 full time Health Visitors (including five Visitors dealing entirely with persons suffering from tuberculosis) were employed in the area. The shortage of trained Health Visitors which applied throughout the country was overcome, as far as possible, by employing 17 Part-time Clinic Nurses to undertake clinic and school health work, thus freeing Health Visitors for those duties for which their training was especially required. During the year the number of Health Visitors appointed as 19 Group Advisers was increased from two to three. Five Student Health Visitors undertook the practical work of their course in Havering, their field training being supervised by the two Health Visitors who are appointed as Field Work Instructors. One student from the Borough commenced her training in September 1966. TABLE - 13 Home Visits by Health Visitors Home Visits to Total No Visited N otes 1965 Visits for comparison Children 15988 Born in Born in Born in 1966 1965 1961/64 3953 3355 8650 14925 Tuberculosis Households 1174 1169 visited by tuberculosis Visitors 1796 Elderly Persons (over 65) 1216 Including 266 at special request of hospital or family doctor (1965-88) 547 Persons (excluding maternity patients) discharged from Hospital (other than Mental Hospitals) 66 Including 61 at special request of hospital or family doctor (1965-18) 37 Mentally disordered Persons 64 Including 11 at special request of hospital or family doctor (1965-13) 33 Cases of Infectious diseases TOTAL 6 18514 Excluding Tuberculosis 21 17359 Day Nurseries During 1966 the Day Nursery in Clockhouse Lane which opened in August, 1965, was approved for the training of Nursery Students, and three students commenced training in September, 1966, in addition to the six students under training at Elm Park Nursery. All the students undertake their theoretical training at the Hornchurch College of Further Education. Table 14 below gives details of the average attendance. The average daily attendance at all Nurseries during the year increased from 141,13 in 1965 to 144.58 in 1966. The number of admissions on priority grounds for medical or social reasons increased, and the waiting list of priority cases increased from 18 at the end of 1965 to 47 at the end of 1966. 20 Details of the attendance figures and waiting list relative to each of the four Day Nurseries are given in the following Table:— TABLE - 14 Nurseries Places Average daily attendance over the year Waiting List Priority on 31.12.66 Non-Priority Diban Avenue Elm Park 50 45.03 24 28 Western Road Romford 40 28.43 17 16 Collier Row 50 38.14 4 24 Rush Green 50 32.98 2 26 TOTAL 190 144.58 47 94 HOME NURSING The staff of nurses employed in providing nursing care to patients in their own homes consisted of 25 full-time and 9 part-time at the commencement of the year. The number varied slightly throughout the year and at 31st December there were 28 full-time and 5 part-time nurses employed. The total full-time equivalent was approximately the same. Four of these nurses are attached full-time to Group practices, and included in this total are six male nurses whose services enable the female nurses to be relieved of the necessity of attending to heavy male patients. The statistics relating to this service are given in Table 15. TABLE - 15 TOTAL Under 5 years of age Age 5 - 64 Age 65 and over Number of persons nursed during year 2081 33 661 1387 Number of nursing visits made during the year 68275 245 18215 49815 21 The equivalent totals for 1965 were 2078 persons nursed, and 49341 visits. Whilst therefore the number of patients has remained practically static, the number of visits paid to patients has increased by 38%, largely due to terminal cases being discharged from hospital for nursing at home. The number of patients requiring two, or in some instances, three visits daily has therefore increased considerably. During the year, the Home Nurses, together with the Health Visitors assisted in the field work training of 129 student nurses from Oldchurch Hospital. In addition 12 lectures were given by Health Visitors and Home Nurses to the student nurses at this Hospital. SICK ROOM EQUIPMENT Table 16 sets out details of the wide variety of articles of sickroom equipment which were issued on loan, free of charge, to persons being nursed at home. This service, which makes available, at short notice, various items needed for adequate home nursing or alternatively, for improving the comfort of patients, obviates the need which would otherwise exist for many to receive institutional care. TABLE - 16 Article No. Disposable Sheets 49,500 sheets Air Rings 90 Back Rests 229 Bed Cradles 106 Bed Pans 245 Bed Pans (Rubber) 12 Bedsteads 10 Bed Tables 12 Commodes 295 Crutches 21 pairs Draw Sheets 97 Feeding Cups 30 Foam Rings 154 Fracture Boards 15 Hydraulic Hoists 15 Mattresses 18 Pillows 4 Plastic Sheets 204 Pulleys 15 Rubber Sheets 13 Sputum Mugs 4 Contd. 22 Article No. Sputum Mug Holders 14 Urinals (Female) 13 Urinals (Male) 130 Walking Aids (Tripod) 28 Walking Aids (Quadruped) 14 Walking Frames 1 Walking Sticks 46 Wheelchairs 254 NURSERIES AND CHILD MINDERS REGULATION ACT 1948 Applications for the registration of daily minders and premises under the above act were carefully investigated by Health Visitors and Public Health Inspectors. In addition the Fire Prevention Department of the London Fire Brigade were asked to report on the premises concerned in each application. Registration was granted subject to the observance of fixed standards regarding space and amenity, and of the recommendations contained in the report from the Fire Brigade. At the end of the year, 36 church or social halls, providing places for a total of 1259 children, mainly in play groups, and 14 daily minders, providing for the daily minding of 118 children were registered. No applications were refused during the year. All premises and daily minders were inspected periodically by the Health Visitors. NURSING HOMES There are four Nursing Homes in the Borough registered in accordance with Sections 187 to 194 of the Public Health Act 1936 as amended by the Nursing Homes Act 1963. These homes, which provide a total of 72 beds for acute and chronic sick persons, are visited at regular intervals. One Home changed ownership during the year, and registration in the name of the new owner was granted subject to improved day room facilities being provided. HOME HELP SERVICE This service, administered by a Senior, and four Domestic Help Organisers, includes not only the provision of home helps during the day for aged, chronic sick, mentally disordered, maternity and other parients in need of assistance with housework, cooking and shopping etc., but also the night attendant service under which a night attendant is provided for seriously ill patients to give relief to relatives who would otherwise be occupied day and night in care of the patient, and in some 23 instances for patients living alone for whom alternative arrangements cannot be made. The patients for whom night attendants are provided are in the main terminal cases. The service was extended in June 1966 by the inauguration of a. Good Neighbour Service. Under this scheme, neighbours of housebound patients are enrolled to give daily care to patients additional to that provided by the Home Help Service, by calling in at various times during the day to ensure the comfort of the patient and to see that any immediate needs are met. Statistics relating to the service are given in Table 17 TABLE - 17 Home Help Service Requests for help from new cases during the year. 1092 Cases not eligible for assistance or not requiring services. 202 New cases helped during the year 890 Cases being helped at the end of the year 1667 Totalcases helped during the year 2374 Total number of hours of help provided during the year 327,210 The total number of cases helped increased by 8.5% over the figure of 2188 for 1965, and the number of hours of help provided increased by 7.4% over the 1965 figure of 304,789, illustrating the continued expansion of this service. The categories of cases helped during the year were as follows:— Chronic Sick under Aged 65 years of age or 1626 65 years of age. 288 over. Maternity. 247 Others (Acute illness, Mental Disorder, Problem Families etc. 213 Statistics relating to the Night Attendant Service are given in Table 18. 24 TABLE - 18 Night Attendant Service Number of Patients helped during the year 34 Number of hours for which attendants were supplied 808 A night attendant was supplied for each patient for whom a request for this service was received. The equivalent figures for 1965 were 6 patients involving 210 hours. Requests for this service however, fluctuate continually and therefore the increase over 1965 cannot be taken as an intimation that a similar expansion will occur in succeeding years. The Good Neighbour Service between it's commencement in June and the end of the year assisted 13 patients, 10 of whom were still receiving assistance at the end of the year. RECUPERATIVE HOLIDAYS During the year 95 patients were recommended for a recuperative holiday by general medical practitioners or by Hospitals. 75 availed themselves of the arrangements made for their admission to various private convalescent homes, the normal period of convalescence of two weeks applying in 67 instances. Of the remaining eight patients, seven were recommended for one week only, and the eighth although recommended for two weeks returned at the end of a week. The number of recuperative holidays provided showed only a slight increase on the figure of 71 for 1965. PREVENTION OF TUBERCULOSIS Mass Radiography Unit 6B of the North East Metropolitan Regional Hospital Board visited the Borough between April and August, 1966 . 26,343 persons (11,890 male and 14,453 female) were X-rayedatthe sessions held in various parts of the Borough. Of these, 188 males and 163 females were referred for further investigation. 104 subsequently being found to be normal. Dr. D.J. Lawless, Medical Director of the Unit, has provided the following details of the conditions revealed on investigation: Tuberculous lesions Male F emale Total D 1. Tuberculosis. Presumed healed. No further action needed. 22 14 36 D.3. Tuberculosis. Occasional supervision onlv needed. 9 9 18 25 Tuberculous lesions (contd.) Male Female Total D.4. Tuberculosis. Close clinic . supervision needed. ( 7 6 13 D.5. Tuberculosis. Requiring immediate I treatment. Other adnormalities revealed Abnormalities of the bony thorax and soft tissues — congenital 2 1 3 Abnormalities of the bony thorax and soft tissues — acquired 8 2 10 Congenital malformations of the lungs. - 1 1 Bacterial and virus infections of the lungs . 10 4 14 Bronchiectasis 2 4 6 Emphysema 9 5 14 Pulmonary fibrosis — non-tuberculous. 14 14 28 Spontaneous pneumothorax 1 1 2 Benign tumours of the lungs and mediastinum — 2 2 Carcinoma of the lung and mediastinum. 10 1 11 Metastases in the lung and mediastinum. — 1 1 Sarciodosis and collagenous diseases. — 1 1 Pleural thickening or calcification — non-tuberculous 13 8 21 Abnormalities of the diaphragm and oesophagus — congenital and acquired. 5 7 12 Congenital abnormalities of heart and vessels 3 3 Acquired adnormalities of heart and vessels. 14 27 41 Miscellaneous — 2 2 Cases who fail to attend for further films or clinical examination 6 2 8 Totals 132 115 247 It will be noted that tuberculous - infection was detected in 67 cases and of these, 13 (7 male and 6 female) were significant cases (those in need of immediate treatment or very close supervision), giving an overall incidence rate of 0.49 per thousand examined. The rate for males was 0.06 and for females 0.41 per thousand examined. Bronchial carcinoma was detected in 11 cases (10 males and 1 female). CARE OF THE TUBERCULOUS An annual grant is made by this Council to the Havering Tuberculosis Care Association who provide extra nourishment grants and various other forms of assistance to patients and contacts. This is a continuation of the arrangement formerly 26 operated in this area by the Essex County Council. The Chest Physicians act as medical advisers to the Association, and all assistance given is subject to their approval. The Committee of the Association consists of representatives of the Borough Council, of local voluntary organisations interested in service to the Community and the Tuberculosis Health Visitors. The clerical work of the Association is undertaken by the staff of the Health and Welfare Department. Dr. S. Steel, Chest Physician reports on the work of the Romford Chest Clinic as follows:— The Romford Chest Clinic has continued its service to the population of the London Borough of Havering. The number of notified cases of tuberculosis on the Clinic register has continued its downward trend and the figure is now 628. However, the number of patients attending the Clinic with non-tuberculous chest conditions has again increased and this number has been added to by the annual visit to the area of the Mass Radiography Service. Milk for Tuberculous Patients The scheme whereby one pint of milk daily is provided, on the recommendation of the Chest Physician for patients suffering from Tuberculosis showed an increase compared with 1965. 115 patients received milk in 1966 compared with 90 in 1965. CHIROPODY SERVICE The Chief Chiropodist Mr. L.T. Bolland, reports as follows: — The year showed a considerable increase in both treatments given at Clinics and in domiciliary visits, but comparison with 1965 would be unfair as this is the first year of working with a full establishment of Chiropodists (1 Chief and 10 Senior — the latter posts being filled by 8 full-time Chiropodists and 5 part-time) The following number of treatments were given: — At Clinics 19,213 Domiciliary 6,243 At Old People's Homes 1,620 Extension of Services With the appointment of one additional full-time and one parttime chiropodist it became possible to improve the service, mainly in the easing of domiciliary visiting in the Central Romford 27 area plus allowing a weekly visit to the "Grange" Old People's Home. Previously this home could only be visited once every three weeks owing to the fact that it had to be included with the duties of the chiropodist at Harold Hill Health Centre. Domiciliary Visiting This section of the service has now reached saturation point— patients can only be seen at 10 — 12 week intervals. This is less than satisfactory and leads to complaints from some patients. Accommodation The chiropodists at Rainham, Elm Park, South Hornchurch and Upminster still have to share accommodation with other services which naturally limits the flexibility of any chiropodial arrangements. All have been supplied with portable equipment which will still be of use for domiciliary visiting when purposebuilt chiropody rooms are built and equipped. Education Two members of the staff attended a refresher course at the London Foot Hospital. Summary The chiropody service has now reached the limit permitted by the present accommodation and number of staff. TABLE - 19 Chiropody - Attendances and Treatments during year New Cases Clinic Attendances Domiciliary Treatments Treatments at Old People's Homes Pre-School Children 6 43 - - School Children 45 2 42 - - Expectant Mothers 12 46 - - Physically Handicapped 12 228 29 10 Aged — Males over 65 Females over 60 1,118 18,441 6,201 1,610 Others 24 213 13 - TOTAL 1,220 19,213 6,234 1,520 28 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 is given in Table 20. TABLE - 20 No. of completed primary courses Type of antigen No. of children Diphtheria/Pertussis /Tetanus/Poliomyelitis 24 Diphtheria/Pertussis /Tetanus 4467 D iphtheria/Pertussis 2 Diphtheria /Tetanus 513 Diphtheria 15 Pertussis 71 Tetanus 1304 Poliomyelitis (salk vaccine) 34 (sabin vaccine) 4548 Smallpox vaccination 2967 Table 21 sets out the number of children protected against each disease including those who were given combined antigens. The equivalent figures for 1965 are given for comparison. TABLE - 21 No. of children protected against each disease Disease No. of children immunised 1966 1965 Diphtheria 5021 3792 Pertussis 4564 3518 Tetamnus 6308 5784 Poliomyelitis 4606 4515 Smallpox 2967 2048 Tuberculosis 1973 1990"" The following is an estimate of the proportion of children under one year of age who received a primary course of immunisation:-- Diphtheria 81% Whooping Cough 78% Tetanus 81% Poliomyelitis 79% 29 A total of 8473 re-inforcing doses were given during the year as shown in Table 22. TABLE - 22 Re-inforcing Doses Given Type of Antigen No of Re-inforcing Doses Diphtheria/Pertussis/Tetanus/Poliomyelitis 4 Diphtheria/Pertussis/Tetanus 1166 Diphtheria/Pertussis 3 Diphtheria/Tetanus 1547 Diphtheria 775 Pertussis 235 Tetanus 302 Poliomyelitis (salk vaccine) 38 (sabin vaccine) 3138 Smallpox vaccination 1265 The number of children under 16 years of age who were given re-inforcing doses against each disease including those who received combined antigens is given in Table 23. TABLE - 23 Number of Children Receiving Re-inforcing Doses Disease No of children who received a Re-inforcing dose Diphtheria 3495 Pertussis 1408 Tetanus 3019 Poliomyelitis 3180 Smallpox 1265 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 2205 Positive result 256 Negative result 1822 Vaccinated 1822 30 All children found to give a positive reaction to the skin test are referred to the Chest Physician for routine investigation as a precautionary measure. B.C.G. vaccination is also provided at the Chest Clinic for known contacts of tuberculous patients. 151 contacts were skin tested during the year and 126 of those who showed a negative reaction to the test were given B.C.G. vaccination. VENEREAL DISEASE Returns received from the Treatment Centre at Oldchurch Hospital show that during 1966 the numbers of new cases of infection were as follows: — TABLE - 24 Total Male Female (a) Syphilis 5 5 -. (b) Gonorrhoea 87 60 27 (c) Other conditions 579 412 167 671 477 194 105 males and 7 females included under (c) above, were found to require no treatment in the centre. The figures given above are the total for the Centre and include persons attending from adjacent areas. The net figures for Havering residents after extracting non-Havering residents from the Oldchurch Hospital figures and adding those received from other treatment centres in London, are as follows: — Syphilis 3 Gonorrhoea 52 Other conditions 364 419 31 SCHOOL HEALTH SERVICE 1966 School Population 42,050 Primary Schools 76 Secondary School 27 (including Grammar Schools) Technical Schools 2 Schools for Handicapped Pupils 2 The school population has fallen slightly during the year and there has been a slight reduction in the number of maintained schools which is accounted for as follows: — (1) The opening of Nelmes Primary School, Hornchurch (2) Closure of the old village school at Wennington (3) Dycorts Junior and Priory Junior Schools have been merged to form a single primary school (4) Pettits Secondary Boys and Pettits Secondary Girls have been merged to form a single co-educational school Routine Medical Inspections 11,008-pupils were given routine medical inspections during the year and 1,477(13.42%)were found to have conditions requiring treatment. Of the total number inspected, only 7 (0.06%) were considered to be in an unsatisfactory physical condition. The principal defects found were: — TABLE - 25 Defects found at routine School Medical Inspections Conditions No of Defects found requiring: — (a) Treatment (b) Observation Defective vision 5 73 488 Orthopaedic (inc postural abnormalities) 227 485 Nose & Throat abnormalities 163 484 Diseases of the Skin 136 227 Developmental abnormalities (inc hernia) 60 173 Speech defects 78 105 Squint 65 49 Defective Hearing 101 346 Mental development or psychological conditions 59 311 Lung abnormalities 32 134 Middle ear infection 21 83 Other conditions 115 420 32 Special Inspections A special inspection is a medical examination carried out at the special request of a parent, doctor, nurse, teacher or other person. It can be arranged at any time during a child's school career and is usually carried out in the clinic at the Minor Ailment session. A total of 1,874 special inspections were carried out during the year and the defects found included the following conditions: — Skin Conditions 377 Vision Defects 175 Hearing Defects 124 Mental Development and Psychological Conditions 160 Foot Conditions 106 Speech Defects 49 Re-Inspections A re-inspection is a follow-up examination arising from a routine or special inspection. 1,445 re-inspections were carried out during the year. Screening Tests Routine screening tests of vision and hearing are carried out by the school nursing staff and any child failing the tests is referred to a School Medical Officer who arranges treatment or further investigation by a Consultant. These screening tests are normally carried out at the time of the routine medical inspection with additional tests at about 7 or 8 years of age. Colour vision is also tested at the second or third routine inspection. Hygiene Inspections Hygiene inspections, which are carried out at intervals by the school nursing staff, include a check on general cleanliness and an examination for head infestation. Foot inspections for plantar warts and fungal infections are also carried out. 26,232 hygiene inspections were carried out during the year and 212 cases of infestation were detected, almost all of which were of a minor nature. The maximum incidence of plantar warts is found amongst children of 11, 12 & 13 years of age and a complete survey 33 of foot infections in this age group was carried out in the Autumn term. The resulting early diagnosis and treatment was considered to be of value in reducing cross infection to a minimum. Treatment Services A list of clinics in the Borough, showing the facilities available for school children, appears on page 40. Minor Ailment Clinics Regular Minor Ailment sessions are held at 11 separate clinics throughout the Borough, providing treatment for minor conditions and facilities for special consultations with the School Medical Officers. The most common conditions treated were skin diseases, 784 children attended for this purpose during the year. Other conditions treated included minor eye diseases, ear, nose and throat conditions, enuresis (bed wetting) and minor injuries, etc. 150 children were treated for enuresis by means of enuresis alarms. Ophthalmic and Orthoptic Clinics In co-operation with the Regional Hospital Board, regular Ophthalmic Clinic sessions were held at 8 separate clinics in the Borough and weekly Orthoptic sessions were held at 2 of the clinics. The Ophthalmic sessions were attended by Specialists who advise on the treatment of eye conditions and prescribe glasses where necessary or refer children to the Orthoptists who provide non-surgical treatment of squint. 3,055 children attended the Ophthalmic Clinic for treatment of eye conditions during the year 859 of whom were new referrals and 1,000 were given prescriptions for glasses. 139 children were referred to the orthoptic clinics for treatment of squint and 612 attendances were made during the year. Orthopaedic and Physiotherapy Clinics Orthopaedic Specialist clinic sessions are held at intervals at 4 of the Council's Clinics and physiotherapy is provided under the direction of the Orthopaedic Specialists at 5 separate clinics. These services are arranged in co-operation with the Regional Hospital Board. 394 examinations were carried out by the Orthopaedic 34 Specialists during the year and 3,372 physiotherapy treatments given. The service at the Harold Hill Health Centre has had to be discontinued owing to the resignation of the physiotherapist and it has not been possible to obtain a replacement by the end of the year. Speech Clinics Speech therapy is provided at each of the Council's clinics and the Speech Therapists also make regular visits to the schools for Educationally Sub-Normal Children and to the Belford Junior Training Centre. 621 children received speech therapy during the year, including 257 new referrals and a total of 8,718 treatments wete given. At the end of the year 276 children were under treatment. Expansion of the Speech Therapy Service has been hindered by shortage of staff and by inadequate accommodation at some of the clinics. It is hoped that the staffing situation will improve in the near future and the proposed alterations to Upminster, Hornchurch and Elm Park clinics should do much to overcome the accommodation problem. Dental Clinics 12,801 children were inspected in school by the School Dental Officers during the year and treatment was offered to all children found to require it. A total of 15,649 treatments were carried out at the Council's dental clinics. The Chief Dental Officer's report on the School Dental Service appears on page 41. Child Guidance and School Psychological Service The Child Guidance and School Psychological Services are provided by the Education Department under the direction of the Medical Director, Dr. J. Vincenzi, and his staff of consultant psychiatrists who are provided by the Regional Hospital Board. The Child Guidance Centre is situated at Raphael House;Western Road, Romford. During 1966 there were 379 new referrals to the Consultant Psychiatrists as against 258 for the nine months from April to December 1965, and the increased referral rate caused an extension of the waiting period for the first psychiatric 35 ation. The waiting list at the end of the year being 95 as compared to 52 at the end of 1965. The average waiting time is about six months but priority is given to court referrals, psychiatric emergencies and acute school refusals which must be dealt with immediately if there is to be any hope of success. The treatment caseload carried over from 1965 was 302 and a total of 2,548 attendances were made by new and old patients during the year. All children referred for psychiatric treatment have preliminary interviews with an educational psychologist, while the parent is seen by a psychiatric social worker who records the childs history for the information of the psychiatrist. 342 interviews of this type were carried out during the year and the psychiatric social workers also interviewed 1,599 parents either at the Centre or in their own homes. The psychological team was also responsible for administering lengthy diagnostic procedures in 36 cases and provided weekly treatment in 14 cases. The School Psychological Service is the responsibility of the Educational Psychologists who interviewed 287 children in school and saw their parents as necessary. They also kept schools informed of any relevant developments in the progress of children under treatment at the Centre. 95 children were given educational therapy by remedial teachers on the recommendation of the consultant psychiatrists. The Peripatetic Teacher of the Deaf also operates from Rapheal House and the staff of the Child Guidance Centre have found this most valuable when dealing with children who have problems of both hearing and learning. In addition to his responsibilities for the diagnosis and treatment of children referred to the Centre, the Medical Director has also made regular visits to the Diagnostic Unit at Corbets Tey School and the special classes for disturbed children at Mead Infants School, Crowlands Infants School and Manor Primary School. Health Education in Schools A full time Health Education Officer was appointed by the Health and Welfare Committee in February, 1966 followed by the appointment of an assistant in August. The early months of the year were devoted to assessing the health educational needs of the Borough and obtaining the necessary supplies and equipment, following which it was possible for a number of programmes which has been planned to be put into operation. 36 With the co-operation of Head Teachers and the Education Department, arrangements were made for health education subjects to be integrated into the school curriculum at 2 junior schools, 7 secondary schools and 1 grammar school in the Borough. Health education lectures were also given on a short term basis at 2 other grammar schools. The subject included: — Health hazards associated with cigarette smoking. The physical and psychological problems of the adolescent. Mental attitudes as part of healthy living. The normal development of children. Nutrition and food hygiene. Safety in the home and the kiss of life. Oral hygiene and care of the teeth. The Health Education Officer or his assistant attended each of the schools on one session a week,teachingtwo classes, each class receiving approximately a one hour lecture on each of the subjects. Handicapped Pupils During the year 83 children were assessed as being in need of special educational treatment by reason of physical, intellectual or emotional handicaps and 92 admissions to special schools for handicapped pupils were arranged. Educationally sub-normal children form the largest single category of handicapped pupils and in order to reduce the waiting list for admission of such children to Havering Grange or Corbets Tey Schools a special class for E.S.N, pupils was commenced at Dycorts Infants' School in January, 1966. The nursery class for pre-school maladjusted children at Mead Infants' School has continued and the similar class at Parklands Infants' School was transferred to Crowlands Infants' School during the year. These classes have proved most helpful in enabling emotionally disturbed young children to stablize sufficiently to benefit from attendance at an ordinary primary school when they reach 5 years of age. The following statistics relate to handicapped pupils assessed as being in need of special educational treatment:— 37 TABLE - 26 Handicapped Pupils Category Total No of Pupils Ascertained as Handicapped at the end of the year No of Pupils Ascertained During the year No of Pupils Admitted to Specia1 Schools During the year Total No. of Pupils in Special Schools at end of year D ay Residentia1 Blind 1 — — — 1 Partially Sighted 9 1 1 8 1 Deaf 9 — — 4 5 Partially Hearing 23 2 5 20 2 Physically Handicapped 43 5 11 27 12 Delicate 38 13 14 16 19 Maladjusted 23 7 8 — 19 E.S.N. 308 53 51 231 14 Epileptic 6 2 2 — 5 Speech Defects — — — — — TOTALS 460 83 92 306 78 29 pupils included in the above table are known to suffer from more than one handicap. 14 of these are in attendance at day special schools and 13 at residential special schools. A joint circular issued by the Department of Education and Science and the Ministry of Health in March 1966 invited all Education and Health and Welfare Authorities to review their services for handicapped children and young people and, as a result of consultation between the various staff concerned, proposals were presented with the following aims:— (a) to co-ordinate the many services available to handicapped persons (b) to provide continuity of care (c) to provide a personal and individual service available to each handicapped person or family (d) to provide early diagnosis, treatment and advice so that secondary effects of handicap can be minimised. (e) to reduce the incidence of handicap by raising the standard of health. The report which was prepared proposed that the work of Medical Officers, Social Workers, Health Visitors and the Education Welfare Officers and Youth Employment Officers be 38 co-ordinated by regular meetings and case conferences to be held at the Health and Welfare Clinics so that each clinic would become a liaison centre for a team of Medical, Social and Educational Workers operating in the surrounding area. The team would be jointly responsible for providing services and making recommendations about handicapped persons but one member of the team would maintain regular contact with the handicapped person or family and be available to them whenever assistance was required. Early diagnosis and assessment of handicap would be encouraged by increased liaison with family doctors and hospital staff and by giving publicity to the range of services available. A co-ordinated plan for assessment of handicaps and attainments in young children at Day Nurseries and Nursery Classes by Doctors, Educationalists, Psychiatrists, Health Visitors and Social Workers is being established. By the end of the year the recommendations of this wide ranging report were ready for implementation. A steady reduction in the incidence of congenital and acquired handicap can be expected as a result of immunisation against infectious disease, progressively higher standards of ante-natal and obstetric care, expansion of health education programmes and increased knowledge resulting from research. The number of cases of handicap resulting from accidents is increasing however, and the life expectation of handicapped persons is higher than ever before, due to the greater potential of medical services. For these reasons it is unlikely that there will be any reduction in the number of handicapped" persons in the near future. 39 40 Clinic Services for School Children 1966 Name and Address of Clinic Minor Ailment and Medical Consultation Clinics (No. of Sessions each week) Other Services Provided Harold Hill Health Centre Gooshays Drive, Harold Hill 2 Dental Ophthalmic - - - Speech Therapy Elm Park Clinic Abbs Cross Lane, Hornchurch 1 Dental Ophthalmic Orthoptic Orthopaedic Physiotherapy Speech Therapy Cranham Clinic Avon Road, Cranham Alternative weeks only - - - - Physiotherapy Speech Therapy Harold Wood Clinic Gubbins Lane, Harold Wood 1 Dental Ophthalmic Orthoptic - - Speech Therapy Hilldene School Clinic, Straight Road, Romford 1 - - - - - Speech Therapy Collier Row Clinic Hulse Avenue, Collier Row 2 Dental - - - - Speech Therapy Romford Clinic Marks Road, Romford 1 Dental Ophthalmic - Orthopaedic Physiotherapy Speech Therapy South Hornchurch Clinic South End Road. Rainham 1 Dental Ophthalmic - Orthopaedic Physiotherapy Speech Therapy Upminster Clinic St Mary's Lane, Upminster 1 Dental Ophthalmic - Orthopaedic Physiotherapy Speech Therapy Hornchurch Clinic Westland Avenue, Hornchurch 1 Dental Ophthalmic - - - Speech Therapy Rainham Clinic Upminster Road, Rainham 1 Dental Ophthalmic - - — Speech Therapy Raphael House 62, Western Road, Romford Child Guidance Service — Treatment of behaviour and emotional disorders and educational or vocational difficulties School Dental Service 1966 Mr. J.G. Potter, Dental Officer from the Department of Education and Science made a two day official visit to the Borough during the year to study the dental services provided by the Authority, and to inspect the dental clinic premises. In the report which followed this inspection it was stated that the organisation of the School Dental Service was regarded as being generally satisfactory, with fairly comprehensive treatment, including much conservation of deciduous teeth. The ratio of teeth filled to teeth extracted being better than average and the orthodontic service satisfactory. It was pointed out however, that the percentage of the school population inspected was low, the Ministers realising that this state of affairs was caused by staffing difficulties. Although the shortage of staff during 1966 was as acute as ever, more inspections were carried out and it will be noted that treatment was accepted by 70% of all patients to whom it was offered. Inspections The following table gives particulars of inspections carried out during 1966, compared with the previous year, and the acceptance rates. TABLE - 27 Dental Inspections 1965 1966 (a) School Population 42331 42050 (b) First inspections 15217 (36% of A) 16641 (39% of A) (c) Found to require treatment 8815 (58% of B) 8278 (50% of B) (d) Offered treatment 7487 (85% of C) 7374 (89% of C) (e) Treated 4338 5185 (f) Acceptance Rate (E as % of D) 58% 70% With this high acceptance rate, and working with a ratio of approximately one Dental Surgeon to 6,000 school children, the time available for carrying out school dental inspections is necessarily limited. To enable staff to treat more decay in its early stages, inspections were concentrated on primary school children. Treatment Table 28 gives an outline of the routine treatment carried out in the School Dental Service compared with the previous year. 41 TABLE - 28 Dental Treatment TEETH FILLED TEETH EXTRACTED General Anaest hetic s C rowns Inlays Dentures Permanent Deciduous Permanent Deciduous 1965 5183 3767 613 1982 7 79 20 10 1966 5871 3918 697 2374 800 11 12 Orthodontic Treatment With more children being seen for the first time, the number requiring orthodontic treatment for the straightening of teeth rose, and this is shown in Table 29. TABLE - 29 Orthodontic Treatment New Case Commenced Cases Completed Removeable Appliances Fitted Fixed Appliances Fitted Referred for Consultant advice 1965 110 41 221 14 63 1966 145 45 229 5 38 Mentally Handicapped Children A dental inspection of children attending the Belford Junior Training Centre revealed 22 children in need of dental treatment, all of whom accepted treatment at Harold Wood Clinic. Dental Treatment for Pre-School Children It is important that the first set of teeth are well cared for and that a child is taken to the dentist early enough for a check to be kept on the teeth so that appropriate action may be taken at the first signs of dental decay. Much better that a child has several visits to the dentist when nothing needs to be done, rather than wait until the first visit is necessitated by tooth-ache and probably means the loss of a tooth. The earlier in life that the needs and treatment of the child is undertaken the better, and to this end, a paragraph has been incorporated on consent forms given to school children informing parents of the availability of an inspection and treatment service at the Council's dental clinics for all children of pre-school age. Dental Health Education Pierre Picton, "Pierre the Clown", who is already known 42 in the area for his talks on road safety, spent a week in the Borough during February when he visited 20 Primary Schools giving talks to over 8500 school children on oral hygiene and the benefits of finishing a meal with an apple. His visit was part ofa pilot scheme sponsored by the Apple Producers Council who provided free apples for distributions to the the children. This was something new so far as dental health education is concerned and all the children seemed to enjoy it. F luoridation It is a matter of considerable regret to many who are interested in the dental well-being of the community, that the Borough Council was not able during the year, to give a definite decision in favour of the fluoridation of the water supply. There is no doubt that adjustments of the fluoride content of the public water supplies to 1 part per million is a most effective means of reducing dental decay. Caries experience is reduced by at least 50% in both deciduous and permanent dentitions following fluoridation of water supplies. The procedure has been shown to be perfectly safe and practical at the concentrations shown to be effective and the Minister of Health has given it his wholehearted support. Staff- Post Graduate Refresher Courses Three members of the staff attended refresher courses organised by the British Postgraduate Medical Federation during the year. These took the form of halfday sessions spread over six weeks. Two courses were in Orthodontics and the third in Periodontology. Clinic Premises In the Ministry's report on the Borough's dental services comment was made regarding clinic premises and in particular Elm Park, Hornchurch and Rainham Clinics came in for adverse criticism. Plans for alterations and extensions to Elm Park and Hornchurch Clinics are expected to be put into operation in the near future and proposals to replace Rainham Clinic are included in the 10 year development plan. 43 SECTION III SOCIAL SERVICES Statistics of the Social Services Section relating to both Mental Welfare Officers and Social Welfare Officers, under Miss K. Wells, Principal Social Welfare Officer, and details of the various services provided are as follows: — Staff The policy of appointing as field welfare officers only those applicants holding social welfare qualifications has continued. Difficulties have been experienced in recruiting qualified officers, but although there was a shortage of staff during the year the number of qualified staff increased as can be seen from the following* qualifications held by the 22 social workers on the staff at the end of 1966. No. at 1.4.65. No. at 31.12.65. Applied Social Studies Certificate 1 1 Mental Health Certificate 1 3 Medical Social Work Certificate - 1 Certificate in Social Work - 3 Recognition of experience in Social Work Certificates 5 5 Home Teacher for the Blind Certificate 2 3 10 17 At the end of the year two other members of the staff were on leave of absence attending Courses leading to the Certificate in Social Work. A Senior Social Welfare Officer, two Psychiatric Social Workers and a family case worker were appointed during the year and in addition a welfare trainee returned as a Social Welfare Officer having successfully completed the two-year course for the Certificate in Social Work. Due to the difficult financial position, the recruitment of Social Welfare trainees was suspended during the year, although a number of applications were received from candidates of good calibre, who in the normal way would have been accepted for training. Many members of the staff attended short courses and seminars during the year to refresh their knowledge of the work. The facilities afforded by the London Boroughs Training Committee were especially valuable in providing opportunities in this connection. One of the Social Welfare Officers attended an introductory 44 course run by the Essex Welfare Department on Communication with the Deaf. As a result it was possible to provide social work help directly for deaf people known to the Department to be in special need of help. Students During 1966 the social work section provided field placements under qualified supervision for eight students from the following Universities etc:— London University, Nottingham University and Barking Regional College of Technology. COMMUNITY CARE OF THE MENTALLY DISORDERED The importance of making medical and social care easily available to the patient suffering from mental illness, in accordance with the Mental Health Act, 1959 cannot be over emphasised, also admissions to Hospital, for treatment, on an informal basis rather than under Order. (a) Mentally III The Hospitals serving the Borough are Warley Hospital and the Ingrebourne Centre at St. George's Hospital. (b) Links with Warley Hospital The liaison and after care arrangements with the Hospital and the Community Care Services were revised in October 1966 and it was established that referral procedures have improved considerably. Monthly staff meetings are held, at which a member of the Hospital's Medical Committee attends. During the Mental Health Week, 1966, the Hospital provided exhibition stands displaying the work of a Psychiatric Hospital. These stands were exhibited in the Belford Training Centre and in the Central Library, Romford. (c) Links with Ingrebourne Centre Regular Group meetings have continued to be held at this centre and it has been possible to arrange for a psychiatric social worker to attend the meetings, thus establishing a regular liaison for discharge referrals with the Centre. Regular participation of two mental welfare officers, in group sessions, with the Senior Citizens started in January 1966. During the Mental Health Week 1966 the Centre organised an open evening, thus participating in the educational programme of the week. 45 (d) Ardleigh Green Group Regular Group meetings continue to be held with success. New referrals are now being received not only from the Ingrebourne Centre but from Psychiatric Out-patient Clinics, Warley Hospital and General Medical Practitioners. (e) Psychiatric Out-Patient Clinics at Harold Wood Hospital The arrangements whereby a mental welfare officer attends this Clinic each Monday continues and provides social help and support to newly referred out-patients and to those who are seen by the Consultant Psychiatrist prior to their discharge. In addition a psychiatric social worker together with Dr. Cronin and Dr. Dibb from Warley Hospital attend each Wednesday. (f) Social Clubs The Thursday Club has now become firmly established and attendances continue to increase. Admissions to Hospital Admissions to Hospital Between 1.1.66. and 31.12.66 Informal admissions 53 Section 29 (72 hours) 19 Section 25 (28 days) 6 Section 26 (12 months) 107 Section 60 (Court Order) 3 188 Mental Subnormality The Belford Adult and Junior Training Centres continue to function to capacity. To relieve the pressure plans are in hand for 35 adult female trainees to be accommodated in the former Hulse Avenue Nursery which will be adapted to meet their needs. Arrangements are also in hand to adapt Harold Wood Hall to accommodate 57 Havering trainees at present attending the Castle School, Barking. Parent Teachers Association This Association is now firmly established and very active, forming a very valuable link between the parents and the teachers. The committee comprises parents and teachers, the Hon. Secretary being a member of the Administrative staff of the Health and Welfare Department and all the administrative work is done in this Department. 46 47 TAELE - 30 Patients Referred During 1966 Referred By Mentally 111 Psychopathic Subnormal Severely Subnormal Total Grand Total under 16 over 16 under 16 over 16 under 16 over 16 under 16 over 16 under 16 over 16 General Practitioners 3 185 — — — — — — 3 185 188 Hospitals or discharge from in-patient treatment — 205 — 3 — — — — — 208 208 Hospitals, after or during out-patient or day treatment — 3 — — — — — — — 3 3 Local Education Authorities — — — — 10 — 5 — 15 — 15 Police and Courts 1 — — — — — — — 1 — 1 Other Sources — 27 — — — — — — — 27 27 TOTALS 4 420 — 3 10 — 5 — 19 423 442 48 TABLE - 31 Number of Patients under the Care of the Authority as at 31.12.66. Mentally 111 Psychopathic Subnormal Severely Subnormal Total GRAND TOTAL under 16 over 16 under 16 over 16 under 16 over 16 under 16 over 16 under 16 over 16 Attending day training Centre - - - - 44 43 37 54 81 97 178 Awaiting entry thereto - - - - - 3 8 8 3 11 Awaiting home training - - - - - - - - - - - Resident in Local Authority Home/Hostels - 13 - - - 23 - 7 - 43 43 Awaiting admission thereto - - - - - - - - - - - Resident at Local Authority expense in other residential Homes/Hostels - - - - - 12 - 4 - 16 16 Resident at Local Authority expense by boarding out in private household - - - - - - - 1 - 1 1 Receiving home visits 1 250 - 8 6 137 14 37 21 432 453 TOTALS 1 263 - 8 50 218 59 103 110 592 702 RESIDENTIAL CARE OF THE MENTALLY DISORDERED Collier Lodge. This Hostel continues to function as a short stay Hostel for 26 persons with a history of psychiatric illness, mostly men and women on discharge from Goodmayes and Warley Hospitals. The residents are regularly interviewed by the Psychiatric Social Worker and weekly group meetings are held by the Warden to assist them in their everyday problems. Experience has shown that vacancies should be offered on the basis of need rather than allocation and this policy will be put into effect for 1967. The allocation of places remains at 13 to Essex County Council, the remaining 13 to be shared by the London Boroughs of Barking, Redbridge, Waltham Forest and Havering. Westmarsh Lodge continues to function to capacity for 30 adult mentally subnormal residents. The majority attend the Training Centre daily and so far it has been possible to place four in remunerative employment. It is hoped to place more in suitable employment from time to time. The allocation of places remains, i.e. half of the placements are allocated to Essex County Council and the remainder shared between the London Boroughs of Barking, Redbridge, Waltham Forest and Havering. COMMUNITY CARE - WELFARE SERVICES Close co-operation continued during the year between the visiting staff, comprising Health Visitors, Psychiatric Social Workers, Social Welfare Officers, Mental Welfare Officers, and Home Help Organisers — District Nurses, Occupational Therapist, Chiropodists and Home Helps, in ensuring that any known need for domiciliary care was met. The increase in the number of Health Visitors and Home Nurses attached to, or working in close liason with general medical practitioners, enhanced this co-operation, providing a link between the patients in the practice and the various local authority services. In addition to the supportive and review visits by Social Welfare Officer and Health Visitors, and nursing care by District Nurses, various other services are provided for the Blind, Physically Handicapped and Elderly, including Domestic Help, Night Attendants and Meals-on-Wheels, the latter service being financed by the Council, but the actual delivery being undertaken by the Womens Royal Voluntary Service in Romford, and by the Hornchurch Old Peoples' Welfare Association in Hornchurch. Extensions to Services Extensions to the services include the following: — 49 1. The Good Neighbour Service, organised in conjunction with the Home Help Service. Details of this are given under the Section of the report dealing with the Home Help Service. 2. Expansion of the Luncheon Services for the elderly by opening a ninth Luncheon Centre at the Elm Park Assembly Hall, and by providing transport to convey residents in the Harold Wood area to the Luncheon Centre at Harold Hill. 3. The Occupation Centre for the Physically Handicapped which opened at the end of 1965, is now functioning to capacity and the report on the first year's working is as follows:— The Faringdon Centre The Faringdon Centre opened on November 1st, 1965 has therefore completed its first operational year. The numbers of registered permanently and substantially handicapped persons attending have increased gradually which has enabled the staff to develop and where necessary re-organise such things as the workshops resulting from the day by day experience of having increasing numbers of handicapped people working together. By April 1.966, 70 persons were attending and since then the number had continued to increase. By the end of 1967 it is expected that about 200 people will be attending the Centre. The social welfare officers from the Health and Welfare Department are responsible for recommending handicapped people to attend the Centre. They keep in touch with their clients at the Centre and offer a social work service for those who have personal and emotional problems. Those attending at present have varying degrees of handicap. The numbers of very severely incapacitated people needing constant personal attention have to be limited at any one time for various reasons. However, this range of handicaps enables a wide variety of activities to be carried out thus keeping the Centre a very lively interesting place. The main purpose of the centre is to offer to handicapped people a place to which they can go where some occupation is provided and where they will meet other handicapped people. Many of those attending would otherwise be home-bound; attending the Centre gives them an opportunity to lead a fuller and more interesting life. The Centre can fulfill a most important need for the individual handicapped person in helping him to overcome and adjust to his handicap, in building up his confidence, independence and self respect. The way in which this is achieved is mainly by the attitudes of the 50 staff, mutual support by the members and the variety of occupation that is offered at the Centre, i.e. woodwork, a wide range of handicrafts and out-work from local industries. The Centre workshops were re-organised with the addition of more sophisticated tools and machinery which enabled many more handicapped persons to take part in the inwork production of the Centre. As a result of a personal visit by the Superintendent to more than 50 local industries a reasonable amount of out-work such as spectacle frame making, and assembly sample packing in excess of three million was obtained. Today we are assembling electric packing machinery for the export market and are successful in competitive tendering against commercial organisations. The Centre is now recognized for its reliability, product quality and service with local industries; thus members may begin to earn something for the work they do for the first time for many years; their achievement is recognized and valued. The age range of those attending is from 16 years to over 60 years. Some special activities such as printing and a pop record session have been developed for the younger members. The attendance of a hairdresser and barber are most important in encouraging interest in personal appearances. Transport is a vital factor in the life of most handicapped people. The acquisition of a second vehicle this year has enabled more people to attend. However there is an almost insatiable need for transport of varying kinds. Many of those attending have their own invacars and are not dependent on others for getting to and fro. During the year the social club has flourished and their membership is now well over 100. They meet regularly one evening a month at the Centre. Three other clubs for handicapped people also use the facilities of the Centre during the evenings. Social activities in the borough have increased and given housebound people an opportunity to meet socially with others and to share in various social activities and entertainments. A wider variety of occupations with the growing numbers attending the Centre is already resulting in a lack of space. Extensions to the building will soon be necessary. Likewise more staff will be required. The additional Instructor who joined the staff in December has been fully occupied and enabled a wider choice of handicrafts to be given with more individual attention to the members. 51 Generally this has been a year of expansion. The continuing growth in attendance, further widening of activities, will obviously continue throughout 1967. Services for the Handicapped and Elderly Details of the various services available for the Handicapped and the Elderly were given in my last annual report. The following are the statistics relating to these services for the year 1966. No. of handicapped persons assisted with alterations to premises or the issue of special equipment 324 No. of handicapped persons for whom holidays were arranged 108 No. of elderly people who were provided with a week's holiday at a Holiday Camp or Guest House 2073 No. of elderly people for whom a Day's'Outing was provided 2199 No. of lunches provided for the elderly at 9 Luncheon Centres 168,517 No. of Mid-day meals delivered by Meals on Wheels Service 28,196 No. of elderly people who were provided with a Christmas Parcel 5567 Entertainments Several of the local operatic and dramatic societies in the Town supplied complimentary tickets for Old Age Pensioners or held special performances of their productions for pensioners. In addition the "Be Our Guest" organisation arranged a number of variety shows specially for the old people. Tickets for these entertainments were distributed by this Department through Old Peoples' Clubs, and coaches were hired by the Council to transport those attending. 23 such evenings were arranged, the number who attended totalling 5033, an average of 218 Statistics relating to the Chiropody Service which is provided primarily for the Handicapped and Elderly, are given on Page 28 Other services include the Workshop for the Elderly which 52 has continued to function to capacity throughout the year, providing for 32 elderly people (16 at each morning and afternoon session ) who undertake various forms of light work carried out under contract for various firms, and two Day Centres for the Elderly — one purpose built by the former Romford Borough Council and maintained by this Department and the second HOPWA House, also incorporating one of the Luncheon Centres, having been specially built by the Hornchurch Old Peoples Welfare Association, and for which the Council provide financial assistance with the running expenses. RESIDENTIAL CARE A new residential home for the elderly, The Grange, opened in September 1966. This increased the number of beds available by 61, the accommodation for the elderly now totalling 381 beds as follows: — Ravenscourt 48 Beds Hillside 63 " The Manor 51 " The Willows 158 " The Grange 61 " Total 381 The opening of the Grange considerably reduced the waiting list of those waiting admission to a Home but the list has since grown again. During the year residents'House Committees were established at Hillside and Ravenscourt, and a very successful autumn bazaar was held at the Manor. A series of meetings with all the staff at "The Willows" was held with a view to introducing changes to improve the amenities of the Home, but these were postponed owing to extensive redecorations of the bedrooms and day rooms. 47 elderly people spent a few weeks at the Homesduring the summer whilst their relations or friends with whom they normally reside were on holiday. In addition, several of the elderly, really in need of residential accommodation but apprehensive of accepting a vacancy when it arose - possibly still thinking in Workhouse terms — were encouraged to visit the Homes spending a few hours looking round, or if they wished, staying for a few days. In this way many who were previously hesitant, gladly applied to stay. 53 REGISTRATION OF OLD PEOPLE S HOMES AND HOMES FOR THE MENTALLY DISTURBED There were no new registrations or cancellation of registrations during the year. Three homes are registered in the Borough, each for old persons, providing accommodation for a total of 40 persons. TEMPORARY ACCOMMODATION At the beginning of the year 15 families from this Borough were occupying temporary accommodation at Suttons Hostel. During 1966 20 other families from Havering were admitted. The reasons they became homeless were : 5 Evicted because of rent arrears. 4 Became homeless following domestic disputes. Usually they had been turned out by relatives or friends who were putting them up temporarily. Living conditions had often been very crowded, and there had been frequent rows and domestic difficulties. 3 Landlord required premises. 2 Overcrowding. 1 Home destroyed by fire. 1 Unauthorised tenants. 1 Desertion of husband leading to homelessness of wife and children 1 Furnished accommodation no longer available on return from a visit away for some weeks. 1 No fixed abode. 1 Not known (family only stayed one night) It is interesting to note that in the whole of the Greater London Area during 1966, 1754 families came into temporary accommodation for homeless families run by local authorities. 310 of these families, or 17.6%, were evicted because of rent arrears. In Havering, 5 of the 20 families admitted to temporary accommodation, or 25%, were evicted for rent arrears. In line with the Council's policy of closing Suttons Hostel, 32 families were discharged, leaving only three families for whom the Havering Council was responsible. The designation of those discharged during the year was as follows: — Work on the new Reception Centre to replace Suttons Hostel was well advanced by the end of the year and it is hoped that this Centre will be brought into operation early in 1967. Rehoused by Greater London Council Rehoused by Havering Borough Council Private Housing other destination 1 22 1 8 54 SERVICES FOR THE BLIND AND PARTIALLY SIGHTED Close co-ordination has continued between the Senior Medical and Social Welfare Officers of the Department, and the head of the Ophthalmic Department at Oldchurch Hospital to ensure that a high standard of service is maintained in the services for the blind and partially sighted. Blind The number of registered blind persons in the Borough at 31.12.66 is given in the following Table: — TABLE - 32 No. of Registered Blind Persons Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65+ M - 2 3 3 26 17 71 122 F - 2 1 2 17 34 156 212 Total - 4 4 5 43 51 227 334 During the year 41 persons were added to the Register of Blind Persons, as shown below: — TABLE - 33 Ages of Persons Added to Blind Register in 1966 Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65+ M - 1 - - 1 5 4 11 F - - - - 2 6 22 30 Total - 1 - - 3 11 26 41 Employment 30 Blind persons were employed at the end of the year, 2 in special workshops, 3 in Home Workers Schemes and 25 in open employment. The occupations of the 30 Blind persons in employment were as follows:— 55 TABLE - 34 Occupation of Blind Persons in Employment Proprietors, Managers & Executive Workers 2 Typists, Shorthand Typists, Secretaries 7 Telephone Operators 3 Working Proprietors, Shop Managers 1 Farmers, Farm Workers etc. 1 Machine Tool Operators 2 Grocers, Fitters, Packers 3 Baskfet Makers 2 Boot & Shoe Repairers 1 Piano Tuners 1 Labourers 3 Domestic/Canteen Workers, Caretakers etc. 3 Miscellaneous Workers 1 Total 30 Residential Accommodation Table35 gives details of blind persons in residential accommodation as at 31st December, 1966. TABLE - 35 Blind Persons in Residential Accommodation M F Residential Accommodation Provided under Part III of the National Assistance Act 1948 (a) Homes for the Blind 2 14 (b) Other Homes 3 9 Residential Homes other than above - 1 In Hospitals for Mentally 111 1 3 In Hospitals for Mentally Subnormal 2 1 Other Hospitals 5 15 Total 13 43 56 Partially Sighted At 31st December, 1966, 112 persons were registered as partially sighted, an increase of 15 since the same date in 1965. Details of the age groups of those on the Register are given in the following table. TABLE - 36 Number of Partially Sighted Persons on Register as at 31.12.66. Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65* M — — 8 — 16 6 18 48 F — 1 5 1 6 10 41 64 Total — 1 13 1 22 16 59 112 New Registrations during the year are shown in Table 37 below: — TABLE - 37 Persons Newly Registered as Partially Sighted during the year Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65* M — — — — 2 3 3 8 F — — 1 — 2 4 7 14 Total — — 1 — 4 7 10 22 Included amongst those removed from the Register were six persons admitted to the Blind Register, and 3 who were decertified due to improved visual acuity. 52 of the 112 persons on the Register were near or prospectively blind. Seven of these were in employment, and the remaining 45 were not available for, or incapable of work, 41 being over 65 years of age. Details of the other 60 persons on the register are as follows: — 57 ' TABLE - 38 AGE GROUPS Mainly Industrially Handicapped: — 16-20 21-49 50-64 65* Total Employed: Male — 9 2 — 11 Female 1 2 . 4 — 7 Available for and capable of training for work : Male — 2 — — 2 Female 1 1 — — 2 Not available for work: Male — 1 3 6 10 Female — 2 — 5 7 Requiring observation only : Male — — — 2 2 Female — — — 5 5 2 17 7 18 46 AGE GROUPS Children under 16 : 0-5 5-16 Total Attending Special Schools : Male — 7 7 Female — 4 4 Attending other Schools: Male — 1 1 Female — 1 1 Not at School: Female 1 — 1 1 13 14 CARE OF THE PHYSICALLY HANDICAPPED During 1965, as mentioned in my report for that year a greater awarenesr of the Community Care facilities available in the Borough, resulted in an increase in the number of physically handicapped persons being brought to the attention of the Department. The following table illustrates that this increase continued, the number of persons on the register at 31st December, 1966, showing an increase of over 35% during the year 58 TABLE - 39 Registers of Handicapped Persons Handicap No. of persons on Register at 31.12.66. No. of persons whose names were added to the register during year ended 31.12.66 Deaf with Speech 36 4 Deaf without Speech 59 2 Hard of Hearing 37 12 General Classes 873 249 Total 1005 267 The age groups of the persons on the register, together with an analysis of those in the general classes register are set out in the following table: — 59 TABLE - 40 Handicaps and Ages of Persons on Register of Physically Handicapped Handicap. under 16 16-29 >30-45 l50-64 65+ Total Deaf with Speech 4 2 14 5 11 36 Deaf without Speech 4 15 21 16 3 59 Hard of Hearing — 5 4 3 25 37 General Classes (1) Amputation — — 3 18 14 35 (2) Arthritis or Rheumatism 6 15 56 194 271 (3) Congenital Malformation or Deformity 1 — 1 2 2 6 (4) Diseases of digestive and genito-urinary systems, of the heart or circulatory systeir (other than Tuberculosis of the skin) l 8 25 38 65 136 (5) Injuries of the head, face, neck, thorax, abdomen, pelvis or trunk. Injuries or diseases (other than tuberculosis) of the upper & lower limbs and of the spine. 6 9 25 24 32 96 (6) Organic nervous diseases-epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica etc. 8 57 76 93 67 301 (7) Neurosis, psychosis, and other nervous and mental diseases not included in 6. 1 1 1 3 9 4 18 (8) Tuberculosis (Respiratory) — — 1 1 1 3 (9) Tuberculosis (Non-respiratory — 1 — — 1 2 (10) Diseases and injuries not specified above — — 2 2 1 5 TOTALS 24 104 190 267 420 1005 60 SECTION IV GENERAL ENVIRONMENTAL HEALTH SERVICE The Chief Public Health Inspector Mr. M.F.G. Randall, has supplied the following report on the environmental health services, including details, contributed by Mr. S.F. Titterton, Senior Shop & Offices Inspector, relating to the Shops Acts and the Offices, Shops and Railway Premises Act. Staff Four vacancies for Public Health Inspectors which existed at the beginning of the year were filled by the appointment of three district Public Health Inspectors and one Meat Inspector. The establishment for Shops and Offices Inspectors was increased during the year by two posts. At 31st December 1966 the staff of the Seption was as follows:— Chief Public Health Inspector Associate Chief Public Health Inspector Two Divisional Public Health Inspectors Two Specialist Public Health Inspectors Twelve District Public Health Inspectors One Senior Shops & Offices Inspector Three Shops & Offices Inspectors Two Meat Inspectors Two Rodent Officers/General Assistants. FOOD AND DRUGS ADMINISTRATION A total of 406 samples (77 formal and 329 informal) were taken during the year and examined by our Public Analysts Two formal samples were found to be not entirely satisfactory. One was a tin of imported stewed steak with a meat content slightly under the amount stated on the label and this"was taken up with the manufacturers concerned. The other unsatisfactory formal sample concerned a proprietary drug, objection having been taken to the wording on the label. This was taken up with the manufacturers concerned and the label has been amended. 12 informal samples were found to be either unsatisfactory regarding ingredients or incorrectly labelled.No formal action was required in these cases but the matters were taken up with the manufacturers concerned. In addition 48 samples — the subject of purchasers' complaints were also referred to the Public Analysts. Three prosecutions were taken, the details of these are included in the list below. 61 129 other food complaints were dealt with without reference to the Public Analysts. In 10 of these cases legal proceedings were taken. The 177 food complaints are summarised as follows:— TABLE — 41 Complaints Bread 30 Milk/Milk Products 22 Meat Pies 17 Flour Confectionery 17 T inned Meat 13 Baby Food 9 Sugar Confectionery 7 Bacon 6 Fresh Meat 5 Cooked Meat 4 Frozen Food 4 Tinned Fruit 4 Cereals 4 Butter 3 Sausages 3 Vegetables 3 Tinned Fish 3 Fresh Fruit 3 Eggs 3 Cheese 3 Pickles 2 Soft Drinks 2 Beverages 2 Flour 2 Fish 2 Tinned Vegetables 1 Salt 1 Wine 1 Drugs 1 The 13 cases in which proceedings were taken are as follows:— Complaint Results of Proceedings String in Bread roll £10 fine Decomposed bacon £10 fine Mouldy steak & kidney pie £ 5 fine 10/- costs Glass in Bread £20 fine Beetle and dirt in pork pie £20 fine Mouldy sausage rolls £25 fine £3.3.0d. costs 62 Contd. Complaint Results of Proceedings Maggots in bacon £15 fine £3.3.0d. costs Metal clip in tin of meat £40 fine Mouldy cheese £28 fine Glass in sweets £25 fine £9.3.0d. costs Mouldy porJ< pie £25 fine £5.5.0d. costs Mouldy steak & kidney pie £10 fine £5.5.0d. costs Mould in bottle of milk £10 fine £6.6.0d. costs Recent mechanisation in the food industry coupled with greater public interest in hygiene appears to have led to an increasing number of complaints by consumers. The increase in such complaints this year over that of 1965 was 29. It will be seen that the commonest articles where foreign bodies were found included bread and cakes, milk bottles, meat pies and tinned meat. String, cardboard, feathers, broken glass, wire, oil, grease, insects, metal bolt, nails, hair curler, sand, jubilee clip,.wood splinters, pieces of metal, cement and mould featured among the contaminants. UNSOUND FOOD During the year the following foods were voluntarily surrendered to the Public Health Inspectors as being unfit for human consumption. TABLE - 42 Unsound Food Surrendered Tons. Cwts. Lbs. Ozs. Tinned Food 2 16 88 — Tinned Meat 1 61 — Tinned Milk 3 27 — Tinned Fish — 93 — Meat (Retail shops) 7 24 — Meat (Wholesale depots) 2 18 11 — Fish 3 70 — Saugages 2 87 — Frozen F ood 5 40 — TOTAL 6 19 53 — 63 ICE CREAM SAMPLING During the year 166 samples of ice cream were submitted for bacteriological examination with results as shown: — Grade I 89 Grade II 22 Grade III 26 Grade IV 29 166 14 samples of ice lollies were also taken for bacteriological examination, 5 of which were found not to be completely satisfactory and follow-up action was taken. Most of the unsatisfactory samples of ice cream (grades 3 & 4) were from the "soft" ice cream making machines and the vendors concerned were duly advised on the necessary improvements required to be made in the preparation of this product. In addition to those mentioned above, 12 samples of ice cream and lollies were submitted to the Public Analysts for chemical examination and all proved satisfactory. PRESERVED FOOD, ETC. SAMPLING Bacteriological sampling of other food products was carried out in respect of the undermentioned commodities: — Meat Products (Including pies, sausages & cooked meat) 46 Shellfish 8 Cream Cakes 7 All these samples were free from pathogenic organisms with the exception of two samples of cooked ham taken from a local producer. Investigations showed that one of the employees engaged in the preparation of the ham had sustained a cut finger and it was considered likely that the ham became contaminated from this source. Action was taken to exclude this employee from handling ham until his condition was satisfactory. Subsequent samples proved to be free from contamination. MILK SAMPLING The following samples were taken for bacteriological examination during the year with the results as shown:— 64 Untreated 30 samples taken 25 satisfied methylene blue test 4 failed " " " 1 declared void Pasteurised 235 samples taken 209 satisfied methylene blue test 18 failed " " " 8 declared void 234 passed phosphatase test 1 failed Sterilised 6 samples taken 6 passed turbidity test Vending machines included in above. 116 samples taken 100 satisfied methylene blue test 13 failed 3 declared void In all cases of failure to satisfy the methylene blue test the cause was inefficient stock rotation and this was taken up with the person responsible and the necessary improvements effected. All the samples of untreated milk were from a vending machine supplied by a producer from outside this area and were also submitted for examination both for anti-biotics and brucella abortus. All these samples proved to be negative. This supply was discontinued before the end of the year. 39 samples were submitted to the Public Analysts for chemical examination and all were satisfactory. Three of these were also tested for the presence of anti-biotics and proved negative. THE LIQUID EGG (PASTEURISATION) 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. POULTRY PROCESSING PLANTS There are no poultry processing plants in the Borough. 65 FOOD& DRUGS ACT. 1955, Section 16 During the year 12 new applications for registration of premises for the manufacture, storage or sale of ice cream and 44 new applications for registration of premises for the manufacture of sausages or potted, pressed, pickled or preserved food intended for sale were granted. ESSEX COUNTY COUNCIL ACT. 1952, Section 103 During the year under review 8 new applications for Registration as Hawkers of Food were granted. MILK DISTRIBUTORS There are 9 registered milk distributors with 16 dairy premises in the Borough. In addition, 147 shop keepers are registered for the sale of milk. 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 153 Sterilised 129 Ultra-heat Treated 24 Untreated 49 The number of licences in respect of ultra-heat treated milk rose from 8 in 1965 to 24 this year. "Ultra-heat treated" milk means milk which has been retained at a temperature of not less than 270°F for not less than one second. It must then be put into the sterile containers in which it is to be supplied to the consumer. These containers must be so closed and securely fastened that they are airtight. This milk is commonly referred to as "long life" milk and in all probability by the very nature of its keeping quality will create new methods of distribution. It may well be that with this special type of container a considerable diminution of the number of complaints regarding dirty milk bottler will come about and thus eventually dispose of one of the main causes of complaint from members of the public. 1 think it can truthfully be said that over the past few years dirty milk bottles have — apart from possibly bread and cakes — been one of the main sources of food complaints. FOOD HYGIENE (GENERAL) REGULATIONS, I960 Ministry of Health Circular 1/67 requests details of food 66 premises subject to the Food Hygiene (General) Regulations I960, grouped in categories of trade and including the following information:— TABLE - 43 Food Premises Category (of trade) Number of premises Number of premises fitted to comply with Reg 16 Number of premises to which Reg 19 applies Number of premises complying with Reg 19 Bakehouses 16 16 16 16 Butchers 153 153 153 153 Cafes 118 118 118 118 Confectioners (Bread) etc 52 52 52 52 Confectioners (Sugar) 240 232 212 212 F ish Shops 48 48 48 48 Grocers 303 303 303 303 Greengrocers 164 164 164 164 Ice Cream Manufacturer s 3 3 3 3 C lubs 20 20 20 20 Public Houses 73 73 73 73 School Canteens 81 Si 81 81 Staff Canteens 79 79 79 79 Off Licences 32 32 20 20 Regulation 16 deals with the provision of wash-hand basins and Regulation 19 with facilities for washing food and equipment. 64 notices were served under these Regulations during the year. It speaks well for the co-operation of the majority of shopkeepers that in only one instance was recourse to formal action necessary. Court proceedings were taken in respect of the following offences against these Regulations:— A lleged Offence Unclean food storeroom (Reg.23) Smoking whilst handling open food (Reg.9) -ditto- (Reg.9) -ditto- (Reg.9) -ditto- (Reg.9) Result Withdrawn — work carried out Fined £5 O.Od. • -dittoFined £2.O.Od. Fined £15.O.Od. with £3.3 Od. tosts 67 Smoking whilst handling open food (Reg.9) Fined £2.O.Od. -ditto- . (Reg.9) Summons not served -ditto- (Reg. 9) -ditto- All the seven cases of "smoking whilst handling open food" were in respect of market traders. In two instances the summonses were unable to be served as the offenders — barrow boys — had disappeared. MEAT INSPECTION The Meat Inspection (Amendment) Regulations, 1966 The Meat Inspection (Amendment) Regulations, 1966, came into operation on 30th September, 1966 the main object of these regulations being to achieve 100% meat inspection throughout the country. The Council agreed to the slaughtering hours being restricted from 8 a.m. to 6 p.m. Monday to Friday and the slaughterhouse owners duly lodged appeals against these proposals. At the end of the year these appeals were with the IVJinister of Agriculture, Fisheries and Food for determination. Slaughter of Animals Act, 1958 44 slaughtermens licences were issued during the year, 20 of these being in respect of Jewish slaughtermen authorised to slaughter by the Jewish method. 68 69 Cattle Calves Sheep & Lambs Pigs Horses Goats D eer TOTAL TABLE - 44 Meat Inspection - Carcases Inspected and Condemned The following statement shows the post-mortem inspection of animals during the year 1966 at the five .slaughterhouses in the Borough licensed by the Council. During the year one of these closed down Number Killed 14,516 3,984 70,562 22,754 178 22 1 112.017 Number Inspected 14,516 3,984 70,562 22,754 178 22 1 112,017 A11 Diseases except Tuberculosis and Cysticerosis Whole Carcases Condemned 7 6 173 42 1 – – 229 Carcases of which some part or organ was condemned 5,189 98 11,995 1,216 25 – – 18,523 Percentage of number affected' 35.79% 2.61% 17.24% 5.5% 14.6% – –— 16.74% Tuberculosis Only Whole Carcases Condemned – – – 4 – – – 4 Carcases of which some part or organ was condemned 4 – – 298 _ _ _ 302 Percentage of number affected 0.27% – – 1.3% – – – 0,27% Cysticercosis only Carcases of which some part or – – – – – – organ was condemned 7 – – – – – – 7 Carcases submitted to treatment by refrigeration 7 – – – – – – 7 Generalised and totally condemned - – – – – – – – TOTAL WEIGHT CONDEMNED 40 tons, 3 cwts, 82 lbs / WATER SUPPLIES 10 samples were taken from the main water supplies during the year. 9 were submitted for bacteriological and chemical examination and one for bacteriological examination only. All were found to be satisfactory. Mr. P. Gordon Spencer, General Manager and Chief Engineer, South Essex Waterworks Company, has kindly supplied the followinginformation concerning the main supply for the Borough. "The Chigwell Row Works are now in operation Length of mains laid in yards:— 3'7698 4"/2,677 6"/365 9"/164 12"/49. The water supply for the area and of its several parts has been satisfactory both as to quality and quantity. Bacteriological and chemical examinations are made of the raw water, of the water in its various stagesoftreatment. of the water supplied from the Company's wells and of the water going into supply. Analyses are also made of samples obtained from consumer's taps in the various parts of the Company's district and all proved to be satisfactory. A total of over 8,152 chemical, bacteriological and biological examinations have been made. In addition samples were examined for radioactivity. 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. The waters are not liable to plumbo-solvent action. No contamination has arisen, therefore no action has been necessary. The number of dwelling houses supplied as at the 31st December last was 79.061 and the population as at the 31st December last as obtained from the Registrar-General was 250,190. We are unable to state the number of houses supplied by standpipe, but the total is quite insignificant." 70 Main Water Supply, Pinewood Road, Havering The Council agreed to the provision of a main water supply to the properties in Pinewood Road, Havering. The question of some long term planning arrangements fell to be considered and eventually this problem was resolved by the Minister of Housing and Local Government. The Council were then able to proceed with their request to the South Essex Waterworks Company for the provision of an adequate mains water supply to these properties. This mains supply was installed at the end of the year. RAINFALL DURING THE YEAR The subjoined information on rainfall for the year under review was recorded at two of the Council's recording stations, viz: Raphael Park, Romford and Spring Farm Park, Rainham. The national average for England and Wales is in the region of 35.6 per year and the average number of rainy days 186. The long term average for this locality is approximately 22.5 per year and it will be seen from the monthly figures below that we had a much heavier rainfall in June, July and Aygust than is normally the case, which more or less accounts for our higher than average figure. TABLE - 45 Rainfall MONTH RAPHAEL PARK SPRING FARM PARK Amount of rainfall in inches No of da.ys on which rain fell Amount of rainfall in inches No of deaths on which rain fell January 1.26 13 1 55 14 F ebruary 1.97 17 2.40 19 March 0.50 12 0.32 8 April 3.39 17 3 48 16 May 1 33 12 1 12 11 June 3 10 13 2.42 11 July 2.57 14 2.92 14 August 2.85 12 3.10 9 September 1.01 7 1 08 8 October 3.90 19 3.26 19 N ovember 1 53 16 1 37 15 December 2.67 21 2 82 19 26.08 173 25.84 163 71 SWIMMING POOLS During the year, one new public swimming pool and 2 new school swimming pools were brought into use, so that at present there are 3 public swimming pools and 9 school swimming pools in the Borough. 35 samples were taken from the public swimming pools, 33 for bacteriological and chemical examination and two for chemical examination only. 31 samples were taken from school swimming pools for bacteriological and chemical examination. The results of these examinations were satisfactory with the exception of the new public swimming pool which, although bacteriologically satisfactory, showed a degree of organic impurity during the peak summer period. Measures are being taken to remedy this. Teething troubles of this nature are bound to arise with a new pool whilst the capacity of the pumps and equipment are being tried and a period of trial and error must inevitably elapse before equipment of this type functions entirely satisfactorily. This new pool is the first to be completed by the new Borough. The pool is of County Championship size (110' x 48') within a hall incorporating a gallery for 300 spectators and a bathers sun bay. The building is set in a spacious park in the grounds of which are the Pool Manager's house, a car park for 100 cars, a sub-station, service and access roads, and a turning space for coaches. The southern windows of the pool overlook a sunbathing terrace which is entered through a long footpool. Adjoining the shallow end of the pool hall is a refreshment room accommodating some 80 people with bar service from the service area which opens also to the sun terrace, the bathers refreshment ar£a and the park. A special feature of the pool is in the circulation to and from the changing rooms. While bathers pass from changing rooms into the pool hall through the pre-cleansing units, the return from the pool to the changing rooms is through warmed re-entry rooms. This arrangement keeps the changing rooms dry and obviates the wet, and hence dirty floors, due to bathers who in other pools return to the changing rooms through the pre-cleansing units, taking footpool and shower water back into the dressing areas. These re-entry rooms are super heated and ventilated, serving as quick drying rooms. 72 In the interests of hygiene and the comfort and convenience of bathers, poolside toilets are provided in addition to the normal bathers toilets located between the pre-cleansing and the changing rooms. Within the pool itself several new features have been incorporated, one of which is a continuous 6" rest ledge at 4'6" depth, enabling bathers to rest anywhere at the pool side. Ancilliary accommodation on the upper floor includes a club room for up to 30 people, for organisations such as the Royal Life-Saving Society, while accommodation on the ground floor includes instructors rooms and a first aid room, all opening off the pool surround. There is no doubt that this pool is a tremendous acquisition and will prove of immense value as an additional amenity in the Borough and will cater for healthy exercise and swimming education of the residents. PADDLING POOLS 28 samples were taken from the Council's 11 paddling pools during the summer months and generally speaking the results were satisfactory. CLEAN AIR The Havering (Nos. 1 & 2) Smoke Control Areas became operative on 1st July and 1st November, 1966 respectively and at the end of the year some 1,877 claims for grant for works of adaptation had been dealt with in connection with these two areas. In addition belated claims for the Hornchurch (No.6) Smoke Controlled Area were receiving attention during the early part of the year. The Havering (No.3) Smoke Control Order was made by the Council on 14th December, 1966. The necessary confirmation has now been forthcoming from the Ministry of Housing and Local Government and theOrder willbecome operative on 1st November, 1967. Details of this Area are as follows: — 660 acres 3,768 dwelling houses An area commencing on the western boundary of the district at the south side of London Road and High Street to the River Rom. 73 Along the River Rom to the Liverpool Street/Romford Railway line then along the railway line in an eastward direction to the west side of South Street. Proceeding along the west side of South Street in a southerly direction to a point where it joins the boundary of the Hornchurch (No.6) Smoke Control Area; then proceeding along the boundary of the Hornchurch (No.6) Smoke Control Area until it joins the boundary of the Borough with the London Borough of Barking. Proceeding along the southern and western boundaries of the Borough to the point of commencement at the south side of London Road. At the end of the year it was estimated that half of the total number of houses in the Borough were included in Smoke Control Areas. Added to this estimate is the possibility that somewhere in the region of at least one-third of the remaining houses have approved appliances, thus our ultimate aim of making the whole of the Borough "smoke free" begins to achieve reality . The up-to-date position is shown in the following table: — No. of smoke control areas: — (a) In operation at 31st December, 1966 10 (b) Number of dwellings 33,188 (c) Acreage covered 7,289 (a) Confirmed by the Minister but not operative at 31st December, 1966. Nil (b) Number of dwellings — (c) Acreage covered — (a) Awaiting confirmation by Minister at 31st December, 1966 1 (b) Number of dwellings 3,768 (c) Acreage covered 660 74 The 3 smoke control areas made by the Council are subject to the new grant arrangements and a note of the circumstances whichhavenecessitated changes in smoke control administration is given. The earlier smoke control areas, following the recommendations of the Beaver report, were based on the concept that bituminous coal would be replaced by gas coke. To do this it was only necessary to replace ordinary stool bottom grates by improved open fires. Technological changes in the gas industry — the use of cheap gas from oil plants, methane from the Sahara, and now natural gas from the North Sea — have made gas production from coal uneconomic so that coke, the by-product from this process, has become a declining commodity. A review by the Minister of Power on the availability of smokeless fuels showed that it was no longer possible everywhere to rely on supplies of gas coke which hitherto had been the processed fuel used to replace raw coal in smoke control areas. Consequently, where little open fire gas coke was available for new smoke control areas it would be necessary to ensure that only appliances capable of using other available smokeless solid fuels, or gas, electricity or oil, were installed. Recent price trends and the development of new appliances had resulted in these fuels becoming increasingly competitive in running costs with solid fuel fires. In the light of this new thinking the Ministerconsidered that the installation of openable stoves, under floor draught fires, or gas, electric storage or oil heaters should now be regarded by_Local Authorities as reasonably necessary works, and that approved expenditure should rank for grant. The effect of this new directive was to increase the cost <?f smoke control to the Local Authority and to the Exchequer. The householder, of course, also had to pay more, but he obtained a much better buy in the increased heating value that the more expensive appliances provided. Fortunately these changes were brought about by administrative action and without recourse to further legislative action. Smoke control was made even more expensive a little later when the Clean Air Act was amended by Section 95 of the Housing Act, 1964. The definition of a new dwelling was changed from "one which was erected prior to 5th July, 1956" to "one which was erected before 16th August, 1964". This added eight years of new building as potentially eligible for grant. The model byelaws in this connection where adopted by Local Authorities reduced some of this expenditure. A further amendment was made 75 to the Clean Air Act so as to enable the provision of gas, electric or other special means of ignition to rank for grant. This has the effect of including all pre-1964 houses burning solid fuel and not provided voluntarily with means of ignition to rank for grant, even if they had approved appliances. Various steps have been taken by the Minister to ease the administrative burden on Local Authorities, resulting in several circulars being issued. Recent communications from the Ministry indicate that in certain areas supplies of gas coke may be insufficient for the demand to be met solely by gas coke. The Minister states, therefore, that it would no longer be justifiable for Local Authorities not to pay grant for the replacement of an improved open fire by an appliance capable of burning hard coke or by an electric storage heater, gas room heater or fixed oil burning appliance. He added, however, that he anticipated that Local Authorities would not normally find it necessary to designate improved open grates as being unsuitable for installation in their area unless they were satisfied that the combined supplies of all kinds of smokeless fuels are likely to be inadequate for a particular smoke control area. I would once again like to place on record my appreciation of the assistance given by the Alkali Inspector in connection with the problem of smoke and fumes from the heavy industrialised Thames-side region in the southern part of the Borough. Details of complaints in this connection have been submitted to the Council from time to time and it is gratifying to record the ready advice which is always obtainable from the Alkali Inspector. Atmospheric Pollution Details of the number of stations operatingwithin the Borough in connection with the investigation of atmospheric pollution were given in last year's report. During the year 24 notifications were received under Section 3 of the Clean Air Act, 1956 regarding the installation of furnaces. In addition two applications for prior approval were granted by the Council. Plans were submitted to the Department for adjudication in connection with the height of new chimneys, as required by Section 10 of the Clean Air Act, 1956. 76 In six cases higher chimneys were recommended and in 10 instances chimney heights were found to be adequate and received our approval Advice was given in 14 other instances of chimneys to be erected outside the scope of the Act, such as shops, office blocks and schools. In general our requirements regarding shops and office blocks were met without much difficulty but in the case of schools the proposed chimneys were usually at a height substantially lower than that recommended by the official Ministry memorandum on this subject, mainly due to the financial limits imposed in the construction of a school by the appropriate Ministry. This is a most unfortunate state of affairs and it would be helpful if the existing legislation could be amended so that chimneys of all boiler plants exceeding 650 lbs/steam/hour are included. In the following graph the average levels of pollution by smoke and sulphur dioxide as recorded at No.3 station sited in South Street, Romford, is reproduced for information. Although this graph is for the period April to March 1965 these are the latest figures available from Warren Spring Laboratory who, on receipt of local figures, have to carry out considerable research on them so as to make them applicable for national comparison. 77 78 The Council accepted an invitation to join the Joint Conference of Local Authorities dealing with atmospheric pollution. This Joint Conference consists of the London Boroughs of Barking, Hackney, Newham, Redbridge and Waltham Forest, and the Chigwell Urban Council. Matters of mutual interest and concern arising from the implementation of the Clean Air Act are discussed and in this connection the Joint Conference submitted representations to the Ministry of Transport concerning the emission of smoke and fumes from diesel lorries. The observations of the Ministry are as follows:— "When lorries are stopped during heavy goods vehicle checks, they are examined thoroughly, and, if they are emitting excessive fumes and smoke, they are banned from use until this has been corrected. The prosecution of a wide variety of offences against the Motor Vehicles (Construction and Use) Regulations is handled by the police and it is not apparent what advantage there' would be in Local Authorities assuming this function in respect of offences relating to excessive smoke. The power to stop moving vehicles is of course vested in the Police. The use of heavy lorries to transport goods is an important part of our transport system and it is the Government's policy to develop a properly co-ordinated, efficient and flexible system in which each form of transport does the job to which it is best suited. Banning lorries from using roads where their exhaust fumes might affect the general public or from using the highways altogether would hardly be consistent with this policy. Motor manufacturers are already actively engaged in practical work aimed at reducing potentially toxic emissions from petrol engined vehicles. As regards diesel engines, if these are used in accordance with the manufacturers instructions and properly maintained and adjusted, very little smoke should be emitted. Unfortunately engines are not always used properly and goods vehicles are often underpowered or overloaded and hence emit excessive smoke. It is therefore against the users (or rather misusers) of these engines that we are taking steps rather than the manufacturers. The Road Safety Bill, which was introduced recently will enable goods vehicles to be required to bear a plate showing the maximum weight beyond which it will be an offence to load that vehicle. A British Standard for diesel engines which 79 contains maximum levels for smoke emissions will be published very soon. We hope that the measures which have been mentioned plus the continued enforcement of the existing regulations and the programme of checking by our Vehicle Examiners will greatly reduce smoke from diesel engined vehicles." THE RADIO ACTIVE SUBSTANCES ACT, I960 The increasing use of radio-isotopes in industry and for medical purposes during recent years made it necessary to promote legislation to regulate and control the use and disposal of radio active substances. The Radio Active Substances Act, 1960 was therefore brought into being and sufficient time was allowed to enable the many novel problems and features to be evaluated and set in order before the Act came into force on 1st December, 1963. From this date the holding of radio active substances on premises and the discharge or disposal of either liquid or solid radio active waste from those premises required an authorisation from the Ministry of Housing and Local Government. The Radio-Chemical Inspectorate of the Ministry of Housing and Local Government exercises very close supervision upon the permission to use, store and dispose of any radio active material, and there is no doubt at all that the authorisations made do not infringe upon the recommendations of the Medical Research Council in any way. Establishments under the control of the United Kingdom Atomic Energy Authority are excluded from this Act because they are dealt with independently. Certificates of Authorisation for the disposal of accumulations of radio active waste are received from time to time by the Council both in respect of users registered within our district and in some cases from outside the district. There are four premises in the district where Certificates of Registration have been issued by the Ministry. These apply in two instances to other Public Authorities and in two instances to private firms. SEWERAGE & SEWAGE DISPOSAL Over the past few years the Bretons Farm Sewage Farm Works has been grossly overloaded and in consequence has been 80 unable to deal adequately with the flow of sewage and trade effluent. Many complaints have been received from local residents of the foul smell arising from the sludge drying areas and, the then Romford and Hornchurch Joint Sewerage Committee after discussions with the London County Council arranged for all the liquid sewage sludge which has formally been disposed of on the land at Bretons Farm to be carried by road tanker to the Northern Outfall Works of the L.C.C. for final disposal at sea. The first load was despatched in February 1965 and apart from a period of about a week in September 1965 when as the result of the sinking of a sludge vessel in the Thames Estuary deliveries had to be stopped, the whole of the output of sludge has been disposed of by this method. The quantity disposed of each day averages approximately 66,000 gallons or 17,000,000 gallons per year. On the recommendation of the Engineer and Manager of the Sewage Purification Department, the Highways Committee agreed that the liquid sludge from the Bury Farm Sewage Works should also be removed by road tanker and since April 1966 the whole of the output from this works has been disposed of by this method. The quantity removed averages approximately 5,500 gallons per day or 1,200,000 gallons per year. < The disposal of sludge by removal has reduced the smell from these works to minimal proportions. Foul Sewers The following works have been completed: — Riversdale Road diversion (9" dia.) Approx. 112 yds Wingletye Lane/Wych Elm Park relief diversion (9" dia.) " 70 yds Additional manholes for access to old sewers (23 No.) Lambs Lane extension (6" dia.) " 115 yds N.B. The first two schemes alleviate overflowing of sewage through home drains in times of storm, the extra manholes facilitate sewer maintenance and rodent control and the last scheme eliminated cesspool(s) 81 Work will shortly commence on — Bird Lane Sewer Extension (from Dee Close) The Regional Sewerage Scheme Work is still proceeding on the extensions of Riverside S.P. Works. The Trunk Sewers are nearing completion. Surface Water Sewers (and stream improvements) The following works have been completed: — Fen Lane — relaying (12" dia.) Approx. 20 yds Heather Avenue — renewal (39" dia.) " 7 5 yds Lovers Walk (9" dia.) 250yds Syracuse Avenue — new sewer (9" dia) " 80 yds Upper Rainham Road (Elm Park Avenue) outfall (27" dia.) " 60 yds Wingletye Lane (Rayburn Road) relief diversion (9" dia.) ' " 30yds Wingletye Lane (Minster Way/The Walk) relief (9" dia.) " 95 yds Wood Lane to Bader Way (12" dia.) " 240 yds Improvement to River Rom — north of Collier Row Road " 1 mile Frinton Road — culverting (48" dia.) " 20 yds I 967/8 Programme Foul Sewers ' Rom Valley Stage I (Bretons Farm to Ravensbourne) Rom Valley Stage II (Waterloo Road) and diversion Ferry Lane Trade effluent sewer. Surface Water Sewers Upminster Road South — relief Bryant Avenue/A.127 Western Road/Mercury Gardens Havering Roai/Moray Way North Street (Parkside) Church Lane (ParkEnd Road) Fairholme Avenue — outfall Boscombe Avenue Como Street — extension. 82 River and Stream Improvements Piping ditch — Bryant Avenue Betterton Road/Philip Road culverting. Wantz Stream _ , _ c ti deterred until Ravensbourne Stream — Stage II 1968/9 STREETS MADE UP AND TAKEN OVER The Borough Engineer & Surveyor has supplied the following list of streets adopted or made up during the year ended 31st December, 1966. Streets Adopted in 1966 following Private Street Works Askwith Road, Rainham 1324 ft. Spencer Road, Rainham 1369 ft. Holme Road (Part) Hornchurch 439 ft. Somerset Gardens, Hornchurch 932 ft. Victory Road, Rainham 334 ft. Stanhope Road (Part) Rainham 143 ft. Lewis Road (Part) Hornchurch 70 ft. Hubbards Chase (Part) Hornchurch 1217 ft. Hubbards Close (Part) Hornchurch 204 ft. Alexandra Road, Rainham 768 ft. Holden Way (Part) Upminster 754 ft. The Fairway (Part) Upminster 600 ft. Private Street Works completed in 1966 Rayburn Road, Hornchurch 556 ft. Manor Crescent (Part) Hornchurch 189 ft. Arterial Avenue (Part) Rainham 910 ft. Orchard Avenue (Part) Rainham 286 ft. UNDERGROUND ROOM REGULATIONS Regulations enabling the Council to control the use of underground rooms for human habitation were confirmed by the Minister of Housing and Local Government during the year. This enabled the Council to deal with a basement flat in the central area of Romford which was considered to be unfit for habitation and not capable at reasonable expense of being rendered so fit. GIPSIES The question of a permanent site for gipsies came to a head during the course of the year as an influx of gipsies settled on the caravan site in Oldchurch Road and overflowed on to Oldchurch Park. The situation was described by the Council's 83 Public Relations Officer in his bi-monthly journal "Havering Review", which is reproduced below: — "The invasion of parts of Havering by gipsies has occupied space in the national and local Press. The Council is not unsympathetic towards gipsies — indeed it believes in the desirability of helping to integrate them into the community. Despite impressions to the contrary which may have been induced by the fact that Havering took steps for the physical eviction of gipsies from Oldchurch Park the Council is in the van of progress in dealing with the over-all problem of gipsy incursion. This is clearly demonstrated by the decision which was made by a majority of 50 to 6 at the meeting of the Council on January 18. This reads:— "That the Town Clerk be authorised to prosecute gipsies who contravene the local byelaws. I "That gipsy caravans on unauthorised sites be physically moved on to the highway with the assistance of contractors. "That protective measures be taken where necessary to prevent access to unauthorised sites. "In order to provide an alternative site on which the gipsies may settle temporarily, an ad hoc committee ... be authorised to consider a temporary site with basic sanitary facilities provided pending the establishment of a permanent site for gipsy families. "The Council urges the Minister of Housing and Local Government to issue a directive requiring at least ten of the London Boroughs in the outer area to provide and manage encampments for gipsies. "That responsibility for financing these establishments and controlling the sites should be the collective responsibility of all the London Boroughs". PICTURE WINDOWS It has become fashionable for householders to remove woodwork and small panes of glass and to substitute large panes of glass known as picture windows. Picture windows are increasing in popularity among householders but recent experience 84 has shown that some householders have infringed the building regulations because they have failed to allow for adequate ventilation. These windows, being large and heavy, do not lend themselves to easy opening and the result is that some occupiers have come to rely purely on fanlights for providing the necessary ventilation. It has been found in most instances that this is not enough and that windows have had to be altered so as to provide the required area of opening light, so that adequate ventilation can be maintained. It is stressed that all householders who are contemplating conversions of this kind should make the necessary enquiries from the Council so as not to violate the building regulations. These regulations require that an area equal to one twentieth of the floor space of a room should be capable of opening for the provision of proper ventilation. CONDENSATION IN HOMES Many complaints were received during the year concerning dampness but on investigation it was found to be mainly due to condensation. This condensation occurs in varying types of dwellings and in the main it is caused by modern design and methods of construction coupled with the use of modern materials. There has been a tendency to increase the number of rooms without chimney flues and permanent ventilation of flueless rooms by other means is not now considered necessary. Whether this is always advisable is questionable. In addition, certain changes in the ways of living increase the humidity in the air, particularly with the advent of washing machines, dryingmachines and the like. In the old days sculleries and outhouses were designed to keep any steam away from the rest of the house but, of course, in the majority of cases these are no longer provided and all work is done in the kitchenette or kitchen/living room. Oil and gas burning appliances are in more widespread use, adding to the difficulty caused by condensation. Solid floors without an insulating finish also tend to increase this problem, as doconcrete lintels, metal windows and the like. Allied to the complaints of dampness by condensation is the question of mould growth. These damp areas create an ideal situation for spores to promote mould growth. Experts on this matter state that the only sure way of stopping mould growth and condensation is the improvement of air circulation and the maintenance of reasonable temperatures. This, however, is easier said than 85 done, as in the middle of winter with a strong north easterly gale force wind blowing it is obviously virtually impossible to have any windows open and the cost of electric and gas heating also limits the period for which the normal household can afford this form of heating. It may well be that the Building Research Station will produce an answer to this problem. RENT OFFICE The Office of the Senior Rent Officer for Havering moved during the year from the Town Hall to 35 North Street, Hornchurch. The Rent Officer will assist in any queries which may arise in connection with the Rent Act and, in particular with the fixing of a fair rent. The age, character, locality and condition of the premises is considered in the assessment of a fair rent. The Rent Officer is excluded from dealing with any queries concerning furnished accommodation or controlled tenancies. IMPROVEMENT GRANTS During the year members of my staff liaised with staff of the Borough Engineer and Surveyor in connection with 131 applications for improvement grants. A breakdown of these applications is given in the following table. It is quite obvious that despite considerable publicity the members of thepublic still appear to be unaware that theycansecure financial assistance through their local Council for the installation of such improvements as inside W.C.'s, baths and hot water supplies. The object of these Government grants is to provide a better domestic standard of living in homes which, though sturdily built, lack certain modern amenities. The main conditions a ttaching to a grant are that the house is sound and in a good state of repair; that it will have at least a further fifteen years of useful life after improvement; that you own the freehold, or if you are a leaseholder that the lease has at least fifteen more years to run at the time that the application is made. It should be stressed that a grant cannot be obtained for repairs or to replace existing facilities. If a house already has a fixed bath in a bathroom an owner is not entitled to a grant to replace the bath with a more modern one. 86 TABLE - 46 Improvement Grants A Standard Owner/Occupiers T enanted Standard Standard 5 point 3 point 5 point 3 point 1 NumberofapplicationsReceived 72 - 1 - Approved 68 - 1 - Refused 1 - - - 2 Number of dwelling? Improved 41 - - - 3 Amount paid in grants £2669 14s Id. 4 .Average grant per house £ 65 2s . 4d. 5 Number of amenities provided (a) fixed bath/shower 12 (b) wash hand basin 23 (c) hot water supply (to any fittings) 28 (d) water closet 24 (e) food store 10 B. Discretionary Owner/Occupiers T enanted 1 NumberofapplicationsReceived 55 ' 3 2 '' " " Approved 46 3 3 " " " Refused 5 - 4 Number of dwellings Improved 57 - 5 Amount paid in grants £16,212. 17s. 3d. 6 Average grant per house £ 284. 8s. 9d. 87 THE NUMBER OF HOUSES ERECTED DURING THE YEAR (i) By the Local Authority 724 (ii) By private enterprise 451 (iii) By Housing Associations 121 Total 1,296 The 724 units of Local Authority accommodation which were erected during the year consisted of the following: — Bed-sitters/bed-recess 32 One bedroomed 189 Twobedroomed 242 Three bedroomed 243 Four bedroomed 18 724 At the end of the year the Council had 782 dwellings under construction or in contract. HOUSING ACT 1957 - Sections 17 & 18 Number of demolition orders made 4 Number of closing orders made 7 The above mentioned Orders involved the re-housing of 11 families, totalling 29 individuals. In addition to the above the Council made one clearance area during the year which involved 5 houses and the displacement of 5 families totalling 12 individuals. RENT ACT 1957 - C ERTIFICATES 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 of 1st January to 3lst December, 1966: — PART I — Application for Certificates of Disrepair: 1. Number of applications for certificates 12 2. Number of decisions not to issue certificates Nil 3. Number of decisions to issue certificates: — (a) in respect of some but not all defects 6 (b) in respect of all defects 6 4. Number of undertakings given by landlords under paragraph 5 of First Schedule 7 5. Number of undertakings refused by Local Authority under proviso to paragraph 5 of First Schedule Nil 6. Number of certificates issued 5 88 PART II — Applications for Cancellation of Certificates: 7. Applications by landlords to Local Authority for cancellation of certificates 2 8. Objections by tenants to cancellation of certificates 1 9. Decision by Local Authority to cancel despite tenant's objection 1 10. Certificates cancelled by Local Authority 2 Common Lodging Houses There are no registered Common Lodging Houses in the Borough. ESTABLISHMENT FOR MASSAGE OR SPECIAL TREATMENT At the end of the year 17 licences had been issued by the Council. One application for a licence to carry on an establishment for massage or special treatment (Chiropody) was refused as it was felt that the applicant had not had sufficient practical experience. The London Boroughs Association have established a central registry of employment agencies, nursing agencies, theatrical agencies, establishments for massage or special treatment, refreshment houses and the like in which the Honorary Clerk (the Town Clerk of Westminster) circulates quarterly amendments which will enable Local Authorities to ascertain the names and addresses of applicants who have been refused applications by other Authorities. LAUNDRY SERVICE FOR THE INCONTINENT The total number of persons assisted by this service during the year was 71. The number of garments washed during the year was 13,943 and the number of visits paid to these cases for collection and delivery was 2,083. INFECTIOUS AND OTHER NOTIFIABLE DISEASES The following notifications were received during the year: — 89 TABLE - 47 Notifications of Infectious Diseases Male Female Total Dysentery 101 91 192 Encephalitis (Infective) 1 - 1 Erysipelas 3 1 4 Food Poisoning (or suspected food poisoning) 138 166 304 Infective Hepatitis 31 28 59 Measles 832 808 1640 Meningococcal Infection - 1 1 Ophthalmia Neonatorum 2 2 4 Pneumonia 3 1 4 Puerperal Pyrexia - 1 1 Scarlet Fever 103 96 199 Tuberculosis: Respiratory 39 19 58 Other 4 1 5 Whooping Cough 44 49 93 Of the 304 cases of Food Poisoning (or suspected) notified only 6 (3 males and 3 females) were confirmed bacteriologically and in 3 other cases the diagnosis was amended to Sonnei Dysentery. The food poisoning organisms isolated were Salmonella Typhimurium 5, Salmonella Indiana 1. 70 of the cases notified as Dysentery were found to be negative on laboratory investigation. It is pleasing to report that no cases of Poliomyelitis, Diphtheria, Smallpox, Enteric Fever, Anthrax, Tuberculous Meningitis or Tuberculosis of the central nervous system were notified during the year. More than half the Measles cases occured in the last quarter of the year and this confirmed the expectation that 1967 might well become an "epidemic" year. NOISE ABATEMENT ACT, I960 45 complaints concerning noise were received and investigated during the year, involving some 229 visits. These complaints referred to 17 industrial premises, 10 commercial and 13 domestic, and with the exception of 4 of the domestic complaints remedial action was taken.The most common causes of complaint concerned barking dogs and musical instruments on the domestic side and noise from factories and sites in the case of the industrial and commercial premises. In addition to the above, numerous complaints were received regarding the sounding of ice cream chimes. 4 prosecutions were instituted and fines totalling £12 imposed on the offenders. 90 The degree of nuisance caused by the operation of ice cream chimes is debatable. The sounding of chimes and bells by these vendors on Sundays and in the evenings is sweet music to some, whereas to others it is somewhat disturbing and alleged to be a nuisance. The Havering Council have power to deal with offenders by virtue of Section 147 of the Hornchurch Urban District Council Act, 1936; "Every person ho shall on Sunday in any street or public place in the district call, or shout, or ring any bell, or use any noisy instrument for the purpose of selling, or advertising any article or commodity shall, for every such offence, be liable to a penalty not exceeding 40/-." This section is applied to the whole of the Borough under the Local Laws (North East London Boroughs) Order, 1965. Whilst the law concerning Sundays is quite clear, the question of weekdays is more difficult. The legislation applying to weekdays is the Noise Abatement Act, 1960, but here again it is somewhat obscure because whilst there is a general embargo that a loud speaker in a street may not be operated between the hours of nine in the evening and eight in the morning for any purpose except for Police, Fire Brigade, Ambulance or Local Authority purposes, etc., the operation of a loud speaker between the hours of noon and seven o'clock in the evening is permissible if the loud speaker is fixed to a vehicle which is being used for the conveyance of a perishable commodity for human consumption, and is operated solely for informing members of the public that the commodity is on sale from the vehicle, and is so operated as not to give reasonable cause for annoyance to persons in the vicinity. It seems, therefore, that it is permissible to use a loud speaker on a vehicle to advertise the sale of ice cream, etc., between noon and 7 p.m. on any weekday provided it does not annoy and on Sundays loud speaker chimes and the rest are definitely prohibited by virtue of the Local Act. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS To endeavour to ensure that long-stay immigrants learn how to use the Health Service their destination addresses are forwarded by the port of arrival to the Medical Officer of Health of the Authority concerned, so that advice can be given on registering with a general practitioner as soon as possible. During the year destination addresses of 33 immigrants were received and the necessary follow-up visits made. 91 Many visits proved to be futile as on enquiry at the addresses given the person named is often unknown, and it is therefore apparent that in some instances accommodation addresses are being used. DISEASES OF ANIMALS ACT, 1950 The Disease of Animals Act, require that before any animal is moved from a market, sale or auction a licence must be obtained from the Disease of Animals Inspector. One copy is sent to the Authority to which the animals are travelling and the other accompanies the animal and must be produced on request of an Inspector or Police Officer. If any notifiable disease is prevalent in the area the movement of all animals is subject to licences issued by the Disease of Animals Authority and the Ministry. During the year 570 Movement Licences have been received and dealt with. Most of these have been in respect of animals moved from markets into the slaughterhouses in the Borough. The 43 farms and 37 piggeries in the area were inspected regularly during the year and where applicable the waste food boiling apparatus checked to ensure adequate sterilization of pig swill. One suspected case of anthrax was reported. The animal concerned was a horse which was found dead in a field. A meeting was arranged with the veterinary officer at the farm and specimens taken from the dead animal for laboratory investigation. The results proved to be negative and consequently no restrictions were imposed on the farm in question, and the owner was responsible for the disposal of the carcase. Once again the absence of notifiable disease in the area is an indication of the success of Ministerial policy. DISEASES OF ANIMALS (WASTE FOOD) ORDER, 1957 20 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. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 8 licences to keep Animal Boarding Establishments were issued during the year authorising a total Boarding capacity for 494 dogs and 170 cats. 92 RIDING ESTABLISHMENTS ACT, 1964 At the end of the year 7 riding establishments had been licensed by the Council. PET ANIMALS ACT, 1951 19 licences to keep pet shops were issued during the year. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 There are 2 addresses in the Borough registered under Section 2 of this Act. SCRAP METAL DEALERS ACT, 1964 7 new registrations were effected during the year, making a total of 76 names on the register at 31st December, 1966. ESSEX COUNTY COUNCIL ACT, 1933, PART V 12 licences to carry on Employment Agencies were issued during the year. PHARMACIES & POISONS ACT, 1933 133 sellers involving 189 shops had been listed at the end of the year as required by Section 18 of this Act. PIGEONS Following the Council's approval to the destruction of pigeons at one of the shopping districts in the Borough, this work was undertaken during the year by a firm licensed by the Ministry of Agriculture, Fisheries and Food to carry out treatment using narcotic baits. Whilst the firm concerned could not guarantee a 100% clearance, with the operation carried out in the open, only three or four pigeons remained after the treatment and the work was regarded by all concerned (including the shopkeepers involved) as satisfactory and well worth while LITTER An activity causing much concern to Local Authorities and their officials is the objectionable practice of dumping refuse on the roadside or in hedges adjoining the highway. During the year 7 prosecutions were taken under Section 1 of the Litter Act, 1958 and fines totalling £35 were imposed. 93 SUMMARY OF INSPECTIONS AND VISITS BY ENVIRONMENTAL HEALTH INSPECTORATE The main headings under which work was done is classified as follows:— TABLE - 48 Summary of Inspections Subject of Visit or Inspection No. of Visits or Inspections Clean Air Act 11,487 Public Health Acts 5,003 Food & Drugs Act & Regulations 3,553 Incontinent Laundry Service 2,083 Prevention of Danjage by Pests Act 3,146 Offices, Shops & Railway Premises Act 1,660 Shops Act 1,478 Infectious Diseases 2,088 Housing Acts 965 Sampling 1,342 Factories Act 299 Noise Abatement Act 229 Diseases of Animals Act 128 Miscellaneous 1,916 Slaughterhouse & Meat Inspection 1,622 Number of Notices Served. Informal 295 Statutory 117 94 RODENT CONTROL The Ministry of Agriculture, Fisheries & Food has amended the form of Local Authorities Annual Report on rats and mice commencing with the year 1966. This Report is now required in a simpler form than previously and will be used by the Ministry to assess the general situation respecting infestations of rats and mice over the whole country from year to year. During the 12 months ended 31st December, 1966 inspections under the Prevention of Damage by Pests Act, 1949 were dealt with as under. TABLE - 49 Properties Inspected for Infestation by Rats and Mice N on-Agricultural Premises Agricultural Premises 1 Total number of properties (including nearby premises) inspected following notification 3,033 2 Number infested by: (a) Rats 849 1 (b) Mice 219 - 2 Total number of properties inspected for rats and/or mice for reasons other than notification 2,157 128 Number infested by: (a) Rats 6 - (b) Mice - - Routine baiting of sewers is carried out by the Council's C ontractors under the control of the Borough Engineer and Surveyor. 95 FACTORIES ACT, 1961 Prescribed particulars on the administration of the Factories Act, 1961, as required by Section 153(1) and Ministry of Health Circular 1/67. TABLE - 50 Factories Act, 1961 PART 1 OF THE ACT 1. Inspection for the purposes of Provisions as to Health: Premises No. on Register No. of Inspections No. of written notices No. of Occupiers prosecuted (1) Factories in which Sections 1,2,3,4 and 6 are to be enforced by local authorities 41 9 - - (2) Factories not included in (1) in which section 7 is enforced by the local authority 640 214 24 - (3) Other premises in which section 7 is enforced by local authority 35 41 - - TOTAL: 716 264 24 - 2. Cases in which Defects were found: Particulars Found Remedied Referred to H.M. Inspector Referred by H.M. Inspecto Prosecutiotis Want of cleanliness (s.l) 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 2 - - 2 - (b) unsuitable or defective 21 4 5 (c) not seperate for sexes 2 - - - - Other offences against the Act (excluding Outwork) 8 1 - - - TOTAL: 35 5 - 7 - 96 PART VIII OF THE ACT OUTWORK - SECTIONS 133 and 134 Nature of work Number of outworkers in August list Wearing apparel — making, etc. 129 Box making 5 There were no instances of work in unwholesome premises. During the year 35 visits were made to outworkers' premises. THE SHOPS ACTS. The Shops Acts are quite old legislation and date back to the Shops Hours Act, 1892. The Act of 1950 with which Local Authorities are concerned merely consolidated the measures of 1912-1938 and made no change in the law. This Act makes provision for closing hours of shops, restrictions on Sunday trading, conditions of employment for the worker, maximum working hours for young persons, weekly half-holidays, intervals for meals and rest, and additional holidays when employed on a Sunday. Visits were made to shop premises on varying days of the week in the evening and on Sundays. Warnings were issued for all contraventions detected. Contraventions found are listed in the following table. TABLE - 51 Shops Acts Contraventions Early Closing Day Failing to exhibit an early closing day notice. 72 Failing to close for the "serving of customers" 2 Failing to observe the Regulations. 3 Evening Closing Hours Failing to close for "the serving of customers" 4 Sunday Trading Failing to close for the "serving of customers" 17 Failing to observe the Regulations. 31 Conditions of Employment Failing to exhibit notice specifying the day of Assistants' weekly half-holiday 41 Failing to allow intervals for meals and rest 6 Failing to exhibit the Abstract of Act and to keep records of hours worked by young persons. 56 Failing to keep a record of Sunday employment 5 Failing to allow holidays in lieu of Sunday Employment 1 97 Prosecutions Six summonses were issued for contravening the Sunday Trading provisions. Fines of £83 were imposed ranging from £3 for a first offence to £20, the maximum, for a second offence. The Council were awarded £30. 9s. Od. costs. One summons was "dismissed". Further summonses have been served for the hearing of the Magistrates' in 1967. In 1965, The Shops (Early Closing Days) Act, 1965, made a fundamental change in that "shops authorities" were no longer empowered to fix the day of the weekly half-day closing of shops. The choice of the early closing day is now entirely for the shopkeeper himself to decide. Throughout the Country shop-keepers are in doubt whether to operate a five-day week (there is no legal objection to this) or a six-day trading week, this latter arrangement is permitted under the Act subject to certain legal procedure. In the Central district of Romford, the advocates of six-day trading submitted evidence to the Council that a majority of shopkeepers were in favour of being exempted from the early closing day provisions, Section 1 of the Shops Acts, 1950, as amended by the Shops (Early Closing Days) Act, 1965. The Council decided to hold a ballot as laid down in the Regulations. The Council listed forty groups of shops forming a particular class. The following classes voted in favour and the Council were therefore bound to make an exemption order now known as the Havering Early Closing Day Exemption Order No.1. China, Glass and Pottery Cosmetics, Toilet Requisites and Chemists Sundries Dyers, Cleaners and Launderettes Electrical Appliances and Accessories Grocery and Provisions Hairdressing — Female Handbags, Umbrellas, Leather and Imitation Goods Knitting Wools Pet Animal Shops Photographers, Cameras and Photographic Supplies Shop and Office Equipment and Supplies Spectacles and Allied Sundries Stationers Tailors Timber Merchants Wearing Apparel — Female The following classes voted against exemption and therefore are still subject to the early closing day of their choice. 98 Antiques and Second Hand Goods Artistic Reproductions, Paintings and Accessories Booksellers and Lending Libraries Building, Decorating, Supplies and Materials Camping and Sports Equipment Carpets and other Floor Covering Coal and Fuel Domestic Heating Appliances Drapery and Haberdashery Footwear Furniture and Bedding Furrier Hairdressing — Male Horticulturist, Gardening Requisites and Seedsmen Ironmongery and Hardware (including Bathroom and Kitchen fittings and Fireplaces) Jewellers, Precious Metals, Watches and Clocks Milliners Musical Instruments, Records and Music Philatelist Prams, Baby and Maternity Wear, Nursery Goods Radio and Television Sewing, Knitting Machines and Accessories Toys — Games Wearing Apparel — Male The result of the "referendum" did not in practice acquire the desired effect of what is termed "a true six-day trading week". In fact it has turned out to be a "six-day wonder". Very few shops are open for six-day trading. The consumer obviously has not taken an advantage of the change. The problem at which times shops should open or close is indeed a contraversial matter. Most interested bodies agree there is need for some flexibility. However, the Government's proposals on Retail Trading Hours, referred in my report of last year brought forward many suggestions but no clear consensus of opinion for the Government to introduce a Bill at this stage. CONSUMER PROTECTION ACT, 1961 This Act gives the Secretary of State power to make Regulations on safety requirements and construction of certain goods likely to cause death or personal injury. Regulations are in force for the provision of guards to heating appliances, standards of safety for portable oil heaters, standards as to flammability of children's nightdresses and babies carry-cot stands. With the ever increasing number of deaths and injuries caused 99 in the home by certain kinds of consumer goods; oil and electrical appliances, inflammable nightwear, electric irons, do-it-yourself tools and childrens toys, it may be expected that further regulations will be made. Under consideration are, children's toys and core flexes of electrical appliances. Toys draft regulations (limited) are at an advance stage and it is hoped will be in operation before the Christmas shopping spree of 1967. Even in the absence of safety regulations for toys one retailer in the Borough submitted a large quantity of musical baby rattles which were considered to be dangerous, for destruction by the department. Amendments to The Childrens' Nightdresses Regulations are under discussion and causing some alarm among the traders affected. Five childrens' nightdresses exposed for sale were purchased and submitted to an approved testing station to ascertain compliance with the Childrens' Nightdresses Regulations, 1964. Each was reported as complying with the tests. Four oil heaters exposed for sale were purchased and submitted to the British Standards Institution for testing and report. Noneof these conformed to the new Regulations which came into force on the 1st June. The Oil Heaters Regulations, 1966 make certain amendments to the Oil Heaters Regulations, 1962. The Regulations apply to heating appliances manufactured before the 1st June, 1962, thus bringing into line second-hand oil heaters of which there are many in circulation some causing destruction of property and death and injury to the occupants. Proceedings for the offences are down for hearing by the Magistrates in 1967. One guard to an electric fire was found not to conform with the Heating Appliances (Fireguards) Regulations, 1953. This matter was referred to the manufacturer and subsequent discussion resulted in the manufacture of a modified guard. OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 This Act makes provision for the safety, health and welfare of those employed in shops or offices and follows closely the provisions of the Factories Acts. 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, 1979 were registered with this Authority, an increase of 59 over the previous year. 100 343 premises were inspected fully with the following results:— TABLE - 52 Summary of Infringements SECTION DETAILS NUMBER 4 Cleanliness 58 5 Overcrowding 14 6(1) Temperature 11 6(4) Thermometers 101 7 Ventilation 44 8 Lighting 21 9 Sanitary Conveniences 77 10 Washing Facilities 76 11 Drinking Water 28 12 Clothing Accommodation 12 13/14 Sitting Facilities 4 16(1) Floors, Passages and Stairs 85 16(2) Handrails and guarding of open sides 18 17 Fencing Machinery 7 18 Avoidance of exposure to dangers of cleaning machinery 1 22 Dangerous Conditions and Practices 23 24 First Aid Provisions 104 49 Registration 24 50 Abstracts 133 TOTAL 841 Observations By the numbers and varying kinds of infringements noted, it appears that most employers are either not aware of their obligations under the Act or prefer to wait for the Inspector to call before doing anything to bring their premises up to an accepted standard. General maintenance in many of these places which ought to have been done anyhow, is wanting. For example, an old age pensioner was working in a disused stoke-hole, black with soot were the walls and ceiling and the 101 artificial lighting over his paper baleing machine was only two lumens; a truly Dickensian condition. In another place, ceilings had collapsed, wallplaster crumbling, floorboards missing exposing the rooms beneath and staircases rickety and old. In this case the Council authorised that application be made to the Magistrates' Court for closing of part of the premises. The firm in question acted promptly on being notified of the Council's intention and, in a few days the premises were made safe. The worst rooms were sealed off. Obstructions Floors, passages, stairs are high on the list where obstructions occur. There appears a lack of thought for the other person, premises are untidy and lack discipline. Todays shop has to make best available use of its space. Public areas have increased whilst the stock area has decreased. This creates a serious problem for the shopkeeper. Prior to the Christmas shopping period when stocks are at their maximum, spot checks are made to ensure that gangways, passages and staircases are free from obstructions . As a result of one spot check a trader was prosecuted and fined £50. Goods on staircase landings stood 9'6" high and reduced the width of the staircase, in parts, to less than six inches. One hundred and six boxes, the heaviest weighing 461bs were stacked on the steps of the staircase. Summonses for a similar offence against another trader are due to be heard by the Magistrates' in 1967. Sanitary Accommodation In premises where none are provided or where additional closets are required is a matter of concern. Employers response is very slow in meeting the demands of the Act. Accidents Employers are required to notify the "appropriate Authority" of accidents occuring within their premises. Sixty-five accidents were notified to this Authority and are summarised in Tables 53 and 54. Reporting of accidents is lagging, some mentioned in the table being found by the Inspectors when carrying out routine visits. To encourage employers to comply with the Act, a letter was sent to all employers registered with this Authority and a copy is now given to each new registered employer. 102 Accidents notified, included a young woman who severely damaged a finger by getting it caught between a strong room door and frame; a young girl who lacerated a finger on an unguarded gravity feed slicing machine, two men, one an old age pensioner who received fractured arms by falling from step-ladders. In one case the ladder collapsed due to a defective jointing pin. This was reported to the engineering division of the Factory Inspectorate who advised the manufacturers as to the modification required to, prevent further accidents of this kind. In the other case, the man was standing on the platform of a ladder without proper support. The ladder toppled over throwing him onto a concrete floor. TABLE - 53 Accidents - Analysed by Workplace Workplace Number Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Inf. Advice Offices 2 2 - - 1 1 Retail Shops 52 17 1 - 2 14 Wholesale Shops Warehouses 9 5 - - 3 2 Catering Estabs. open to public, canteens 2 2 - - 2 - Fuel Storage Depots - - - - - - TOTALS 65 26 1 - 8 17 103 TABLE - 54 Analysis of Reported Accidents Offices Retail Shops Wholesale Warehouses Catering Est open to public, canteens Fuel Shortage Depots Machinery - 2 - - - Transport - - 1 - - Falls of Persons 2 22 4 1 - Stepping on or striking against Object or Person - 6 - - - Handling Goods - 7 2 - - Struck by Falling Object - 7 2 - - Fires and Explosion - - - - - Electric ity - - - - - Use of Hand Tools - 5 - - - Not Otherwise Specified - 2 1 1 - TOTALS 2 51 10 2 - ANNUAL REPORT - OFFICES, SHOPS AND RAILWAY PREMISES ACT, 1963 A copy of the 1966 report may be seen by the public at the Town Hall, Romford and is reproduced below. TABLE - 55(A) Registrations and General Inspections (1) Class of Premises (2) Number of Premises Registered during the year (3) Total Number of Registered Premises at the end of year (4) Number of Registered Premises receiving a General Inspection luring the year Offices 24 438 119 Retail Shops 70 1363 209 Wholesale Shops, Warehouses 3 41 9 Catering Estabs open to public, Canteens 7 129 5 Fuel Storage Depots - 8 1 TOTAL 104 1979 343 104 TABLE - 55(B) Number of visits of all kinds by Inspectors to Registered Premises. = 1675 TABLE - 55(C) Analysis of Persons Employed in Registered Premises by Workplace Class of Workplace (1) Number of Persons Employed (2) Offices 3305 Retail Shops 7941 Wholesale Departments, Warehouses 787 Catering Establishments open to Public 1054 Canteens 15 Fuel Storage Depots 44 Total 13,146 Total Males 4,854 Total Females 8,292 Exemptions 1 Prosecutions 1 Inspectors:- Number of Inspectors appointed under Section 52(1) 22 Number of other staff employed for most of their time on work in connection with the Act. 1 105