HAV 3 II London Borough of Havering ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1967 London Borough of Havering ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1967 HEALTH & WELFARE DEPT., BILLET LANE, HORNCHURCH CONTENTS Page SECTION I INTRODUCTION Preface 1 Committee Members 2 Staff 3 General Statistics 5 SECTION II - PERSONAL HEALTH SERVICES PERSONAL HEALTH Introduction 11 Maternity Services 12 Mothercraft and Relaxation Classes 12 Ante-Natal and Post-Natal Clinics 12 Midwifery 13 Dental Treatment — Expectant and Nursing Mothers 14 Un-Married Mothers 14 Congenital Malformations 14 At Risk Register 15 Women's Welfare 16 Cervical Cytology 16 Handicapped Register 16 Clinic Services 17 Medical Staff 17 Child Welfare Clinics 18 Health Visiting (and Clinic Nursing) 19 Day Nurseries 21 HOME NURSING 21 SICK ROOM EQUIPMENT 22 NURSERIES AND CHILD MINDERS REGULATIONS ACT, 1948 23 NURSING HOMES 23 HOME HELP SERVICE 24 NIGHT ATTENDANT SERVICE 25 GOOD NEIGHBOUR SERVICE 25 RECUPERATIVE HOLIDAYS 26 PREVENTION OF TUBERCULOSIS 26 CARE OF THE TUBERCULOUS 27 MILK FOR TUBERCULOSIS PATIENTS 27 CHIROPODY SERVICE 27 IMMUNISATION AND VACCINATION 30 VENERAL DISEASE 32 i DENTAL SERVICES Introduction 33 Dental Inspection & Treatment of Schoolchildren 37 Dental Service for Expectant & Nursing Mothers &, Children under 5 years 38 SCHOOL HEALTH SERVICE Introduction 39 Medical Inspections 39 Screening Tests 41 Hygiene Inspections 42 Minor Ailment Clinics 42 Opthalmic and Orthoptic Clinics 42 Orthopaedic and Physiotherapy Clinics 42 Speech Clinics 43 Dental Clinics 43 Child Guidance Clinic and School Psychological Service 43 Handicapped Pupils 43 School Dental Service 43 SECTION III - SOCIAL SERVICES Introduction 45 Statistics 52 Temporary Accommodation 56 Community Care — Mental Health Services 58 Residential Care — Mental Health Services 61 Residential Care for the Elderly 66 Workshops for the Elderly 72 Entertainments for the Elderly 72 Services for the Physically Handicapped & Elderly 74 SECTION IV GENERAL ENVIRONMENTAL HEALTH SERVICES Introduction 76 Infectious Diseases 77 Medical Arrangements for Long-Stay Immigrants 80 Food and Drugs Administration 82 Ice Cream Sampling 82 Milk Sampling 83 Other Bacteriological Food Sampling 83 Liquid Egg (Pasteurisation) Regulations, 1963 84 Food and Drugs Act, 1955 — Section 16 84 Slaughter of Poultry Act, 1967 84 Poultry Processing Plants 84 Food Hawkers 85 ii Milk Distribution 85 Pesticide Residues in Foodstuffs 85 Game Act, 1931 85 Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations, 1966 86 Food Hygiene (General) Regulations, 1960 87 Meat Inspection 89 Unsound Food 90 Pharmacies and Poisons Act, 1933 90 Water Supplies 91 Rainfall and Meteorological Information 92 Swimming Pools 97 Paddling Pools 97 Caravans and Camping Parks and Open Spaces 98 Rivers, Streams and Watercourses 100 Radio-Active Substances Act, 1960 102 Houses Erected 103 Houses in Multiple Occupation 105 Housing Priority on Medical Grounds 105 Building Control 105 Improvement Grants 105 Demolition and Closing Orders 108 Certificates of Disrepair 108 Sewerage and Sewage Disposal 108 Streets Made Up Ill Clean Air Ill Atmospheric Pollution 114 Industrial Pollution 115 Noise Abatement 117 Inspections and Visits 117 Establishments for Massage and Special Treatment 118 Animal Boarding Establishments Act, 1963 118 Riding Establishments Act, 1964 118 Pet Animals Act, 1951 118 Rag, Flock and Other Filling Materials Act, 1951 119 Scrap Metal Dealers Act, 1964 119 Litter Act 119 Employment Agencies 120 Rodent Control 120 Theatrical Employers Registration Acts 120 Performing Animals Act 120 Diseases of Animals Act, 1950 121 Laundry Service for the Incontinent 121 Factories Act, 1961 122 Shops Act, 1950 123 Offices, Shops and Railway Premises Act, 1963 125 Consumer Protection Act, 1961 129 iii Telephone Homchurch 52555 Health & Welfare Department Billet Lane, Homchurch. To: The Mayor, Aldermen and Councillors of the London Borough of Havering. Mr. Mayor, Ladie's and Gentlemen, I present my report on the health and welfare of the Borough for the year 1967. The development and expansion of the various services as envisaged in the ten year development plan has commenced, extensions to one clinic having been completed, and extensions to two others nearing completion at the end of the year. Plans for a new adult training centre were finalised during the year with the prospect of commencing building work early in 1968.Meanwhile an extension to the Junior Training Centre was opened at Hulse Avenue, Collier Row during the year. Owing to the need for economy, however, many of the other projects in the Plan have had to be delayed for the present. Dr. J.T. Jones, Deputy Medical Officer of Health resigned during the year on obtaining an appointment with the Ministry of Health, and Dr. F.W. Murphy, the Principal Medical Officer was appointed to fill the vacancy. I record my thanks to the Members of the Council, my colleagues in other Departments, and to the staff of my Department, for their help and assistance throughout the year. I am, Mr. Mayor, Ladies and Gentlemen, Your obedient servant, F.GROARKE Medical Officer of Health. 1 HEALTH AND WELFARE COMMITTEE as at 31st December, 1967 His Worship the Mayor Alderman W.A. Sibley, J.P. (ex-officio) Chairman Councillor F.J. Powell Vice-Chairman Councillor F.A.J. Morley Councillor R.W. Blythe, J.P. Councillor F.J. Coffin, J.P. Councillor N.F. Kemble Councillor H.F. Moss Councillor S.E. Shute Councillor A.E. Winch Councillor R.M. Carnaby Councillor H.H. Green, J.P. Councillor R.W.E. Manning Councillor H. Packham Councillor M.J. Ward Councillor Mrs. A.V. Winch, J.P. Non-voting Members: Councillor R.C. Baker, J.P. Dr. M.J. Kehr Councillor L.F.P. Eley Dr. A. Muir 2 HEALTH AND WELFARE DEPARTMENT STAFF as at DECEMBER, 1967 Medical Officer of Health F.L. GROARKE, M.B., L.M., D.C.H., D.P.H. Deputy Medical Officer of Health F.W. MURPHY, M.B., Ch.B., D.P.H., D.T.M & H. Assistant Medical Officers of Health JULIE C. ALLARDICE, M.B., Ch.B. H.C. GUPTA, M.B., B.S., D.P.H. ELIZABETH M. HAGA, M B., B.S., M.R.C.S., L.R.C.P., D.P.H. L.J. MARSHALL, M.B., B.S., L.M.S.S.A. JEAN M. WARE, M.B., B.S. MAIR E. WILLIAMS, M.R.C.S., L.R.C.P. Chief Dental Officer E.B. HODGSON, B.D.S. Dental Officers K.N.A. JOHNSON, L.D.S., R.D.S. MRS. O. SAUNDERS, D.D.S. K. KNIGHT, 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. Superintendent Health Visitor MISS A. CATTLE, S.R.N., S.C.M., H.V. Non-medical Supervisor of Midwives and Superintendent of Home Nurses MISS D.D.K. MARTIN, S.R.N., S.C.M. 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, C.S.W. 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. 3 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 Orthopeadic. 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. D.J.F. NICOL, M.B.B.S., D.O. 4 GENERAL STATISTICS Area in Acres 29,550 Population (Registrar-General's Estimate for Mid 1967) 251,160 Number of dwellings as at 31.12.67 78,088 Rateable value as at 31.12.67 £12,099,730 Estimate product of a Penny Rate £45,500 During the year, the natural increase (4105 live births, minus 1985 deaths) would have resulted in an increase in population of 2220, but the Registrar-General's mid year estimate of251,160 shows an increase of only 970 over the 1966 population of 250,190. It follows therefore that the number of people moving away from this Borough exceeded by 1250 the number of those who came to live in Havering. This compares with a figure of 2187 in 1966. The population of certain neighbouring authorities is reproduced for information, the figures for the previous year being given in brackets. Barking 170,100 (171,000) Redbridge 245,300 (246,600) Newham 257,350 (258,690) Basildon U.D. 114,600 (111,300) Brentwood U.D 57,000 ( 56,450) Thurrock. U.D. 121,670 (120,790) The leading London Borough is Lambeth with 338,130 (339,400), followed closely by Wandsworth 330,470 (331,450) and Croydon 328,290 (327,190). Of the 33 authorities comprising the Greater London conurbation only 6 show an increase on the previous year, viz. Bexley, Bromley, Croydon, Havering, Hillingdon, Lewisham. 5 The population for the whole of England and Wales is 48,390,800 (48,075,300) and the Greater London area — the City of London and the London Boroughs — with its population of 7,880,760 (7,913,600) accounts for 16.3 (16.5) per cent of the population of England and Wales. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR (Figures for 1966 are given in parenthesis) Live Births Male Female T otal Legitimate 1968 1929 3897 (4013) Illegitimate 111 97 208 ( 211) Total 2079 2026 4105 (4224) Birth Rate per 1000 population 14.9 (15.5) Illegitimate live births (percentage of total live births) 5.3% (5.0%) Still Births Male Female Total Legitimate 25 36 61 (57) Illegitimate 1 2 3 ( 3) Total 26 38 64 (60) Total live and still births 4169 (4284) Still birth rate (per 1000 live and still births) 14.9 (14.0) Infant Deaths (under 1 year) Male Female T otal Legitimate 42 26 68 (54) Illegitimate 1 4 5 ( 4) Total 43 30 73 (58) Infant Mortality Rates — Total infant deaths per 1000 total live births 17.8 (13.7) Legitimate infants per 1000 legitimate live births 17.4 (13.5) Illegitimate infants per 1000 illegitimate live births 24.0 (18.9) / Contd. 6 Neo Natal Mortality Rate (Deaths under 4 weeks of age per 1000 live births) 12.2 (9.7) Early Neo Natal Mortality Rate (Deaths under one week of age per 1000 total live births 11.2 (8.8) Perinatal Mortality Rate (Still births and deaths under one week of age combined per 1000 live and still births) 26.4 (22.6) Maternal Mortality (including abortion) Number of deaths 0 (1) Rate per 1000 live and still births — (0.23) Deaths Male F emale Total 1025 960 1985 (2177) Death rate per 1000 population 10.3 (11.4) Comparison of above rates with those of England and Wales is shown on the following table. Havering England & Wales Outer London Greater London Birth Rate 14.9 17.2 15.4 15.8 Illegitimate Live Births (percentage of total live births) 5.3 Not available 8.7 11.4 Still birth rate 14.9 14.8 13.1 13.3 Infant Mortality rate 17.8 18.3 17.4 18.4 Neo Natal Mortality rate 12.2 12.5 12.4 12.9 Early Neo Natal Mortality rate 11.2 10.8 10.8 11.1 Perinatal Mortality rate 26.4 25.4 23.7 24.2 Maternal Mortality rate 0.0 0.20 0.25 0.33 Death Rate 10.3 11.2 10.8 10.9 7 8 TABLE 1 REGISTRAR-GENERAL S ABRIDGED LIST OF CAUSES OF DEATH IN CERTAIN AGE GROUPS (Corrected for Inward and Outward Transfers) 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 over Total Male Female M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. M. F. 1- Tuberculosis, Respiratory 6 3 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 1 _ 2 _ _ _ 2. Tuberculosis, Other 1 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 _ _ _ _ _ 3. Syphilitic Disease 7 4 3 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3 _ 1 2 _ 1 4. Diphtheria _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 5. Whooping Cough 1 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 6. Meningococcal infections _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 7. Acute Poliomyelitis _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 8. Measles _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 9. Other infective and parasitic diseases 3 1 2 _ _ _ _ _ _ _ _ _ 1 _ _ _ _ 1 _ _ _ _ _ _ 1 10. Malignant neoplasm, stomach 50 18 32 _ _ _ _ _ _ _ _ _ _ _ 2 1 _ 3 4 6 2 4 8 4 16 11. Malignant neoplasm, lung, bronchus 138 123 15 _ _ _ _ _ _ _ _ _ _ _ _ 6 1 13 3 38 5 48 4 18 2 12. Malignant neoplasm, breast 42 _ 42 _ _ _ _ _ _ _ _ _ _ _ _ _ 6 _ 12 _ 9 _ 11 _ 4 13. Malignant neoplasm, uterus 6 _ 6 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 3 _ _ _ _ 14. Other malignant 8t lymphatic neoplasms 234 127 107 _ _ _ _ _ _ _ _ 2 _ 3 1 10 4 14 15 37 26 29 24 32 37 15. Leukaemia, Aleukaemia 11 5 6 _ _ _ _ 1 _ 1 1 _ 1 _ _ _ _ _ _ 3 2 _ _ _ 2 16. Diabetes 19 8 11 _ _ _ _ _ _ 1 _ _ _ _ _ 1 1 _ 1 2 1 _ 3 4 5 17. Vascular Lesions of Nervous System 280 101 179 _ _ _ _ _ _ _ _ _ _ _ _ _ 1 5 7 15 18 21 37 60 116 18. Coronary Disease, Angina 448 273 175 _ _ _ _ _ _ _ _ _ _ _ _ 11 1 37 5 73 15 79 58 73 96 19. Hypertension with heart disease 14 7 7 _ _ _ _ _ _ _ _ _ _ _ _ 1 1 _ 4 4 2 2 2Q, Other heart disease 100 44 56 _ _ _ _ _ _ _ _ _ _ _ _ 3 2 1 _ 5 6 11 9 24 39 21. Other circulatory disease 55 26 29 _ _ _ _ _ _ _ _ _ _ _ _ 2 _ 1 _ 3 4 5 5 15 20 22. Influenza 3 1 2 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 1 1 23. Pneumonia 127 55 72 1 1 3 1 _ 1 _ 1 _ _ _ _ 1 _ 1 1 2 2 2 6 45 59 24. Bronchitis 105 74 31 1 _ 4 2 _ _ _ _ _ _ _ _ _ _ 2 _ 18 5 23 7 26 17 25. Other diseases of respiratory system 23 13 10 _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1 1 3 1 4 3 5 5 26. Ulcer of stomach and duodenum 11 5 6 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ 1 1 2 5 27. Gastritis, enteritis & diarrhoea 9 2 7 _ _ 1 _ _ _ _ _ _ _ 1 _ _ _ _ 1 _ 1 _ 1 _ 4 28. Nephritis and nephrosis 12 8 4 _ _ _ _ _ _ 1 _ 1 _ _ _ 1 1 _ _ 2 1 _ _ 3 2 29. Hyperplasia of prostate 4 4 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 2 _ 2 _ 30. Pregnancy, childbirth, abortion _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 31. Congenital malformations 23 11 12 7 6 3 3 _ 1 _ _ _ _ _ _ _ _ 1 1 _ 1 _ _ _ _ 32. Other defined & ill-defined diseases 199 79 120 19 15 3 2 3 _ 1 2 2 - 1 1 4 S 6 8 8 13 10 16 22 58 33. Motor vehicle accidents 16 11 5 _ _ _ _ _ _ 1 1 5 _ 1 _ _ _ 1 _ _ 1 2 2 1 1 34. All other accidents 28 15 13 _ _ _ _ 1 1 4 _ 1 _ 1 1 _ _ 2 _ 1 1 1 1 4 9 35. Suicide 9 5 4 _ _ _ _ _ _ _ _ _ _ _ _ _ 1 3 2 _ 1 1 _ _ _ 36. Homicide & operations of war 1 _ 1 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Total All Causes 1,985 1,025 960 28 22 15 8 5 3 9 5 11. 2 8 5 40 24 92 64 224 118 250 207 343 502 The crude birth rate for Havering in 1967 was 16.3 live births per 1000 population. After adjustment by the comparability factor, the rate is 14.9, a decrease of 0.6 compared with 1966. The rate of 14.9 is 2.3 below the comparable rate of 17.2 for England and Wales, but the decrease in Havering is in line with the decrease irt the national rate, which was 0.5 lower than the figure for 1966. The death rate of 10.3 shows a decrease of 1.1 per 1000 population, compared with the 1966 rate of 11.4. The 1966 rate was, however, 0.6 higher than the preceding year, and the rates for the last three years as set out below, have followed the rates for England and Wales, although showing a wider fluctuation which often occurs when dealing with comparatively small numbers. This is shown as follows: 1965 1966 1967 Death Rate Havering 10.8 11.4 10.3 ,, ,, England & Wales 11.5 11.7 11.2 The Infant Death Rates, including Neo-natal, Early neo-natal and perinatal mortality rates have all shown a steady decrease for many years. It is therefore disappointing that in 1967, all these rates should show an increase. The number of deaths of infants under one year of age increased from 58 to 73, the rate per 1000 total live births increasing from 13.7 to 17.8, an increase of 4.1. By comparison, the rates for England and Wales showed that over the country as a whole, the decrease in infant mortality is continuing, the infant death rate of 18.3 for 1967 showing a reduction of 0.7 over the 1966 figure. Examination of the causes of death of the 73 infants reveals that the increase is mainly attributable in Bronchitis, Broncho pneumonia and Pneumonia which increased by 10. As stated above, fairly wide fluctuations occur from time to time when comparatively small numbers are involved, and it is hoped that the figures for 1968 will indicate that this is such a variation. The causes of infant deaths and of neo-natal deaths are given in Tables 2 and 3. The number of illegitimate births decreased from 221 to 208, but with the drop in the total number of births, the percentage of illegitimate births in relation to total live births increased to 5.3%. 9 TABLE 2 Infant Deaths 0-1 months 1-3 months 3-6 months 6-12 months T otal Anencephalus 2 _ _ _ 2 Asphyxia Neonatorum 5 _ _ _ 5 Atelectasis 2 _ _ _ 2 Birth Injury 2 _ _ _ 2 Bronchitis 1 1 4 1 7 Broncho-pneumonia _ 3 2 _ 5 Congenital Heart Disease _ 2 _ _ 2 Congenital Malformations 6 1 _ _ 7 Fibrocystic Disease _ _ 1 _ 1 Gangrenous Bowel 1 _ _ _ 1 Gastro-enteritis _ _ _ 1 1 Hydrocephalus 1 _ _ 1 2 Intra -uterine Anoxia 1 _ _ 1 Meningitis 2 1 _ _ 3 Meningococele 1 _ _ _ 1 Meningomyelocele I _ 1 _ 2 Otitis Media _ _ 1 _ 1 Pneumonia 2 _ _ _ 2 Prematurity 23 1 _ _ 24 Rhesus Incapatability 1 _ _ _ 1 Whooping Cough _ 1 _ _ 1 TOTAL 51 10 9 3 73 TABLE 3 Neo-natal Deaths Under 1 Week 1-2 weeks 2-3 weeks 3-4 weeks T otal Anencephalus 2 _ _ _ 2 Asphyxia Neonatorum 5 _ _ _ 5 Atelectasis 2 _ _ _ 2 Birth Injury 2 _ _ _ 2 Bronchitis _ _ 1 _ 1 Congenital Malformations 6 _ _ _ 6 Gangrenous Bowel 1 _ _ _ 1 Hydrocephalus _ 1 _ _ 1 Intra-uterine Anoxia 1 _ _ _ 1 Meningitis 1 _ 1 _ 2 Meningococele 1 _ _ _ 1 Meningomyelocele _ 1 _ _ 1 Pneumonia 1 _ _ 1 2 Prematurity 23 _ _ _ 23 Rhesus Incomp-atability 1 _ _ _ 1 TOTAL 46 2 2 1 51 10 SECTION II PERSONAL HEALTH SERVICES SECTION The Personal Health Services are the local health authority's functions under the National Health Service Act which almost twenty years ago, provided for a complete medical service, covering Hospital, General Practitioners, Dental, Ophthalmic, Pharmaceutical Services etc. The close co-operation between the services envisaged when the Act was first adopted, was to be by the provision of Health Centres by the local health authority from which general medical practitioners,dentists, ophthalmic practitioners, pharmacists would practise, side by side with local health authority services and specialist clinics in the same building. Some Health Centres have been established throughout the county, including one at Harold Hill in the Borough, but the concept of Health Centres in all built-up areas in the country, all within easy reach of the population to be served, and each providing a full range of services for the locality did not materialise. Nevertheless, co-operation between the Hospitals, General Practitioners and local health authority service have advanced considerably since 1948, with local authority health visiting midwifery and home nursing staff attached to group practiceswhere this proves possible, and with a ready exchange of information. Interest in the provision of Health Centres in growing, and a number of general practitioners in the Borough have recently intimated that they would be prepared to consider transferring to Health Centres if such were provided.' The Ministry have indicated that loan sanction would not be withheld for Health Centres planned in new areas of development or in areas where there is a demand from general medical practitioners for Health Centre facilities to be provided. Possibly, therefore the next twenty years will show a greater advance in the provision of Health Centres under Section 21 of National Health Service than has been evident to date, leading to even closer co-operation between the various services provided under the Act, with, it is hoped, a consequential improvement in the already high standard of services to the public. The Local Health Authority Services provided under the other relevant Sections of the Act, have, since 1948, all been expanded and extended considerably. Some extensions have resulted from new discoveries, poliomyelitis vaccine and other 11 improved vaccines give an example of this; others have resulted from additional services, forexample, chiropody, beingsanctioned. In a few instances, advances in medical, science and methods of treatment have resulted in the need for -some services diminishing — particularly those relating to the care and after-care of the Tuberculous. Maternity Services Statistics relating to the Ante-natal and Post-natal Clinics are given in the following table:— TABLE 4 Ante-natal and Post-natal Clinics Ante-natal Post-natal Total Number of Women attending C lin ics 1135 11 1146 Number of Sessions Doctor Midwife T otal 47 923 970 Mothercraft and Relaxation Classes: These classes continued to be held at each of the main clinics in the area throughout the year. The number of mothers attending, was 946, compared with 822 in 1966 which when related to the total number of confinements represents an increase of approximately 3.5%. These classes are staffed by Health Visitors who at the sessions dealing with analgesia are assisted by Midwives. TABLE 5 Mothercraft and Relaxation Classes Booked for Hospital Confinement Booked for Home C onfinement Total Number of Women attending 802 144 946 Midwifery: At the end of the year the midwifery staff consisted of 29 Full-time and 2 Part-time Midwives. Table 6 sets out the number of maternity patients attended:— 12 TABLE 6 M idwifery No. of Domiciliary Confinements attendedby Midwives Number of patients delivered in Hospitals and other institutions and discharged and attended by domiciliary midwife before 10th day Doctor not Booked Doctor Booked Doctor present at delivery Doctor not present at delivery Doctor present at delivery (either the booked doctor or another) Doctor not present at delivery T otal 10 40 466 621 1137 2421 The proportion of domiciliary births related to the total decreased still further in 1967, as shown in the following table: — TABLE 7 Domiciliary and Institutional Births Place of Birth Total adjusted by notifications transferred in or out of the area 1967 1966 Domiciliary 1137 1352 Institutional 3014 2864 Percentage of Hospital Births 72.6 68.0 It is estimated that 70-75% of all expectant mothers fall within one or other of the priority groups forhospital confinement and therefore the above table indicates that during 1967, accommodation in hospital was available for those expectant mothers requiring admission on medical or social grounds. The number of maternity patients discharged from Hospital to the care of domiciliary midwives before the tenth day after confinement rose from 1899 in 1966 to 2421 an increase of about 27 per cent, and 927 of the total of 2421 were discharged within 48 hours. This has a considerable effect on the duties of domiciliary midwives who are now required to undertake fewer confinements, but instead are providing care to a steadily increasing number of mothers and babies discharged from hospital very shortly 13 after confinement. This also entails close co-operation between the Hospitals and this Department to ensure that details of the patients discharged are transmitted by telephone from the Hospital to the Department, and immediately on to the midwives. Dental Treatment for Expectant and Nursing Mothers: This is provided free of charge for expectant and nursing mothers and details are included in the report of the Chief Dental Officer on Pages Un-married Mothers The Chelmsford Diocesan Moral Welfare Association provided care during the ante-natal period for unmarried mothers and arranged subsequent admissions to Mother and Baby Homes where necessary. The costs of the Association in this connection are apportioned between the various local authorities in the County of Essex and the London Boroughs which were formerly in the administrative county. The total number of unmarried mothers from Havering who received help from the outdoor worker of the Association during the year was 81, and of these 47 were admitted to Mother and Baby Homes. Congenital Malformations: During 1967, 124 congenital malformations observed at birth were reported on the notifications of birth received from hospital and midwives. These notifications related to 106 children. An analysis is given below in Table 8. These were notified to the Registrar General, and details were transferred to the Health Visitors for follow-up. TABLE 8 Malformation Diagnostic Group No. Reported 0 Central Nervous System 21 1 Eye, Ear 10 2 Alimentary System 15 3 Heart and Great Vessels 4 4 Respiratory System 1 5 Uro-genital System 12 6 Limbs 33 7 Other Skeletal 1 8 Other Systems 16 9 Other Malformations 11 TOTAL 124 14 At Risk Register At the end of the year 473 children were being carefully followed up, as they were considered to be "at risk" due to various hereditary, ante-natal or post-natal factors. As soon as it has been ascertained that a child is normal and making proper progress, the need for special observation ceases to exist, and the child's name is removed from the "At Risk Register". All premature infants are included on the Register and Table 9 below gives details of the number of Havering infants regarded as premature on the basis of a birth weight of 5'/2lbs or less. TABLE 9 Weight at birth Premature live births Pre* mature stillbirths Born In hospital Born at home or in a nursing home Nursed, entirely at home or in a nursing home Transferred to hospital on or before 28th dey Total births Died Total births Died Total births Died Born within 24 hour* of birth in 1 and under 7 days in 7 and under 28 days within 24 hours tyi birth in 1 and under 7 days in 7 and under 2 8 days wMhin 24 hours j 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 ! 2 13 14 1. 21b. 3oz. or less 12 4 6 _ _ _ _ _ _ _ _ _ _ _ 2. Over 21b. 3oz. up to and in eluding 3lb. 4oz. 17 3 5 _ _ _ _ _ 2 _ _ _ 7 _ 3. Over 31b. 4oz. up to and including 41b. 6oz. 31 2 5 _ 1 _ _ _ 2 _ _ _ 8 _ 4. Over 41b. 6oz. up to and in eluding 41b. 15oz. 47 3 1 1 3 _ _ _ 3 _ 1 _ 4 _ 3. Over 41b. 15oz. up to and in. eluding Sib. 8oz. 116 1 _ 1 15 1 _ _ _ _ _ _ 7 2 6. TOTAL 223 13 17 2 19 1 _ _ 7 _ 1 34 2 15 Handicapped Register Babies and young children found to be handicapped are kept under regular observation, referred, if needed, for specialist advice and treatment, and in due course where necessary recommended for special education. At the end of the year, 165 children under the age of 5 years were recorded as handicapped or under investigation for potential handicap. Women's Welfare Sessions continued at Homchurch, Elm Park, Harold Wood and Cranham clinics at which contraceptive advice was available to women having a medical indication for a voiding childbirth. Owing to staff changes, it was necessary to discontinue an evening session which had been held regularly up to and including the previous year, and this had the effect of reducing a number of women attending from 321 in 1966 to 191 in 1967. As stated in my report for 1966, the Council accepts responsibility for treatment provided on medical grounds to women resident in the Borough by the Family Planning Association at their clinic held in Romford, and in addition the Council provides the clinic premises free of charge, also making a grant for heating, lighting and cleaning. Cervical Cytology The number of smears taken during the year at the six clinics where sessions are held totalled 3,140, an increase of 620 compared with the 1966 figure of 2,500. The results are set out in Table 10. Smears are also taken at the Family Planning Clinic, by general medical practitioners and at hospitals in the area. All women over the age of 35 are advised to have a test at intervals of not more than five years. Whilst the publicity which has been given to the scheme has encouraged a considerable increase in smears taken, nevertheless there are many women who have not heeded the advice. The test not only enables the possibility of cervical cancer to be detected, and measures to be taken to prevent the disease developing, but also enables the disease to be cured when detected in the early stages. 16 TABLE 10 Results of Cytological Examinations 1 Absence of Atypical Cells 3105 11 Atypical Cells, but no evidence of malignancy 15 11+ Atypical Cells, early repeat desirable 6 111 Cytology Suggestive of, but not conclusive for, malignancy 10 IV Cytology strongly suggestive of malignancy 3 Clinic Services As an extension to the clinic services, a child welfare clinic was commenced at the Mardyke Social Centre on 22nd May, 1967. This session is held twice monthly to serve the Mardyke Estate, Rainham. Plans for extensions to three other clinics were finalised during the year, and work commenced at Upminster Clinic in April, the work being completed in November. At Elm Park and Homchurch Clinics work commenced in July and was still continuing at the end of the year. Whilst these clinic buildings were in the hands of the builders, the sessions were carried on at various private or Council owned premises in the vicinity of the various clinics. At the time when all three clinic premises were out of use, six privately owned halls and five Council owned establishments were in use for the various sessions and services normally provided at these Clinics. Whilst some disorganisation was inevitable, very few difficulties were encountered, and both members of the public and the staff co-operated to the full in accepting the temporary arrangements. Medical Staff The establishment of assistant medical officers remains at eight, but owing to resignations during the year, it was not possible to maintain this number. At the end of the year, two vacancies still existed, but appointments to fill these were pending. In addition to duties connected with maternity and child welfare, the medical staff also undertake school health work and 17 examination of staff. Local general practitioners also attend occasionally on a sessional basis, but at times when vacancies occur as in 1967, the general medical practitioners attend on a more regular basis. Child Welfare Clinics The total number of children attending the Clinics decreased from 8921 in 1966 to 8279 in 1967. 74.4% of children born in 1967 attended the clinics compared with a equivalent figure of 75.8% in 1966. Total attendances also fell from 51,628 in 1966 to 43,265 in 1967, the average number of attendances for all children falling from 5.8 to 5.2 per annum. A number of factors are involved in the decrease in attendances. The fall in the birth rate obviously means that there are fewer babies to attend, but the change in the concept of the child welfare clinic from the centre where the baby comes to be weighed regularly to ascertain progress, to a clinic where routine screening tests and medical examinations, with the parent being able to consult doctor and health visitor, has tended to reduce the largerattendanc.es of healthy infants, and led to a more beneficial use of the clinic services for those mothers who have any doubt about the progress or development of their babies. An additional factor in the reduced attendances has been the closure of the three clinics mentioned earlier in this report, for building works to be carried out. This had the effect of reducing the total number of sessions from 1,489 in 1966 to 1,417 in 1967. The temporary accommodation provided for the clinic services was not in all cases as readily accessible, and, of course, did not have the facilities available in the purpose built clinic premises they were temporarily replacing. Table 11 which follows gives details of the sessions helc and number of children attending. TABLE 11 Child Welfare Clinics No. of children attending Born in 1967 Bom in 1966 Born in 1962-65 TOTAL 3,054 2,808 2,417 8,279 Sessions held by Doctors Health Visitors TOTAL 903 514 1,417 18 Health Visiting (and Clinic Nursing) At the end of the year, whilst the establishment for Health Visitors remained at 58 the equivalent of 29.5 Full-time Health Visitors were employed.These included three Group Advisors, one Fieldwork Instructor, 19 Full-time and 17 Part-time Health Visitors, and three Visitors dealing entirely with persons suffering from Tuberculosis. In order to allow the Health Visiting staff to be available as far as possible for duties for which their training is required. 1 Full-time and 18 Part-time Clinic Nurses were employed to undertake clinic and School Health work. Co-operation with general practitioners has increased, with a greater number of liaison arrangements whereby the Health Visitor pays a weekly visit to the surgery for a discussion with the doctor. In addition one Health Visitor is attached to a large Group Practice, with additional help from a Clinic Nurse for Ante-natal and Immunisation Sessions held at the surgery. The Health Visitors undertake domiciliary screening tests such as hearing assessment of young children where it is not possible for the mother to attend the clinic, and with a greater emphasis on medical social work, the number of geriatric visits has increased considerably over the past two years. Some of the geriatric visiting is undertaken by the Clinic Nurse under the Health Visitor. The Health Visiting Staff have also established a good relationship with voluntary organisations which is proving of great value. Health Education forms an important section of the Health Visitors duties — personal health education is an integral part of her work, and all personal contacts provide an apportunity for this. In addition, all the Health Visitors take part in mothercraft teaching to groups in the clinics, and in many instances these incorporate a session to which fathers and expectant fathers are invited. Some Health Visitors are actively taking part in Health Education in schools, and give talks etc., to professional and cultural community groups. Health Visitors are also engaged in training of staff. The Fieldwork Instructor, in addition to her designated duties involving 19 the practical training of Health Visiting Students, undertakes lectures to the student nurses at Oldchurch Hospital. One Health Visitor is engaged in in-service training to groups of members of the staffs of the residential welfare establishments in the Borough. In addition all Health Visitors are involved in the observation visits arranged for students who are undertaking professional training, groups from local Youth Organisations, parties of school children, pre-nursing course pupils etc. The Superintendent Health Visitor undertakes a variety of Health Education talks, and also gives in-service training talks to members of staff locally and under the organisation of the London Boroughs Training Committee. During 1967, one Health Visitor student sponsored by the Department qualified, and took up an appointment as Health Visitor, and two Health .Visitor Students were accepted as sponsored students to commence training in September 1967. Table 12 below gives details of the Home Visits by Health Visitors TABLE 12 Cases Visited by Health Visitors Home Visits to Total No. Visited Notes 1966 figures for comparison Children 16,885 Born in Born in Born in 1967 1966 1964/65 3,743 3,943 9,199 15,988 Tuberculosis Households 1,415 1,412 visited by Tuberculosis Visitors 1,174 Elderly Persons (over 65) 1,137 Including 357 at special request of hospital or family doctor (1966=266) 1,216 Persons (excluding maternity patients) discharged from Hospital (other than Mental Hospitals) 159 Including 103 at special request of hospital or family doctor (1966=61) 66 Mentally disordered Persons 27 Including 13 at special request of hospital or family doctor (1966=11) 64 Cases of Infectious diseases 3 Excluding Tuberculosis 6 TOTAL 19,069 18,514 20 Day Nurseries Table 13 below gives details of the average attendance at the four day nurseries in the Borough. It was necessary to restrict admissions on occasions when children attending contracted measles, whooping cough, etc. and this reduced the average daily attendance at all nurseries from 144.58 in 1966 to 133.83 in 1967. TABLE 13 Day Nursery Attendances and Waiting List Nurseries Places Average daily attendance over the year Waiting List Priority on 31.12.66 Non-Priority Diban Avenue Elm Park 50 37.91 20 46 Western Road Romford 40 23.97 5 39 Coilier Row 50 40.97 3 50 Rush Green 50 30.98 8 22 TOTAL 190 133.83 36 157 Home Nursing At the end of the year 32 Full-time and 5 Part-time nurses were employed in providing nursing care to patients in their own homes, an increase of four Full-time nurses in the twelve months under review. Included in this total were seven male nurses, compared with six employed at the commencement of the year. Four of the nurses are attached full-time to group practices. The number of persons nursed and the total number of nursing visits made are set out in Table 28. Similar statistics for 1966 are given for purposes of comparison. It will be noted that the demands for this service continue to expand, and it is anticipated that with average age of the population likely to increase for some years, the number of home nurses required will similarly increase until the present establishment of 45 Full-time nurses is reached. 21 TABLE 14 Home Nursing 1967 1966 Number of Persons Nursed: Under 5 years of age 51 33 Ages 5 — 64 779 661 Age 65 and over 1663 1387 Total Number of Persons Nursed 2433 2 081 Number of Nursing Visits made during the year 71,699 68,275 Sick Room Equipment The issues of sick room equipment, loaned free of charge, to persons being nursed at home continued to increase, as shown in Table 15 below: TABLE 15 Sick Room Equipment issued on loan from January to December, 1967 No. issued on loan during year Article 1967 1966 Air Rings 61 90 Back Rests 243 229 Bed Cradles 118 106 Bed Pans 241 245 Bed Pans (Rubber) 3 12 Bed Pans (Slipper) 2 - Bedsteads 24 10 Bed Tables 15 12 Commodes 346 295 Crutches 20 pairs 21 pairs Draw Sheet 175 97 Feeding Cups 31 30 F ireguards 17 - Foam Rings 195 154 Fracture Boards 9 15 Hydraulic Hoists 15 15 Mattresses 33 18 Pillows 4 Pillow Covers 1 - Plastic Sheets 228 204 Pulleys 21 15 Contd 22 No. issued on loan during year Article 1967 1966 Rubber Sheets 22 13 Sani-cushions 2 — Sputum Mugs 7 4 Sputum Mug Holders 7 14 Urinals (Female) 22 13 Urinals (Male) 146 130 Walking Aids (Quadruped) 15 28 Walking Aids (Tripod) 14 14 Walking Frames 32 1 Walking Sticks 54 46 Wheelchairs 256 254 TOTAL 2375 2089 In addition to the above approximately 40,600 Disposable Sheets, and 16,800 Interliners, were issued — a total of 57,400 compared with 49,500 issued in 1966. Nurseries and Child Minders Regulation Act 1948 During the year new registrations of premises under the above Act increased the total number of places provided for children, mainly in play-groups from 1259 at the end of 1966 to 1479 at the end of 1967. The number of Church or Social halls registered increased by eight to a total of 44. The number of child minders registered increased by four, 18 being registered at the end of the year, providing for the daily minding of 135 children. All applications for registration were granted subject to the observance of fixed standards regarding space and amenity, and of recommendations contained in reports by the Public Health Inspector, Health Visitor, and the Fire Prevention Department of the London Fire Brigade. All premises and child minders are inspected periodically by the Health Visitors. Nursing Homes: One nursing home closed during the year, leaving three homes registered in the Borough. Regular visits of inspection are made to the homes which provide a total of 60 beds for acute and chronic sick. 23 Home Help Service This service which is administered by a Senior and four Home Help Organisers, provides domestic help during the day for aged, chronic sick, mentally disordered, maternity and other patients in need of such assistance. Each Home Help organiser is responsible for the provision of help, and the supervision of the staff employed in that portion of the Borough allocated to her, under the general supervision of the Senior Home Help Organiser. The night attendant service and good neighbour scheme are run in conjunction with the Home Help Service, and the Senior Organiser is responsible for the operation of these services. Statistics relating to the Home Help Service are given in Table 16. The total number of cases helped during the year decreased by approximately 1.3% compared with the figure of 2374 for 1966, and the number of hours of help provided also decreased from 327,210 hours to 318,457 — approximately 2.6% In cases of Toxemia of Pregnancy, a home help is provided free of charge. TABLE 16 Home Help Service Requests for help from new cases during the year. 1090 Cases not eligible for assistance or not requiring services. 201 New cases helped during the year. 797 Persons being helped at the end of the year. 1691 Total persons helped during the year. 2343 Total number of hours of help provided during the year. 318,457 24 The categories of cases helped during the year were as follows:— Chronic Sick under 65 years of age Aged 65 years of age over, or - 266 — 1615 Maternity - 255 Other (Acute illness, Mental Disorder, Problem Families etc.) 207 Night Attendant Service Under this service, night attendants are provided for seriously ill patients and to give relief to relatives who would, without this help, be occupied day and night in caring for a patient being nursed at home. In other instances, a night attendant is provided for a patient living alone, and for whom no other arrangements can be made. Statistics relating to this Service are given in Table 17. TABLE 17 Night Attendant Service Number of Patients helped during the year 16 Number of hours for which attendants were supplied 366 Good Neighbour Service This Service, ancillary to the Home Help Service, is provided to give care for housebound patients, by enrolling neighbours to visit them at various times during the day to attend to the personal care of the patient and work in conjunction with the Home Help Service. Statistics relating to the scheme for 1967 are given in the following Table. TABLE 18 Good Neighbour Service No. of patients provided with help under the Good Neighbour Service. 23 No. of patients being assisted under the Scheme at the end of the year. 7 25 Recuperative Holidays 104 patients were recommended for a recuperative holiday by hospitals or general medical practitioners during the year. Of these 77 availed themselves of the arrangements made for their admission to various private convalescent homes for a period of two weeks. Prevention of Tubercuious Mass Radiography Unit 6B of the North East Metropolitan Regional Hospital Board made a short visit to the Borough during the first three weeks in August, visiting some of the areas of the Borough which could not be included in the two-year survey made in 1966. 4,493 persons (2002 males and 2491 females) were x-rayed, and of these 33 males and 38 females were referred for further investigation. Dr. D.J. Lawless, Medical Director of the Unit, has provided the following details of the conditions revealed on investigation:— Tuberculous lesions Male Female Total D.1. Tuberculosis,Presumed healed. No further action needed. 4 5 9 D.,3. Tuberculosis. Occasional supervision only needed. 1 1 2 Other abnormalities revealed Abnormalities of the bony thorax and soft tissues — acquired. - 1 1 Bacterial and virus infections of the lungs. - 2 2 Emphysema 3 - 3 Pulmonary fibrosis — non-tuberculous. 3 1 4 Pneumoconiosis - 1 1 Benign tumours of the lungs and mediastinum. 1 2 3 Carcinoma of the lung and mediastinum. 4 1 5 Sarcoidosis and collagenous diseases. - 2 2 Pleural tickening or calcification— non-tuberculous. 2 4 6 Abnormalities of the diaphragm and oesophagus —congenital and acquired. 1 5 6 Congenital abnormalities of heart and vessels. - 1 1 Acquired abnormalities of heart and vessels. 3 3 6 26 Other abnormalities revealed contd. Cases who failed to attend for further films or clinical examination. 1 - 1 Cases found to be within normal limits after further large film examination 10 9 19 TOTALS 33 38 71 Care of the Tuberculous Care of the Tuberculous is undertaken by the Havering Tuberculosis Care Association, the Council making a grant for the purpose. The Association works in close co-operation with the Chest Physicians, who act as medical advisers, and with the staff of the Chest Clinics. The clerical work of the Association continues to be undertaken by staff in the Health and Welfare Department. M ilk for Tuberculosis Patients The Council provide one pint of milk daily to patients suffering from Tuberculosis where recommended by the Chest Physicians. During the year 100 patients received milk, 30 of whom are new cases. Chiropody Service The Chief Chiropodist, Mr.L.A. Bolland, reports as follows I . Persons eligible for treatment Children Expectant Mothers The Elderly Physically Handicapped Persons Certain cases referred by Medical Practitioners 2.Services in Operation (a) Full-time chiropody clinics. Health Centre, Harold Hill. Collier Row Clinic. Romford Clinic. Hornchurch Clinic. (b) Part-time chiropody clinics. Harold Wood Clinic. Cranham Clinic. Contd./ 27 Elm Park Clinic. Upminster Clinic. Rainham Clinic. South Hornchurch Clinic. Park Lane Community Centre. (c) Services at Welfare Establishments "Hillside" ' 'The Manor" "The Willows" ''The Grange" ' 'Ravenscourt" 61, Main Road, Gidea Park. (d) Domiciliary Treatment A domiciliary visiting service is available for housebound patients. (e) The Mentally Handicapped It was noticed at a medical inspection that many were in need of chiropodial attention. In view of the apprehension natural in these persons it was decided that treatment should be given in surroundings familiar to them and therefore the chiropodist attends at Westmarsh Lodge and the Junior Training Centre. It has been very rewarding for some of the older patients were badly in need of treatment and the subsequent improvement has been most marked. Even though some of the younger children merely required only their nails to be cut this was done because it was felt that it helped to dispel apprehension by receiving "Treatment" that could not possibly hurt. Some 200 treatments were given to the Mentally Handicapped during the year. 3. Chiropody Treatment Given During The Year TABLE 19 GROUP New cases during year Cases Under Treatment at end of year Clinic attendances during year Domiciliary treatments during year At Welfare Estab' i. Pre-school children 5 5 27 - — ii. School-children 62 19 315 — — Contd./ 28 Table 19 contd. GROUP New cases during year Cases Under Treatment at end of year Clinic attendances during year Domiciliary treatments during year At Welfare Estab' iia Mentally Handicapped 76 43 - 204 - iii Expectant Mothers 8 5 32 1 — iv Aged 1053 3782 18,225 8321 2317 v Physically Handicapped 10 35 187 62 - vi Others 23 27 283 18 TOTAL 1237 3877 19,069 8606 2317 4. Health Education One talk on the care of the feet was given to a class of final year female students. 5. Accommodation and Equipment The Upminster Clinic now has a purpose-built chiropody room and on the completion of the alterations at present being undertaken at the Hornchurch and Elm Park Clinics only at Rainham, South Hornchurch and at the Park Lane Community Centre will chiropodists have to share accommodation with other services. 6. Staffing One member of the full-time staff resigned in July and as yet it has not been possible to fill the vacancy. 7. Summary There is a slight fall in the number of persons treated at Clinics. This is mainly due to the fact that during alterations to clinics it was not possible to arrange alternative accommodation enabling the usual number of sessions to be worked. Certain cases were temporarily placed upon the domiciliary list in order that they were not deprived of treatment. Domiciliary visiting; This is still causing a great strain upon the. service and though staff who normally only work in clinics have been assisting with these visits it is still not possible to reduce the waiting list. This part of the service is very time consuming but is much appreciated by those receiving 29 it and indeed many are only ambulant because of it. Further the visiting chiropodist also serves as a "Sentinel", often being the means of bringing to the notice of other members of the Department aspects requiring their help. IMMUNISATION AND VACCINATION Statistics relating to the number of children immunised in the first year of life show that over 80% received protection against Diphtheria, Tetanus and Poliomyelitis, whereas only 71% were immunised against whooping cough. The one death from these four diseases in 1967 was that of a baby aged one month. This baby was discharged from a maternity hospital at a time when it appeared that another child, in the family, aged 3 years who had not been immunised against the disease, was in fact suffering from whooping cough but had not then been diagnosed. Both children are subsequently admitted to Hospital but the baby died eleven days later. This emphasises the need to be on guard that the unprotected older child does not transfer infection to a younger and more vulnerable sibling. At a time when the mother is in hospital, as in this instance, there is a greater possibility that the symptoms may not be noticed as early as when the mother is at home. Immunisation of all infants with re-inforcing doses at the appropriate intervals is the insurance against such fatalities. The vaccination and immunisation statistics are given in the following tables with the 1966 figures for comparative purpose:— 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 1967 1966 Diphtheria/Pertussis/Tetanus/Poliomyelitis 1 24 Diphtheria/Pertussis/Tetanus 3681 4467 Diphtheria/Pertussis — 2 Diphtheria/Tetanus 611 513 Diphtheria 25 15 Pertussis 32 71 Tetanus 1487 1304 Poliomyelitis (salk vaccine) 1 34 Poliomyelitis (sabin vaccine) 4240 4548 Smallpox vaccination 3336 2967 30 Table 21 sets out the number of children protected against each disease including those who were given combined antigens. TABLE 21 No. of children protected against each disease Disease No. of children immunised 1967 1966 Diphtheria 4318 5021 Pertussis 3714 4564 Tetanus 5780 6308 Poliomyelitis 4242 4606 Smallpox 3336 2967 Tuberculosis 2270 1973 The following is an estimate of the proportion of children under one year of age who received a primary course of immunisation:— Diphtheria 88% Whooping Cough 71% Tetanus 88% Poliomyelitis 81% A total of 10,964 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 1967 1966 Diphtheria/Pertussis/Tetanus/Poliomyelitis 0 4 Diphtheria/Pertussis/Tetanus 2031 1166 Diphtheria/Pertussis 4 3 Diphtheria/Tetanus 2937 1547 Diphtheria 597 775 Pertussis 105 235 Tetanus 450 302 Poliomyelitis (salk vaccine) 28 38 Poliomyelitis (sabine Vaccine) 4437 3138 Smallpox vaccination 375 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. 31 TABLE 23 No. of Children Receiving Re-inforcing Doses Disease No. of children who received a Re-inforcing dose 1967 1966 Diphtheria 5569 3495 Pertussis 2140 1408 Tetanus 5418 3019 Poliomyelitis 4465 3180 Smallpox 375 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:— 1966 1967 Skin Tested 2559 2205 Positive result 281 256 Negative result 2124 1822 Vaccinated 2124 1822 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. 183 contacts were skin tested during the year and 146 of the 183, who showed a negative reaction to the test were given B.C.G. vaccination. VENEREAL DISEASE The number of new cases of infection included on the returns for 1967 received from the Treatment Centre at Oldchurch Hospital were as follows:— 32 TABLE 24 Venereal Diseases Total Male Female (a) Syphilis 7 5 2 (b) Gonorrhoea 95 78 17 (c) Other conditions 603 422 181 Total 705 505 200 130 males and 45 females included under (c) above, were found to require no treatment in the Centre. The figures given above include persons who attended the Centre but who reside in adjacent areas. Subtracting these non-Havering residents, and adding Havering residents included on returns received from other treatment centres in London, the net figures in respect of this Borough are as follows:— Syphilis 2 Gonorrhoea 59 Other conditions 390 Total 451 Returns for the year 1967 were received from more London Centres than was the case in 1966. For purposes of comparison only, if the above figures were related to the same Centres as were included in the 1966 figures, the total would read as under:- 1966 1967 Syphilis 3 1 Gonorrhoea 52 49 Other conditions 364 334 Total 419 384 ANNUAL REPORT OF CHIEF DENTAL OFFICER Mr. E.B. Hodgson, Chief Dental Officer has supplied the following report on the priority dental services an,d the dental service for school children. Although the year began with the staffing situation reasonably satisfactory with seven full-time dental surgeons and three 33 part-time dental surgeons, resulting in a full-time equivalent of 8.3, this unfortunately was not to last for long. By the end of the first quarter, three full-time members of staff had resigned — one. to gain further experience in America and two to start practice in the General Dental Service. This meant that almost simultaneously three dental surgeries — those at the Health Centre, Collier Row and Elm Park — were left unstaffed. On 1st April, the first of three major clinic improvement schemes began, with the closing of the clinic in St. Mary's Lane, Upminster. Mr. Wright, who had been operating full-time at Upminster, transferred to the vacant surgery at the Health Centre — this providing continuity of treatment for those Upminster patients prepared to travel and for those who had already been attending the Health Centre. The clinics at Hornchurch and Elm Park were the next to close, and Mrs. Saunders transferred from Hornchurch to Harold Wood Clinic, and from then on, began to divide her time between Harold Wood, to which clinic the patients from Hornchurch travelled, and Collier Row Clinic — in order to provide a part-time service in that part of the Borough. This arrangement continued until the end of the year. For those patients attending the Elm Park clinic, arrangements were made for treatment to be available at South Hornchurch Clinic. The temporary closure of these three clinics helped to minimise the very acute staff shortage which persisted for the remainder of the year. In September an improved salary structure was announced for Local Authority Dental Officers by the Dental Whitely Council, and it was hoped that this would help in some way towards recruitment. Advertisements for staff were placed in the professional journals giving the new salary scale, but the result was disappointing, as no suitable applications were received. It would seem that the remuneration laid down by the Government Review Body for dentists practising in the General Dental Service, together with the advantages of being selfemployed, provide a combination which leave the financial status of the Local Authority Dental Officer far behind. Unless there is a true vocation to treat children, then recruits to the service will not be forthcoming. Dental decay affects 99% of children under twelve years 34 of age in this country, and this a fact which comes as no suprise when we are told that we consumed 614,000 tons of sweets during the year, equivalent to 251bs. of sweets for every man, woman and child. The only proven preventive measure that can be taken to help reduce the incidence of dental decay is the national fluoridation of the public water supply. Although a few areas of the country enjoy this benefit now, it seems that it will still be many years before a fluoridated water supply becomes a practical reality for everyone. Assuming that our national eating habits are not going to suddenly change, then we must accept that dental decay is going to be with us for a long time to come. If a sufficiently large number of dental surgeons could be recruited, whose sole purpose was to treat the school and pre-school population of the country, and so be in a position to arrest decay in its early stages and to instil the importance of healthy teeth into young minds, then the national bill of some £100,000,000 which dental disease costs this country each year could certainly be drastically reduced. Inspections Due to staff shortage and the closure of clinic premises for rebuilding, it was not possible to inspect as many children as in the previous year. Whenever schools have been inspected, every effort is made to keep this a regular annual occurrence, and at the same time make available, treatment for those children found to require its When schools are being re-visited and records compared with previous inspections it is noticed that there is one factor common to all. Each school contains a percentage of children where treatment has been found necessary, the parents have been duly notified that this can be obtained either through the General Dental Service or from the School Dental Service, but nothing has been done about it. Efforts have been made at these reinspections, with the co-operation and help of Head Teachers, to point out to the parents concerned the facilities available for free treatment, but it seems there will always be some parents who make no effort to see that their children obtain the necessary treatment. The end result of this neglect is often a frantic visit to the dentist with a child in great pain with toothache. Emergency visits of this kind rose by 100 during the year to a total of 517 35 — the greater majority being in the 5-9 year age group. Courses In these days when dental science is advancing more rapidly than ever before, it is essential that opportunities exist for staff to attend post-graduate refresher courses and conferences and so keep up-to-date with the latest developments. The British Post-graduate Medical Federation organises some excellent refresher courses for dentists in the London area, which usually take the form of one half day session per week over a period of 4 - 6 weeks. During the year a course of this nature in Orthodontics was attended by two members of staff. Priority Dental Service The total number of sessions available for treatment was considerably reduced this year, but the proportion of time spent in treating the priority classes was maintained at 7% of the total. That those under five years old who attend the clinics for treatment receive a high standard of dental care is demonstrated by the fact that many fewer teeth were extracted in relation to the number conserved and saved. The ratio of teeth filled to those extracted rose to a new high level of 7 to 1. This compares with a ratio of 5 to 1 last year. The corresponding figure for permanent teeth is 11 teeth saved for every tooth extracted. An increasing number of mothers now realise the importance of seeking a dental examination for their children when they reach 3 years of age. This is due in no small way to the continued efforts of doctors, dentists and health visitors and other workers to emphasise this point at every opportunity. If a child is introduced to the dentist in his surroundings at this age, when little, if any, treatment is required, and these check-ups are continued until school age is reached, then it is possible for the dentist to build up a friendly relationship which stands the child in good stead for the rest of its life. Visits to the dentist then become an acceptable part of the routine business of keeping fit and not something to be dreaded and avoided whenever possible. Health education is a sphere which can be slow to show results and it is only by continued repetition and emphasis on points such as the importance of early dental inspections that new attitudes are adopted. 36 The full annual statistics for the Dental Service are given in the following tables. TABLE 25 Dental Inspection & Treatment of School Children Inspections (a) First inspection at school. Number of Pupils 7556 (b) First inspection at clinic. Number of Pupils 3668 Number of (a) + (b) found to require treatment 6274 Number of (a) + (b) offered treatment 5787 (c) Pupils re-inspected at school or clinic 1002 Number of (c) found to require treatment 680 Attendances and Treatment Ages 5 to 9 Ages 10 to 14 Ages 15 & over Total First Visit 2340' 1626 265 4231 Subsequent Visits 3889 3781 681 8351 Total visits 6229 5407 946 12582 Additional courses of treatment commenced 288 154 15 457 Fillings in permanent teeth 1305 3394 846 5545 Fillings in deciduous teeth 3782 324 — 4106 Permanent teeth filled 1075 2829 734 4638 Deciduous teeth filled 3173 255 — 3428 Permanent teeth extracted 51 315 61 427 Deciduous teeth extracted 1245 526 — 1771 General anaesthetics 249 77 7 333 Emergencies 388 112 17 517 Number of Pupils X-rayed 497 Prophylaxis 1138 Teeth otherwise conserved 1004 Number of teeth root filled 57 Inlays 6 Crowns 25 Courses of Treatment completed 3560 Orthodontics Cases remaining from previous year 132 New cases commenced during year 74 Cases completed during year 55 Cases discontinued during year 16 Number of removable appliances fitted 169 Number of fixed appliances fitted 1 Pupils referred to Hospital Consultant 22 37 TABLE 26 Dental Service for Expectant and Nursing Mothers and Children under 5 years Number of Visits for Treatment during year Children 0-4 (incl.) Expectant and Nursing Mothers First Visit 461 83 Subsequent Visits 567 192 Total Visits 1028 275 Number of Additional Courses of Treatment other than the First Course commenced during year 52 6 Treatment provided during the year — Number of Fillings 739 272 Teeth Filled 656 213 Teeth Extracted 95 37 General Anaesthetics given 41 - Emergency Visits by Patients 77 19 Patients X-Rayed 8 30 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 98 43 Teeth Otherwise Conserved 243 — Number of Courses of Treatment Completed during the Year 252 47 Prosthetics Patients Supplied with F.U. or F.L. (First Time) 3 Patients Supplied with Other Dentures 4 Number of Dentures Supplied 6 Inspections Children 0-4 (incl.) Expectant and Nursing Mothers Number of Patients given First Inspections During Year A.586 D.103 Number of Patients in A and D above who required Treatment B.347 E. 89 Number of Patients in B and E above who were offered Treatment 341 89 38 SCHOOL HEALTH SERVICE, 1967 School Population 42,573 Primary Schools 80 Secondary Schools (including Grammar Schools) 27 Technical Schools 2 Schools for Handicapped Pupils (Educationally Sub-Normal) 3 The following New Primary Schools were opened during 1967:— Gidea Park Primary Mitchell Primary Pinewood Infants' Towers Infants' Nelmes Junior Dycorts Infants'School closed in July and re-opened in September 1967, as a school for Educationally Sub-Normal pupils. Periodic Medical Inspections All children are medically examined periodically during their school life. The first medical inspection is carried out during the first year in the Infants' School; an intermediate inspection follows at 10 years of age, during the last year in the Junior School, and the final inspection is carried out during the year before reaching school leaving age. Arrangements are made for investigation or treatment of any defects found at these medical inspections, in consultation with the child's family doctor. During 1967 the Education Committee agreed to a pilot scheme of selective medical inspection of children in the intermediate age group in two separate areas of the Borough, the object of the scheme being to concentrate the School Medical Officer's time on examination of those children most likely to be in need of medical attention and to eliminate the considerable amount of time spent in examining healthy children. The parent of each child included in this scheme was asked to complete an enquiry form designed to provide information about the child's health background, and the teaching and nursing staff concerned were invited to report on any child who they considered should be referred for medical examination. The 39 School Medical Officer then examined the medical record of each child, together with the enquiry form completed by the parents and any other available reports, and selected for examination those children who gave an indication of possible medical need; any doubtful cases being discussed with the Head Teacher or nursing staff before reaching a decision. All children were given screening tests of vision and hearing by the School Nurse irrespective of the selective procedure. Parents were afforded the opportunity of requesting a medical examination for their children if they so desired and any such children were included on the list selected for examination regardless of Medical history. 766 children were included in this pilot scheme, of which 269 (35.1%) were selected for examination. 82 of these (10.7% of the total)were found to have defects requiring attention, which is comparable to 10.5% of children in the same age group who were found to have defects requiring attention following routine medical inspections during the previous school year. The reduction in the number of children called for examination allowed the School Medical Officers to devote more time to each individual child, and the scheme was considered to be sufficiently satisfactory to warrant an extension of the selective procedure during the forthcoming year. The total number of children examined at periodic medical inspections (including the selective inspections) was 9,764; 1,591 (16.29%) of these were found to have defects requiring treatment and only 10 were considered to be in an unsatisfactory physical condition. Defects found at periodic medical inspections included the following:— Condition Number of Defects found requiring— (a) Treatment (b) Observation Defective Vision 728 624 Squint 69 47 Defective Hearing 53 314 Nose and Throat Abnormalities 118 345 Speech Defects 64 94 Lung Abnormalities 43 138 40 Number of Defects found requiring- (a) Treatment (b) Observation Developmental Abnornalities (including Hernia) 68 187 Skin Diseases 217 256 Mental Development and Psychological Conditions 55 375 Orthopaedic Defects 246 433 Special Medical Inspections and Re-Inspections In addition to the periodic medical inspections, many children are examined by the School Medical Officers as a special inspection at the request of the parent, teacher or nurse etc. Follow-up examinations arising from periodic or special inspections are also carried out when necessary. 2,014 children were specially examined by School Medical Officers during the year and 1,797 re-inspections were carried out. Defects found at special inspections included the following:- Skin Conditions 279 Defective Vision 298 Hearing Defects 120 Nose and Throat Abnormalities 73 Speech Defects 46 Orthopaedic Conditions 110 Psychological Conditions and Mental Development 193 Screening Tests Routine screening tests of vision and hearing are performed by the school nursing staff as part of the periodic medical inspection procedure and additional tests are carried out at about 7 or 8 years of age. Colour vision is also tested at the intermediate or final medical inspection. Any children failing the screening tests are seen by a School Medical Officer for a more thorough examination and referred to a Specialist if this is found to be necessary. During the year under review a pilot scheme of examination of vision using a compact portable self-illuminated testing machine was carried out. The advantages of this vision screener are that 41 the testing conditions are constant and a wider range of tests can be applied. It has been found, however, that appreciable numbers of children who fail the screening test are later shown to have visual acuity within normal limits and the usefulness of this device is under continuing evaluation. Mr. D.G. Edwards, Peripatetic Teacher of the Deaf, has worked closely with the medical and nursing staff in further testing the hearing of children with doubtful hearing ability or those who have not given a clear response to the routine screening tests. Hygiene Inspections Periodic hygiene inspections are carried out in school by School Nurses and include the inspections of the feet and general cleanliness, as well as examination for head infestations. 34,173 hygiene inspections were carried out during the year resulting in 171 pupils being found to be infested. These were mostly of a minor nature and in only 14 cases was it considered necessary to issue an official notice to the parents requiring the child to be cleansed. Minor Ailments Clinics The regular minor ailment sessions held at each of the Health and Welfare Clinics afforded the opportunity for special consultations with the School Medical Officers as well as providing treatment facilities for minor conditions such as skin diseases, enuresis (bed-wetting), minor eye diseases, ear, nose and throat conditions, injuries etc. 3,811 medical consultations were given at Minor Ailment Clinic sessions and 1,885 children received treatment. Specialist Services Resulting from the periodic and special medical inspections a number of children are referred for examination by Ophthalmic and Orthopaedic Consultants, and specialist sessions are held at the Health and Welfare Clinics for this purpose in co-operationwith the Regional Hospital Board. Regular ophthalmic specialist sessions are held at eight Clinics and weekly orthoptic sessions, providing non-surgical treatment of children suffering from squint, at two Clinics. 42 During the year 3,019 children made 5,066 attendances at the Ophthalmic specialist sessions, including 903 new referrals, and of these 108 were referred to the orthoptic clinics. Regular orthopaedic specialist sessions continued at four of the Health and Welfare Clinics supported by physiotherapy sessions at five clinics. 201 children were examined by the orthopaedic specialist during the year, including 55 new referrals and 2,660 physiotherapy treatments were carried out. Speech Therapy Regular speech therapy sessions at each of the Health and Welfare Clinics, Special Schools and Training Centre have continued to be limited by staff shortage, but this situation showed some improvement towards the end of the year. 233 children were newly referred for speech therapy during the year and 7,663 treatments were given. Dental C linics 7,556 children were inspected in school by the School Dental Officers during the year and treatment was offered to all who were found to require it. The total number of attendances for treatment at the Dental Clinics amounted to 12,582 The Chief Dental Officer's report on the School Dental Service appears on pages33-38. Child Guidance Clinic 358 children were newly referred to the Child Guidance Clinic during the year and 2,906 attendances were made for treatment. In addition, the Educational Psychologist conducted 638 preliminary interviews and 1,419 interviews with parents were carried out by the Psychiatric Social Workers. At the end of the year 370 cases were under treatment and 62 patients awaiting their first appointment. Handicapped Pupils 86 children were newly assessed as being in need of special educational treatment during the year because of physical, mental or emotional handicaps, and 109 admissions to Special Schools for handicapped pupils were arranged, including 53 children who 43 44 TABLE 27 Handicapped Pupils Totel No. of Pupils ascertained as Handicapped at end of year No. of Pupils newly ascertained during the year No. of Pupils admitted to Special Schools during the year Total No attending Schools a Day . of Pupils Special end of year Residential Blind 5 3 2 - 4 Partially Sighted 11 3 2 10 - Deaf 10 2 2 6 4 Partially Hearing 30 7 3 , 22 4 Physically Handicapped 44 3 3 27 10 Delicate 66 13 10 15 18 Maladjusted 43 7 8 - 28 E.S.N. 305 45 76 271 12 Epileptic 8 3 3 - 8 Speech Defects - - - - - TOTAL 522 86 109 351 88 had been ascertained as handicapped pupils before January, 1967. At the end of the year 40 children were awaiting admission to special schools, compared to 75 at the end of 1966. This improvement can largely be attributed to the opening of Dycorts School in September, 1967 which considerably reduced the number of educationally sub-normal pupils awaiting special schooling. The following table shows the situation relating to handicapped pupils at the end of the year: — SECTION III SOCIAL SERVICES The Principal Welfare Officer Miss K. Wells, has supplied the following report on the social welfare services. Staff By the end of the year all vacancies but one in this section had been filled (this final vacancy for a P.S.W., was filled early in 1968). The establishment had been agreed in April, 1965 and was related to the amount of work existing at that time. Since then, the current caseload had greatly increased (the physically handicapped register alone has gone up from 621 at the end of 1965 to 1058 at the end of 1967) and a continuing stream of new work has had to be dealt with. So, though several new social workers joined the department during 1967, there were limitations on the new work which could be taken on as these new officers were badly needed to help reduce the huge caseloads their colleagues has been carrying for so long. During the year a senior medical social worker was appointed to supervise the section's social work for the deaf and also to carry a varied caseload. Two social workers newly qualifying from Certificate in Social Work courses were also appointed, and a trainee returned to the department having successfully completed the same two-year course. The Deputy Principal Welfare Officer Mr. A.K. Huddlestone, was seconded for a special one-year course which led to the qualification of Certificate in Social Work. A family caseworker continued his two-year secondment on another Certificate in Social Work course. The recruitment of welfare trainees, which had been suspended during 1966 due to the difficult financial position, was resumed towards the end of 1967 and three candidates were appointed. By 31st December 1967 the position was a follows: No. in Position Post Qualifications held Principal Welfare Officer 1 Applied Social Studies Certificate Deputy Principal Welfare 1 Certificate in Social Work Officer 45 Position No. in Post Qualifications held Senior Psychiatric Social Worker 1 Mental Health Certificate Senior Social Welfare Officer 1 Medical Social Work Certificate Senior Mental Welfare Officer 1 Certificate of Recognition of Experience in Social Work Psychiatric Social Worker 2 Both with Mental Health Certificates Mental Welfare Officers 5 One with Certificate in Social Work, two with Certificate of Recognition of Experience in Social W ork. Social Welfare Officer with special responsibility for for the deaf 1 Medical Social Work Certificate Family caseworkers 3 Two with Certificates in Social Work, the third seconded to a two-year course. Social Welfare Officers 9 25 Three with Certificates in Social Work, three with Home Teacher for the Blind Certificate (these include two officers who hold the Certificate of Recognition of Experience in Social Work and one qualified as an Occupational Therapist). Welfare Trainees 3 All will be seconded for twoyear courses. It will be seen that by the end of 1967 the department had 25 social workers and 3 trainees, and that 13 members of staff had received professional training in social work. The equivalent figure for April 1965 was 16 social workers and 2 trainees; only 2 members of staff at that time had received professional training. 46 With so many professionally qualified social workers it has been possible to provide good consultation for staff, and also casework placements for students, though lack of accommodation reduced the number of students who could be taken. The crowded working conditions for the social workers, which were to some extent relieved early in 1968, and the shortage of clerical and other office resources, hampered the work throughout 1967. Review of Work In spite of all these difficulties, it was possible to inaugurate a full review system for all cases carried by special workers from October 1967 onwards. This is making it possible for clients' needs to be studied more closely to ensure that services are mobilised to bring about the best possible help with the present resources available, and also to provide detailed information on which to base further staff requirements. Future Developments As a result of the case reviews, the collection during 1967 of a number of new facts about the work of the section, including the plotting of all current cases on a map of the Borough, and the filling of vacancies on the staff with senior social workers, it has been possible to make major organisational changes in 1968. These have led to closely integrated social work teams operating in the borough, in areas which coincide with clinic boundaries. Work of the Social Workers The social workers were occupied in five different ways: 1) Investigating, and giving continuing help where necessary, to all new cases that were referred to the social work section. 2) Investigating, and giving continuing help where necessary, to re-opened cases — closed cases known formerly to the section but needing help again. 3) Giving continuing help to the regular caseload of mentally, physically or socially handicapped people and their families. 4) Running clubs, classes, discussion groups, attending hospitals, out-patient clinics, etc. 47 5) Office duties and meetings, correspondence and case recording, liaison with other agencies, case conferences, etc. Social workers carry out most of their work during interviews with families and individuals. A note was kept during 1967 of the places where the department's social workers carried out any interviews which lasted longer than 15 minutes. There were 16,830 such interviews, and they took place as follows: 10,519 in peoples own homes 1,367 in the Billet Lane offices 1,032 in hospitals, particularly Warley psychiatric hospital 421 in Collier Lodge or Westmarsh Lodge, the department's mental health hostels 297 in the department's temporary accommodation for homeless families 277 in the Belford Centre, the adult and junior training centres for the mentally subnormal 258 in old peoples homes 242 in the Faringdon Centre, the occupation centre for the physically handicapped 2,417 in other places 16,830 New Cases During 1967 1,498 new cases came to the attention of the social work section. The individuals, or families, concerned were initially referred as needingthe followingservices(some,after being contacted by social workers, were found to require other services too): Services for the physically handicapped — 354 A place in one of the department's old peoples homes — 240 Families and individuals needing help for a variety of reasons other than those mentioned in this list — 179 (87 of these were elderly people) Families with problems connected with housing, including some who were homeless — 176 48 After-care by the mental health social workers — 147 Services for the blind or partially sighted — 91 Requiring admission to psychiatric hospital — 85 Services for the mentally subnormal — 32 A place in one of the department's mental health hostels — 26 Services for the deaf or hard of hearing — 16 In addition, 152 new cases were referred to the social workers for investigation or reports in 102 of which mental health social workers made the necessary enquiries. 1106 of the 1498 new cases were helped by social workers in the social welfare section, the remainder by social workers in the mental health section. To help the section organise its work with new cases to the best advantage of the families and individuals concerned, a careful check was kept on the methods and times of referral. This showed that during 1967 37% of the new cases came to the notice of the section by telephone, 25% by letter, 18% by personal visit to the office, 6% came through Warley Hospital, the remaining 14% in other ways. Those coming to the office were usually people wanting help for themselves, rather than asking the section to help others. These office visitors tended to come in during the morning rather than the afternoon, 65% arriving before 1 p.m. Services for the Physically Handicapped The number of severely physically handicapped people known to the department during the year and requiring its services rose by 21%. Exact figures are given in table 28. During the year, the arrival in the section of more social workers made it possible to begin to reduce the huge caseloads of the two social workers who had virtually carried this service since April 1965, and to place more emphasis on helping the family as well as the individual. It is clear that in a number of instances the strain of the handicap is not only on the person 49 directly suffering from it but also affects their close relatives and friends and even neighbours. Practical help of some kind is nearly always needed by people on the department's handicapped register— aids to daily living, adaptations to their homes, especially where wheelchairs must be used, special holidays, attendance at the department's occupation centre, the Faringdon Centre. In addition, more intensive help is sometimes required to meet other needs. The social workers are starting to develop a casework service for those individuals, and their families, who want an opportunity to work out ways of resolving personal problems their handicap has created for them, or where family difficulties have arisen or become much worse because of their handicap. The emphasis lies, as always, on helping the handicapped person to become as independent as possible in their usually very dependent existence, to encourage self-reliance and a sense of purpose and interest in life where the handicap has seemed to undermine both confidence and the possibility of much further achievement. All this is relatively new for local authority community care work, but a start has been made to give a more comprehensive and personally-tailored service to each severely handicapped person in the borough. Housing for the Disabled During 1967 the first purpose-built flat for a disabled person became available from the Housing Department. It was very soon occupied, and in fact had been constructed with a particular handicapped person and his family in mind. Since 1965, staff of the Housing Department, the Borough Architect, and the Deputy Medical Officer of Health with two of the social workers from this Department who have expert knowledge of the housing needs of severely disabled people, have been working in close consultation on a project launched by the Housing Committee to provide special accommodation for the disabled. This has been a happy instance of inter-departmental co-operation, and the results have been very successful. Residential Accommodation for the Disabled It will be seen from Table 42 that by the end of 1967 there were 10 people from Havering who were being accommodated by voluntary organisations because they were so severely physically handicapped they could no longer be looked after at home, or they had no home and family who could care for them. They were too young for the Department's old peoples homes; even 50 if they had been older, their handicap might have made them ineligible, as the facilities in these homes only enable people with a limited degree of handicap to be looked after. There are no homes for the physically handicapped in this area, so accommodation has to be found outside the district. Services for the Deaf The appointment of a senior medical social worker to supervise the section's work for the deaf helped this work to get more actively under way during the year. Already one of the social welfare officers had been opening up the service, following their attendance at a introductory course in communication with the deaf. This second officer has also been on a similar course and contact is being made with nearly all those known to be deaf in the Borough, and their special needs are being ascertained. The inauguration of a new voluntary organisation for deaf children,the Havering Association for Parents of Deaf and Partially Hearing Children, has helped bring public attention to the needs of these children. The peripatetic teachers of the deaf, employed by the Education Department, work very closely with the staff of the Health and Welfare Department in providing services to deaf and partially hearing children and their families. Blind During 1967 one of the social workers dealing with the blind started a class for general mobility especially for the newly blind. This takes place once a week, and people from all over the Borough are introduced to it through their social workers. Those who have been blind for some years and who would like to benefit from lessons to help them to get around better in their home and locally are also welcomed, and a number of varied activities including old time dancing and better use of the white cane are now undertaken by this class. 51 TABLE 28 Handicaps and Ages of Persons on Registers of Physically Handicapped 31st December 1967 Handicap under 16 16-29 30-4S 50-64 65+ Total Deaf with Speech 4 3 13 3 15 38 Deaf without Speech 3 15 22 17 3 60 Hard of Hearing - 5 4 5 24 38 General Classes (1) Amputation - - 7 18 22 47 (2) Arthritis or Rheumatism - 5 15 71 260 351 (3) Congenital Malformation or Deformity 2 2 2 2 2 10 (4) Diseases of digestive and genito-urinary systems, of the heart or circulatory system (other than Tuberculosis of the skin) - 7 12 46 89 154 (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. 10 10 22 28 45 115 (6) Organic nervous diseases — epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica etc. 13 64 88 104 79 348 (7) Neurosis, psychosis, and other nervous and mental diseases not included in 6 1 - 2 8 7 18 (8) Tuberculosis (Respiratory) - - 1 1 1 3 (9) Tuberculosis (Non-respiratory) - 1 - - 2 3 (10)Diseases and injuries not specified above 1 - 4 2 2 9 TOTALS 27 89 153 280 509 1058 52 TABLE 29 Register of Physically Handicapped Persons Handicap No. of Persons on Register at 31.12.67 No. of persons whose names were added to the register during year ended 31.12.67 Deaf with Speech 38 6 Deaf without Speech 60 3 Hard of Hearing 38 5 General Classes of the Physically Handicapped 1,058 3 06 Total 1,194 320 The age groups of the persons on the register, together with an analysis of those in the general classes register are set out in Table 28. TABLE 30 No. of Registered Blind Persons Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65 + M - 2 5 1 27 17 71 123 F - 2 1 2 17 35 160 217 Total - 4 6 3 44 52 231 340 During the year 49 persons were added to the Register of Blind Persons, as shown below:— TABLE 31 Ages of Persons Added to Blind Register in 1967 Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-4 9 50-64 65 + M - - 2 - - 3 12 17 F - - - - 1 8 23 32 Total - - 2 - 1 11 35 49 53 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: — TABLE 32 Occupation of Blind Persons in Employment Proprietors, Managers & Executive Workers 2 Typists, Shorthand Typists, Secretaries 7 Telephone Operators 2 Working Proprietors, Shop Managers 1 Farmers, Farm Workers etc. 1 Machine Tool Operators 3 Boxers, Fitters, Packers 3 Basket Makers 2 Boot & Shoe Repairers 1 Piano Tuners 1 Labours 3 Domestic/Canteen Workers, Caretakers etc. 3 Miscellaneous Workers 1 Total 30 Residential Accommodation Table 33 gives details of blind persons in residential accommodation as at 31st December, 1967. TABLE 33 Blind Persons in Residential Accommodation M F Residential Accommodation Provided under Part III of the National Assistance Act 1948 (a) Homes for the Blind 3 13 (b) Other Homes 2 8 Residential Homes other than above - 1 In Hospitals for Mentally III 1 4 In Hospitals for Mentally Subnormal 3 1 Other Hospitals 3 12 Total 12 39 54 Partially Sighted At 31st December, 1967, 123 persons were registered as partially sighted, an increase of 11 since the same date in 1966. Details of the age groups of those on the Register are given in the following table. TABLE 34 Number of Partially Sighted Persons on Register as at 31.12.67 Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 5 0-64 65 + M - - 8 1 15 5 20 49 F - - 8 1 8 8 49 74 Total - - 16 2 23 13 69 123 New Registrations during the year are shown in Table 35 below: — TABLE 35 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 - - 1 6 9 F - - 2 - 1 1 18 22 Total - - 4 - 1 2 24 31 Included amongst those removed from the Register were 9 persons admitted to the Blind Register, and 2 who were decertified due to improved visual acuity. 51 of the 123 persons on the Register were near or prospectively blind. 7 of these were in employment, and the remaining 44 were not available for, or incapable of work, 42 being over 65 years of age. Details of the other 72 persons on the register who were mainly industrially handicapped, requiring observation only, or under the age of 16 years are as follows:— 55 TABLE 36 Registered Partially Sighted Persons other than those near or prospectively blind AGE GROUPS Mainly Industrially Handicapped:- 16-20 21-49 50-64 65 + Total Employed: Male — 9 2 — 11 Female 1 3 3 — 7 Available for and capable of training for work: Male — 1 — — 1 Female — — 1 — 1 Not available for work: Male — 1 2 4 7 Female — 1 — 4 5 Requiring observation only: Male — — — 5 5 Female — 3 1 14 18 Children, 16 and over, still at school: Male 1 — — — 1 2 18 9 27 56 AGE GROUPS Children under 16: 0-5 5-16 Total Attending Special Schools: Male — 8 8 Female — 6 6 Attending other Schools: M ale — — — Female — 2 2 Not at School: — — — — 16 16 Work with Homeless Families The Health and Welfare Department has a duty under Section 21 of the 1948 National Assistance Act to provide temporary accommodation for families who find themselves homeless in circumstances they could not reasonably have foreseen, or in such other situations as the authority may in any particular case 56 determine. In Havering, families with children are given temporary shelter when it is found they have nowhere else they can possibly go. During 1967, as Table 37 shows, 21 families were given shelter by the department. 7 families who had been evicted by the local authority for large and long-standing rent arrears were helped by social workers in the department, but only 2 had to be admitted to the department's temporary accommodation. 63 families in all were helped because they had become, or were about to become, homeless, but only a third of them, 21, had actually to be admitted to Suttons Hostel or to the new hostel. Suttons Hostel in Hornchurch took Havering families until June 1967, when the new hostel was opened. This new hostel, a large house in a busy part of Romford, was specially adapted to give separate flats for 6 different families at any one time. Each family has their own kitchen and sitting room (or kitchen-sitting room) bathroom, and bedrooms, so nothing has to be shared with other families except the entrance, corridors and staircases. Furniture and bedding is provided by the department. There is a large garden for the children to play in and huts to take the families' own furniture and their prams. A small room is set aside as an office for visiting social workers and others. There is no residential or permanent staff on the premises. This is very unusual for this kind of local authority accommodation, and some people thought the absence of supervision would lead to endless difficulties with neighbours and between the families themselves. However, everything has gone remarkably well, considering the large number of small children there have sometimes been in the hostel. Neighbours have been extremely tolerant, although their patience has often been tried by the children who have gloried in the company of the children from some of the other families in the hostel, and in the large playing spaces near the house, unfortunately not always realising the bother they may be causing to others living nearby. The parents have been co-operative in limiting this problem and have appreciated that they are expected to behave responsibly and to care for the building, possibly more so than if a member of the department's staff had been permanently available to keep them in order. By the end of 1967 11 families had been in the new hostel. 57 TABLE 37 Applications and Admissions Year ending 31st December, 1967 Cause of Homelessness Applications Admissions 1. Through Action taken by Landlord (a) by Court Order 10 6 (b^ by other than Court Order 4 1 2. Through Action by Local Authority (a) as a Landlord 7 2 (b) otherwise Nil Nil 3. Other Reasons 42 12 63 21 Community Care — Mental Health Services Mr. J.Horak, Senior Psychiatric Social Worker, has supplied the following report. The importance of making psychiatric and social care easily available to the mentally handicapped and to those suffering from mental illness and emotional stress, cannot be overemphasised. In accordance with the Mental Health Act, 1959 further extension of services has been achieved and admissions to Hospital on an informal basis rather than under order have steadily increased. Also, there has been an appreciable increase in after-care referrals from the Hospitals serving the Borough, i.e. from Warley Hospital and the Ingrebourne Centre at St.George's Hospital. (a) Links with Warley Hospital Followingthe revision of liaison and after-care arrangements between the Hospital and the Community Care Services, one mental health social worker visits the Hospital regularly twice a week in order to collect after-care referrals as well as to discuss special follow-up problems with the medical and social work staff. With the increased volume of referrals, informal meetings and discussions with the medical and nursing staff have been more frequent and have lead to better understanding as well as better services to the clients. Two mental health social 58 workers have taken part in lecture programmes for student nurses in Hospital's Training School, and visits of students to residential establishments and day-care centres have now become part of their training curriculum. (b) Links with Ingrebourne Centre A regular liaison with the Centre has continued and a psychiatric social worker attends staff and group meetings and to accept discharge referrals. Also, the alternative participation of two mental welfare officers in group sessions with the Senior Citizens' Group has regularly continued. The Centre has again taken part in the educational programme open to the public, during the Mental Health Week 1967, which was organised jointly by the Havering Association for Mental Health and the Medical Officer of Health. (c) Links with Voluntary Organisations Through formal and informal discussions with voluntary bodies, such as the Havering Richmond Fellowship, the Samaritans, The South-East Essex Society for Mentally Handicapped Children and the Havering Association for Mental Health, liaison has been established in order to improve the services for the mentally handicapped and mentally ill. One Psychiatric Social Worker provides an advisory service to the Samaritans. In co-operation with the Havering Association for Mental Health, a successful educational programme was organised during the Mental Health Week 1967, including a programme on careers in mental health field for the senior pupils in the Borough Secondary Schools, and a separate meeting for the School Careers Masters. (d) Ardleigh Green Group Regular group work after-care sessions have continued to be held twice a week for clients who need more frequent and intensive social work help. (e) Psychiatric Out-patient Clinics at Harold Wood Hospital Two mental health Social Workers have continued to attend out-patient sessions on Monday and Wednesday respectively. The work at these sessions is of the utmost importance since the provision of medical help as well as social care often leads 59 Admissions to Hospitals Year ending 31.12.67 Year ending 31.12.66 Mental Health Act, 1959 Section 25 = 20 19 ,, Section 26 = 3 6 ,, Section 29 = 98 107 ,, Section 60 = — 3 ,, Informal = 30 53 Total 151 188 The total number of admissions from the Borough to Warley Hospital during 1967 was approximately 635. Mental Subnormality In October 1967 a twelve-months in-service training programme began for the trainees attached to the Junior Training Centre. As a number of lectures and seminars was of general interest, all staff of both Centres were invited to attend and though the programme is still continuing, it is apparent that discussions are useful and lead to better understanding of the work with mentally handicapped. The Assistant Wardens from Westmarsh Lodge Hostel have also taken part in this in-service training programme. 60 to prevention of hospitalisation and a further breakdown. (f) The Thursday Club This Social Club which meets once a week at the Belford Centre, has been providing opportunities for social contact to the unattached and isolated as well as to those who attend with their partners or friends. A social worker from Warley Hospital attends regularly and the majority of referrals come from Warley Hospital. In March 1967, a most successful social evening was held at Collier Lodge Hostel, attended by hostel residents, members of Ardliegh Green Group and the members of the Thursday Club who Qrganised the venture. Parent Teacher Association — Belford Training Centre This Association was formed in 1965 and is now firmly established and very active, forming a valuable link between parents and teachers. Primarily the Association was formed to enable the parent to meet and discuss, not only with themselves but with the teachers, problems that presented themselves in the care, training and well-being of their mentally handicapped children and by liaison with the Health and Welfare Authorities to provide amenities for the trainees and staff at the Centre and supplement the services provided by the local authority. When the Association was formed the members agreed unanimously to provide a swimming pool within the grounds of the Centre for the use of the trainees and for this purpose to raise the sum of £2000. As a result of fund raising functions already held (Christmas, Summer and Spring Faires) £900 has already been accumulated and the Committee are confident that they can reach the target set in the not too far distant future. The Association has been pleased to help the trainees by donating sums of money from time to time for outings etc. in which the trainees partake and have made provision for a cine camera to be bought in order that films taken when the trainees are on holiday or at their Sports Day etc. can form an album and be shown to parents and other interested bodies from time to time. It is pleasing to note the enthusiasm of the parents and the pleasure it gives them in playing an active part in the interests, care and training of their children. The Committee which meets at least once a month comprises parents and teachers, the Honorary Secretary being a member of the staff of the Health and Welfare Department and all the administrative work is done in this Department. Collier Lodge This Hostel has been used to almost full capacity, (14 female places and 12 male places) throughout the year. It provides social rehabilitative programme for residents, mainly discharged 61 patients from Warley Hospital, who remain in need of sheltered environment before establishing themselves independently in the community. The admissions to the Hostel have been considered on the basis of need rather than adhering to original allocation of beds to each user authority and on 31st December 1967, the occupancy was as follows: From the Essex County Council 8 L.B. of Barking — L.B. Havering 9 L.B. Redbridge 2 L.B. Waltham Forest 2 Other 1 22 Fortnightly evening group meetings continued to be held by the Warden, the Senior Mental Welfare Officer and the Senior Psychiatric Social Worker to discuss problems arising from communal living, problems connected with employment and return into the community. Individual interviews dealing with more personal problems are arranged as the need arises, and reviews of progress of individual residents are discussed at monthly staff meetings attended by the Borough Psychiatric Adviser, Dr. Vincenzi, social workers, and a senior medical officer from Warley Hospital who is acting as a liaison officer between the Hostel and the Hospital's Medical Committee. Westmarsh Lodge This hostel for 30 mentally handicapped men has been fully occupied throughout' the year. In co-operation with the Supervisor and staff of Belford Adult Training Centre, a rehabilitation programme of potentially employable residents aims to achieve greater social independence as well as placement into part-time or full-time employment. An increasing number of residents have joined local social clubs. As at Collier Lodge Hostel, monthly staff meetings with the Borough Psychiatric Adviser are held to discuss problems of psychiatric management residents' progress and treatment, and the interaction of residents amongst themselves and with hostel staff. Monthly evening group sessions with selected residents are planned for 1968. On the 31st December 1967, the occupancy of beds was as follows: — 62 E.C.C. 15 Havering ? Barking 5 Redbridge 4 Waltham Forest 2 (+1 temporary vacancy). The Hostel also provides placements for Temporary Care of mentally handicapped living in the community during the school holidays when almost one-third of the hostel residents return to parent(s) or relatives for a short holiday. The need for Temporary placements of mentally handicapped persons living at home appears to be increasing. Hospital Waiting List The trend of care for mentally handicapped persons over recent years is to enable care in the home or community if at all possible and hospital beds are available only to those persons really needing them. However, the shortage of such beds in this and all other parts of this county does present both the family and the community services with great problems. At present in Havering there are 13 adults and 15 children (out of a total of over 600 subnormal persons) who need hospital care but no places are available. Many of these people have been waiting for several years. This problem was the subject of discussion with hospital staff, the Regional Hospital Board and the Ministry of Health during the year. 63 64 TABLE 38 Patients Referred During 1967 Referred by Mentally 111 Psychopathic Subnormal Severely Subnormal Total Grand Total under 1 6 over 16 under 16 over 16 under 16 over 16 under 1 6 over 16 under 16 over 16 General Practitioners - 134 - - 5 • - 1 2 6 136 142 Hospitals or discharge from in-patient treatment - 134 - 1 - - - - - 135 135 Hospitals, after or during out-patient or day treatment - 28 - - - - - - - 28 28 Local Education Authorities - - - - 9 - 5 1 14 1 15 Police and Courts - 12 - - - - - - - 12 12 Other Sources - 12 - - - - - - - 12 12 TOTALS - 320 - 1 14 - 6 3 20 324 344 65 TABLE 39 Number of Patients under the Care of the Authority as at 31.12.67 Mentally 111 Psychopathic Subnormal Severely Subnormal Total Grand Total under 16 over 16 Elderly Mentally Inform over 16 under 16 over 16 under 1 6 over 16 under 16 over 16 Attending day training Centre/ Workshop _ 3 _ _ 22 55 48 53 70 111 181 Awaiting entry thereto _ 4 1 _ _ 1 4 1 4 7 11 Receiving/Awaiting home training _ _ _ _ _ _ _ _ _ _ _ Resident in Local Authority Home/Hostels _ 8 _ _ _ 3 _ _ _ 11 11 Awaiting admission thereto _ _ _ _ _ _ _ _ _ _ _ Resident at Local Authority expense in other residential Home/Hostels _ _ _ _ _ _ _ Resident at Local Authority expense by boarding out in private household _ _ _ _ Receiving home visits 1 251 7 7 5 108 2 38 8 411 419 TOTALS 1 266 8 7 27 167 54 92 82 540 611 RESIDENTIAL CARE Accommodation Accommodation in old people's homes provided by Havering Council consists of:— Places Home 61 The Grange 63 Hillside 51 The Manor 48 Ravenscourt 223 In addition, the department runs The Willows where 158 places are shared by the four ex-Essex boroughs: Havering, Barking, Redbridge and Waltham Forest. During 1967, Havering occupied an average 48 beds at The Willows. Places available to Havering residents in the borough's homes during 1967 amounted therefore to 271. On 31st December, 1967, 46 of these 271 places were occupied by people from other Authorities. 63 elderly Havering people were being looked after by other Local Authorities or voluntary organisations. As in previous years, the department used its places in old people's homes both for people needing permanent accommodation and also for those needing only to stay a short while. In either case they had to be in need of care and attention and unable to cope on their own even if they had appropriate accommodation. In fact though, sometimes people had to be admitted who might have managed in the community if only they had had appropriate accommodation. They could no longer manage in a large house perhaps, or where they had to use stairs, but could have coped if they had a small bungalow or flat or bed-sitter on the ground floor. 67 elderly people from Havering came into old people's homes for short visits, usually for about two weeks at a time. Often this was because their family were away for their annual holiday or the person who looked after them had become ill or been admitted to hospital. 89 others from Havering came into the department's homes during 1967 as permanent residents, 32 of these being admitted from hospitals. Liaison with Hospitals As will be seen from the above figures, over a third of the permanent admissions to the department's old people's homes during 1967 came direct from hospitals. These were sometimes people who had not been on the waiting list as long as others admitted straight from their own homes, but the policy of the department was to help hospitals discharge patients who might otherwise occupy beds urgently needed for acutely ill patients. In return, the department asked hospitals to take residents from their old people's homes who needed hospital treatment or care as these needs arose and without waiting for the department to create a vacancy in exchange. This exchange system still operates in many parts of the country, but at last it seems that Havering has been able to move away from it on the basis of mutual trust and goodwill between hospital and Local Authority. In spite of this, the shortage of available psychiatric beds for old people still presented considerable problems throughout the year, some residents of homes having to wait many months before a transfer for psychiatric treatment became available. Waiting List At the end of 1967, 128 Havering residents were waiting for places in the department's old people's homes, and 19 more people resident in other areas wanting to be admitted to Havering old people's homes. A new home, The Grange, with 61 beds, had been opened toward the end of 1966, and was still taking new residents for the first few weeks of 1967. The number of permanent admissions during 1967 therefore, 89, was rather larger than is to be anticipated in a normal year when no new home is opened. New Old People's Homes Planning of a new old people's home in Clockhouse Lane, Collier Row, reached an advanced state of development but construction had to be postponed because of the difficult financial position. The Williams Committee Report The Committee of Enquiry set up by the National Council of Social Services on Staffing in Residential Homes (under the chairmanship of Lady Williams) published their report during 1967 under the title "Caring for People". It made many recommendations covering conditions of work, recruitment and a career 67 structure for staff, and laid special stress on the need for training. The Committee studied old people's homes, children's homes, special and approved schools and remand homes, hostels, nurseries, mother and baby homes, homes for physically handicapped adults and for the mentally ill and mentally handicapped. Most of the recommendations concerning old people's homes are already being carried out by this department, whose homes compare very favourably with those studied by the Williams Committee. 1,548 local authority old people's homes were studied (87% of all local authority homes). The ratio of residents to"care" staff (matron, assistant matron and attendants) was found to be 6.2 for homes of 51/100 residents (i.e. 6.2 residents per one full-time "care" staff), 5.4 for homes of 101—250 residents and 6.1 for all sizes of home. The equivalent figures for the department's homes are 5.7, 4.4 and 4.9. While the Williams Committee was still in session, the department was holding a preliminary training seminar for matrons and social work staff specially concerned in helping elderly people in groups, and was planning a training scheme for all attendants at its homes. This attendants course began in January 1968. The discussion with matrons led to an approach being made to the London Boroughs Training Committee to set up a course, to commence in early 1968. Developments in Old People's Homes Considerable progress was made during 1967 to improve the way of life and amenities for residents in the department's homes. Two separate schemes were adopted, one specially for The Willows, the other for the other smaller homes. The 158 residents at The Willows, who come from the London Boroughs of Barking, Redbridge and Waltham Forest as well as from Havering, are accommodated in premises inside the grounds of St. George's Hospital, a geriatric hospital. These premises are constructed on hospital lines. None of the bedrooms take less than 7 people, and it is not possible to accommodate married couples together. There are four large day rooms, no special dining room, and long wide corridors. There has always been a long waiting list, especially of women. The waiting list consists 68 of people with a greater degree of handicap or physical or mental frailty than can be accommodated in smaller homes, as the numbers of staff to residents is higher, and the more open lay-out makes it easier for wheelchairs to be used. Early in 1967 all the bedrooms were redecorated, (the day rooms and corridors were redecorated in 1966). Immediately afterwards the accommodation was changed so that more women were admitted and fewer men, the numbers changing from 86 places for women and 72 for men to 118 places for women and 40 for men. The day room separators, which had been installed in 1964, were put into use, making separate dining and living rooms, and by moving storage space a further small sitting room was provided for the men. The Willows has always had a number of voluntary groups and individual visitors willing to help, and this programme was greatly increased. Meetings of volunteers were held, and HOPWA (Havering Old People's Welfare Association) now provide voluntary helpers to run a social afternoon once a week in the largest day room and Bingo another afternoon a week for anyone wishingto take part. Another group under Mrs. Regan of South Hornchurch holds a social afternoon in another day room. The Catholic Women's League comes in on a regular basis, also from time to time other groups especially Toc H and Rotary. One of the social workers who is also a senior occupation therapist runs a pastimes afternoon in one of the day rooms once a week, helped by two HOPWA volunteers, and has been joined by the department's new Craft Instructor who works under her and plans to extend the work during 1968 to the men. HOPWA, through their visiting organiser, Mrs. Earle, has compiled, with matron's help, a list of residents who rarely if ever have a visitor, and gradually voluntary visitors are being introduced to them, each person having if they wish it, their own visitor, so that no one has to share — an important consideration in a place where so many other things have to be shared. All this has greatly increased the number of activities the residents can take part in or watch others doing—some of them prefer to watch things going on rather than take an active part themselves, as they may have got out of practice at doing things and are now too easily tired to want to start again, or may simply be too old. It has also greatly increased the number 69 of visitors at the home. The co-operation of both the staff, in helping with all these changes, and of the volunteers, who are not deterred by the long walk from Hornchurch station in even the worst weather, to bring the community to The Willows, which can so easily feel itself cut off is very greatly appreciated. There is much still to be done, and never enough volunteers to do it all, but 1967 saw many good changes, and with more helpers even more can be done in the future. Progress in the other smaller homes run by the department took the form of self-help rather than more outside help. It was felt that communication between staff and residents and further encouragement to the residents to do as much as they could both for their new home, where they wished to, and for themselves should be developed. A start was made by creating residents' house committees in three of the homes, so that the views of the residents could more easily be expressed to the staff. The department's craft instructor spends half a day a week in each of the small homes helping individual residents who wish to do craft or art work of various kinds. Programmes of activities and entertainments are arranged in consultation with the residents, and the four homes co-operate with each other so that the best facilities can be provided. For instance, one of the homes suggested through its superintendent that a monthly programme of feature films be arranged. and now every month each home shows the same film on successive evenings. "Great Expectations", "Doctor in the House" and similar films have been enjoyed by residents who can no longer go to the cinema themselves. Bingo is popular. Two of the homes now have facilities for residents to make tea or coffee for themselves or their visitors any time they wish. Two of the homes some distance from shopping centres run a daily "shop" so that people who cannot easily get out can still choose what they wish to buy instead of always having to ask others to do all their shopping for them. At Christmas time one of the Romford stores, in conjunction with the Chamber of Commerce, remained open one evening for visitors from the old people's homes, the Faringdon Centre for the physically handicapped, and other elderly or disabled people who would not otherwise have been able to cope with the Christmas shopping crowds. All the Shop Assistants gave their services, free refreshments and transport were provided and a most welcome "shopping spree" in great comfort was made 70 available. All this has meant changes for the staff as well as for the residents, and the interest and goodwill of staff has greatly helped in bringing about these improved facilities. TABLE 40 Old Peoples Homes Run by the Department Places ADMISSIONS IN 1967 Permanent from own home From Hospital Short Stay The Grange 61 14 11 17 Hillside 63 17 3 20 The Manor 48 7 4 9 Ravonscourt 51 7 3 16 The Willows * 158 • 12 • 11 • 5 # 381 57 32 67 * Shared with London Boroughs of Barking, Redbridge and Waltham Forest. Havering used approximately 48 places throughout the year. • Havering residents only. # Only approximately 271 places available to Havering residents see The Willows* above. TABLE 41 Accommodation Provided for Havering Residents Not Run by the Department 31st. December, 1967 Aged Under 65 65 + Total Accommodated by other Local Authorities 3 34 37 Accommodated by Voluntary Organisations 19 29 48 Totals 22 63 85 71 TABLE 42 Accommodation for Physically Handicapped and Others Provided by Voluntary Organisations 31st December, 1967 Aged Under 65 65 Total Blind 4 12 16 Deaf 1 — 1 Epileptic 4 — 4 Physically Handicapped 10 — 10 Mentally Handicapped — — — Others — 17 17 19 29 48 Elderly People's Workshop. This continued to flourish during 1967 under the direction of Mrs. M. Lyon. 32 elderly people attend, 16 for a 2-hour morning shift, 16 for a 2-hour afternoon shift. Contract work is carried out for local firms. Travelling expenses are paid for all members and an honorarium of 1s. per hour. Attendances are remarkably high even in the worst weather. The workshop is near one of the department's luncheon centres. which helps members to have a hot meal each day. Training The social work section is committed to training at all levels of the service, and a staff development programme is carried out. Members of the social work staff were encouraged during 1967 to attend appropriate courses, seminars and lectures, particularly those sponsored by the London Boroughs Training Committee (Social Services). Sometimes places were not available as the courses had been over-subscribed, or financial stringency within the department prevented applications going through. However, a number of. staff were able to take part in outside training events and benefitted considerably from these. Within the department, three different seminars were arranged and included all staff: one for experienced but unqualified officers, one for professionally qualified officers, and one for social workers 72 and matrons of old peoples' homes who were working with the elderly in groups. This latter seminar paved the way for a later request to the London Boroughs Training Committee for a special training course for senior staff in old peoples' homes in conjunction with the three other ex-Essex boroughs, and this was started in April 1968. All new members of staff were allocated to a senior professional social worker who acted as their casework consultant. As well as helping its own staff to continue to learn and improve their skills, the section also took a number of students from outside courses for social work training. The section now has a growing number of staff qualified to act as supervisors to students on professional courses, and many courses ask for fieldwork placements for their students in the department. During 1967 9 students on professional courses,and 6 on pre-professional courses were taken for supervision from the following: London University External Diploma in Social Studies: 3 London School of Economics Certificate in Social Science: 1 Bedford College Social Science Degree: 1 National Society for Prevention of Cruelty to Children Training Course: 1 National Institute for Social Work Training: 1 Barking Regional College of Technology: 4 North West Polytechnic: 4 The last three college courses led to the Certificate in Social Work Training. The social worker who is also a senior occupational therapist continued during 1967 to take students from the occupational therapy course at Oldchurch Hospital for visits of observation, to show them something of domiciliary occupation therapy in a local authority setting. Liaison with other Departments The social workers in the Health and Welfare Department count themselves fortunate to be able to work so closely and harmoniously with their social work colleagues in the Children's Department, which has premises next door to them. More and 73 more work done by social workers becomes work for families, and many of these families have children of school age or younger who from time to time turn out to have been in contact with the Children's Department. There have never been any difficulties in deciding which social workers from which department should deal with problems that may be arising in cases found to be joint ones, and this became even easier to achieve during 1967 when the Children's Department 'Families At Risk' register was made more immediate and active. Liaison with the Housing Department has also been greatly helped by their officers being in the building adjoining the Health and Welfare Department and connected by an internal corridor. There is a great deal of contact between their staff and the social workers, and many Havering residents have benefitted from this. Such easy day-to-day contact is important but usually difficult to carry out and is not always to be found within the same local authority. Services for the handicapped and elderly Statistics for 1967 in respect of the various services available for the Handicapped and for the Elderly, additional to those mentioned earlier in this report are as follows:— No. of handicapped persons assisted with alterations to premises or the issue of special equipment 798 No. of handicapped persons for whom holidays were arranged 119 No. of elderly people who were provided with a week's holiday at a Holiday Camp or Guest House 2,349 No. of elderly people for whom a Day's Outing was provided 2,621 No. of lunches provided for the elderly at 9 Luncheon Centres 163,626 No. of Mid-day meals delivered by Meals on Wheels Service 30,066 74 No. of elderly people who were provided with a Christmas Parcel 5,554 Entertainments This scheme maintained its popularity with elderly residents who took advantage of the invitations extended through my offices from local groups. Concerts and variety shows and plays were staged with great success, a total of 5,071 persons attended 29 productions. Tickets were distributed through old people's clubs, and coaches were hired by the Council to convey those attending to and from the entertainments. 75 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. Staff — Inspectorate Under the direction of the Chief Public Health Inspector the following are the general arrangements:— For purposes of Public Health, Shops/Offices inspection the Borough is divided into 12 and 4 areas respectively and the two Divisional Public Health Inspectors supervise the work of all the inspectorate. Three Inspectors specialise in food, drugs, water sampling, food complaints, and diseases of animals legislation and two Rodent Officer/General Assistants carry out pest eradication and disinfection. The Associate Chief Public Health Inspector is responsible for dealing with meat inspection problems, staffing and other arrangements at the slaughterhouses where our two authorised meat inspectors are engaged full time and where students from Tottenham Technical College and other local authorities receive tuition in meat inspection. At the end of the year four student Public Health Inspectors were undergoing training in the Department — two attending a three year "sandwich course" at Tottenham Technical College and two a four year "day release" course at the same college. A further student who had qualified at the end of the previous year was subsequently appointed as a Public Health Inspector by a neighbouring authority in January, 1967. During the year one District Public Health Inspector left the service of the Council and the vacancy was filled. 76 TABLE 43 Notification of Infectious and other Notifiable Diseases During the Year 1967 Disease Male Female Total Dysentery 18 19 37 Encephalitis (Infective) 2 — 2 Erysipelas 6 5 11 Food Poisoning (or suspected Food Poisoning) 97 104 2 01 Infective Hepatitis 26 19 45 Measles 1434 1421 2855 Ophthalmia Neonatorum 2 — 2 Paratyphoid Fever — 1 1 Pneumonia 12 9 21 Puerperal Pyrexia — 2 2 Scarlet Fever 120 98 218 Tuberculosis: Respiratory 30 10 40 Other 1 1 2 Typhoid Fever 1 — 1 Whooping Cough 66 66 132 Once again it is my pleasure to report that no cases of Poliomyelitis, Diphtheria, Smallpox, Anthrax, Tuberculosis of meninges and central nervous system were notified during the year. I would again stress to all concerned the importance of vaccination against Smallpox in early childhood. There can be no guarantee of immunity merely on the grounds that this disease is not endemic in this country at present. It only needs a slight lessening of vigilance by health authorities and their officers to cause the present satisfactory position to be reversed with dire results. There was a considerable reduction in the number of Tuberculosis cases notified during the year, although unfortunately the mortality from this disease remained the same, i.e. 7 (6 respiratory 1 non-respiratory). There was also one death from whooping cough — a male of 5 weeks. As was to be expected, the first quarter of the year was a "carried forward" of the bi-annual "Measles Cycle", some 77 2,204 cases being notified in this first quarter. The second quarter produced 595 notifications, tailing off to the third quarter with 47 and during the last quarter of the year only nine cases were notified. The number of cases of food poisoning (or suspected food poisoning)notifiedshowed a marked reduction, as did the number of cases of dysentery, the notifications of which reduced from 192 to 37. Of the 201 cases of food poisoning (or suspected food poisoning) only 23 proved to be positive, of which four were food handlers. In the confirmed cases appropriate steps were taken to prevent the spread of infection and in no case was it necessary for compensation for loss of earnings to be made. The following table shows the number of faecal specimens submitted by the Section during the year, and my thanks are due to Dr. E. Atkinson, Pathologist, Oldchurch Hospital Laboratory, and his staff, for the very able and efficient manner in which they dealt with our requests in this connection. TABLE 44 Taken From Total No. of persons swabbed Total No. of swabs taken Negative Positive Shig. Sonnei Salmonella * ** Chlost. ridium Welchii Food Handlers 37 52 48 — — 4 NonFood Handlers 290 411 369 23 16 3 *** Salmonella Stanley 5 Salmonella Prendensy 1 Salmonella Typhimurium 6 Salmonella Enteridis 1 Salmonella St. Paul 1 Salmonella Panama 1 Salmonella Unidentified 1 Total 16 78 There were two outbreaks of food poisoning during the year which were reported to the Ministry of Health in accordance with their Memorandum 188 MED. Details of these two outbreaks are as follows:— Information was received in mid-March that following a dinner held at a local hotel at least half of the hundred guests attending suffered from stomach pains, sickness and diarrhoea. Investigation was made and it was found that members of the kitchen staff and a waitress had also eaten parts of the meal and suffered the same symptoms. No samples of the meal remained, but as all sufferers had eaten the prawn cocktail, the batch number of the imported prawns was obtained and samples of the same consignment were taken from the U.K. suppliers. These were sent for analysis but no pathogenic organisms were isolated. All the swabs taken proved to be negative and every case quickly recovered with medical treatment. The probable origin of the cause of this outbreak was not definitely ascertained but at a later date a second outbreak occured at this same hotel. The second outbreak was reported at the end of August. On investigation it was learned that at a wedding reception 112 had sat down to a meal and at least 40 people had suffered from diarrhoea and sickness. The average interval of onset was 16 hours and the severity was considered to be moderate. Due to the dispersement of the guests it was only possible to take a total of 20 swabs from guests and staff. A portion of the turkey consumed at the reception was available, and a sample of this was sent for bacteriological examination. The result of this showed a varied bacterial flora consisting mainly of aerobic spore bacilli and Gram Positive cocci. Chlostridium Welchii was also isolated in a scanty amount. The results of faecal swabs taken showed 13 to be negative but four guests and three staff had Chlostridium Welchii isolated. 79 All cases recovered quickly after medical treatment and the necessary negative swab results obtained. This outbreak, as possibly in the first outbreak reported, might have been caused by the meat being pre-cooked during the day before consumption, left to cool at room temperature and then slowly warmed the following day before being served. However, the evidence was not conclusive as to the exact cause of either outbreak. Necessary instructions were issued to the hotel and no further cases were reported. All the other cases of food poisoning or suspected food poisoning notified were isolated cases and all made uneventful recovery after routine medical treatment. At conclusion of treatment negative swab results were obtained in all cases. Smallpox Contacts Eight references were made to the Department during the year for the surveillance of smallpox contacts who had arrived in this country from endemic or locally infected areas and were reported as proceeding to addresses in Havering. This surveillance was necessary as these travellers were not in possession of valid International Certificates of Vaccination against Smallpox, and the authority for this control measure is given to Health Authorities by the Public Health (Aircraft) Regulations, 1966 and the Public Health (Ships) Regulations, 1966. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS During the year advice notes were received from the Port Health Authorities in respect of 75 immigrants who were alleged to be staying at addresses in the Borough, but in only 43 cases was successful contact made with the immigrant to advise on health matters. A revised hand-out card for immigrants has now been reprinted in eight languages — Spanish, English, Italian, French, Hindi, Urdu, Bengali and Punjabi, as opposed to the previous card which was printed in six languages. FOOD AND DRUGS ADMINISTRATION A total of 512 samples (71 formal and 441 informal) were 80 taken during the year and examined by our Public Analysts. The description of one product formally sampled was found to be misleading and the manufacturers were informed. This resulted in the label being amended. Two informal samples also had faulty labelling, but after approaching the manufacturers concerned the labels were amended and no formal action was required. Included in the above figures are 49 food complaints which were referred to the Public Analysts. Eight prosecutions were taken, details of which are included in the list below. 127 other food complaints were dealt with without reference to the Public Analysts. In eight of these legal proceedings were taken. The 176 food complaints are summarised as follows:— Bread 46 Sauce 2 Milk/milk products 20 Biscuits 2 Flour confectionery 12 Butter 2 Fresh meat 10 Soft drinks 2 Meat pies 8 Rice 2 Tinned fruit 7 Ice lollies 2 Frozen foods 5 Tinned Fish 1 Bacon 5 Cooking oil 1 Fresh fruit 4 Ice Cream 1 Cheese 4 Coffee 1 Baby food 4 Pickles 1 Offal 4 Margarine 1 Vegetables 4 Dripping 1 Tinned meat 3 Sugar confectionery 1 Fish 3 Jam 1 Tea 3 Mushrooms 1 Sausages 3 Ground Almonds 1 Chicken 2 Black pudding 1 Cereal 2 Dental fixative powder 1 Tinned Vegetables 2 The sixteen cases in which legal proceedings were taken are as follows:— Complaint Results of Proceedings Metal in bread Fine £20. Costs £10.10.0. Nail in lemonade Case dismissed Decomposing chicken Fine £25. Costs £10.10.0. 81 Complaint Results of Proceedings Metal in cake Fine £40. Costs £5. 5. 0. Glass in milk Fine £10. Glass in baby food Fine £20. Costs £5. 5. 0. Mouldy bread Fine £10. Costs £5. 5. 0. Mouldy apple pie Fine £10. Costs £5. 5. 0. Plastic in fish cake Fine £25. Costs £5. 5. 0. Mouldy bread Fine £15. Costs £5. 5. 0. Mice excreta in crisps Absolute discharge. Costs £2. 2. 0. Mouldy sausage roll Fine £30. Costs £5. 5. 0. Mouldy bread Fine £25. Costs £5. 5. 0. Mould in milk Fine £30. Costs £5. 5. 0. Foreign matter in bread Fine £25. Costs £5. 5. 0. Rubber band in cake Fine £20. Costs £5. 5. 0. Ice Cream Sampling During the year 154 samples of ice cream were submitted for bacteriological examination, with results as shown:— Grade 1 (Satisfactory) 115 Grade 2 (Satisfactory) 14 Grade 3 (Poor) 10 Grade 4 (Unsatisfactory) 15 154 In addition 28 samples of ice lollies were taken for bacteriological examinations, eight of which were found to be not entirely satisfactory. In these cases appropriate follow-up action was taken. There was a marked improvement on the previous year in the number of unsatisfactory samples taken from "soft" ice cream making machines. Nine samples of ice cream were submitted to the Public Analysts for chemical examination and in each case a satisfactory report was received. A breakdown of the grading of the 154 ice cream samples was as follows:— 82 Grade 1 Grade 2 Grade 3 Grade 4 Soft — mobiles 36 — — 8 Other — mobiles 40 7 3 4 Soft — shops 7 2 4 3 Other — shops 32 5 3 — Other Bacteriological Food Sampling Bacteriological sampling of other food products was carried out in respect of the following commodities:— Meat Products 105 (93 cooked, 12 raw) Cream cakes 17 Shellfish 10 Salad cream 1 Egg noodles 1 Complete meals 6 * The 105 samples of cooked and raw meat products consisted of the following:— Meat Pies 14 Sausage rolls 12 Hams 67 Raw meat products 12 Three meat product samples were not entirely satisfactory and the necessary action was taken to obtain the required improvement. * The six complete meals prepared, cooked and served at the central kitchen for the Welfare Services, and comprised of a total of 33 items of meat, vegetables, sauces and sweet courses. In two instances the meat was found to be not entirely satisfactory and appropriate remedial measures were taken. Milk Sampling The following 240 samples were taken during the year and submitted for bacteriological examinations with the results shown:— Ultra heat treated 1 6 satisfactory Pasteurised 187 satisfactory 15 unsatisfactory 3 void Sterilised 19 satisfactory 83 Included in the above were 57 samples taken from vending machines, 55 being satisfactory and 2 unsatisfactory. Appropriate action was taken in the case of the unsatisfactory samples. It is gratifying to record that there was a marked improvement in the sampling results obtained from the milk vending machines over the previous year. 24 samples (23 formal and one informal) were submitted to the Public Analysts for chemical examination and all proved to be satisfactory. No raw milk is now retailed in the Borough. 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. SLAUGHTER OF POULTRY ACT, 1967 The Slaughter of Poultry Act, 1967 was placed on the Statute Book during the year although the Minister concerned has not yet made an order giving the appointed day for the commencement of this legislation. This Act provides for the humane slaughter of poultry for certain commercial purposes, and will place responsibility on local authorities for the administration of the sections regarding the mode of slaughter, registration of premises in which slaughter takes place and provisions for securing humane conditions of slaughter. In anticipation of this Act coming into force, extra visits were paid to all known poultry keepers in the Borough, with a view to eventual implementation of the Act and any Regulations which the Minister may make thereunder. FOOD & DRUGS ACT, 1955 - SECTION 16 During the year 22 applications for registration of premises for the manufacture, storage or sale of ice cream, and 34 applications for registration of premises for the manufacture of sausages 84 or potted, pressed, pickled or preserved food intended for sale were granted. ESSEX COUNTY COUNCIL ACT, 1952 - SECTION 103 During the year underreview 7 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, 183 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 151 Sterilised 119 Ultra-heat Treated 23 Untreated 45 PESTICIDE RESIDUES IN FOODSTUFFS Eighteen samples were taken during the year in connection with a phased scheme formulated jointly by the Couaty Councils' Association, the Association of Municipal Corporations and the Urban District Councils' Association to enable a systematic enquiry to be carried out into the extent of contamination of foodstuffs by toxic chemicals. All samples proved genuine and free from pesticide residues. GAME ACT, 1831 To add to the complexities of modern life 6 licences were issued during the year under this very ancient piece of legislation authorising the licensee to buy Game from any person authorised to sell Game by virtue of this Act and to sell from his house, shop or stall any Game so bought. In addition to the licence granted by the Local Authority these licensees have to obtain an excise licence under the terms of the Game Licences Act, 1860. The power of the Local Authority to grant licences to deal 85 in Game is derived from the Game Act, 1831, as amended by Section 27 of the Local Government Act, 1894. The latter section transferring the jurisdiction to grant such licences from the local justices to Local Authorities. It is quite obvious that this Act must have deen designed to cope with a totally different set of circumstances to those existing today. In these days of supermarkets and frozen food it would seem difficult to decide if portions of grouse, partridge or pheasant packed by one of the specialist frozen food firms and stored in the frozen food cabinet of a local supermarket required the issue of a licence under this Act. These licences are for the period 1st July to 30th June presumably thus conforming to the "shooting season". THE FOOD HYGIENE (MARKETS, STALLS & DELIVERY VEHICLES) REGULATIONS, 1966 These Regulations were effective from 1st January, 1967 and revoked the corresponding requirements contained in the existing Food Hygiene (General) Regulations, 1960, which continued to apply to food businesses in fixed premises and ships. These Regulations apply to any handling of, or trading in food, which is undertaken either in any market or market premises or away from fixed premises. Delivery vehicles used for the sale of food come within the definition of "stall" and are thus subject to the requirements of the Regulations. The Council are empowered to grant Certificates of Exemption from some of the requirements of the Regulations to certain kinds of businesses carried on from stalls, etc. provided they are satisfied that the necessary facilities are conveniently and readily available elsewhere, and without payment, for. the use of persons engaged in those businesses. As a result of this a considerable number of stallholders in Romford Market were issued with Certificates of Exemption in connection with water supplies and wash hand basins as these are made available by the Council in the Market Place. 86 The Council were unable to grant any exemptions with regard to first aid materials as it was felt that the facilities available in the Market Superintendent's office were not adequate to enable such exemptions to be made. No exemptions were granted in connection with facilities for washing and sorting food and equipment. FOOD HYGIENE (GENERAL) REGULATIONS, I960 Ministry of Health Circular 1/68 requests details of food premises which are subject to the provisions of the Food Hygiene (General) Regulations, 1960, grouped in categories of trade carried on in them and including the following information for each category:- TABLE 45 Food Premises Grouped in Categories of Trade 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 154 154 154 154 Cafes 116 116 116 116 Confectioners(Bread) etc. 52 52 52 52 Confectioners (Sugar) 240 232 212 212 Fish Shops 48 48 48 48 Grocers 303 303 303 303 Greengrocers 164 164 164 164 Ice Cream Manufacturers 3 3 3 3 Clubs 20 20 20 20 Public Houses 72 72 72 72 School Canteens 82 82 82 82 Staff Canteens 77 77 77 77 Off Licences 31 31 20 20 NOTE: Regulation 16 deals with the provision of wash hand basins and Regulation 19 with facilities for washing food and equipment. 93 notices were served under these regulations during the year and no formal action was required. No legal proceedings were taken during the year in respect of other offences against these regulations. The Meat Inspection (Amendment) Regulations, 1966 The Council's proposals regarding hours of slaughter at each 87 of the four slaughterhouses which had been submitted to the Ministry of Agriculture, Fisheries and Food during 1966 had not achieved finality at the end of the year. Meat Inspection Regulations, 1963 Legal proceedings were taken during the year against one of the slaughterhouse owners in respect of the removal of a carcase from the slaughterhouse contrary to Regulations 7 and 16 of the Meat Inspection Regulations, 1963. The firm concerned was fined £20 and the Council awarded £6.6.0d. costs. Slaughter of Animals Act, 1958 52 Slaughtermen's Licences were issued during the year, five including the slaughter of horses and 26 being in respect of the ritual slaughter of animals by the Jewish method. Public Health Act, 1936 — Section 107. Offensive Trades During the year the Council gave their consent to the establishment of an offensive trade — namely a fat extractor — at a plant adjacent to the slaughterhouse at 29 Oldchurch Road Romford. The Council resolved that this consent would be renewable annually so as to run for the same period as the Slaughterhouse Licence. 88 Cattle Calves Sheep & Lambs Pigs Horses Goats Total TABLE 46 Carcases Inspected and Condemned Number killed 14,022 4,532 80,585 20,061 30 45 119,275 Number Inspected 14,022 4,532 80,585 20,061 30 45 119,275 All Diseases except Tuberculosis and Cysticercosis Whole Carcases Condemned 40 11 223 39 — — 313 Carcases of which some part or organ was condemned 5,829 113 13,728 1,288 7 5 20,970 Percentage of number affected 41.14% 2,73% 17.32% 6.61% 23.33% 11.11% 17.83% Tuberculosis Only Whole Carcases Condemned — — — — — — — Carcases of which some parts or organs were condemned 1 — — 281 — — 282 Percentage of number affected 0.007% — — 1.4% — — 0.23% Cysticercosis Only Carcases of which some parts or organs were condemned 5 — — — — — 5 Carcases submitted to treatment by refrigeration 1 — — — — — 1 Generalised and totally condemned — — — — — — — MEAT INSPECTION The following table shows the post mortem inspection of animals during the year 1967 at the four licensed slaughterhouses in the Borough Total meat condemned: 47tons: 19cwt: 381b. 89 UNSOUND FOOD Duringthe year the following foods were voluntarily surrendered to the Public Health Inspectors as being unfit for human consumption. TABLE 47 Unsound Food Surrendered TONS. CWTS. LBS. Fish 2 16 14 Frozen Food — 3 47 Meat (Retail Shops) 1 12 43 Meat (Wholesale Depots) 1 4 43 Offal — 5 56 Poultry — — 87 Sausages — — 44 T inned Fish — 3 — Tinned Food 1 2 12 Tinned Fruit 1 9 16 Tinned Meat — 13 21 Tinned Milk — 1 43 TOTAL 9 11 90 The breakdown of electricity supply to shop premises creates problems for the shopkeeper with frozen food cabinets although it now seems to be recognised that in the event of a power-cut frozen food stored in a correctly packed cabinet should, with the possible exception of the top layer, keep satisfactorily for up to five hours. The actual time, however, would depend on a number of factors, including the ambient temperature, the efficiency of the cabinet before the breakdown and whether the retailer himself had taken any precautionary measures such as insultating the top of the cabinet. PHARMACY AND POISONS ACT, 1933 The sale of certain poisons — generally those used for sanitary, domestic and horticultural purposes — by persons other than pharmacists is subject to the provisions of this Act and the rules made thereunder. Persons selling such poisons must have their name entered 90 on a list kept by the Council and must make application annually for re-entry and pay a prescribed fee. Compliance must be made with the requirements relating to storage, transport, labelling and containers. Nine names were added to the list during the year and fourteen were removed. At the end of the year the names of 113 persons were entered on the poisons list involving some 177 premises. One person selling poison listed on Part II of the poisons list and whose name was not entered on the Local Authority's list of sellers was prosecuted during the year and was fined two pounds with two guineas costs. The offender was a market stallholder and it should be noted that a person cannot be entered on the list of sellers of these poisons unless he or she sells from shop premises. A stall is not a "shop" within the meaning of this Act. 353 visits were made during the year in connection with the administration of this Act. WATER SUPPLY The domestic water supply in the whole of the Borough is provided by the South Essex Waterworks Company and has been satisfactory both in quantity and quality. No action has been necessary during the year in respect of eny form of contamination. The number of dwelling houses supplied from the mains at the end of the year was 79,259, and the population as estimated by the Registrar General was 251,160. The number of houses supplied by stand pipes is quite insignificant. The fluoride content of the sources of the main supply at October, 1965 was:— Principal sources (river derived) — 0.25 p.p.m. Local well (Dagenham) — 0.71 p.p.m. The Company maintain laboratory control and carry out 91 bacteriological and chemical examinations of the raw water, of the water in its various stages of treatment and of the water coming into the mains supply. It is the statutory duty of every local authority to take such steps as are necessary for ascertaining the sufficiency and wholesomeness of the water supplies within their district, and in this connection the Department took 10 samples of water for routine chemical and bacteriological examination. In all cases satisfactory reports were received. The following table shows the amount of rainfall for the year as recorded at the recording stations at Raphael Park, Romford; Spring Farm, Rainham; Langtons, Hornchurch; and Berry Farm Upminster. Raphael Park Spring Farm Langtons Berry Farm TABLE 48 Meteorological Information Month Amount of rainfall in inches No. of days on which rain fell Amount of rainfall in inches No. of days on which rain fell Amount of rainfall in inches No. of days on which rain fell Amount of rainfall in inches No. of days on which rain fell January 1.43 15 1.28 17 1.62 16 1.29 18 February 1.79 12 1.61 12 1.74 10 1.82 13 March 1.06 8 1.13 11 1.74 6 1.02 11 April 2.13 13 2.34 13 2.16 14 2.07 14 May 3.39 25 3.53 24 3.42 23 3.57 25 June 1.98 7 1.79 4 1.84 4 1.86 4 July 1.08 7 1.04 6 .82 6 .70 7 August 1.76 14 2.37 13 1.99 14 2.16 13 September 2.05 15 2.03 15 1.88 16 1.96 18 October 3.42 21 3.32 18 3.71 20 3.47 20 Novembe 1.99 13 1.93 12 2.06 13 2.05 16 Decembe 2.14 19 2.06 20 2.25 20 2.24 19 24.22 169 24.43 165 25.23 162 24.21 178 92 93 . In order to compare the above mentioned figures with the official figures, the following table showing the rainfall at Kew Observatory is given. In addition to rainfall this table also gives details of sunshine, which should prove enlightening. RAINFALL SUNSHINE TABLE 49 Kew Observatory1.967 Month Total ins. Percentage of Average Wettest Day No. of Dry Days Total hrs. Percentage of Average Sunniest Day Date ins. Date hrs. January 1.24 56 25 0.41 18 64 138 3 6.6 February 2.03 133 27 0.50 17 86 136 23 8.5 March 1.43 97 8 0.41 20 170 151 29 9.4 April 1.91 104 9 0.58 18 144 90 16 9.9 May 3.87 213 14 0.68 7 191 96 31 12.6 June 2.07 120 25 1.23 24 214 100 13 15.0 July 2.21 90 22 1.41 24 245 124 9 15.1 August 1.61 72 18 0.42 19 187 99 4 13.1 September 2.25 114 17 0.46 15 121 85 6 9.8 October 3.56 158 16 0.78 12 97 99 23 9.5 November 1.37 56 1 0.51 16 68 128 18 6.8 December * 1.98 97 18 0.61 12 54 136 4 6.2 Year* 25.53 107 22nd July 1.41 202 1641 108 9th July 15.1 A dry day is defined as one with less than 0.1 inch of rain during the 24 hours. * Provisional. The main features of the weather in the London area during the year were as follows:— January Dry and generally mild. The London Weather Centre had its warmest January day since 1958 on the 29th with 14°C (57°F) and it was generally the mildest January since 1962. 19 ground frosts were recorded. The rainfall for this month was 16% below average. February Dry, then unsettled and windy. Kew, with a minimum temperature of 11.2°C (52.2°F) on the first night of the month had its mildest February night for nine years. Rainfall for this month was 26% above average. There were 16 days with ground frost. March Mild, becoming cooler during the last week; windy. The London Weather Centre had 180% of its usual sunshine although the rainfall was 26% above average. 15 ground forsts. April Cool in second week and mainly dry during the last fortnight. 102% of usual sunshine at the Weather Centre with 123% of average rainfall. 14 ground frosts. May Wet and thundery. Kew with a minimum temperature of -1.2°C (29.8°F) on the morning of 3rd May had its coldest May night, and with 0.62" rain on 14th had its wettest Whit Sunday since records began in 1871. It should be noted, however, that the rainfall in Upminster on this day was .45", but the wettest day at Langtons was the 5th with .43". The percentage average rainfall in Havering for May was 212. Everywhere had 23 or more rain days. 5 ground frosts. June Mainly dry, but some heavy rain during the last week. The percentage average rainfall in Havering was 123. There was a normal amount 94 of sunshine during this month. 5 ground frosts. July Mainly fine until the last 10 days. Sunshine was 130% of average at the London Weather Centre and it was the warmest July since 1959 at Kew. 2.13" of rainfall on 23rd at Heath Row whereas the rainfall in the Havering area on this day was 0.25", giving a percentage average of 35-65% below normal. August Changeable at first, settled later, Sunshine was more or less normal, the rainfall being 3% below average. September Unsettled. Sunshine was 9% less than normal at the Weather Centre and the rain in Havering was 106% of normal. October Unsettled. Sunshine was 111% of normal at the Weather Centre but rainfall in Havering was 177% of average with 21 rain days at Raphael Park. 4 ground frosts. November Rather dry with some frosty spells. 18 ground frosts were recorded. The London Weather Centre had 153% of average sunshine and Havering had 92% of average rainfall. December Alternating mild and cold spells. More than average rainfall in Havering, i.e. 119% with 20 rain days recorded at Spring Farm. 19 ground frosts recorded although sunshine was 136% of normal at Kew. Details of the temperature at Kew Observatory during 1967 are given in the following table. 95 96 TABLE 50 Kew Observatory-1967 TEMPERATURE Month Mean Difference from Average Mean Max. Difference from Average Mean Min. Difference from Average Warmest Day Coldest Day Warmest Night Coldest Night °c °F °C °F °C °F °C °F °C °F °C °F Date °C °F Date °C °F Date °C °F Date °C °F Jan. 5.3 41.5 +1.0 +1.8 7.3 45.1 +1.0 +1.8 3.3 37.9 +1.1 +1.9 29 13.3 55.9 8 -0.1 31.8 28 9.4 48.9 9 -3.1 26.4 Feb. 6.6 43.9 +2.0 +3.7 9.1 48.4 +2.2 +4.0 4.1 39.4 +1.9 +3.4 2 13.3 55.9 14 3.9 39.0 2 11.2 52.2 18 -1.1 30 0 March 8.2 46.7 +1.5 +2.6 11.5 52.7 +1.4 +2.5 4.9 40.8 +1.6 +2.9 21 16.8 62.2 31 8.4 47.1 25 7.6 45.7 30 0.4 32.7 April 8.6 47.5 -0.8 -1.4 12.3 54.1 -1.0 -1.8 4.9 40.8 -0.6 -1.1 17 20.7 69.3 11 7.0 44.6 29 10.0 50.0 1 -1 4 29.5 May 11.9 53.5 -06 -1.0 15 9 60.6 -0.8 -1.5 8.0 46.4 -0 2 -0.4 11 25.3 77.5 2 9.7 49.5 28 13.1 55.6 3 -1.2 29.8 June 15.5 59.9 -0.4 -0 7 20 0 68.0 -0.3 -0.5 10.9 51.7 -0.7 -1.2 30 24.4 75.9 11 14.3 57.7 29 15.5 59.9 9 6 .0 42.8 July 18.9 66.1 +1.3 +2.4 23.6 74.5 +1.8 +3.3 14.2 57.6 +0.7 +1.3 17 29.3 84.7 3 19.1 66.4 31 17.6 63.7 6 9.6 49 3 Aug. 17.3 63.1 0.0 0.0 21.5 70.7 +0.1 +0.2 13.0 55.4 -0.2 -0.4 1 25.8 73.4 15 16.7 62.1 8 16.2 61.2 21 9.4 48.9 Sept. 14.9 58.8 0.0 0.0 18.1 64.6 -0.4 -0.7 11.6 52.9 +0.3 +0.6 1 22.0 71.6 16 15.7 60.3 26 15.8 60.4 9 5.6 42.1 Oct. 12.1 53.7 +1.0 +1.8 14.6 58 3 +0.4 +0.7 9.5 49 1 +1.6 +2 9 8 20.5 68.9 31 9.0 48.2 9 16.1 61.0 30 2.3 36 1 Nov. 6.5 43.7 -1.2 -2.2 9.3 48.7 -0.8 -1.5 3.8 38.8 -1.5 -2.7 11 15.4 59.7 26 5.3 41.5 14 9.2 48.6 17 -1.8 288 Dec. 5.1 41.1 -0.3 -0.6 6.9 44.4 -0.4 -0.7 3.3 37.9 -0.2 -0.4 23 13.2 55.8 8 -0.6 30.9 23 11.7 53.1 9 -6.3 20.7 Year* 10.9 51.6 +0.3 +0.5 14.2 57.5 + 0.3 + 0.5 7.6 45.7 +0.3 + 0.6 17 July 29.3 84.7 8 Dec -0.6 30.9 31 July 17.6 63.7 9 Dec -6.3 20.7 *Provisional SWIMMING POOLS A total of 35 bacteriological and 34 chemical samples were taken from the 3 public swimming pools during the year and in each case a satisfactory report was received. One new school swimming pool was opened during the year making a total of 13 school swimming baths. A phased programme of sampling was maintained resulting in 52 bacteriological and 47 chemical samples being taken. The results of these samples were satisfactory with one exception. This could be put down to teething trouble and appropriate advice was given and the necessary action taken to improve the condition of the water. PADDLING POOLS 28 samples were taken from the Council's 11 paddling pools —which are only open during the summer months—and bacteriological examination proved satisfactory in each case. CARAVANS AND CAMPING The number of privately owned residential site licences issued under the Caravan Sites and Control of Development Act, 1960, and operating at the end of the year was 5 individual and 4 multiple. The total number of caravans involved being 263. One of the multiple sites was made subject to conditions for reducing caravans during the year and two sites were made subject to Section 20 of the Act which deals with the termination of use. The Council owns one residential caravan site accommodating 66 caravans. This site is administered by the Housing Department. In last year's report mention was made of the problem created by a considerable number of gypsies who settled in the Oldchurch Road Area.and were subsequently moved on. The majority of these gypsies then settled at the disused R.A.F. Station at Hornchurch with the resultant problems which have now become common place to Local Authorities whose districts attract this type of caravan dweller. 97 The Council are comtemplating the establishment of a permanent site to take somewhere in the region of 27 caravans, and in the meantime are investigating various sites for the establishment of temporary arrangements for these gypsies. There is one tented camping site owned by the Council consisting of 450 tent pitches. This site has satisfactory water supply, sanitary accommodation, washing facilities and refuse facilities. Whilst it is understood that the Government is considering legislation to deal with the problem of gypsies it would be extremely advantageous to Local Authorities if some comprehensive legislation could also be evolved to give direct control over unauthorised itinerant caravans. PARKS AND OPEN SPACES The general health of the inhabitants of all urban areas can be greatly affected by the services offered in the shape of parks and open spaces by the Council and the extent to which they are used. The Council is very conscious of the benefits which accrue from well-appointed parks and open spaces and does all that is possible to provide local inhabitants with facilities for relaxation, recreation, sports and games in an endeavour to promote the health of all age groups within the Borough. The forty-five parks and open spaces comprising a total of 1180.7 acres belonging to the Council are listed below:— Bedfords Park 214.50 Berwick Ponds 9.00 Brittons Playing Fields 26.37 Central Park 50.36 (not fully developed). Clockhouse Gardens 3.50 Collier Row Rec. Ground 6.00 Coronation Gardens .75 Cottons Park 15.70 Dagnam Park 75.12 (not fully developed). Elliott Playground 3.00 Gaynes and Hacton Parkway 20.17 98 Gidea Park Sports Ground 11.52 Grenfell Park 27.62 Hall Lane M.G.C. 8.00 Harrow Lodge Park 120.00 Harold Wood Park 45.00 Havering Green 1.50 Havering Field 4.60 Havering Well Gardens 0.19 Haynes Park 27.00 Hornchurch Stadium 5.50 Hylands Park 16.00 Jutsums Rec. Ground 4.30 King Georges Field 23.98 Land off New Road, Rainham 20.52 Laurie Gardens 0.40 Lawns Park 17.00 Lodge Farm Park 12.68 Lucas Childrens Playground 0.39 Noak Hill Sports Ground 5.92 Noak Hill Recreation 4.16 Oldchurch Park 50.00 (not fully developed). Park Lane Playground 5.55 Parklands 10.75 Rainham Rec. Ground 3.80 Rise Park 23.50 Raphael Park 42.43 St. Andrews Park 7.00 Spring Farm Park 7.00 Suttons Parkway 23.70 The Dell 6.00 Upminster Park 18.00 Warley Hall Woods 11.00 Childrens Playground, Elm Park 0.85 Childrens Playground, Severn Drive 1.54 In addition to the above there are numerous childrens play spaces situated throughout the area provided with playground equipment and these include four adventure playgrounds which provide children with an unorthodox approach to games with individual projection. The Greater London Council own certain land used as 99 amenity greens on their housing and industrial estate at Harold Hill. The Greater London Council also administer Hainault Forest, 78 acres of which are within the Borough. A small group of woodlands within the eastern boundary of the Borough amounting to 58.6 acres is owned and administered by the Essex County Council as also is Upminster Common comprising 77 acres. At the present time the Council provides the following sports pitches:— Football pitches 49 Cricket squares 26 Hockey Pitches 7 Rugby pitches 3 Bowling greens 7 Tennis courts 85 Netball hard courts 4 Putting greens 10 Miniature golf courses 6 Boating lake 1 Fishing lakes 2 Roller skating arena 1 Sports stadium (Floodlit) 1 Grass athletic track 1 All-weather pitch (Floodlit) 1 RIVERS, STREAMS AND WATERCOURSES The principal river in the area is the Thames which forms the southern boundary of the Borough. Two tributaries of the Thames (Rivers Ingrebourne and Rom) traverse the district from north to south and in the case of the Rom is joined by the Ravensbourne in the southern part of the Borough to form the Beam River. During the year under review the water in the River Rom and Beam River has remained reasonably clean down to the outfall of the Bretons Farm Sewage Works. 100 Closure of this Sewage Works during 1968 is expected to result in a marked improvement in the quality of the lower Beam River. During the summer when reconstruction of Nags Head Lane Sewage Works resulted in a marked reduction in effluent purification the Ingrebourne River became grossly polluted and caused much public complaint. A considerable amount of attention was given to investigating these complaints and nine samples of river water were taken during this period for bacteriological and chemical examination. Following forceable representations to the Essex River Authority and the Brentwood Urban District Council—the owners of Nags Head Lane Sewage Works—arrangements were made for the chlorination of the effluent as a precautionary measure until such time as the new treatment units come into operation to give a marked improvement in the quality of the river water. The dilution effect of heavy rainfall during the autumn months also helped to alleviate this nuisance. Restoration of the river water to a quality far better than has been experienced for many years is expected to be achieved during the forthcoming year. No significant pollutions were caused by direct discharges of industrial effluents to rivers in the Borough during the year but several cases of oil pollution and accidental minor pollutions of various kinds were investigated by the River Authority and appropriate remedial action applied. The levels of radioactivity (Beta-emission) in the Rivers Beam and Ingrebourne have been checked regularly. The levels of radioactivity, in excess of that occurring naturally, found during the year were very small, varying from nil to 13 pico-curies per litre of water. This radioactivity, derived from residual fall-out from nuclear test explosions is rather less than that observed in 1966, and very much below that observed following the Russion megaton test explosions carried out within the Arctic Circle in 1961/62. The levels of radioactivity in river waters observed during the year are considered to be satisfactorily low and harmless. 101 The discharge of effluent from Bretons Farm Sewage Works into the Beam River will cease in the summer of this year and as a result the dry weather flow in the river will be insufficient to enable a large riverside industrial plant to abstract their full water requirements. A scheme is under investigation whereby the effluent from the Riverside Sewage Works would be given tertiary treatment to improve the quality then either pumped through a pipeline to the headwaters of the Mardyke for abstraction or transferred to the Beam utilising existing watercourses. The River Authority has carried out a scheme to strengthen the tidal defences on the east bank of Rainham Creek and improve the revetted face. On the west bank work is in hand on a temporary scheme to raise the level of the defences at the upper end of the creek. THE RADIOACTIVE SUBSTANCES ACT, 1960 A system for the disposal of solid radioactive waste has been evolved in this country and has been used for the last 3 years. The Act contains provision for the registration of all users of radioactive material, provision for authorisation for the disposal of radioactive waste and powers to exempt minor users from registration. In this connection the Ministry of Housing and Local Government cancelled the four authorisations which were in force in this Borough during the year and issued revised registrations and authorisations in each case. These authorisations are held by two other public authorities and twoprivate firms. The radiochemical inspectors of the Ministry as a result of extensive investigations have established a strict criteria for the disposal of radioactive material. The exposure of people handling the waste has to be kept as far below the acceptable limit as possible, and the final resting place has to be carefully chosen to ensure that no-one—'including small boys who can get almost anywhere' —inhaled or ingested active material, particularly if alpha or beta-emitting radionuclides are present. In addition, there has to be adequate shielding of the waste, particularly when it contained gamma-emitters, until the activity decayed to a negligible level. A range of disposal methods, which catered for four basic 102 types of disposal, has been worked out. Authorisations usually permitted one or more of these four methods. One of these methods is disposal without special precautions by the normal refuse route. However, using this method, activity is severely limited. Originally the limit was a maximum of two microcuries per cubic foot of refuse, but under the new regulation the waste has to be in special containers, there has to be not less than 3 cu.ft.of refuse in the container at the time of collection, the total activity in the container—including decay products—is not allowed to exceed ten microcuries and no article in the waste must contain more than one microcurie, including decay products. Disposal by burial in a local authority tip is also allowed if special precautions are taken and a small number of authorisations for this method have been granted. However, the waste is not allowed to pass through any sorting process or incinerator. Therefore it had to be sorted at source and taken direct to the tip, where it is buried as soon as possible under at least 5 ft. of refuse or refuse ash. Disposal by burning—in most cases with disposal of the residual ash in one of the ways already described—is also allowed in particular cases, but it is not generally encouraged. The radiochemical inspectors are satisfied with the overall position. Among all the registered premises—over two thousand in the county as a whole—and those operating under exemptions, very few have given cause for concern. The inspectors are equipped with sensitive instruments which can give an indication of the natural background radiation. These are used to check registered premises, wastes awaiting disposal and, on demand, dumps and tips. NUMBER OF HOUSES ERECTED DURING THE YEAR 513 units (319 by private enterprise, 194 by Housing Associations) were erected during the year. In addition, the Local Authority erected 608 units of accommodation during the year consisting of the following:— 103 2 bedroomed houses 30 3 bedroomed houses 131 Bedsitters 33 1 bedroomed flats 149 2 bedroomed flats 154 3 bedroomed flats 3 2 bedroomed maisonettes 20 3 bedroomed maisonettes 88 The sites upon which these completions were made were as follows:— Heaton Avenue Phase I 10 dwellings Mardyke Phase III 69 ” Highfield Phase III 27 ” Dunedin Road 48 ” Upper Brentwood Road 28 ” Barn Hall, Wickford 70 ” South End Road 103 ” Cherry Tree Lane 66 ” Highfield Phase IV 111 ” Highfield Phase V 76 ” 608 The development at South End Road and known as Albyns Close included a block of 35 pensioner villa flats where the occupants have the services of a warden. At the end of the year the number of properties managed by the Council was 10,400 including pre-war and post-war dwellings. At the end of December the housing list consisted of 4,438 applications which included 1,122 from engaged couples. The transfer waiting list contained 485 tenants wishing to move from two bedroomed flats to either two or three bedroomed dwellings with a garden. One of the major problems concerning the Council at the present time is the provision of suitable dwellings for persons 104 of pensionable age, this factor being the subject of main consideration in the planning of new estates. HOUSING PRIORITY ON MEDICAL GROUNDS Certificates in support of applications for rehousing are frequently received from General Practitioners or Hospital Consultants. All such certificates are referred to the Medical Officer of Health for an allocation of points under the Council's scheme. There is however a limit to the number of points which can be given on medical grounds—in the same way as there is a limit for points given on other grounds—which are all taken into consideration by the Housing Manager in allocating priority. It sometimes occurs therefore that whilst in the opinion of the applicant's doctor immediate re-housing should be offered on medical grounds, this is not possible because a low allocation of points for other aspects of the applicant's circumstances does not give an overall priority. Further investigations by the staff of the Department are frequently required both to ensure that an appropriate points allocation is made and to find if any other services are needed. The number of medical certificates in support of rehousing applications dealt with during the year was 448. HOUSES IN MULTIPLE OCCUPATION The problems associated with houses in multi-occupation in this area are—by central London standards—infinitesimal. The number of cases which came to light were mainly of the "two family" variety and did not, therefore, involve the Council with the complications of making management orders, directions regarding overcrowding, control orders and the like under the Housing Acts, 1961-1964. The usual practice following the first inspection of premises in multiple occupation is to check with the Town Planning Department that the occupation is legal and that there has been no alteration in the use of the premises. BUILDING CONTROL Close liaison is maintained with the Borough Engineer and Surveyor on the question of the submission of plans which fall within the scope of our activities. 105 During the year observations were submitted to the Borough Engineer & Surveyor in respect of 244 deposited plans. IMPROVEMENT GRANTS During the year members of my staff liaised with staff of the Borough Engineer and Surveyor in connection with 122 applications for improvement grants. Fuller details of improvement grant activities during the year are given in the following table:— 106 TABLE 51 Improvement Grants A Standard Owner/Occupiers Tenanted Standard Standard 5 point 3 point 5 point 3 point 1. Number of Applications Received 76 - 1 - Approved 74 - 1 - " " Refused 3 - - - 2. Number if dwellings improved 61 - - - 3. Amount paid in grants £5585. 12s. 8d. 4. Average grant per house £91. 11s. 4d. 5. Number of amenities provided (a) fixed bath/shower 29 (b) wash hand basin 36 (c) hot water supply (to any fittings) 49 (d) water closet within dwelling 49 (e) food store 16 B Discretionary Owner/ Occupiers Tenanted 1. Number of Applications Received 53 1 2. " " Approved 47 1 3. " " Refused 2 - 4. Number of dwellings improved 54 - 5. Amount paid in grants £16,062. 7s. 2d. 6. Average grant per house £297. 9s. 0d. 107 Rent Act, 1957—Certificates of Disrepair The following is a copy of the return made under the Rent Act, 1957, to the Ministry of Housing and Local Government for the period 1st January, to 31st December, 1967:— PART I—Application for Certificate of Disrepair: (1) Number of applications for certificates 9 (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 5 (b) in respect of all defects 4 (4) Number of undertakings given by landlords under para. 5 of First Schedule 3 (5) Number of undertakings refused by local authority under proviso to para. 5 of First Schedule Nil (6) Number of certificates issued 6 PART II—Applications for Cancellation of Certificates: (7) Applications by landlords to L.A. for cancellation of certificates 3 (8) Objections by tenants to cancellation of certificates 1 (9) Decision by L.A. to cancel despite tenant's objection 1 (10) Certificates cancelled by Local Authority 3 Housing Act, 1957—Sections 17 and 18 Number of demolition orders made 8 Number of closing orders made 3 The above-mentioned orders necessitated the re-housing of 9 families totalling 26 persons. SEWERAGE AND SEWAGE DISPOSAL In last year's report, mention was made of the inadequacy through overloading of Bretons Farm Sewage Works. It is expected that during the summer of 1968 these works will be closed and the whole of the sewage and trade effluent from Havering—other than that draining to the Bury Farm Sewage Works—will be treated at the Riverside Sewage Works of the 108 London Borough of Barking. The Bury Farm Sewage Works has at present ample capacity and no extensions are expected to be necessary in the forseeable future. It is expected that sewage disposal and much of the sewage system in the Borough will become the responsibility of the Greater London Council as from 1st April, 1969. The amount of sludge removed from the Bretons Farm and Bury Farm Works during the year was as follows:— Bretons Farm Bury Farm 18,444,320 gallons 1,520,400 gallons The new trunk sewers which are part and parcel of the Regional Sewerage Scheme are due to become operative during 1968 and give relief to overcrowded parts of the sewage system, particularly in the Ravensbourne Valley. The Rom Valley schemes, stages one and two, also give relief to the overloaded system and will pave the way for further stages of the improvement to alleviate the overflowing of foul sewage in the vicinity of Raphael Park, Rise Park and Collier Row. The other major foul sewer scheme (which has temporarily given way to the Ferry Lane Scheme) is the Corberts Tey Sewer. It is a matter of regret to report that all capital works proposed for 1968/69 have suffered a severe set-back in the recent cuts, and apart from several minor schemes, none of the larger surface water sewerage schemes envisaged will proceed in the coming financial year. Foul Sewers The following works have been completed: The Regional Sewerage Scheme—Trunk Sewers (24" to 63" dia.) Approx. 5 miles Bird Lane sewer extension (from Dee Close) (6" dia.) l 513 yards Clockhouse Lane North (Pinewood School) extension (6" dia.) 115 yards 109 (A further length of 230 yards of 6" and 9" dia. sewer has also been incorporated in the public sewer system). Riverside Sewage Purification Works (L.B. of Barking) Work is nearing completion on the extensions. Work has commenced on Rom Valley Foul Sewer Stage I (Bretons Farm to Ravensbourne) 45% complete Work will commence shortly on Rom Valley Foul Sewer (Stage III part) Mercury Gardens. Surface Waters Sewers (and stream improvements) The following works have been completed Upminster Road South (Rainham) relief (27"/24"/18" dia.) 203 yards Bryant Avenue/A.127. (36" dia.) 488 yards Church Lane (Park End Road) (15" dia.) 143 yards Piping of ditch at Bryant Avenue.(12" dia) 110 yards Betterton Road (culverting of ditch) (36" dia. and foul sewers) 175 yards Work has commenced on the following Havering Road/ Moray Way flood plain and sewers Western Road/Mercury Gardens. Work will commence shortly on Hornchurch Central Area Sewers (Stage III) Como Street extension Boscombe Avenue (Langtons outfall) Fairholme Avenue (enlarged outfall). 1968/9 Programme Foul Sewers Rom Valley Sewer (Stage II Part) Waterloo Road (Tenders received) Ferry Lane Trade Effluent sewer 110 Dury Falls Close (relaying) Surface Water Sewers North Street (Parkside). (Tenders received) McLintosh Road (New outfall) Allendale Road/Craigdale Road (relaying) Havering Road/A.12 (outfall) Abbs Cross Cross Lane (outfall at railway) Athelstan Road (extension) Stream Improvements Wantz Stream Streets made up and adopted The following streets were made up and taken over during the year ended 31st December, 1967:— Feet Albion Close 261 Arterial Avenue (Part) 870½ Astra Close 431 Athelstan Close 222 Ayloffs Close 112¾ Ayloffs Walk 1,629 Barleycorn Way 802 Beverley Gardens (Extension) 60 Blake Close (Part) 579 Brooklands Close 112 Brookside 1,912 Ferguson Court 241½ Ferndown (Part) 381 Ferry Lane 4,503 Lakeside (2 parts) 819 Manor Crescent (Part) 190 Orchard Avenue (Part) 288½ Palmerston Road 349 Rayburn Road 555¼ Shenstone Gardens 759 The Mount 1,179 Waterloo Gardens 498 CLEAN AIR The Havering (No.3) Smoke Control Area became operative 111 on the 1st November, 1967, and at the end of the year some 1123 claims for grant for works of adaptation had been dealt with in connection with this area. In addition, belated claims for the Havering (Nos. 1 & 2) Smoke Control Areas were also receiving attention during the year. The Havering (No.4) Smoke Control Order was made by the Council on the 6th December, 1967. If the necessary confirmation is forthcoming from the Ministry of Housing and Local Government the Order will become operative on the 1st November, 1968. Details of this area are as follows:— 1,920 acres 4,564 dwelling houses An area commencing on the south side of Colchester Road (A.12) from Gallows Corner to the Borough boundary; thence in a southerly direction along the Borough boundary to the junction with Nags Head Lane; continuingin a southerly direction along the west side of Nags Head Lane along the west side of Hall Lane to the Upminster/ Emerson Park railway line; Proceeding from this pqint in a westerly direction along this railway line to the junction with Wingletye Lane; From here in a northerly direction along the east side of Wingletye Lane to the junction with the Southend Arterial Road (A.127); and along the north side of the Southend Arterial Road to the point of commencement at Gallows Corner. The following table gives details of Smoke Control Areas which were in operation at the end of 1967:— 112 TABLE 52 Smoke Control Areas Smoke Control Area No. of dwellings Boundaries Operative Date Hornchurch 1 260 N. Roseberry Gardens S. Brunswick Avenue E. Roseberry Gardens W. Front Lane 1st September, 1959 Hornchurch 2 1,810 N. Wood Lane S. Ford Lane E. Southend Road W. Rainham Road 1st November, 1960 Hornchurch 3 3,764 N. Ford Lane S. River Thames E. River Ingrebourne W. Borough Boundary 1st July, 1962 Hornchurch 4 4,966 N. District Railway Line S. Wood Lane E. River Ingrebourne W. Rainham Road 5th November 1962 Hornchurch 5 4,644 N. High Street/Upminster Road S. District Railway Line E. Upminster Bridge Railway Station W. River Ravensbourne 1st August, 1963 Romford 1 519 N. Borough Boundary S. Collier Row Road E. River Rom W. Borough Boundary 1st December, 1963 Romford 2 1,486 N. Borough Boundary S. Collier Row Road E. Clockhouse Lane W. River Rom 1st.December, 1963 Hornchurch 6 7,274 N. Brentwood Road S. High Street/Upminster Road E. Romford/Upminster Railway Line W. River Rom 1st July, 1965 Havering 1 3,505 N. Collier Row Road S. Eastern Avenue (A.12) E. Collier Row Lane W. Borough Boundary 1st July, 1966 Havering 2 4,960 N. Southend Arterial Road (A.127) S. Romford/Upminster Railway Line E. Wingletye Lane W. Romford/Harold Wood Railway Line 1st November 1966 Havering 3 3,800 N. London Road (A.118) S. Borough Boundary E. River Rom/South Street W. Borough Boundary 1st November, 1967 113 During the year the Council reconsidered the phasing of their Smoke Control programme—which had originally anticipated the inclusion in Smoke Control Areas of approximately 8,000 dwellings per year—and agreed on the remainder of the district being split into seven proposed areas, each averaging in the region of 5,750houses,commencingwith No.4 Area in 1968 and concluding with the proposed No.10 Area in 1974. Frequent requests are received from occupiers of dwellings not in Smoke Control Areas asking if grant can be available for replacing non-approved appliances in regular use. It must be stressed, however, that at present grant is only available when a dwelling is in a Smoke Control Area and to qualify for grant the work should be carried out after the date of confirmation of the Order and before the date the Order comes into operation. REDUCTION IN POLLUTION The thirty-second report of the Warren Spring Laboratory, "The Investigation of Atmospheric Pollution 1958—1966" shows that between 1955 and 1962 the amount of smoke in London's air fell by two-thirds, and more slowly since, and in the rest of Britain by about a quarter in the seven years from 1958—59 to 1964—65. In Britain as a whole, smoke emission is estimated to have fallen from 2.3 million tons in 1952 to 1.15 million tons in 1965, a steeper fall than in coal consumption which was 203 million tons and 181 million tons respectively in these two years. Sulphur dioxide emission rose from 5.02 million tons in 1952 to 6.32 million tons in 1965; but pollution from this source declined by about one-fifth—"a tribute to wise replanning in so far as chimney heights and the location of industry are concerned." The report points out that year-to-year changes in measured pollution are affected by the weather, but that trends over a period of years, observed at enough sites, can be considered meaningful. INVESTIGATION OF ATMOSPHERIC POLLUTION The London Borough of Havering is one of the participating authorities in the National Survey of air pollution and is also a member of the co-operating bodies for the investigation of atmospheric pollution. Seven smoke filters and seven sulphur dioxide volumetric 114 measuring instruments are sited in selected areas of the Borough and measurements taken daily. In addition to providing useful local information on the amount of air pollution these results are forwarded monthly to Warren Spring Laboratory and the Department of Scientific and Industrial Research for integration with the national figures. INDUSTRIAL POLLUTION The Southern (Riverside) part of the Borough contains several large industrial concentrations with heavy industries and from time to time are the subject of complaints of smoke and/or smell. The principal sources of concern are processes registered under the provisions of the Alkali etc. Works Regulation Act, 1906 as extended by the Alkali etc. Works Order, 1966, and are in the main the responsibility of the Alkali Inspectorate. Modern industry is very complicated and massive and creates a wide range of complex chemical, engineering and combustion problems which are dealt with in close liaison with the Alkali Inspector with whom our relationship has been excellent and a teamwork has developed which reacts to the advantage of both sides. The Alkali Inspectorate dealing with national problems can, of course, call upon a much wider reservoir of knowledge than that within the area of one Local Authority. One of the complaints in which joint action had to be taken concerned one of the largest foundaries in the world which produces iron castings for cars, tractors, and commercial vehicles. Metal to make the castings is melted in 5 furnaces known as cupolas of which 3 usually operate at a time. In the operation of these furnaces, which use coke as the fuel to melt the metal, a considerable volume of smoke is emitted from the top of each furnace stack which protrudes above the foundry roof level. The company concerned have long been conscious of the unpleasant effect of this smoke on people living and working in the locality and are taking steps for air pollution prevention equipment to be fitted to their largest cupola. If this plant proves to be satisfactory 115 the company propose to build two more units to embrace the remaining 4 cupolas. The size of this task can be gauged by the fact that a sum of £600,000 has been allocated by the firm for this work. 11 notifications were received during the year, as required by Section 3 of the Clean Air Act, 1956, regarding the installation of new furnaces and/or boilers, and for the determination—where applicable—of chimney heights under Section 10 of the Act. In eight cases alterations to the chimney heights were requested and three were found to be adequate. In seven cases advice was given regarding plans which were submitted voluntarily to the Department and were of the categories exempted from the provisions of this Act, such as school buildings, office blocks and departmental stores. This latter practice is to be welcomed, for in addition to providing the applicant with an assurance that the plant can be operated without contravening the Clean Air Act, it enables the Department to consider the chimney heights and other relevant factors necessary for the installation to operate with the minimum of nuisance. During the year the Ministry of Housing and Local Government issued a revised edition of their Memorandum on Chimney Heights, which was published in 1963. The most important difference lies in the treatment of furnaces emitting only small amounts of sulphur dioxide. Experience has shown that the levels in the original memorandum were unduly onerous, having regard to the smallness of the emission of certain furnaces, and the new memorandum accordingly allows for uncorrected chimney heights starting at 16 feet. Where school buildings are concerned the Department of Education and Science are commending the new Memorandum to local Education Authorities as a source of guidance which it is normally desirable to follow. This will go a long way to resolve the difficulties which have arisen from time to time in the case 116 of school buildings, where the architects found themselves unable on aesthetic and economic grounds to meet recommendations regarding chimney heights. NOISE ABATEMENT 53 complaints of noise were received and investigated during the year, necessitating 174 visits by the Public Health Inspectors. In 47 cases the matter was dealt with by informal action and in six cases no action was required by this Department The most common cause of domestic complaints, mostly originating from neighbours were concerning radios, "pop" groups and barking dogs. These complaints are frequently found on investigation to be of a relatively minor nature, but nevertheless extremely annoying to the complainants. The complaints referring to industrial and commercial premises —which numbered 31—were mostly concerned with the noise of machinery in factories and on sites of building operations. In addition to the above the usual number of complaints were received regarding ice cream chimes and three prosecutions were taken under a local Act for sounding chimes on a Sunday. Fines totalling £6 were imposed on the offenders, and costs totalling £4.4.0d. were awarded to the Council. SUMMARY OF INSPECTIONS AND VISITS BY ENVIRONMENTAL HEALTH INSPECTORATE The main headings under which work was done is classified as follows:— TABLE 53 Summary of Inspections Subject of Visit or Inspection No. of Visits or Inspections Clean Air Act 8,116 Public Health Acts 6,486 Food & Drugs Act & Regulations 4,501 Incontinent Laundry Service 3,113 Prevention of Damage by Pests Act 3,636 Offices, Shops & Railway Premises Ac 3,145 Shops Act 2,130 Infectious Diseases 1,249 Housing Acts 904/contd. 117 TABLE 53 contd. Subject of Visit or Inspection No. of Visits or Inspections Sampling 1,903 Factories Act 474 Noise Abatement Act 174 Diseases of Animals Act 453 Miscellaneous 3,026 Slaughterhouses and Meat Inspection 1,604 Consumer Protection Act 211 Number of Notices Served: Informal 330 Statutory 119 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. PET ANIMALS ACT. 1951 There are 20 licensed pet shops in the Borough, including three stalls in Romford Market. No contraventions of the conditions contained in these annual licences were discovered. RIDING ESTABLISHMENTS ACT, 1964 This Act provides for the licensing and inspection of any establishment at which a business of keeping horses for hire, for riding or for providing riding instruction is carried on. Seven riding establishments in the Borough were licensed during the year and in addition to routine inspection by the Public Health Inspector, visits are made and reports received from the duly authorised veterinary officer and the Fire Prevention Branch of the London Fire Brigade. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT One new licence to carry on an establishment for massage or special treatment under Part IV of the Essex County Council Act, 1933, was issued during the year and 17 existing licences were renewed. These licences are in respect of 16 chiropodists, one physiotherapist and one beautician. 118 The question of whether or not acupuncture clinics came within the scope of this Act was investigated during the year. It was decided to conform to general practice and not to register these premises. LITTER ACT, 1958 The Council was active with the enforcement of this legislation during the year and 18 persons were prosecuted under Section 1 of this Act for depositing and leaving rubbish in a public place. Fines totalling £78.8s.0d. were imposed by the magistrates and costs amounting to £37.8s.0d. were awarded to the Council. RAG, FLOCK & OTHER FILLING MATERIALS ACT, 1951 This Act, designed to secure the use of clean filling materials in articles which are upholstered, stuffed or lined required the the registration of premises where rag flock is manufactured or stored, or filling materials used. Regulations made under the Act require standards of cleanliness in filling materials. There are two premises in the Borough registered under Section 2 of this Act. Three samples of filling material were obtained from these registered premises during the year and submitted to the prescribed analyst for examination. In each case a satisfactory report was received. SCRAP METAL DEALERS ACT, 1964 One new registration was made during the year making a total of 77 names on the register on 31st December, 1967. Section 1 of this Act requires a dealer to notify any alterations to his licence to the Council and to notify the Council if he ceases to carry on business as a scrap metal dealer in the Area of the Local Authority. Registrations made under this Act are automatically cancelled at the end of three years and if renewed, for successive periods of three years. The bulk of the persons registered with the Council as scrap 119 metal dealers are of the itinerant variety and in the vast majority of cases cannot read or write, thus making administration of this Act exceedingly difficult. ESSEX COUNTY COUNCIL ACT, 1933 - PART V Twenty licences to carry on employment agencies were issued during the year. THEATRICAL EMPLOYERS REGISTRATION ACT, 1925 & 1928 Four persons are registered in this connection, the initial registration having been made by the Essex County Council. PERFORMING ANIMALS (REGULATION) ACT, 1925 There are no current registrations under this Act. RODENT CONTROL The Ministry of Agriculture, Fisheries and Food require Local Authorities to submit an annual report on rats and mice for the year under review and the figures as shown below are an extract from the Ministry's form I.R.31. TABLE 54 Properties Inspected for Infestation by Rats and Mice NonAgricultural Premises Agricultural Premises 1. Total number of properties (including nearby premises) inspected following notification 4,134 2 Number infested by: (a) Rats 1,063 1 (b) Mice 315 - 2. Total number of properties inspected for rats and/or mice for reasons other than notification 3,515 233 Number infested by: (a) Rats 16 - (b) Mice - - 120 These reports are used to assess the general situation respecting infestations of rats and mice from year to year and the form in which this information is sent to the Ministry is designed to achieve uniformity. The Department is represented on the London No. 1 (Northern) Pest Control Committee and the No.2 (Essex) Workable Area Committee. Routine baiting of sewers is carried out on a contractual basis under the control of the Borough Engineer & Surveyor. SPECIAL LAUNDRY SERVICE The Department continued to operate the service forlaundering bed linen and clothing for the acutely ill or incontinent. The total number of cases receiving this service during the year was 66, the number of garments involved being 12,580 and the number of visits paid in this connection for collection and delivery was 1,956. DISEASES OF ANIMALS ACT, 1950 In November the Ministry of Agriculture, Fisheries and Food declared the whole of England and Wales to be a controlled area due to the extensive number of outbreaks of Foot and Mouth Disease which were being reported. The "Controlled Area" restrictions and procedures are equally as stringent as those enforced in "Infected Areas", the main conditions being as follows:— "Before any animal can be moved a licence authorising the movement must be obtained from the Local Authority. The movement must be necessary and carried out within the conditions laid down in the licence. Once the movement has been carried out, the vehicle must be disinfected." Up to the end of the year a total of 850 movement licences were issued by the Department involving the following number of animals. Cattle — 5,489 Calves — 1,248 /contd. 121 Sheep — 17,345 Pigs — 6,416 Lambs — 2,312 Goats — 1 TOTAL 32,811. Twenty licences are in force in the Borough to operate plant and equipment for the boiling of waste food for feeding to animals and poultry as required by the Diseases of Animals (Waste Food Order) 1957. During the foot and mouth disease outbreak frequent visits were made to all such licence holders and all other piggeries and the breeders reminded of their responsibilities with emphasis on the thorough boiling of all swill and the cleansing of their premises. FACTORIES ACT, 1961 Prescribed particulars on the administration of the Factories Act, 1961, as required by Section 153(1) and Ministry of Health Circular 1/68. TABLE 55 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 37 20 - - (2) Factories not included in (1) in which section 7 is enforced by the local authority 610 334 34 - (3) Other premises in which section 7 is enforced by local authority 19 23 1 - TOTAL 666 377 35 - / contd. 122 process of being passed through Parliament. Its purpose is to rationalise the law in respect of the sale of food (including animal foods) and the opening of launderettes. It includes also provision for additional holidays for those employed on a Sunday, irrespective of whether the shop is open for the serving of customers or not. The existing Act has no such provision. The present Act makes provision for:— closing hours, Sunday restrictions, maximum hours for young people, weekly half-holidays and holidays in respect of Sunday employment, and intervals for meals and rest. Visits to shop premises were made on weekends as well as weekdays and after normal working hours in order to ascertain whether the provisions of the Act were beingobeyed. Contraventions were found and a detailed analysis of them is listed below. In some cases, warnings were issued and in others prosecutions were instituted against the offenders. Early Closing Day Failing to exhibit an early closing day notice 94 F ailing to close for the "serving of customers" 4 Failing to observe the Regulations 27 Evening Closing Hours Failing to close for the "serving of customers" 4 Sunday Trading Failing to close for the "serving of customers" 22 Failing to observe the Regulations 29 Conditions of Employment Failing to exhibit notice specifying the day of Assistants' weekly half-holiday 166 Failing to allow Assistants a weekly half-holiday 4 Failing to allow intervals for meals and rest 7 Failing to exhibit the Abstract of Act and to keep records of hours worked by young persons 119 Failing to keep a record of Sunday employment 19 Failing to allow holidays in lieu of Sunday employment 3 PROSECUTIONS Twenty-one summonses were issued for contravening the 124 various provisions of the Act. Fifteen related to Sunday Trading, four concerning the failure to keep records of hours worked by shop assistants and one for trading from a "place" after the general closing hour of 8 p.m. One alleged Sunday Trading offence was dismissed. Fines imposed ranged from £5 to £20 amounting in all to £265. The Council were awarded £68. 5s. Od. costs. 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 1882 were registered with this Authority, including 184 new registrations. TABLE 56 Registrations and General Inspections (1) (2) (3) (4) Class of Premises Number of Premises Registered during the year Total Number of Registered Premises at the end of year Number of Registered Premises receiving a General Inspection during the year Offices 56 400 153 Retail Shops 119 1319 446 Wholesale Shops, Warehouses 3 30 21 Catering Establishments open to public, Canteens 6 126 26 Fuel Storage Depots - 7 - TOTAL 184 1882 646 125 TABLE 57 Number of visits of all kinds by Inspectors to Registered Premises = 3145 TABLE 58 Analysis of Persons Employed in Registered Premises by Workplace Class of Workplace Number of Persons Employed (1) (2) Offices 3062 Retail Shops 7589 Wholesale Departments, Warehouses 770 Catering Establishments open to Public 977 Canteens 15 Fuel Storage Depots 42 Total 12,455 Total Males 4,481 Total Females 7,974 646 premises were inspected with the following results:— TABLE 59 Summary of Infringements Section Details Number 4 Cleanliness 65 5 Overcrowding 10 6(1) Temperature 23 6(4) Thermometers 174 7 Ventilation 74 8 Lighting 22 9 Sanitary Conveniences (insufficient or lacked proper maintenance) 156 10 Washing Facilities (insufficient or lacked provision of running hot water) 155 11 Drinking Water 45 12 Clothing Accommodation 28 13/14 Sitting Facilities 6 16(1) Floors, passages and stairs 104 16(2) . Handrails and guarding of open sides 46 17 Fencing Machinery 25 22 Dangerous conditions and practices 14 24 First Aid provisions 214 49 F ailing to register 92 50 Abstracts 265 1518 126 The Act came into operation on the 1st August, 1964, and placed a statutory duty on an employer to comply with the various provisions and regulations. Many, so it appears, are not aware of their legal responsibilities but wait for the Inspector to call before doing anything to bring their premises up to an acceptable standard. One of the important requirements deals with the serious problems of accidents and measures to be taken to prevent such happenings. Defective floors and coverings, worn treads of steps and stairs, provision of handrails and the guarding of open sides of staircases and the fencing of dangerous machinery. Such causes are high on the list in the summary of infringements found. TABLE 60 Analysis of Reported Accidents Offices Retail shops Wholesale Warehouses Catering Est. open to public, canteens Fuel storage Depots Machinery 1 6 4 — — Transport - - 1 - - Falls of Persons 2 26 3 3 - Stepping on or striking against Object or Person 3 5 3 - - Handling Goods - 17 2 1 - Struck by Falling Objects - 8 3 1 - Fires and Explosions - - - - - Electricity - - 1 - - Use of Hand Tools - 15 1 - - Not otherwise Specified 2 1 1 1 - TOTALS 8 77 18 5 - Notification of Accidents Employers are required to notify the "appropriate Authority" of accidents occuring within premises. At the end of the year 109 accidents were reported to this authority as against 65 in the previous year. This represents an increase in notifications of approximately 67%. 127 Accidents notified are summarised in Table 61 and include some serious cases as indicated below:— TABLE 61 Accidents - Analysed by Workplace Workplace Number Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Inf. Advice Offices 8 8 — 2 1 5 Retail Shops 78 48 1 3 15 29 Wholesale Shops, Warehouses 18 12 - - 3 9 Catering Estabs. open to public, canteens 5 4 - - 1 3 Fuel Storage Depots - - - - - — TOTALS 109 72 1 5 20 46 A young man, who had received only 2 weeks training, was crushed by a fork lift truck which he had been driving, sustaining serious abdominal injuries. The vehicle was not faulted mechanically. The cause of the accident remains a mystery. In another investigation an electrician had received burns from an electric shock. An electric socket outlet which had been damaged by a fork lift truck, was not isolated from the mains before carrying out the repair and was live when his hand came into contact with the wiring. A young boy 16 years old was sweeping a gangway in a warehouse when a fork lift truck ran over his foot fracturing a toe. There were a number of septic complications following lacerations or scratches on hands. PUBLICITY An illustrated pamphlet concerning "Fire risk from hair lacquer" was sent to every hairdressing establishment within the Borough. The local "press" gave coverage as did a hairdressers' journal. 128 BOILER EXPLOSIONS IN LAUNDERETTES A Ministry of Labour pamphlet on the possible dangers arising from boilers was circulated to owners of launderettes. No such explosions have as yet been reported to this Authority but the warning and advice given in the pamphlet must not be ignored. PROSECUTIONS After protracted endeavour it was necessary for the Council to issue 32 summonses against 13 employers to secure compliance with the Act. One summons was dismissed. Summary of Offences Section 4 Cleanliness 3 Section 6 Temperature 3 Section 8 Lighting 1 Sections 9 & 10 Sanitary and Washing facilities 9 Section 16 Defective floors, missing handrails and obstructions 4 Section 17 Guarding of dangerous machinery 3 Section 24 Provision of First Aid Boxes 3 Section 48 Failing to report an accident 2 Section 50 Failing to inform employees of the provisions of the Act 4 Fines imposed by the Magistrates' Courts ranged from £10 to £80 amounting to £377. 1s. Od. The Council were granted £87. 3s. 0d. in costs. ANNUAL REPORT TO MINISTER OF LABOUR As required by Section 60 of the Act a copy of the prescribed report sent to the Minister is available at the Town Hall for public inspection. 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. Since my last report further regulations have been made — the 129 Nightdresses (Safety) Regulations, 1967, and the Toys (Safety) Regulations, 1967, (which prohibits use of celluloid in toys other than ping-pong balls and imposes restrictions in relation to the paint that may be used on toys). The Stands for Carry Cots (Safety) Regulations, 1966, came into force on the 1st January, 1967. Also there are Regulations for the provision of guards to portable heating appliances and concerning oil heaters. OIL HEATERS The old design of oil heater has been shown to be dangerous when knocked over or placed in a draught. The Home Secretary states that during the winter of 1967/1968 forty-nine persons died in fires caused by oil heaters. To deal with this problem a campaign was launched with the help of the Public Relations Officer, the Press and the Cleansing Section of the Borough Engineer & Surveyor's Department to appeal to householders to notify the Health & Welfare Department of any unwanted oil heater which could be collected and destroyed. Thus, preventing this type of oil heater falling into hands of dealers or being passed on to other householders. The response to this appeal was worthwhile. At the end of the winter 41 oil heaters had been surrendered and destroyed. The campaign will be continued. PURCHASES. TESTING & PROSECUTION One child's nightdress was purchased from a market stall and submitted to an approved "testing station". The test report showed it did not conform with the Regulations. Similarly, a second-hand oil heater was officially tested and failed the prescribed tests. Proceedings in both instances have been instituted for 1968. PROSECUTIONS Twenty-six summonses concerning infringements of the Oil-Heaters Regulations, 1962 — 1966 were dealt with by the Magistrates Courts. Fines imposed amounted to £100. Costs allowed to the Council were £50. 10s. Od. One case involving the issue of six summonses was dismissed, the Bench refusing an application by the defendant for costs. 130