HAV 4 London Borough of Havering ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1968 CONTENTS SECTION I INTRODUCTION Preface 1 Committee Members 2 Staff 3 General Statistics 5 SECTION II - PERSONAL HEALTH SERVICES PERSONAL HEALTH Introduction 12 Maternity Services 12 Ante-Natal Care 12 Mothercraft and Relaxation Classes 13 Midwifery 13 Dental Treatment — Expectant and Nursing Mothers 15 Unmarried Mothers 15 Congenital Malformations 15 At Risk Register 16 Premature Births 16 Handicapped Pre-School Children 18 Family Planning 18 Cervical Cytology 18 Clinic Services 19 Medical Staff 19 Child Health Clinics 19 Health Visitors and Clinic Nurses 20 Day Nurseries 23 Home Nursing 24 Sick Room Equipment 25 Recuperative Holidays 25 Home Help Service 26 Night Attendant Service 27 Good Neighbour Service 27 Nurseries & Child-Minders Regulation Act 1948 28 Nursing Homes 29 Prevention of Tuberculosis 29 Care of the Tuberculous 30 Milk for Tuberculosis Patients 30 Chiropody Service 31 Immunisation and Vaccination 32 Venereal Diseases 35 Health Education 36 Occupational Health Service 37 i I M.H.O Londer Brough of Havening. Annual report of the M.H.O for year 1968 miss moseley A 223 miss E.G.Boyd A223 DENTAL SERVICES Introduction 39 Dental Inspection and Treatment of School Children 40 Dental Service Expectant Nursing Mothers and Children under 5 years 42 SCHOOL HEALTH SERVICE Introduction 43 Medical Inspections 44 Screening Tests 46 Cleanliness Inspections 46 Specialist Services 46 Child Guidance Clinic 47 Dental Clinics 47 School Clinics 47 Speech Therapy 48 Handicapped Pupils 48 SECTION III - SOCIAL SERVICES SOCIAL SERVICES New Developments during 1968 51 New Cases 52 Work of the Social Workers 53 Social Work Staff 54 Area Social Work Teams 55 Students 56 Services for the Physically Handicapped 57 The Faringdon Centre 59 Housing the Disabled 59 Home Dialysis Machines 61 Services for the Blind 61 Partially Sighted 63 Temporary Accommodation for Homeless Families 65 Services for the Elderly 66 Residential Care 66 Elderly People's Workshop 67 Holidays for the Elderly 68 Outings for the Elderly 69 Luncheon Centres for the Elderly 69 Meals on Wheels 70 Entertainments 70 Mental Health Services 70 The Thursday Club 70 Admissions to Hospital 71 Temporary & Permanent Residential Care 72 Belford Adult Training Centre 72 Belford Parent Teacher Association 73 Hostel for Mentally Subnormal Men 74 Hostel for the Mentally 111 74 ii SECTION IV GENERAL ENVIRONMENTAL HEALTH SERVICES Introduction 78 Food Poisoning and Infectious Diseases 78 Medical Arrangements for Long-Stay Immigrants 82 Smallpox Contacts 82 Food and Drugs Administration 82 Bacteriological Milk Sampling 84 Ice Cream Sampling 84 Other Food Sampling 85 Pesticide Residues in Foodstuffs 85 Pharmacy and Poisons Act 86 Poultry Processing Plants 86 Liquid Egg (Pasteurisation) Regulations 1963 86 Food Hygiene (Markets, Stalls & Delivery Vehicles) Regulations 1966 86 Food Hawkers 86 Milk Distributors 87 Milk (Special Designation) Regulations 1963 87 Game Act 1831 87 Food and Drugs Act 1955 Section 16 87 Food Hygiene (General) Regulations 1960 87 Romford Market 88 Meat Inspection 89 Slaughter of Animals Act 1958 93 Offensive Trades 93 Slaughterhouses (Hygiene) Regulations 1955 93 Diseases of Animals Act 1950 93 Unsound Food 95 Paddling Pools 95 Swimming Pools 95 Water Supply 96 Meteorological Information 97 Rivers, Streams and Watercourses 99 Caravans and Camping 100 Houses erected during the Year 101 Local Authority Accommodation 101 Unoccupied Houses 103 Housing Priority on Medical Grounds 103 Houses in Multiple Occupation 103 Improvement Grants 104 Certificates of Disrepair 106 Demolition and Closing Orders 106 Ventilated Food Stores 106 Building Control 107 Sewerage and Sewage Disposal 107 Streets made up and Taken Over 109 Clean Air Act 1956 110 Investigation of Atmospheric Pollution 112 Chimney Heights and Installation of Furnaces 112 iii Clean Air (Measurement of Grit and Dust) Regulations 1968 113 Clean Air 113 Clean Air Act 1968 115 Noise Abatement 116 Inspections and Visits 118 Public Health Acts — Nuisances 119 Pigeons 119 Fouling of Footpaths by Dogs 119 Bee Swarms 120 Dustbins 120 Rag Flock and Other Filling Materials Act 1951 120 Animal Boarding Establishments Act 1963 120 Pet Animals Act 1951 121 Riding Establishments Act 1964 121 Performing Animals (Regulation) Act 1925 121 Establishments for Massage or Special Treatment 121 Employment Agencies 122 Theatrical Employers Registration Act 1925 and .1928 122 Scrap Metal Dealers Act 1964 122 Litter Act 1958 122 Radio-Active Substances Act 1960 123 Hairdressers and Barbers 123 Burials and Cremations 124 Mortuary Facilities 125 Common Lodging Houses 125 Disinfection and Disinfestation 125 Rodent Control 126 Factories Act 1961 127 Shops Acts 129 Offices, Shops & Railway Premises Act 1963 130 Consumer Protection Act 1961 134 iv Telephone Horn church 52555 Health 81 Welfare Department Billet Lane Horn church. To: The Mayor, Aldermen and Councillors of the London Borough of Havering. Mr. Mayor, Ladies and Gentlemen, I have pleasure in presenting my report on the work of the Health and Welfare Department for the year 1968. During this year of financial stringency emphasis has been placed on developing services to maximal efficiency without expanding resources. The steady increase in the responsibilities of the Department and the need for economy in leaving some posts vacant have put further pressure on the members of my staff and I should like to express my thanks to them for their work which is summarised in this report. My further thanks are due to the Chairman and Members of the Social Services Committee and the Council, and to the wide range of professional colleagues and voluntary workers whose co-operation and goodwill is so important in the efficient provision of services to the public. I am, Mr. Mayor, Ladies and Gentlemen, F. GROARKE, Medical Officer of Health. 1 HEALTH AND WELFARE COMMITTEE as at 31st December, 1968 His Worship the Mayor Alderman W.A.Sibley, J. P. (ex-officio) Chairman Councillor A.T. James Vice-Chairman Councillor Mrs. J. Frost Alderman J.F. Moultrie, J.P. (ex-officio) Councillor G.W. Bunch Councillor B.F. Casey Councillor F.A.J. Morley Councillor F.J. Orrin Councillor C.J. Sherman Councillor Mrs. L.G. Sinclair Councillor M.J. Ward Councillor R.J. Whiting Councillor Mrs. W.L. Whittingham 2 HEALTH AND WELFARE DEPARTMENT STAFF as at DECEMBER, 1968 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. MISS D.J. VASSALLI, B.D.S. K. WRIGHT, L.D.S., R.C.S., B.D.S. Administrative Officer J.F.J. 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, COOKE, A.A.P.S.W. 3 STAFF Contd. 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. 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 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.E.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 1968) 252,290 Number of dwellings as at 31.12.68 79,429 Rateable value as at 31.12.68 £12,272,596 Estimate product of a Penny Rate £48,900 During the year, the natural increase (4070 live births, minus 2256 deaths) would have resulted in an increase in population of 1850, but the Registrar-General's mid year estimate of 252,290 shows an increase of only 1130 over the 1967 population of 251,160. It follows therefore that the number of people moving away from this Borough exceeded by 720 the number of those who came to live in Havering. This compares with a figure of 1250 in 1967. The population of certain neighbouring authorities is reproduced for information, the figures for the previous two years being given in brackets. 1968 1967 1966 Barking 169,520 (170,100) (171,000) Redbridge 246,090 (245,300) (246,600) Newham 255,130 (257,350) (258,690) Basildon U.D. 119,470 (114,600) (111,300) Brentwood U.D. 57,650 ( 57,000) ( 56,450) Thurrock U.D. 123,230 (121,670) (120,790) It will be seen that the population of the adjacent London Boroughs all showed a decrease over the figure for the previous years, in line with the population of the Greater London Area which decreased by 149,780 to a mid-year population of 7,763,820. The population of the three authorities in Essex, however, all increased, illustrating the trend in the movement of population in this part of the country. Havering, lying between the two 5 groups, is affected by the same population movement as the London Boroughs, but not to such an extent as to exceed the natural increase. EXTRACTS FROM VITAL STATISTICS FOR THE YEAR (Figures for 1967 are given in parenthesis) Live Births Male Female Total Legitimate 2034 1834 3868 (3897) Illegitimate 103 99 202 ( 208) Total 2137 1933 4070 (4105) Birth Rate per 1000 population Illegitimate live births (percentage of total live births) 14.8 (14.9) 5.0% (5.3%) Still Births Male Female Total Legitimate 31 18 49 (61) Illegitimate 4 3 7 (3) Total 35 21 56 (64) Total live and still births Still birth rate (per 1000 live and still births) 4125 (4169) 13.3 (14.0) Infant Deaths (under 1 year) Male Female Total Legitimate 38 34 72 (68) Illegitimate 4 5 9 ( 5) Total 42 39 81 (73) Infant Mortality Rates — Total infant deaths per 1000 total live births 19.9 (17.8) Legitimate infants per 1000 legitimate live births 18.6 (17.4) Illegitimate infants per 1000 illegitimate live births 44.6 (24.0) 6 Comparison of the above rates with those of England and Wales is shown on the following table. Havering England & Wales Outer London Greater London Birth Rate 14.8 16.9 15.0 15.3 Illegitimate Live Births (percentage of total live births) 5.0 Not Available 8.7 11.5 Still birth rate 13.3 14.0 13.7 13.5 Infant Mortality rate 19.9 18.0 17.7 18.6 Neo Natal Mortality rate 12.5 12.3 12.1 12.8 Early Neo Natal Mortality rate 10.6 10.5 10.7 11.4 Perinatal Mortality rate 23.8 25.0 24.3 24.7 Maternal Mortality rate 0.0 0.24 0.19 0.20 Death Rate 10.5 11.9 11.5 11.7 7 Neo Natal Mortality Rate (Deaths under 4 weeks of age per 1000 live births) 12.5 (12.2) Early Neo Natal Mortality Rate (Deaths under one week of age per 1000 total live births) 10.6 (11.2) Perinatal Mortality Rate (Still births and deaths under one week of age combined per 1000 live and still births) 23.8 (26.4) Maternal Mortality (including abortion) Number of deaths 0 (0) Rate per 1000 live and still births - (-) Deaths Male Female Total 1229 1027 2256 (1985) Death rate per 1000 population 10.5 (10.3) The number of live births registered in 1968 (2,137 male and 1,933 female) was only 35 fewer than the figure for the figure for the previous year which meant that the birth rate fell by 0.1 per thousand population to a figure of 14.8. The decrease between 1966 and 1967 was 0.6 per thousand. These changes are similar to the national figures: the rate for England and Wales in 1968 was 16.9, a fall of 0.3 on the previous year and 0.8 on the year before that. In 1967 I reported that the infant death rates had shown an increase after steadily decreasing for many years. It was hoped that this was an occasional variation which occurs when dealing with a relatively small number of deaths, but although the peri-natal and early neo-natal rates for 1968 show a decrease, the infant mortality rate again increased by 2.1. The actual numbers were: deaths of infants within the first four weeks of life — 51 in 1963 compared with 50 in 1967; deaths of infants between 4 weeks and 1 year of age — 30 in 1968 compared with 23 in 1967. The increase appears to be largely attributable to a greater number of deaths from respiratory infections: pneumonia, bronchitis etc. The overall death rate, of 10.5 shows an increase of 0.2 over the rate for 1967, but the latter figure is considerably less than the rates for 1966 and 1967 and the current figure is still well under the rate for England and Wales of 11.9. The eighth revision of the international classification of causes of death has been used by the Registrar General to classify the deaths which occurred in 1968. Deaths are now classified under 65 headings instead of the 36 headings which had been used for a number of years. As a result of this change, detailed comparisons with previous years are difficult. However, it is quite clear that the greatest number of deaths during the year were due to diseases of the heart (639 compared with 562 in 1967). The next highest figure is deaths from cancer. By far the commonest cancer was again that of the lung (139 deaths) which is associated with the smoking of cigarettes. However, the number of deaths from this condition was virtually the same as the previous year. It is pleasing to note that for the second consecutive year 8 no deaths were associated with child birth. However, deaths from accident and suicide increased (73 compared with 64 in 1967) These included 20 deaths from motor traffic accidents, 30 from other accidents, 20 from suicide and 3 from other external causes. Continued emphasis on safety in home, on the roads, and at work is clearly necessary. The number of deaths from suicide fluctuates from year to year, 24 in 1966 — 9 in 1967 — 20 in 1968. More widespread understanding of the nature of depressive illness and the need for urgent treatment of acute depression may result in a lowering of these numbers. 9 10 TABLE 1 - CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1968 Cause of Death Sex Total all ages Under 4 Weeks 4 Weeks and under 1 Year AGE IN YEARS 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75 and over Cholera - - - - - - - - - - - - - Typhoid Fever - - - - - - - - - - - - - Bacillary Dysentery and Amoebiasis - - - - - - - - - - - - - Enteritis and other Diarrhoeal Diseases M - - - - - - - - - - - - F 4 2 1 - - - - - - - - 1 Tuberculosis of Respiratory System M 5 - - - - - - - 1 3 - 1 F 1 - - - - - - - - - 1 - Other Tuberculosis, Incl. Late Effects M 1 - - - - - - - - 1 - - F - - - - - - - - - - - - Plague - - - - - - - - - - - - - Diphtheria - - - - - - - - - - - - - Whooping Cough - - - - - - - - - - - - - Streptococcal Sore Throat fit Scarlet Fever - - - - - - - - - - - - - Meningococcal Infection - - - - - - - - - - - - - Acute Poliomyelitis - - - - - - - - - - - - - Smallpox - - - - - - - - - - - - - Measles - - - - - - - - - - - - - Typhus fit other Rickettsioses - - - - - - - - - - - - - Malaria - - Syphilis and its Sequelae M 1 - - - - - - 1 - - - - F - - - - - - - - - - - - Other Infective fit Parasitic Diseases M 2 - - - - - - - 1 - 1 - F 1 1 - - - - - - - - - - Malignant Neoplasm — Stomach M 37 - - - - - 3 1 9 7 12 5 F 21 - - - - - 1 - 1 3 2 14 Malignant Neoplasm — Lung, Bronchus M 119 - - - - - - 1 12 41 39 26 F 20 - - - - - - 1 4 3 8 4 Malignant Neoplasm — Breast M - - - - - - - - - - - - F 43 - - - - - - 3 9 12 10 9 Malignant Neoplasm — Uterus F 20 - - - - - 1 1 6 6 3 3 Leukaemia M 10 - - 2 1 - - - - 4 2 1 F 5 - - - - 1 - 1 3 - - - Other Malignant Neoplasms, etc. M 123 - - - 1 2 6 7 13 37 34 23 F 103 - - - 1 1 1 4 12 22 35 27 Benign & Unspecified Neoplasms M 2 - - - - - - - - 1 1 - F 1 - 1 - - - - - - - - - Diabetes Mellitus M 7 - - - - - - - - 1 3 3 F 14 - - - - - - 2 1 - 4 7 Avitaminoses, and other Nutritional Deficiency M - - - - - - - - - - - - F 1 - 1 - - - - - - - - - Other Endocrine etc., Diseases M 3 1 - - - - - - - - 2 - F 3 - - - - 1 - - - - 2 - Anaemias M 1 - - - - - - - - 1 - - F 5 - - - - - - - - 1 4 Other Diseases of Blood, etc. M 1 - - - - - - - - - - 1 F - - - - - - - - - - - - Mental Disorders M 10 - - - - - - 1 - - 2 7 F 34 - - - - - - - - - 1 33 Meningitis M 3 - 2 1 - - - - - - - - F 1 - - - - - - - 1 - - - Other Diseases of Nervous System, etc. M 21 - 1 - - 2 2 1 1 5 4 5 F 23 - - 1 2 1 2 1 5 7 3 1 Active Rheumatic Fever - - - - - - - - - - - - - Chronic Rheumatic Heart Disease M 7 - - - - - - - 1 2 1 3 F 16 - - - - - - 1 - 4 5 6 Hypertensive Disease M 14 - - - - - - - 3 3 4 4 F 19 - - - - - 1 - - 2 7 9 Ischaemic Heart Disease M 319 - - - - - 3 12 37 74 108 85 F 191 - - - - - - - 7 29 57 98 Other Forms of Heart Disease M 31 - - - - - - - - 7 5 19 F 42 - 1 I - 1 - 1 1 1 1 35 Cerebrovascular Disease' M 142 - - - - - 1 4 9 18 42 68 F 171 - - - - - 1 2 6 10 44 108 Other Diseases of Circulatory System M 41 - - - - - - - 3 12 11 14 F 43 - - - 1 - - - - 4 8 30 Influenza M 3 - - - - - - - - - 1 2 F 2 - - - - - - - - - 2 - Pneumonia M 85 1 2 - 1 - 1 - 3 11 16 50 F 95 - 1 - - - - - 4 2 14 74 Bronchitis and Emphysema M 95 - 1 - - - 2 - 3 19 34 36 F 22 - 1 - - - - - - 2 8 11 Asthma M 5 - - - 1 - - 2 - 1 1 - F 7 - - - - 1 - 1 1 3 1 - Other Diseases of Respiratory System M 10 - 2 1 1 - - - - - 4 2 F 11 - 7 1 - - - 1 - - - 2 Peptic Ulcer M 11 - - - - 1 - - - 2 2 6 F 6 - - - - - - - - - - 6 Appendicitis M - - - - - - - - - - - - F 1 - - - - - 1 - - - - - Intestinal Obstruction and Hernia M 4 2 - - - - - - - - - 2 F '4 - - - - - - - - - - 4 Cirrhosis of Liver M 1 - - - - - - - - 1 - - F 2 - - - - - - - 1 - - 1 Other Diseases of Digestive System M 10 - - - - - - 1 - 3 5 1 F 16 - - - - - - 1 - 1 3 11 Nephritis and Nephrosis M 7 - - - - 1 - - - 2 2 2 F 2 - - - - - - 2 - - - - Hyperplasia of Prostate M 3 - - - - - - - - - - 3 Other Diseases, Genito-Urinary System M 6 1 - - - - - 1 - 1 1 2 F 6 - - - - - - 1 - 1 - 4 Diseases of Skin, Subcutaneous Tissue M - - - - - - - - - - - - F 1 - - - - - - - - 1 - - Diseases of Musculo-Skeletal System M 4 - - - - - - - - 1 2 1 F 12 - - - - - - - 1 2 4 5 Abortion - - - - - - - - - - - - - Other Complications of Pregnancy, Childbirth and the Puerperium. Delivery without mention of complication - - - - - - - - - - - - - Congenital Anomalies M 16 6 6 1 - - - - 1 - - 2 F 13 7 2 3 - - - - - - 1 - Birth Injury, Difficult Labour and other Anoxic and Hypoxic conditions M 10 10 - - - - - - - - - - F 5 5 - - - - - - - - - - Other causes of Perinatal Mortality M 7 7 - - - - - - - - - - F 8 8 - - - - - - - - - - Symptoms and Ill-Defined Conditions M 5 - - - - - - - - - - 5 F 6 - - - - - - - - 1 - 5 Motor Vehicle Accidents M 17 - - - - 5 1 2 2 3 2 2 F 3 - - - - - - - 2 - - 1 All Other Accidents M 14 - - - - - 2 3 3 - 3 3 F 16 - 1 - - - 1 - - 2 4 8 Suicide and Self Inflicted Injuries M 14 - - - - 2 2 2 4 2 1 1 F 6 - - - - 1 - 1 1 1 1 1 All Other External Causes M 2 - - - - - - - - 1 1 - F 1 - - - - - - - - 1 - - TOTAL ALL CAUSES M 1,229 28 14 5 5 13 23 40 106 264 346 385 F 1,027 23 16 6 4 7 9 24 66 120 230 522 11 SECTION II PERSONAL HEALTH SERVICES SECTION During the year work on the Elm Park and Horn church Clinics was completed. In each Clinic this entailed considerable extensions and alterations resulting virtually in complete reconstruction. The result has more than compensated for the inconvenience suffered whilst the building works were being carried out as the services provided at these clinics now have adequate facilities. Several discussions with local general practitioners and officers of the Executive Council on the possible provision of health centres were held during the year, but at the end of the year, no definite proposals had resulted. MATERNITY SERVICES The work of the Maternity Liaison Committee, on which hospital consultants and mid wives, general practitioners, and local authority doctors and mid wives are represented, has again proved of great value in joint planning of the maternity services of the area and I would like to acknowledge again my appreciation of the full co-operation of my colleagues. Ante Natal Care All expectant mothers are either booked for hospital confinement or book a general medical practitioner for home confinement. Therefore, the necessity for the Department to staff ante-natal clinics with doctors as well as midwives has declined considerably over the recent years. A proportion of District Midwives hold their ante-natal clinics in conjunction with general practitioners. Statistics are given in the following table:— TABLE 2 Ante-natal and Post-natal Number of Women attending Clinics Ante-natal Post-natal Total 1191 18 1209 Number of Sessions Doctor Midwife Total 48 939 987 12 MOTHER CRAFT & RELAXATION CLASSES Mother craft and Relaxation Classes are held at each of the ten clinics in the Borough, usually at twice weekly sessions. The classes are particularly valuable to those women expecting their first baby, but are of benefit to all expectant mothers. Almost 900 mothers attended these classes during 1968 and it is clear that they appreciated the preparation for childbirth and the establishment of friendly contacts with other expectant mothers and with the Health Visitor and District Midwife taking the classes. Details of attendance are given in the following table:— TABLE 3 Mothercraft and Relaxation Classes Booked for Hospital Confinement Booked for Home Confinement Total Number of Women attending 772 124 896 MIDWIFERY At December 1968, 25 full-time and 2 part-time Mid wives were in post with 1 appointment pending, compared with 29 full-time and 2 part-time at the end of 1967. The number of mid wives has been reduced in step with the decreasing number of domiciliary confinements, as shown in Table 4. TABLE 4 Domiciliary and Institutional Births Place of Birth Total adjusted by notifications transferred in orout of the area Domiciliary 1968 1967 997 1137 Institutional 3063 3014 Percentage of Hospital Births 75.4 72.6 Table 5 sets out the number of confinements attended by the Midwifery Staff. In addition to the fall in the number of domiciliary confinements attended, there was a slight fall in the number 13 of patients who were discharged from the hospital before the 10th day. 2,359 compared with 2,421. However, the number who were discharged from hospital to the care of midwives within 48 hours of confinement increased again (1,006 compared with 927): TABLE 5 Midwifery No. of Domiciliary Confinements attended by Mid wives 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 Total Nil Nil 207 785 992 2,359 The proportion of births in hospital rose to 75.4 per cent; marginally over the figure of 70 to 75 per cent estimated as those expectant mothers falling within one or other of the priority groups for hospital confinement. In October 1968 a new maternity wing comprising 104 beds was opened at Rush Green Hospital replacing previous accommodation of 96 beds at Old church Hospital and 14 beds at Rush Green Hospital. The transfer of a complete and functioning maternity unit, during the course of one day, from one hospital to another, without any interference with the work was a notable and possibly unique operation and all those concerned merit sincere congratulation. There are insufficient maternity beds in the area to meet all needs but the Regional Hospital Board operate a scheme whereby hospitals in adjacent areas accommodate patients from this area if a bed cannot be booked locally. The need for patients to go to hospitals at a distance from the Borough may become unnecessary when accommodation for such patients is provided at Harold Wood Hospital where the new maternity unit is nearing completion. The duties of the District Midwife include carrying out 14 social assessment of home circumstances at the request of maternity hospital staff prior to hospital booking for 48 hour discharge. DENTAL TREATMENT FOR EXPECTANT AND NURSING MOTHERS Details of the numbers treated and of the treatment given are included in the report of the Chief Dental Officer on pages 42. UNMARRIED MOTHERS The arrangement whereby the Chelmsford Diocesan Moral Welfare Association provide care during the ante-natal period for unmarried mothers and arrange subsequent admission to mother and baby homes where necessary has continued. The number of unmarried mothers from Havering who received help from the outdoor worker of the Association during the year was 70 and of these 38 were admitted to mother and baby homes. CONGENITAL MALFORMATIONS During the year 99 congenital malformations observed at birth were reported on the notifications received from hospitals and midwives. These related to 76 children and an analysis is contained in Table 6. The 76 infants reported as suffering from congenital malformations represents 1.9% of the total births The equivalent figures for 1967 were 106 children and 2.6% of the total notified births for that year. The Registrar General runs an early warning scheme to notify Medical Officers of Health of any untoward rise in the number of notifications in his area. The present number of notifications is within normal limits. TABLE 6 Congenital Malformations Observed at Birth Malformation Diagnostic Group No.Reported 0 Central Nervous System 18 1 Eye, Ear 3 2 Alimentary System 15 3 Heart and Great Vessels 2 4 Respiratory System — 5 Uro-genital System 13 6 Limbs 29 7 Other Skeletal 7 8 Other Systems 8 9 Other Malformations 4 TOTAL 99 15 "AT RISK" REGISTER The number of children considered to be "at risk" due to various hereditary, ante-natal or post-natal factors at the 31st December, 1968 was 439 compared with a figure of 473 at the same date on the previous year. Related to the number of notified live births in each year the number of children "at risk" represented 11% of the total notified live births as against an equivalent figure of 10.7% for 1967. These children are carefully followedup until such time as it is ascertained that proper progress is being made and that no abnormality is apparent. PREMATURE BIRTHS Table 7 below sets out the number of premature infants notified: 16 TABLE 7 Notifications of Premature Births Weight at birth Premature live births Premature 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 day Total births Died Total births Died Total births Died Born with in 2 4 hours of birth in 1 and under 7 days in 7 and under 2 8 days within 24 hours of birth in 1 and under 7 days in 7 and under 28 days within 24 hours of birth in 1 and under 7 days in 7 and under 28 days in hospital at home 1 2 3 4 5 6 7 8 9 10 11 12 13 14 1. 21b. 3oz. or less 7 7 - - - - - - 2 1 - - 5 - 2. Over 21b. 3oz. up to and including 31b. 4oz. 17 5 1 - - - - - 1 - - - 8 - 3. Over 31b. 4oz up to and including 41b. 6oz. 46 3 2 2 - - - - 2 - 1 - 7 - 4. Over 41b. 6oz up to and in* cluding 41b. 15oz. 48 1 1 - 2 - - 2 - - - 1 1 5. Over 41b. 15oz. up to and including 51b. 8oz. 47 2 1 - 13 - - - 1 - - 1 5 2 6. TOTAL 215 18 5 2 15 - - - 8 1 1 1 26 3 17 HANDICAPPED PRE SCHOOL CHILDREN At the end of the year 166 children under 5 years of age were recorded as handicapped or under observation for potential handicap. This compared with a figure of 165 for the end of 1967. The objectives of the service for handicapped young children are to ensure that all available services are offered to the parents; to co-ordinate the efforts of the wide range of persons concerned with the family; and to carry out any further assessment of need which may be required. Doctors, health visitors, educational psychologists, social workers, specialist teachers etc. are available to help handicapped children and their parents and attendances at day nurseries, nursery classes, special units etc. can be of considerable value to the child and the parents. FAMILY PLANNING Family planning sessions are held at Hornchurch, South Hornchurch, Harold Wood and Cranham Clinics at which contraceptive advice is available for those women who require such advice for medical or social reasons. Oral contraceptives are now prescribed at the clinics and no charge is made where a medical indication exists for avoiding childbirth. In addition, the Council provides premises in Romford for the Family Planning Association and makes a grant to cover the cost of the heating, lighting and cleaning of these premises. Financial responsibility is also accepted by the Council for treatment provided on medical grounds by the Family Planning Association for women residents in the Borough. CERVICAL CYTOLOGY The number of smears taken at the 6 clinics in the Borough where cytology sessions are held fell from 3,140 in 1967 to 1,648 in 1968. However, smears are also taken in hospital out-patient departments, by general practitioners, and at the Family Planning Clinics and the total taken over the year was approximately 7,000. At a joint meeting towards the end of the year the hospital pathology department representatives stated that it would be possible to process a slightly greater number — about 8,000 yearly — so a limited publicity programme was initiated by placing posters in clinics and general practitioners waiting 18 rooms. This had the desired effect of re-stimulating demand up to the resources of the hospital laboratories, without overwhelming the service. CLINIC SERVICES As mentioned earlier in this report, alterations to Elm Park and Hornchurch clinics were completed in 1968. Plans for extending two other clinics which had been included in the 10 year development plan had been deferred in view of the present economic position. Since 1960 the Health Centre at Harold Hill and six of the purpose-built clinics have each been either altered or extended to provide additional accommodation needed to cater for the increased services provided by the Local Authority. MEDICAL STAFF During 1968 difficulties were experienced in filling vacancies for Assistant Medical Officers. Appointments which were made were offset by resignations and this resulted in theestablishment of 8 medical officers being under strength for the majority of the year. However, in December, 2 appointments were made which resulted in all vacancies being filled. Most of an Assistant Medical Officer's work is concerned with children either at child health clinics, in the school health service, or in day nurseries and nursery schools etc. but the doctors also staff an occupational health service for the 10,566 Council employees. Local general practitioners are engaged for Clinic and school health on a sessional basis throughout the year, but undertake increased sessions at times when the full-time staff are depleted. CHILD HEALTH CLINICS 81.7% of children born in 1968 attended the child health clinics on at least one ocassion. This shows an increase on the comparable figure for 1967 of 74.4%. However, a smaller number of children over the age of one attended in comparison with the previous year. This is regrettable as experience has shown that a high proportion of mothers of toddler age children appreciate advice on various aspects of their care. Sometimes the needs of this age range can be overlooked, particularly if there is a new baby demanding the major part of a mother's time and attention. Table 8 gives details of the sessions held and the number of children attending. 19 TABLE 8 Child Health Clinics No. of children attending Born in 1968 Born in 1967 Born in 1963-66 TOTAL 3319 2657 2129 8105 Sessions held by Doctors Health Visitors TOTAL 783 685 1468 HEALTH VISITORS AND CLINIC NURSES During 1968 two full-time health visitors resigned and two full-time and one part-time health visitors were appointed. A Fieldwork Instructor Health Visitor was appointed to fill the long-standing vacancy. Two student health visitors, whose training had been sponsored by the Borough, successfully completed the Course and joined the staff as full-time health visitors in September, 1968. Two students were sponsored for training as health visitors in the current academic year. Student health visitors from the Barking Regional College are accepted for their practical work placements and work under the direction of the Field Work Instructors. One T.B. Visitor (full-time) retired at the end of December and in accordance with the changing pattern in the field of T.B. care, she has not been replaced — the work being re-organised and absorbed by other members of staff. One part-time Clinic Nurse resigned during the year, and one was appointed to fill the vacancy. At the end of 1968 the staff consisted of:— 1 — Superintendent Health Visitor 3 — Group Adviser Health Visitors 2 — Fieldwork Instructor Health 18 — Health Visitors (full-time) Visitors 9 — Health Visitors (part-time) 1 — T.B. Visitor (full-time) 20 1 — T.B. Visitor who combined 1 — Full-time clinic nurse, whose T.B. visiting with general duties consist of half-time in duties. T.B. work and half-time as a Peripatetic Clinic Nurse. 18— Part-time clinic nurses, whose duties include school nursing. Some clinic nurses' posts are set against the establishment for health visitors; their services being utilised to carry out some duties under the general supervision of the health visitors. This ensures economy in the use of time expended on duties which do not necessarily require the particular skills of the trained health visitor. The health visitors have continued their work of advising families, at visits to the home or in the clinics, on matters of healthy living, with particular emphasis on the needs of the very young and the elderly. Co-operation with general medical practitioners has been maintained, through the liaison arrangements which enable individual health visitors to act as the channel of communication between the general practitioner and the Health and Welfare and other Departments of the Council. One group practice has a fully attached health visitor. Additional help is supplied by the allocation of a clinic nurse at the ante-natal and child health sessions. Emphasis has continued to be placed on the early assessment and detection of possible defects in young children, and the health visitors carry out screening tests in the home if the mother is unable to attend the clinic. The number of visits to elderly people is increasing. Health visitors are particularly well qualified to assess the needs of elderly people, and to follow up their progress. The services of the clinic nurses in undertaking some of the follow-up visiting, are particularly valuable in ensuring that changes in circumstances and health are observed as early as possible. In this and other aspects of the work the close relationships between many health visitors and local voluntary organisations are of particular value. A certain amount of health education is being carried out 21 by the Superintendent Health Visitor and her staff but this comes under the limitation of shortage of personnel and the other pressing demands upon their time. Education for parenthood receives greatest priority and by the nature of her work, numerous opportunities occur for health visitors to carry out health education at a personal level. It has been possible to undertake sessions in some of the schools, and if more staff were available this could be considerably extended. Effective liaison with hospitals has been maintained by frequent personal contacts between health visitors and medical social workers, and by the weekly attendance of a group adviser at St. George's hospital and at the paediatric wards of Oldchurch and Harold Wood Hospitals. The steadily increasing co-ordination between health visitors and social workers of all disciplines has been maintained, through the medium of formal case conference as well as innumerable personal contacts. The benefits of this co-ordination are readily apparent to those different persons who receive the services of the Department. Table 9 which follows, gives details of the cases visited by the Health Visitors. TABLE 9 Cases Visited by Health Visitors Home Visits to Total No. Visited Notes 1967 figures for comparison Children 16,004 Born in Born in Born in 1968 1967 1965/66 4,480 3,407 8,117 16,885 Tuberculosis Households 1,386 Visited by Tuberculosis Visitors 1,415 Elderly Persons (over 65) 1,143 Including 255 at special request of hospital or family doctor 1,137 Persons (excluding maternity patients) discharged from Hospital (other than Mental Hospitals) 120 Including 83 at special request of hospital or family doctor 159 22 TABLE 9 Contd. Cases Visited by Health Visitors Home Visits to Total No. Visited Notes 1967 figures for comparison Mentally disordered Persons 29 Including 15 at special request of hospital or family doctor 27 Cases of Infectious diseases 5 Excluding Tuberculosis 3 TOTAL 18,687 19,069 DAY NURSERIES The Priority groups for admission to the 190 day nursery places in the Borough include; children with a single parent who has to earn a living, such as unmarried mothers, widows, separated or divorced mothers without maintenance; handicapped children who need extra help during their pre-school years; children from families in special social circumstances or difficulties and mothers in special employment of particular value to the community; parents who because of ill health, admission to hospital etc. cannot care for the child at home for a period. Some non-priority places are also available. Attendance hours are flexible to suit the needs of the individual child and family. Sessional attendance for say, two or three mornings, or afternoons a week is used extensively, particularly for handicapped children. The careful observation of a child's progress at the nursery can be invaluable in giving an assessment of future educational or other needs. Apart from the matron, warden and nursery nurses of each nursery, regular visits are made by doctors and others with specialised knowledge of the needs of young children. The standard charge for attendance is currently 13/- per day but this may be reduced in necessitous cases in accordance with the Council's scale of assessment, subject to a minimum charge 2/6d. per child per day. Two of the nurseries (Collier Row and Elm Park) are fitted 23 with special equipment to help partially hearing or deaf children. Other Borough resources for the day care of young children with special needs include the nursery class at the junior training centre, the observation classes at two special schools, the nursery class for maladjusted children and the special care unit for physically and mentally handicapped children. TABLE 10 Day Nursery Attendances and Waiting List Nurseries Places Average daily attendance over the year Waiting List on 31.12.68 Priotiry Non-Priority Elm Park 50 35.5 9 42 Romford 40 29.0 14 40 Collier Row 50 46.4 12 53 Rush Green 50 33.2 3 29 TOTAL 190 144.1 38 164 HOME NURSING The number of nurses employed at the end of the year in providing nursing care to patients in their own homes was 34 full-time and 7 part-time. This is an increase of 2 full-time and 2 part-time nurses during the year. Of the 2 additional full-time nurses appointed, one was a male home nurse making a total of 8 male nurses now employed on these duties. Table 11 below gives details of the number of persons nursed and the number of nursing visits paid. It will be noted that the number of nursing visits paid rose approximately 11% compared with the previous year, and as the number of patients nursed was lower than in 1967, the average number of visits paid to each patient rose from approximately 30 per patient to 38. 4 district nurses are fully attached to general practice groups. TABLE 11 Home Nursing Number of Persons Nursed: 1968 1967 Under 5 years of age 37 51 Ages 5 — 64 654 779 Age 65 and over 1,368 1663 Total number of Persons Nursed 2,059 2433 Number of Nursing Visits made during the year 79,713 71,699 24 SICK ROOM EQUIPMENT Table 12 below lists the items of Sick Room Equipment, loaned free of charge, to persons being nursed at home. The total number of loans made was 296 more than the figure for 1967, an increase of approximately 11%, Whilst the number of disposable sheets issued increased by a fairly similar percentage, from 40,600 to 45,500, the number of disposable interliners issued rose by nearly 80% from 16,800 to 30,900. TABLE 12 Sickroom Equipment issued on loan from January to December, 1968 Article Quantity Article Quantity Air Rings 52 Mattresses 34 Back Rests 220 Pillow Covers 8 Bed Cradles 143 Plastic Sheets 274 Bed Pans 217 Pulleys 21 Bed Pans (Rubber) 10 Rubber Sheets 8 Bed Pans (Slipper) 4 Sani-cushions 0 Bedsteads 20 Sputum Mugs 1 Bed Tables 22 Sputum Mug Holders 5 Commodes 401 Urinals (Female) 16 Crutches pairs 21 Urinals (Male) 165 Draw Sheets 129 Walking Aids (Quadruped) 25 Feeding Cups 34 Walking Aids (Tripod) 23 Fireguards 21 Walking Frames 106 Foam Rings 227 Walking Sticks 108 Fracture Boards 9 Wheelchairs 315 Hydraulic Hoists 32 Total 2,671 Disposable Sheets issued from January to —Total 45,500 December, 1968 Interliners —Total 30,900 RECUPERATIVE HOLIDAYS A total of 83 recommendations for recuperative holidays were received from hospitals or general medical practitioners during the year. 66 adults were sent to various private convalescent homes for a period of two weeks and also two mothers with their babies. The remaining patients did not avail themselves of the facilities offered. 25 HOME HELP SERVICE The arrangements for the administration of this Service remained the same as in the previous year: 1 Senior and 4 Home Help Organisers assess the need, arrange for the provision of help and supervise the staff employed in the Home Help, Night Attendant and Good Neighbour Services. Statistics relating to the Home Help Service are given in Table 13 with the figures for 1967 shown in parenthesis. A larger number of patients were provided with help than in the previous year, but the total number of hours for which help was provided was slightly lower owing to difficulties in the recruitment of Home Helps in some areas of the Borough. This necessitated the number of hours attendance provided each week being reduced for some patients in areas where this difficulty arose. 362 Home Helps were employed /during the year, all of whom were part-time employees. The in-service training programme for groups of home helps, held at the College of Technology, continued through the year. TABLE 13 Home Help Service Requests for help from new cases during the year. 1163 (1090) Cases not eligible for assistance or not requiring services. 365 (201) New cases helped during the year. 791 (797) Persons being helped at the end of the year. 1678 (1691) Total persons helped during the year. 2696 (2343) Total number of hours of help provided during the year. 309,766 (318,457) 26 The categories of cases helped during the year were as follows:— Chronic Sick under Aged 65 years of age or 65 years of age —266 over —1979 Maternity —245 Other (Acute illness, Mental Disorder, Problem Families etc.) —206 NIGHT ATTENDANT SERVICE This Service is provided to give relief to relatives of seriously ill patients being nursed at home. A relative might have to care day and night for a seriously ill patient and the service is provided to allow the relative to have a rest at night knowing that the patient is being cared for. Details of the assistance given during the year is shown in Table 14 below with the figures for 1967 in brackets. TABLE 14 Night Attendant Service Number of Patients helped during the year 24 (16) Number of hours for which attendants were supplied 1626 (366) The Night Attendant Service is helped considerably by the Marie Curie Memorial Fund which provides a nursing service for certain cases. This service is operated by the Health and Welfare Department as agents for the Marie Curie Fund, the supervision of the scheme being undertaken by the Chief Nursing Officer. During the year 20 patients were provided with night attention for a total of 1,843 hours by this Scheme. GOOD NEIGHBOUR SERVICE The Good Neighbour Service is provided to give care to housebound patients by enrolling neighbours to visit them during various times of the day. The Good Neighbour can see that the fires are attended to, that the patient is fed, and attend to all the other needs of the patient in addition to the attention given by the Home Help who attends for 2 or 3 hours on weekdays to undertake the housework, cleaning, shopping etc. Difficulties are experienced in some instances in enrolling persons willing 27 to act as Good Neighbours in the area of the patient's home. In other cases, offers of service as Good Neighbours cannot be taken up because of the lack of any local need. However, the service can be of great value in individual cases to supplement other forms of assistance. Statistics relating to the Scheme for 1968 are contained in the following Table: TABLE 15 Good Neighbour Service No. of patients provided with help under the Good Neighbour Service 12 (23) No. of patients being assisted under the Scheme at the end of the year. 9 (7) NURSERIES & CHILD MINDERS REGULATION ACT 1948 For the first time for a number of years the number of premises registered (45) did not increase and it appears that all available premises are now in use. However, amendments to previous registrations increased the permitted number of children from 1,479 to 1,533. Full-time day nurseries registered during the year included a factory day nursery providing 24 places for children aged 2 to5 years of age, and a day nursery in private premises accommodating 12 children. During the year persons registered as child-minders i.e. undertaking the care of children in their own homes, increased by 12 to 30; 18 providing all day care for 167 children and 12 sessional care for 117 children. At the end of 1967 the 18 registrations then existing permitted the daily minding of a total of 135 children for either sessional or all day care. Applications for registration are granted subject to planning permission, the observance of standards of space and amenity and implementation of any recommendations contained in reports by staff of the Department and the Fire Prevention Service of the London Fire Brigade. All premises and child-minders are visited regularly by the health visitors to discuss the needs of individual children and any problems which may have arisen, as well as to check that standards are being maintained. Section 60 of the Health Service and Public Health Act 28 1968 amends the Nurseries and Child-Minders Regulation Act, requiring any person caring for a child or children in her home for more than 2 hours a day to register. Under the previous Act, registration was only required where more than 2 children were being cared for. This amendment came into operation on the 1st October, 1968, allowing a period of 3 months to enable applications to be made and registration effected. Accordingly publicity to this change was given in the form of posters, advertisements in local papers etc., with a view to securing the registration of all those concerned before the end of January 1969. NURSING HOMES One Nursing Home closed during the year and there are now only two registered Nursing Homes giving a total of 41 beds for acute and chronically sick patients. These Homes are regularly inspected by the staff of the Health and Welfare Department. PREVENTION OF TUBERCULOSIS Mass Radiography Unit 6(B) of the North East Metropolitan Regional Hospital Board visited the Borough for the usual bi-annual survey. The Unit was in the Borough for the whole of July, August and part of September and held public sessions at 16 different Centres throughout the District, whilst other sessions were held at large factories, industrial sites etc. Visits were also made to some of the Health and Welfare establishments including the Residential homes for the elderly and the training centre for the mentally handicapped. A total of 21,354 persons (9,792 males and 11,562 females) were x-rayed and of these 95 males and 96 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 Calcified primaries 1 2 3 Unilateral inactive post primary P.T. 10 10 20 Bilateral inactive post primary P.T. 4 3 7 Unilateral active post primary P.T. 1 1 2 Bilateral active post primary P.T. 1 - 1 29 Other abnormalities revealed Male Female Total Abnormalities of the bony thorax and soft tissues — congenital 1 - 1 Abnormalities of the bony thorax and soft tissues acquired 4 1 5 Bacterial and virus infections of the lungs 2 3 5 Bronchiectasis 1 1 2 Emphysema 3 - 3 Pulmonary fibrosis — non-tuberculous 7 4 11 Pneumoconiosis 2 — 2 Benign tumours of the lungs and mediastinum - 1 1 Carcinoma of the lung and mediastinum 5 1 6 Sarcoidosis and collagenous diseases 4 1 5 Pleural thickening or calcification — non-tuberculous 9 3 12 Abnormalities of the diaphragm and oesophagus — congenital and acquired 2 6 8 Acquired abnormalities of heart and vessels 9 16 25 Miscellaneous Cases who failed to attend for further films 2 — 2 or clinical examination 1 1 2 A.l. (no abnormality detected on large film) 26 42 68 Total 95 96 191 Of the 33 persons showing tuberculous lesions, 3 proved to have active pulmonary disease. CARE OF THE TUBERCULOUS The Council have continued to make a grant to the Havering Tuberculosis Care Association who, working in close co-operation with the Chest Physicians acting as their medical advisers, provide after-care facilities for patients and contacts. The clerical work of the Association is undertaken by the staff in the Health and Welfare Department. MILK FOR TUBERCULOSIS PATIENTS The Council provide one pint of milk daily to patients suffering from tuberculosis as recommended by the Chest Physicians. During the year 103 patients received milk, 34 of whom were new cases. In 1967 the figures were 100 patients 30 of whom 30 were new cases. CHIROPODY SERVICE The Chief Chiropodist, Mr. L.A. Bolland reports as follows:— One part-time member of the staff resigned during March and it was some months before a replacement could be engaged. A full-time member was appointed to the staff in October and the establishment is now complete. The greatest need for the chiropody service lies in the elderly population but those eligible for treatment under the Council's scheme also include children, expectant mothers, and handicapped persons. In addition treatment is also provided for certain patients referred by medical practitioners. Full-time chiropody clinics continue to be held at the Health Centre, Harold Hill and at Collier Row, Romford and Hornchurch Clinics whilst part-time clinics are held at the remaining six purpose-built Health Clinics and at the Park Lane Community Centre. Alterations at Hornchurch and Elm Park Clinics completed during the year resulted in the chiropodists having a purpose-built room in which to work. In addition to the clinic sessions a domiciliary service is available for house-bound patients and the chiropodists visit the five residential homes for the elderly and also the Housing Department's accommodation for the elderly at 61 Main Road, Gidea Park. A chiropodist also attends periodically at Westmarsh Lodge Hostel and at the Belford Training Centre. Statistics relating to the service are given in the following Table:— TABLE 16 Chiropody Treatment Given During The Year 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 4 6 8 - - ii. School-children 54 101 285 7 - Includes Mentally Handicapped 31 TABLE 16 continued GROUP New cases during year Cases Under Treatment at end of year Clinic attendances during year Domiciliary treatments during year At Welfare Estab' iii. Expectant Mothers 4 6 14 - - iv. Aged 911 4258 19,203 6463 1779 v. Physically Handicapped 3 44 182 53 - vi. Others 5 36 250 16 - TOTAL 981 4451 19,942 8938 2403 As part of the results of requests received in the health education section, two talks were given during the year, one being to a "Young Wives" group, on the subject "Children's Feet", and the other to a mixed age group on the subject "The General Care of the Feet". It is hoped to be able to arrange further similar talks during the coming year. In conclusion all clinics have now reached their capacity and have had to extend the interval between treatments in order that as many persons as possible can be treated. The present staffing establishment does not allow full-time operation at Elm Park Clinic and the weekly sessions held at the Park Lane Community Centre does not, unfortunately, permit all the nearby residents to receive attention there and consequently a number have to attend the Homchurch Clinic. IMMUNISATION AND VACCINATION The total number of persons under 16 years of age who completed a primary course of immunisations and vaccination during the year was 18,345 compared with a figure of 13,414 for 1967. Early in 1968, the Ministry of Health announced the intention of introducing vaccination against measles for all children up to 15 years of age who had not been protected either by previous vaccination or by an attack of the natural disease. 5,431 children were vaccinated against measles during the year and if this figure is deducted from the total of primary courses completed, the 1968 figure shows an increase of 500 over that for 1967. Measles immunisations which were commenced in May 32 consist of a single injection of live attenuated vaccine. Immunisation was initially restricted to susceptible children in the4to 7 year age group, but extended to other ages as increased supplies of vaccine became available. Parents of all children attending infant schools were circularised and invited to have their children immunised as were parents with children in residential establishments and day nurseries. Protection against measles is to be incorporated in the routine immunisation schedule and will then be given to children between the ages of 1 and 2 years. Details of the vaccination and immunisation statistics are given in the following tables with the 1967 figures appended for purpose of comparison: TABLE 17 No. of completed primary courses — children under 16 Type of antigen No. of children 1968 1967 Diphtheria/Pertussis/Tetanus/Poliomyelitis - 1 Diphtheria/Pertussis/Tetanus 3658 3681 Diphtheria/Pertussis — — Diphtheria/Tetanus 679 611 Diphtheria 6 25 Pertussis 3 32 Tetanus 1287 1487 Poliomyelitis (salk vaccine) — 1 Poliomyelitis (sabin vaccine) 4748 4240 Smallpox vaccination 3533 3336 Measles 4431 - Table 18 sets out the number of children protected against each disease during the year including those who received combined antigens: TABLE 18 No. of children protected against each disease Disease No. of children immunised 1968 1967 Diphtheria 4343 4318 Pertussis 3661 3714 Tetanus 5624 5780 Poliomyelitis 4748 4242 Smallpox 3533 3336 Tuberculosis 1848 2270 Measles 4421 - 33 The following is an estimate of the proportion of children aged 1 year who received a primary course of immunisation during 1968. TABLE 19 Havering Average England and Wales Diphtheria 91% 78% Whooping Cough 85% 76% Tetanus 90% Not available Poliomyelitis 90% 74% 64% of children under the age of two received primary vaccination against smallpox, against the national average of 38%. A new immunisation and vaccination schedule was introduced towards the end of the year. This schedule is designed to give life long protection against certain diseases, based on primary protection in infancy with reinforcment doses at the ages of five and fifteen. Immunisation can no longer be thought of as a matter affecting only young infants. The success of immunisation programmes in eradicating diseases such as diphtheria and poliomyelitis, carries the risk of encouraging complacency. However it is vital that high immunisation rates are maintained both to protect the individual and to prevent the possibility of an epidemic. A total of 12,962 reinforcement doses were given during the year as shown in the following table:— TABLE 20 Re-inforcing Doses Given Type of Antigen No. of Re-inforcing Doses 1968 1967 Diphtheria/Pertussis/Tetanus/Poliomyelitis — - Diphtheria/Pertussis/Tetanus 2698 2031 Diphtheria/Pertussis — 4 Diphtheria/Tetanus 3823 2937 Diphtheria 215 597 Pertussis 25 105 Tetanus 572 450 Poliomyelitis (salk vaccine) — 28 Poliomyelitis (Sabine vaccine) 5829 4437 Smallpox vaccination 594 375 34 A number of children under 16 years of age who were given reinforced doses against each disease including those who received combined antigens is given in the following table:— TABLE 21 No. of Children Receiving Re-inforcing Doses Disease No. of children who received a Re-inforcine dose 1968 1967 Diphtheria 6736 5569 Pertussis 2723 2140 Tetanus 7093 5418 Poliomyelitis 5829 4465 Smallpox 594 375 VENEREAL DISEASES The number of new cases of infection included on the returns for 1968 received from the Treatment Centre at Oldchurch Hospital totalled 879 compared with 705 in 1967 as follows. TABLE 22 Venereal Diseases Total Male e (a) Syphilis 13 8 5 (b) Gonorrhoea 129 94 35 (c) Other conditions 737 537 200 TOTAL 879 639 240 206 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 , the 1967 figures being appended for comparative purposes:— 1968 1967 Syphilis 4 2 Gonorrhoea 54 59 Other conditions 380 390 TOTAL 438 451 35 HEALTH EDUCATION In view of the need for financial economy the post of Health Education Officer which had become vacant was not filled, the Health Education programme being continued under the supervision of the Deputy Medical Officer of Health by distributing the work between other members of the staff, with the organisation devolving on the administrative staff. During the year, in addition to regular in-service training for all grades of staff and the regular talks undertaken by the health visitors in schools and clinics, 87 talks attended by a total of approximately 2,400 people, have been given to various organisations on different subjects. Medical Officers, Public Health Inspectors, Health Visitors, Chiropodists Welfare Officers, etc. have all taken part and they gave talks on a variety of subjects. The services of persons outside the Department have also been recruited to give talks and lectures on their own speciality. The Department has a small library of Health Education films, slides and other visual aids and apart from the regular mothercraft and relaxation classes, school projects and departmental staff meetings a total of 64 showings of various films were given. In other instances film slides, demonstration models (particularly for instruction on mouth to mouth resusitation) and flannelgraphs have been ulilised. Films and slides are also made available to schools and lent to other Departments of the Council. Posters concerning health education or home safety were arranged on notice boards outside clinics etc. and on several occasions the Public Relations Officer arranged for posters to be displayed throughout the one hundred or so notice boards owned by the Borough. Other posters are distributed for display inside clinics, schools and youth clubs. Supplies of various leaflets were distributed through clinics, public libraries, local organisations etc. A Home Safety quiz was organised amongst the senior schools in the Borough, the semi-finals and finals being held at the Town Hall, Romford. Keen interest in the Competition was shown by both teachers and pupils and the trophy, a shield presented by Mr. Peter Teskey, a member of the Havering Home 36 Safety Panel, was won by Hyland Secondary Boys after a keenly fought contest. Members of the staff of the Department took part in a pilot pre retirement course, run at the North Havering College of Adult Education, a course in food hygiene run at the College of Technology and lectured pupil nurses and midwives at Oldchurch and Rush Green Hospitals. They also took part in many other similar activities in various professional disciplines. OCCUPATIONAL HEALTH SERVICE This provides medical screening of applicants for Council employ and investigation of any medical matter affecting an individual or group of employees. Screening is based on examination of a questionnaire completed by the applicant. The Assistant Medical Officer on rota duty attends the Billet Lane Office daily to scrutinise the questionnaires and select those indicating a need for full physical examination. Appointments for these examinations are then arranged with the applicant, at one of the Clinics. Teachers and applicants for teacher Training College places come into a different procedure involving a full examination in every case, according to regulations laid down by the Department of Education and Science. Medical screening includes x-raying the chest of all persons coming into contact with children and screening for intestinal pathogens for any person dealing with the preparation of food. Special medical examinations and investigations, including retirement on medical grounds, fitness for work after illness, advising on special needs of individuals or groups of workers, are undertaken by one Assistant Medical Officer (Dr. L.J. Marshall) who takes a particular interest in this aspect of the work. Statistics on the service are listed in Table 23. 37 TABLE 23 Occupational Health Service Number of questionnaires scrutinised 1,426 Number selected for full examination 119 Number found unfit for employment 5 Number recommended for further review 6 Medical examinations for other authorities 14 Number of full medical examinations of teachers and prospective pupil teachers (carried out according to national requirements outside the Council scheme) 295 Number of persons screened by chest X-ray (i.e. duties in contact with children) 1,044 Number of persons screened for intestinal pathogens (i.e. duties concerned with preparation of food) 588 Number of special medical examinations 154 38 ANNUAL REPORT OF CHIEF DENTAL OFFICER Mr. E.B. Hodgson, Chief Dental Officer, reports as follows on the Dental Services provided by the Department Premises: At the beginning of the year, Upminster Clinic was again in operation with Mr. Wright transferring back from his temporary base in Harold Hill. During April, both Hornchurch and Elm Park Clinics were re-opened in greatly improved premises. For the first time in Hornchurch Clinic there was a purpose-built dental suite comprising a good-sized surgery, recovery room and waiting room, together with a combined dark-room and store-room. This proved a welcome change for Mrs. Saunders who for too long had had to make do with one small converted room as a dental surgery with no additional facilities. At Elm Park Clinic the existing dental surgery was modernised and a separate recovery and waiting-room were provided — again resulting in much improved accommodation. Staff: On 1st April the Borough's first Dental Auxiliary took up her appointment. These are girls trained to carry out simple and routine treatments for children on the prescription of and under the supervision of a registered dental surgeon. Dental auxiliaries have proved of great value in the treatment of young children and this was shown to be the case when Miss Fenelon began her duties at the Health Centre and Harold Wood Clinic, both premises having two adjoining surgeries. Following further advertisements for staff, we were fortunate to secure the services of a young lady dental surgeon — Miss Vassalli — who joined the full-time staff during August. This enabled the surgery in Collier Row Clinic, which caters for a large school population, to be fully operative once more after a period of some eighteen months when only a very limited service had been available. Thus the year ended with the staffing situation in a slightly better position with five full-time dental surgeons, one dental auxiliary and a further seven sessions each week being provided by dentists on a contractual basis. 39 This gave a ratio of 8,000 school children per dental officer — as against a national average of 5.600:1. This does not take into account an estimated figure of 21,000 children of pre-school age who are entitled to an inspection and treatment service at the Council's clinics, together with nursing and expectant mothers. Inspections: Annual school dental inspections, as well as assessing dental needs provide a means of bringing the subject of dental health to the minds of both children and their parents. Although the number of children inspected rose considerably over the previous year's total, it was only possible to inspect 36% of the whole school roll during the year. The staffing situation permitting, every effort will be made to increase this figure in the future. Dental Health Education In addition to her clinical training, a dental auxiliary is given instruction in the dissemination of Dental Health Education. In this respect Miss Fenelon was able to make a very valuable contribution during the year. With the co-operation and encouragement of Head Teachers she visited several primary schools and gave dental health talks, usually to a class at a time so that individual participation could be achieved. These were supplemented on occasions by the showing of short dental health films. Good creative ability enabled Miss Fenelon to produce her own materials for use in these talks and also to provide original posters for display in the Clinics. The fuli annual statistics for the Dental Service are given in the following tables. TABLE 24 Dental Inspections & Treatment of School Children Inspections (a) First inspection at school. Number of Pupils 11,910 (b) First inspection at clinic. Number of Pupils 3,568 Number of (a) — (b) found to require treatment 6.380 Number of (a) — (b) offered treatment 5,967 (c) Pupils re-inspected at school or clinic 667 Number of (c) found to require treatment 363 40 Table 24 (contd.) Dental Inspections & Treatment of School Children Attendance and Treatment Ages 5 to 9 Ages 10 to 14 Ages 15 & Over Total First Visit 2,355 1,464 242 4,061 Subsequent Visits 3,295 2,908 544 6,747 Total Visits 5,650 4,372 786 10,808 Additional courses of treatment commenced 354 156 29 539 Fillings in permanent teeth 1,480 2,872 664 5,016 Fillings in deciduous teeth 3,145 136 — 3,281 Permanent teeth filled 1,260 2,656 590 4,506 Deciduous teeth filled 2,846 120 — 2,966 Permanent teeth extracted 41 276 71 388 Deciduous teeth extracted 1,150 433 — 1,583 General anaeshetics 162 36 3 201 Emergencies 302 96 13 411 Number of Pupils X-rayed 437 Prophylaxis 909 Teeth otherwise conserved 1,151 Number of teeth root filled 56 Crowns 12 Courses of treatment completed 3,047 Orthodontics Cases remaining from previous years 135 New cases commenced during year. 106 Cases completed during year 58 Cases discontinued during year 20 Number of removable appliances fitted 164 Number of fixed appliances fitted 4 Pupils referred to Hospital Consultant 22 41 TABLE 25 Dental Service for Expectant and Nursing Mothers and Children under 5 years Children 0-4 (incl.) Expectant and Nursing Mothers First Visit 381 62 Subsequent Visits 467 192 Total Visits 848 254 Number of Additional Courses of Treatment other than the First Course commenced during year 42 4 Treatment provided during, the year— Number of Fillings 608 230 Teeth Filled 533 191 Teeth Extracted 81 35 General Anaesthetics given 31 — Emergency Visits by Patients 52 8 Patients X-rayed 1 26 Patients Treated by Scaling and/or Removal of Stains from the teeth (Prophylaxis) 128 38 Teeth Otherwise Conserved 204 — Teeth Root Filled - 2 Number of Courses of Treatment Completed during the year 247 36 Prosthetics Patients Supplied with F.U. or F.L. (First 7 Patients Supplied with Other Dentures 6 Number of Dentures Supplied 9 Inspections Children 0-4 (incl.) Expectant and Nursing Mothers Number of Patients given First Inspections During Year 638(A) 62(D) Number of Patients in A and D above who required Treatment 342(B) 61(E) Number of Patients in B and E above who were offered Treatment 336 61 42 SCHOOL HEALTH SERVICE, 1968. The School Health Service in Havering provides medical and dental inspection and treatment facilities for over 43,000 pupils attending the Borough's schools. Each child is given a full medical examination shortly after admission to the Infants' School (including tests of hearing and vision) when an opportunity is provided for the parent to discuss any problems with the School Medical Officer who also advises about immunisation, etc. Further tests of hearing and vision and cleanliness inspections are carried out by the School Nurse at intervals during the child's school life, and examination by the School Medical Officer follows during during the final year in the Junior School and in the year before reaching compulsory school leaving age. A special medical examination or consultation with the School Medical Officer can be arranged at any time at the request of the parent or teacher, etc. Any disorders detected at these inspections are followed up by appropriate investigation or treatment, in consultation with the Family Doctor, including referral to a Hospital Specialist when necessary. A variety of treatment facilities are provided at the Council's ten Health and Welfare Clinics including Ophthalmic, Orthoptic, Orthopaedic, Physiotherapy, Speech Therapy, Enuresis, Minor Ailments, etc. A Child Guidance service for children with emotional, educational or family problems is provided at Raphael House, Western Road, Romford, staffed by a team of Psychiatrists, Educational Psychologists, Psychiatric Social Worker and Remedial Teachers. Parents of school-children are also encouraged to maintain the protection afforded to their children in infancy by immunisation against infectious diseases, and facilities are provided for reinforcing doses to be given at appropriate intervals. Vaccination against tuberculosis is also offered to all school-children at about 13 years of age. Routine dental inspections by the School Dental Officers are carried out as frequently as the staffing situation allows 43 and those children found to require dental treatment are invited to attend the Council's dental clinics or advised to obtain treatment through the General Dental Service. In addition to these inspections and treatment facilities, provision is made for the medical examination of any children over two years of age who are thought to be in need of special educational treatment by reason of physical or mental handicap and admission to a suitable Special School or other appropriate care arranged as necessary. The Belford Junior Training Centre, Faringdon Avenue, Romford, is available for the teaching of mentally handicapped children and the Special Care Unit, Hulse Avenue, Collier Row, provides for day care of the multiply handicapped. Schools September 1968 saw the opening of two new Primary Schools — Newtons Infants at Rainham and Pinewood Junior at Collier Row. Two co-educational Secondary Schools were formed by merging Harrowfield Secondary Boys and Girls Schools and Quarles Secondary Boys and Girls Schools. The School situation at the end of the year was as follows:- Primary Schools 82 — 25,925 pupils Secondary Schools 25 — 15,886 pupils (including Grammar Schools) Technical Schools 2 — 1 445 pupils Schools for Handicapped Pupils 3 — 343 pupils (E.S.N.) Total School Population 43,599 pupils Medical Inspections 10,084 pupils were given a full medical examination during the year, 1 552 (15.4%) of whom were found to have conditions (other than dental defects) requiring treatment. Only 3 of the pupils examined were considered to be in an unsatisfactory physical condition. The selective procedure for examination of the intermediate 44 age group (Junior School leavers) which was first introduced as a pilot scheme in 1967, was further extended to include 29 of the 48 Junior Schools in the Borough. Under this procedure children in the appropriate age group are selected for examination only if need is indicated by previous health history, poor performance at school, etc. or if the parent requests an examination. Selection is made by the School Medical Officer with the aid of previous medical records and information provided by the parents, teachers, health visitors and school nurses. All children in the age group are given screening tests of hearing and vision, irrespective of the selection procedure. 563 of the 1,493 pupils included in the selective scheme were given a full examination and 318 of these were found to have conditions requiring treatment or observation. Defects found at periodic medical inspections included the following:- TABLE 26 Condition Number of Defects found requiring:- (a) Treatment (b) Observation Defective Vision 774 759 Squint 75 98 Defective Hearing 57 411 Nose 8s Throat conditions 115 434 Speech Defects 44 139 Lung conditions 35 264 Developmental abnormalities 98 281 Skin diseases 216 370 Psychological conditions 45 463 Orthopaedic defects 161 731 In addition to the perodic medical inspections, 1,683 pupils were specially examined by a School Medical Officer at the request of the parent, teacher or school nurse, etc., and 1,533 follow-up examinations were carried out as a result of periodic 45 or special inspections. Conditions found at special medical inspections included the following:- Skin conditions 211 Defective Vision 221 Hearing Defects 186 Nose and Throat conditions 80 Speech Defects 41 Orthopaedic Defects 158 Psychological Conditions 236 Screening Tests: Routine vision and hearing tests of children in the 7—8 year age group are conducted by the School Nurse in addition to the tests included in the periodic medical inspections. Any pupils who fail these tests are followed up by further investigation and treatment as necessary. Colour vision defects should be taken into consideration when plans are being made for future employment and with this in mind a colour vision test is given either at the intermediate or final medical inspections. Cleanliness Inspections: The School Nurses make periodic visits to schools for foot inspections and cleanliness examinations, including inspections for head infestation. Of the 25.275 hygiene examinations carried out, 131 cases of infestation were found but only 10 of these were sufficiently serious to require a cleansing notice to be issued to the parent. Specialist Services: By arrangement with the N.E. Metropolitan Regional Hospital Board the following Specialist Consultant and Treatment Services are provided at the Council's Health and Welfare Clinics Ophthalmic (8 separate clinics) Orthoptic (non-surgical treatment of squint) (2 separate clinics) Orthopaedic (4 separate clinics) Physiotherapy (5 separate clinics) 46 The Physiotherapy Service was unfortunately suspended during the first six months of the year, owing to the resignation of the Physiotherapist, but was re-introduced in July on a slightly reduced scale following the appointment by the Regional Hospital Board of two part-time Physiotherapists. 3,374 children attended the Ophthalmic Specialist Clinics during the year, including 986 new referrals, 1,171 prescriptions for glasses were issued and 139 children were referred for treatment by the Orthoptists. 216 children were examined by the Orthopaedic Surgeon and 916 Physiotherapy treatments carried out. Child Guidance Clinic: The Child Guidance Clinic is administered by the Education Department and is staffed jointly by that department, which employs the Educational Psychologists; the North East Metropolitan Regional Hospital Board, which provides the Medical Director and Consultant Psychiatrists; and the Health and Welfare Department, which employs the Psychiatric Social Worker. 649 children, including 279 newly referred cases, made 2,626 attendances for treatment during the year. Preliminary interviews by Educational Psychologists numbered 895 and the Psychiatric Social Worker conducted 774 interviews with parents. At the end of the year 365 cases were under treatment and 49 patients awaiting their first appointment. Dental Clinics: 11,910 children were inspected in school by the School Dental Officers during the year and treatment was offered to all of those found to require it. 4.061 pupils were treated at the Council's dental clinics and 10,808 attendances for treatment were made. The report of the Chief Dental Officer appears on page39. School Clinic Sessions: The School Medical Officers hold regular clinic sessions for school-children at each of the Health and Welfare Clinics, when they are available to examine pupils for any special purpose 47 or for consultation about a child's health problems. Treatment facilities for minor conditions are also provided. 3,175 examinations by School Medical Officers were carried out at these sessions, including 1,552 follow-up examinations resulting from previous special or routine medical inspections. 9,446 attendances were also made by children who did not see the Medical Officer. Conditions treated included the following:- Skin diseases 1,596 Eye diseases 46 Diseases and defects of Ear, Nose and Throat 55 Miscellaneous minor conditions 456 Speech Therapy: A Speech Therapy Service for children is provided at each of the Health and Welfare Clinics, Special Schools and Junior Training Centre. The year started with an almost full complement of Speech Therapists but some reduction in the service was inevitable following the resignation during the year of two Speech Therapists for whom no replacements could be obtained. 332 children were newly referred for Speech Therapy and 8,273 treatments carried out. At the end of the year 199 children were currently receiving treatment and 83 others awaiting commencement of Therapy. Handicapped Pupils: Under Section 34 of the Education Act, 1944 it is the duty of the Council, as local Education Authority, to ascertain what children over two years of age are in need of special educational treatment by reason of any disability of mind or body. This function is integrated with other services for the handicapped provided by the Health and Welfare Department and all children who are known to suffer from a congenital malformation or show any signs of developing a handicapping condition are kept under observation, not only to assess their educational requirements, but also to consider any community care services which may be appropriate. Some handicapped children, who are not so disabled as to 48 prevent them from participating in normal schooling, may consequently not be "ascertained" as handicapped pupils, but they are nevertheless kept under observation and regular case meetings are held at each Health and Welfare Clinic where the needs of individual handicapped children are discussed. These Handicapped Case Meetings, which were commenced in 1967, are attended by Assistant Medical Officers, Health Visitors, Social and Mental Welfare Officers, Educational Psychologists, Child Care Officers, Education Welfare Officers, etc., and are proving a useful means of co-ordinating the efforts of the various persons concerned with the welfare of handicapped children and enable a "team" approach to be applied to any problems which arise. A total of 92 children were ascertained as handicapped pupils during the year (within the meaning of Section 34 of the Education Act, 1944) and 81 admissions to Special Schools were arranged. The number of pupils awaiting admission to a Special School at the end of the year was 24. The following table gives particulars of ascertained handicapped pupils at the end of the year:- 49 50 TABLE 27 Handicapped Pupils — 1968 CATEGORY Total number 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. of pupils attending Special Schools at end of year Day Residential BLIND 6 - 1 - 6 PARTIALLY SIGHTED 8 - - 7 1 DEAF 9 - - 5 4 PARTIALLY HEARING 35 5 6 23 4 PHYSICALLY HANDICAPPED 47 6 2 23 9 DELICATE 33 6 7 16 15 MALADJUSTED 47 9 5 - 23 EDUCATIONALLY SUB-NORMAL 314 63 58 293 13 EPILEPTIC 9 3 2 - 9 SPEECH DEFECTS - - - - - TOTAL 508 92 81 367 84 SECTION III SOCIAL SERVICES NEW DEVELOPMENTS DURING 1968 The social work services were reorganised, so that the public are now offered help according to where they live rather than according to their "presenting symptom" of social need. Foundations were laid for a permanent review and evaluation system of the help provided, the beginnings of a much-needed measurement scheme for social work. This will help to assess caseloads, staffing needs, and, it is hoped, will show more economic ways of offering services which are just as effective as the present ones. A new rota system enabled anyone wanting welfare help, whether for themselves or for someone else,to speak immediately to a qualified social worker, who could then and there discuss plans and possibilities with them. Social work staff were able to become more proficient in helping people in groups, and further developments in this side of the work were planned. There was a major step forward in starting training for staff at all levels in the five old peoples homes. In particular, there was a short course especially designed for attendant staff in the homes. Five of these courses took place, each one covering ten to twelve members of the staff. Films were shown, practical lecture demonstrations provided by a Health Visitor, and discussions led by a Social Worker. As far as we know, this is the first such in-service training course of its kind and its value to the staff is already apparent. A number of new ideas were implemented to give the best possible service to residents in the Department's old peoples homes, and to get those who wanted to, to participate in the actual running of their home. A new rent guarantee scheme between the Housing Department, Children's Department and Health & Welfare Department was brought into operation. The closest working relations were 51 effected between these three departments to offer social work help to families in bad rent arrears, and to try and avert evictions for serious non-payment of rent. New Cases During 1968, 1467 new cases came to the attention of the social work section (the 1967 figure was 1498). The individuals, or families, concerned were said to need, primarily, the following services when first coming to the notice of the Department: (1967 figures in brackets) Services for the physically handicapped — 274 (354) A place in one of the Department's old peoples homes — 253 (240) Families with problems connected with housing, including some who were homeless — 231 (176) After-care for mental health problems — 133 (147) Services for the blind or partially sighted — 82 (91) Requiring admission to psychiatric hospital — 76 (85) Services for the mentally subnormal— 44 (32) A place in one of the Department's mental health hostels - 21 (26) Services for the deaf or hard of hearing — 20 (16) Families and individuals needing help for a variety of reasons other than those mentioned above — 273, 142 being elderly people (179, of whom 87 were elderly) In addition, 57 (197) new cases were referred to the social workers for investigation or reports; 45 (147) of these concerned situations involving mental health problems. It will be seen that though the total number of new cases remained much the same, there were many family problems and elderly people in need of help. Many problems concerned accommodation. Fewer straight investigations were carried out, and there was a drop in numbers of people coming to our notice because of physical handicap, which possibly indicates that the section is now achieving a true measure of need. The number of new cases opened each month consistently exceeded the number closed, giving a steady increase in the number of families and individuals being helped. 52 Work of the Social Workers The social workers were occupied in five different ways: 1. Investigating, and giving continuing help were necessary, to all new cases that came to the social work section. 2. Investigating, and giving continuing help were necessary, to re-opened cases (those known formerly to the section but closed, and 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 psychiatric hospital on rota duty, out- patient clinics, manning office rota, etc. etc. 5. Office duties and meetings; correspondence and case recording; liaison with other agencies; case conferences etc. etc. Social workers carry out most of their work during interviews with families and individuals. A note was kept during 1968, as during 1967, of the places where the department's social workers carried out any interviews which lasted longer than 15 minutes. There were 17,760 such interviews (compared with 16,830 in 1967) and they took place as follows: (1967 figures in brackets). 11,835 (10,518) in peoples own homes 1,324 (1,367) in the Billet Lane offices 1,044 (1,032) in hospitals, particularly Warley Psychiatric Hospital. 365 ( 258) in the Department's old peoples homes 293 ( 421) in Collier Lodge or Westmarsh Lodge, the Department's mental health hostels. 269 ( 277) in the Belford Centre, the Department's Adult and Junior Training Centres for the mentally subnormal, and in the Special Care Unit for the severely subnormal. 261 ( 242) in the Faringdon Centre, the Department's Occupation Centre for the physically handicapped. 214 ( 297) in the Department's Temporary Accommodation for homeless families 2,095 (2,417) in other places 53 Social Work Staff No new posts were allowed the section during 1968, though the amount of work increased steadily. In fact, with the departure of two welfare trainees to full-time training, and four social workers leaving with time elapsing before their positions were filled, the section operated with fewer staff than before. Even so, two social workers worked a day a week each for some months at Raphael House, the local Child Guidance Clinic, to help with their acute staff shortage. By 31st December, 1968 the position was as follows: Principal Welfare Officer 1 Applied Social Studies Certificate (includes medical social work and family casework qualifications) Deputy Principal Welfare Officer 1 Certificate of Social Work Area Social Workers 3 One with mental health certificates, two with medical social work certificates Senior Mental Welfare Officer 1 Certificate of recognition of experience in social work Social Workers 20 Two with medical social work (4 mental welfare officers, certificates (both took up 13 social welfare officers their appointments early in 3 family caseworkers) 1969) seven with certificate in social work (one returning from a 2 year full-time course in July 1968) One with degree in social work Three with Home Teacher for the Blind Certificates (these include two officers who hold the certificate of recognition of experience in social work and One qualified as an Occupational Therapist) Two others with certificate Total 26 recognition of experience in social work 54 Welfare Trainees 3 Two seconded during 1968 to a two-year course leading to the certificate in social work; the third will start a similar course during 1969. During 1968, Mr. J. Horak, Senior Psychiatric Social Worker, left to take up an appointment as Principal Mental Health Social Worker in Redbridge. Mrs. Gray, Psychiatric Social Worker, transferred to Raphael House in Romford. Mr. B.R. Munday, Psychiatric Social Worker, left to take up a post as Tutor on the new Child Care Course at the North West Polytechnic. Mr. S. T. Mildenhall Mental Welfare Officer, left to take up a post jointly with the Mental Health Service at Redbridge and with Goodmayes Psychiatric Hospital. All these vacancies were filled. By the end of 1968, 15 social workers out of 26 were professionally qualified. Area Social Work Teams From May 1968 onwards, the social work was reorganised into area teams. Many months of preparation, including participation in planning by the social workers themselves, resulted in three teams being set up, each coinciding with the boundaries of groups of the Department's clinics. The North East area included the Harold Hill GLC estate and Harold Wood. The North West area included Collier Row and Romford. The South area included Cranham, Elm Park, Hornchurch, Rainham and Upminster. Before May, there had been two main groups of social workers. One, the mental health group, consisted of the mental welfare officers and psychiatric social workers. The other included the family caseworkers and the social welfare officers who between them covered services for the physically (as opposed to mentally) handicapped, the blind and the deaf, the elderly with special problems, homeless families or families likely to become homeless, and others in serious social need. People, before May, tended to be helped according to their "presenting symptoms" — mental illness, physical handicap, possible homelessness etc. This could make it difficult to realise that the actual help given was much the same in every case: to assist people to make the best of their social situation; to get 55 the social benefits and social services they needed and were entitled to; to get work if able, or if not, because of mental or physical handicap, to keep occupied, to begin to solve long standing personal or inter-family difficulties resulting in all manner of troubles such as rent arrears and other debts, housing complications, and so on. Also, families helped by social welfare officers sometimes included members who were mentally ill, while mental welfare officers would find themselves helping people who had a physical handicap. So dividing cases into "mental welfare" and "social welfare" was abandoned and both groups of workers merged into three comprehensive teams. This also had the advantage of enabling the social workers to really get to know their colleagues from other agencies covering the same area and to study the particular needs of each area. From May 1968 onwards, therefore, each social worker only took on new cases coming from the area covered by his team. No social worker was required to work with any different groups of people than before, if they did not wish to. So, for instance, if they had dealt only with mentally ill or subnormal people formerly and wished to continue this way, they were protected in doing this, However, flexibility has always been encouraged in the section and new staff have been recruited who believed in the idea of mixed caseloads. At present, 14 of the 23 social workers who carry cases have mixed caseloads. Many ofthese concentrate on on one or two kinds of cases, but also take others. This allows those with a special interest or flair to follow this, without concentrating exclusively on people of the same age or group, or with recurring difficulties. It was only possible to change to effective area team working when two separate stages had been reached. First, when sufficient social workers were available who were willing to take on several different kinds of cases. And secondly, when there were sufficient experienced senior social workers to head the teams. Students The section continued to take full-time students of social work from outside courses for their practical training, but shortage of accommodation restricted numbers to 20 including 13 on professional courses, three on pre-professional courses one on a post-graduate course, and three on a new welfare 56 assistant course. Some were full-time in the office, some two or three days each week and they stayed from three weeks to six months. 9 of the students were on professional casework placements while in the department. SERVICES FOR THE PHYSICALLY HANDICAPPED The number of physically handicapped persons on the register at the end of the year totalled 1,201 an increase of seven since 1967. Details are given in tables 28 and 29. Assistance is given to the handicapped by the Department in providing aids, adaptations to homes, special holidays and also at the Faringdon Occupation Centre for the physically handicapped. 501 handicapped persons were assisted with alterations to premises, or by the issue of special equipment, and holidays were arranged for 132 persons. TABLE 28 Register of Physically Handicapped Persons Handicap No. of Persons on Register at 31.12.68 No. of persons whose names were added to the register during year ended 31.12.68 Deaf with Speech 39 3 Deaf without Speech 56 5 Hard of Hearing 35 5 General Classes of the Physically Handicapped 1071 148 TOTAL 1201 161 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 57 TABLE 29 Handicaps and Ages of Persons on Registers of Physically Handicapped 31st December 1968 Handicap under 16 16-29 30-49 50-64 65+ Total Deaf with Speech 2 7 15 3 12 39 Deaf without Speech 2 15 20 18 1 56 Hard of Hearing 1 5 2 3 24 35 General Classes (1) Amputation - - 6 16 21 43 (2) Arthritis or Rheumatism - 5 16 86 273 380 (3) Congenital Malformation or Deformity 3 ~ 2 2 2 9 (4) Diseases of digestive and genito-urinary systems, of the heart or circulatory system (other than Tuberculosis of the skin) — 7 17 41 87 152 (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. 12 15 22 34 45 128 (6) Organic nervous diseases — epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica etc. 10 63 85 99 71 328 (7) Neurosis, psychosis, and other nervous and mental diseases not included in 6 2 - 2 7 7 18 (8) Tuberculosis (Respiratory) - - 1 1 1 3 (9) Tuberculosis (Non-respiratory) - 1 - - 2 3 (10) Diseases and injuries not specified above - - 3 2 2 7 TOTALS 32 118 191 312 548 1201 58 The Faringdon Centre This Occupation Centre which was opened in 1965, provides facilities for up to 60 physically handicapped persons per day. At the end of the year 185 were on the register at the centre, some who have their own transport, attending daily, others who rely on the centre vehicles attending twice per week on average. Against the total of 60 places an average of 52 are taken up each day. During 1968, Mr. Forester Morgan who had been the Super intendent since the opening of the Centre left to join the Spastics Society and Mr. Curnow, his deputy, was appointed in his place Mr. P.Calkin was appointed Deputy Superintendent in August, and Mr. E.Mather joined the staff in July. Over the year there has been a slight increase in the numbers of handicapped people attending the centre daily. The centre was glad to have their new ambulance before Christmas — this however has not increased the amount of transport available as we continue to have only two vehicles available for use. This results in some members having a very short day at the centre as often the last group do not arrive until after 11.30 a.m. although the vehicle has been on the road since 8.00 a.m. There has been some variation in the activities of the centre and developments in the light commercial work undertaken resulting from new contracts with a firm specialising in plastics. The wood-work room has done more work on adapting aids for individually handicapped people and we hope it will be possible to develop this side of the work much more. Lack of space continues to be the main difficulty of the centre. We hope to be able to develop a small area for use by the hairdresser and chiropodist during the next year. Other plans for a quiet room and games area and for increasing the daily numbers of people attending the centre have to be held in abeyance until more rooms can be added. HOUSING THE DISABLED (a) Purpose Built Dwellings The problems faced by the severely disabled attempting to pursue their daily lives with some degree of independence are 59 many and varied. Aids, appliances, adaptations and alterations may benefit some but for many the only answer is rehousing in specially designed and equipped accommodation. Awareness of this need was shown by the London Borough of Havering some three years ago with the provision of one 3 bedroomed bungalow, one 3 bedroomed groundfloor flat and two 1 bedroomed groundfloor flats. The scheme was the responsibility of the Borough Architect working in close co-operation with the Medical Officer of Health and the Housing Department. The flats were designed for use by families with a disabled member, particularly the housewife but the special facilities included do not decrease the ease with which the accommodation may be used by able members of the family. The principle consideration in planning was the general increase in all areas to provide adequate manoeuvreing space for a wheelchair. Level non-slip floor surfaces, lower level work-tops in kitchens, lower baths and the provision of shower units. All central heating and electric sockets are set in easy accessible positions to be operated from a wheelchair if need be. The entrance to each flat is ramped and thresholds are absent from doorways. Internal doorways are often sliding with a clear opening of2ft.llins. Suitable rails are provided around toilets and provision for overhead hoists are taken into account. A large garage or carport is provided close to the entrance of the flat so that the physically handicapped person has easy accessibility. The garage or car-port is usually 9 ft. wide so that the wheelchair can be operated in or out of a vehicle without difficulty. Three of the purpose-built dwellings were completed in 1968 and families with a physically handicapped member have moved in and are finding this type of accommodation most satisfactory. The other dwelling will be completed early in 1969 and will be let to a young disabled housewife and her husband. Profiting from this first experience another project of five 1 bedroomed groundfloor flats and two 2 bedroomed groundfloor flats is now under way and should be completed by 1970. The value of this accommodation to the disabled has been proved. Independence and ease of circulation lessens their handicap and they become more of a person to family and friends. (b) Adaptations to existing houses During 1968 by close co-operation between Architects 60 Department, Medical Officer of Health and Housing Department, 37 physically handicapped persons have been rehoused in dwellings altered to accommodate their physical disability. Adaptation of Home Premises for Home Dialysis Machines Three home dialysis machines were installed in the Borough during the year. This is a new service following a Ministry directive authorising such a service. The cost of the machines and additional electricity and telephone rental charges are met by the Ministry and the local authority has power to arrange for the installation of the machines. Such installation is quite involved and a close liaison is maintained with the Borough Architect and the Hospital concerned regarding the various aspects of the work for each individual case. In two instances the houses originally occupied by the patients were not suitable for adaptations, one patient being rehoused by the Council to more suitable accommodation, and the other obtaining more suitable accommodation privately. In the third instance the patient occupied a property which was capable of adaptation. SERVICES FOR THE BLIND Social Welfare Officers visit the blind to give advice and guidance on a variety of matters affecting their well being — helping them to obtain, where necessary, any special assistance required in connection with supplementary benefits, financial assistance with holidays, free wireless licences, loan of wireless sets, white walking sticks etc. Three handwork classes are run by Social Welfare Officers who also give braille/moon lessons and handicraft instructions to blind persons in their own homes. 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 4 1 30 15 75 127 F - - 4 1 18 28 163 214 Total - 2 8 2 48 43 238 341 61 During the year 44 persons were added to the Register of Blind Persons, as shown below:— TABLE 31 Ages of Persons Added to Blind Register in 1968 Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65+ M - - - - 2 1 11 14 F - - 1 - 2 2 25 30 Total - - 1 - 4 3 36 44 Employment 31 Blind persons were employed at the end of the year. 3 in special workshops, 4 in Home Workers Schemes and 24 in open employment. The occupations of the 31 Blind persons in employment were as follows:— TABLE 32 Occupation of Blind Persons in Employment Proprietors, Managers & Executive Workers 2 Typists, Shorthand Typists, Secretaries 6 Telephone Operators 3 Working Proprietors, Shop Managers 1 Street Vendors, News Vendors, Hawkers 1 Farmers, Farm Workers etc. 1 Machine Tool Operators 4 Boxers, Fitters, Packers 2 Basket Makers 2 Boot & Shoe Repairers 1 Piano Tuners 2 Labourers 2 Domestic/Canteen Workers, Caretakers etc. 3 Miscellaneous Workers 1 Total 31 Residential Accommodation Table 33 gives details of blind persons in residential accommodation as at 31st December, 1968. 62 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 4 11 (b) Other Homes 4 6 Residential Homes other than above — — In Hospitals for Mentally 111 1 5 In Hospitals for Mentally Subnormal 3 1 Other Hospitals 3 11 TOTAL 15 34 Partially Sighted At 31st December, 1968, 125 persons were registered as partially sighted, an increase of 2 since the same date in 1967. 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 31.12.68 Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65 + M - 1 7 2 14 4 20 48 F - - 5 1 11 5 55 77 Total - 1 12 3 25 9 75 125 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 1 - - - - 2 3 6 F - - - - 2 - 14 16 Total 1 - - - 2 2 17 22 63 Included amongst those removed from the Register were 12 persons admitted to the Blind Register, and 1 who was decertified due to improved visual acuity. 46 of the 125 persons on the Register were near or prospectively blind. 7 of these were in employment, and the remaining 39 were not available for, or incapable of work, all 39 being over 65 years of age. Details of the other 79 persons on the register who were mainly industrially handicapped, requiring observation only, or under the age of 16 years are as follows:— TABLE 36 Registered Partially Sighted Persons other than those near or prospectively blind Mainly Industrially Handicapped AGE GROUPS 16-20 21-49 50-64 65+ Total Employed: Male 1 9 3 - 13 Female - 4 3 - 7 Available for and capable of training for work: Male - - - - - Female - 1 - - 1 Not available for work: Male - 1 - 6 7 Female - 1 — 7 8 Requiring observation only: Male - - - 6 6 Female - 3 2 17 22 Children, 16 and over, still at school: Male 1 - - - 1 Female 1 — — — 1 3 19 8 36 66 Children under 16: AGE GROUPS Attending Special Schools: Male 0-5 5-16 Total 7 7 Female - 3 3 Attending other Schools: Male - - - Female — 2 2 Not at School: Male 1 - 1 1 -12 13 64 TABLE 37 Accommodation for Physically Handicapped and Others Provided by Voluntary Organisations 31st December, 1968 Aged Under 65 65+ TOTAL Blind 4 11 15 Deaf 1 - 1 Epileptic 6 - 6 Physically Handicapped 10 - 10 Mentally Handicapped - - - Others - 14 14 21 25 46 TEMPORARY ACCOMMODATION FOR HOMELESS FAMILIES TABLE 38 Homeless Families admitted to Local Authority Temporary Accommodation 1966 1967 1968 ALL LONDON BOROUGHS 1754 1856 2331 HAVERING 20 21 21 Table 38 shows that the general rise in numbers of families in temporary accommodation throughout London was not reflected in Havering. The cause of this may well be the considerable amount of time allocated by social workers in advising and assisting families to prevent homelessness. Though this reduces the demands on the department's temporary accommodation, it undoubtedly increases the demands made on the social work staff, who are finding that more and more of their work now involves accommodation problems and people having housing difficulties. The average length of stay of the 21 families admitted to the Brentwood Road temporary accommodation during 1968 was 11 weeks. All but three of the families were re-housed by the Borough Housing Department. 65 The first year of operation of the Borough scheme for the prevention and management of homelessness ran particularly smoothly due to the full co-operation of the staff of the Housing and Children's Departments and all others concerned with this problem. SERVICES FOR THE ELDERLY Residential Care The need to extend the Authorities residential accommodation provision is emphasised by the fact that although 111 people were admitted to Homes during the year, the waiting list for beds stands at 154, an increase of 7 over 1967. Primarily crisis situations are being dealt with which to some extent explains the increasing frailty of the old folk to be seen in our homes; the ageing process accounts for the remainder. Old folk need to prepare for their admission — to adjust to the idea of parting with home and friends and all that is familiar and we are having to recognise that unavoidable delays in their admission can result in the often traumatic experience of it being effected in crisis circumstances. Resident participation continues to develop at the Homes as will have been noted by many of those people attending the various coffee mornings, bazaars, open days etc. where residents were very much to the fore both in the provision and sale of the articles and in the planning of such activities. The facility whereby residents at one of our Homes have a kitchen to make their own hot drinks or snacks is proving to be invaluable and is an innovation that can be usefully incorporated in the design of future homes. Staffing A static personnel is a pre-requisite of a happy home, for residents become insecure where they must continually make new realtionships or accustom themselves to new patterns of working. Fortunately the turn-over of staff in the smaller homes has not been great, but a crisis involving attendant staff vacancies developed at the Willows resulting in the need to close one of the blocks so that the most economic deployment of available staff could be achieved. Admissions of residents had to be curtailed accordingly and although this action reduced 66 demand for beds from the joint users and ameliorated the situation, the staffing shortage remained and continues to be under investigation. Table 39 shows the number of admissions to the various Homes during the year. TABLE 39 Old Peoples Homes Run by the Department Places ADMISSIONS 1968 Permanent from own Home From Hospital Short Stay The Grange 61 19 8 18 Hillside 63 12 6 16 The Manor 51 14 1 24 Ravenscourt 48 9 1 10 The Willows *158 *27 *18 *7 #381 81 34 75 *Shared with London Borough of Barking, Redbridge and Waltham Forest. *Havering Residents only. #Only approximately 277 places available to Havering residents — see The Willows* above. Waiting List for Old Peoples Homes 31st December 1968 31st December 1967 Havering Residents on the waiting list 125 128 Residents from other areas on the waiting list 29 19 Totals 154 147 Elderly Peoples Workshop The Workshop moved during 1968 from old and somewhat dark premises almost opposite the Town Hall, to newer and lighter rooms immediately behind the Town Hall. The former 67 premises had to be demolished to make way for a new road. 32 elderly people attend each day, in two shifts. Contract work for local firms is carried out. The Workshop’s success in getting a continuing supply of such work is a mark of the high quality of the members output. Holidays for the Elderly During 1968 a variation took place in the arrangements made the previous year. Because of changes at the Hopton Holiday Camp, the facilities there were no longer available and it was decided to take the Rogerson Hall Holiday Camp, Corton for 7 weeks from mid-May to the end of June. This was roughly 2,100 places. In addition the usual arrangements were made with the Ramsgate Hoteliers Association and accommodation for 80 old persons was booked at Guest Houses for a five week period. This meant 400 old persons could be accommodated at Ramsgate. 3,169applications were received, made up as follows:— 987 Priority cases applied for Corton 355 -do- Ramsgate 1,442 Non-priority -do- Corton 385 -do- Ramsgate Priority cases being those who did not participate in the 1967 Holiday for Old Persons. All priority cases were offered a holiday and in all 2,009 people went to Corton and 390 to Ramsgate. 541 applicants cancelled the holiday offered to them 229 people were not offered a holiday, the majority being people who applied to go to Ramsgate. Bearing in mind that many cancellations were only received a few days before the date of the holiday, every effort was made to fill the vacancy. It should be appreciated that although an old person may want and need a holiday, they cannot always adjust or arrange their lives at short notice to take advantage of an offer. Most of the cancellations received were on the grounds of illness or pressing domestic arrangements. 68 Each person paid £3.4.0d. for the week’s accommodation, this sum also included coach transport from specific pick-uppoints in the district to the Holiday Camp or Guest House. The overall cost to the Council for these holidays was £17,841.6.2d. When making up the parties for the Holiday Camp they are usually from set areas i.e. the whole 300 campers may be from the Town Hall Pick-up or 200 i.e. 4 coaches from Elm Park and 100 from Harold Wood. Thus where an old person indicates they wish to go with a particular club, as most club members live in one area, they then can all be together. Outings for the Elderly 19 outings were arranged during 1968, 11 to Bexhill-on-Sea and 8 to Heme Bay, two coaches going on each occasion. A total of 1,478 persons went on the outings. Approx: 2,000 applications were received and accommodation was booked for 1,606. Of the applicants offered a days outing, 455 cancellations were received. This meant that almost everyone who applied was offered an outing. None of the cancellations were for frivolous reasons and the last minute cancellations were often due to ill health, and although efforts were made to fill the cancellations, it was not always possible for them to be taken up at short notice. Bad weather did not always mean that the old persons failed to turn up, this might have happened in some instances where they were very frail, but generally they preferred to be out rather than ‘sit indoors and look at the rain’. The total cost of the outings for catering and transport was £1,486.11.3d. Each old person contributed 5/- and £370.5.0d. was received by way of income. Luncheon Centres for the Elderly 197,371 meals were served, averaging 3,796 per week, at the Borough's 9 Luncheon Centres situated as under: Community Centre, Gooshays Drive, Harold Hill Hopwa House, Hornchurch Laurie Hall, Romford /contd. 69 Tweedway Hall, Romford Park Lane Community Centre, Hornchurch Cranham Social Centre Elm Park Assembly Hall, South Hornchurch Community Centre Chandlers Corner Community Centre. Special transport is provided to two of the Centres, viz: Tweedway and Gooshays Drive, to bring persons living outside the normal catchment area. The meals are provided from the Marley Kitchen, Dagenham by arrangement with the Barking Borough Council and the meals are cooked under the supervision of the Schools Meals service. Meals on Wheels 28,192 meals were served to old people in their own homes by the “Meals on Wheels” service, averaging 542 per week. These meals are provided from two sources, the Marley Kitchen and St. George's Hospital. They are distributed by voluntary helpers: in the Romford area by the W.R.V.S. and in the Hornchurch area by H.O.P.W.A. members. More than half the people receiving meals have them three times a week, the remainder have five meals a fortnight i.e. three one week and two the next. Entertainments This scheme maintained its popularity with elderly residents who took advantage of the invitations extented through this office from local groups. Concerts and variety shows and plays were staged with great success, a total of 4862 persons attended 23 productions, the tickets being distributed through old people’s clubs. MENTAL HEALTH SERVICES The liaison and after care arrangement existing between the mental health social workers and Warley Hospital, the Ingrebourne Centre and with voluntary organisations as detailed in previous reports has continued. Admissions to hospital on an informal basis rather than order have increased, 60 such informal admissions being arranged, compared with 30 in 1967. The Thursday C lub This Social Club has continued to meet every week at the 70 Belford Training Centre, Faringdon Avenue, Harold Hill, and is now well established after some 3½ year’s duration. It provides opportunities for those in the community who find difficulty in making social contact. Attendance has been very good throughout the year although travel difficulty is experienced by some members of the Club. Prospective members in the south of the Borough find the journey by public transport difficult. Several evening outings were arranged during the year, also a number of social occasions and a Christmas party. Plans are being made for new ventures during the forthcoming year. The Club is supervised by Mental Welfare Officers of this Department, and a Social Worker from Warley Hospital. The majority of referrals are from Warley Hospital although membership is open to any person in the Borough of Havering who has a nervous difficulty, and their partners or friends. Admissions to Psychiatric Hospitals During 1968, the Department’s social workers authorised under the 1959 Mental Health Act as mental welfare officers took 115 people to psychiatric hospitals on Statutory Orders under the Act 14 of these went in under Section 25, 1 under Section 26, and 100 under Section 29. The equivalent figures for 1967 were 121. (20 under Section 25. 3 under Section 26, and 98 under Section 29). In addition, 60 others were aided with informal admissions to hospital (30 in 1967). Admissions to Hospitals Year Year ending ending 31.12.68 31.12.67 Mental Health Act, 1959 Section 25 — 14 20 Section 26—1 3 Section 29 - 100 98 Section 60—2 — Informal — 60 30 Total 177 151 The total number of admissions from the Borough to Warley Hospital during 1968 was approximately 682 compared with 635 in 1967. 71 Temporary & Permanent Residential Care The demand for permanent residential care continues to increase and great difficulty is experienced in obtaining vacancies in hospital and private establishments. In consequence, it has not been possible to satisfy all demands and it has been necessary to establish a waiting list. The requests for temporary residential care also continue to increase and again the accommodation available is very limited. Although it was not possible to meet the numerous demands received, arrangements were made for 11 mentally handicapped persons to be provided with care during the year. This enabled the parents to enjoy a period of relief from the cares and worries of looking after their children. Belford Adult Training Centre The Belford Adult Training Centre provided paid work, recreational activities and social education for 146 mentally handicapped men and women. The work of the programme of the Centre is designed to help mentally handicapped people develop to their maximum potential and acquire social skills to enable them to take their place in society as far as possible. The emotional and psychological needs of each individual and the parents have to be assessed and helped so as to establish maximum awareness and lasting relationship with the family as well as good health. The departments of the Centre include the woodwork section where garden and domestic furniture are manufactured and commercial contracts, including those from the Council, are undertaken; an industrial unit where a large variety of commercial contracts including packing, soldering, sorting, assembly, making rubber link mats, plastic coat hangers and seed boxes, preparation of firewood, making and assembling metal wall lamps, plant holders and house signs, the making of sheets, pillowcases, tea towels and curtains for old people’s homes etc. are also undertaken. A further range of work and interest is provided by maintaining gardens and other outdoor work and running the Centre's allotment and green house. The educational programme includes training in domestic science and teaching competence with personal care and hygiene 72 and a range of social skills including using Post Office services shopping, the use of money, social and health services etc. Considerable attention is paid to the recreational aspects of the Centre's work and a flourishing football and cricket league has been created together with neighbouring Centres. The final of the Football League was held at the Ford Sports Ground (by kind permission of the Ford Motor Company) and was attended by all the supporter's clubs and a large crowd of spectators including parents. There is an annual competitive Sports Day and visits are arranged which combine recreational activities and social education. Visits to the seaside, film shows, indoor bowling, swimming, fishing, minature golf along with many other activities are undertaken. During 1968 a number of the trainees went on a holiday, together with members of staff, at Rogerson Hall Holiday Camp, Corton, near Great Yarmouth. The Centre is regularly visited by specialist advisers including doctors, speech therapists, chiropodists, dentists, educational psychologists, teachers of the deaf. The Borough Road Safety Officer visits twice a year and the Police give demonstrations on the subject of road safety. Parent Teacher Association—Belford Centre This Association, formed in 1965, continues to form a very valuable link between the parents and teachers of the Training Centre and has proved to be of great assistance in resolving problems that arise from time to time concerning the care, training and well-being of the mentally handicapped attending the Centre. Considerable progress has been made in raising funds to provide a Swimming Pool at the Training Centre and this fund now stands at a little more than £1,000. The money has been accumulated as a result of fund raising functions e.g. Spring Fayres, Christmas Fayres, Jumble Sales, Socials, etc. and the Committee are confident that their target will shortly be reached. The Association is grateful for the help and assistance received from many outside organisations which does so much to supplement the hard work and efforts of the parents and teachers in making the social functions such a success. The Association continues to make donations of money from 73 time to time for outings, etc., in which the trainees take part, and have provided a cine camera and films for use by the trainees when on holiday and on Sports Days, etc., in order that an album can be established and shown to parents and other interested bodies. The Committee, which meets on the first Thursday of each month, comprises parents and teachers, the Hon. Secretary being a member of the Health and Welfare Department and all the administrative work is done in this Department. In addition, a general meeting of parents and teachers is held each quarter which is greatly appreciated by all concerned. This is a most active Association and the parents derive much pleasure and satisfaction in being able to take an active part in the interest, care and training of their children. Westmarsh Lodge—Hostel for Mentally Subnormal Men During the year under review, the Hostel has continued to function to full capacity. Three residents departed and their places were quickly filled. The demand for vacancies continues to exceed the capacity and with the present stand-still at South Ockendon Hospital and change of emphasis on types of admission therein, it is likely that the demand will rise. Whilst some residents were away from the Hostel for holidays with relatives or friends we were able to offer 18 vacancies for Temporary Care to persons in the community, which enabled some families to obtain some relief. The residents continued to enjoy activities within the community and monthly group meetings at the Hostel assisted the residents to express themselves on topical subjects and the general administration of the Hostel. On average four residents were in employment during the year. The problem remained to find employers willing to give the more capable residents the opportunity of work within the community. Collier Lodge—Hostel for the Mentally III “ “X” was referred by her psychiatrist following hospital 74 treatment for residential accommodation at Collier Lodge. She was a capable lady who, because of her illness, had had to give up training for a career. Her illness was associated with family matters, and the need for a period away from home was urgent. Her stay at Collier Lodge has given her a chance to recover from the illness, and she has now resumed her training course”. Collier Lodge is a 26 bed residential unit offering short stay accommodation for those who have been psychiatrically ill. The Unit is designed to help the resident to be as selfsupporting as possible. The majority of those accommodated at Collier Lodge are in full-time employment, and with appropriate assistance from psychiatrist, social work and residential staff, the resident is gradually able to rejoin society on an equal footing. The Unit is shared by neighbouring Authorities on a fee-paying basis, and for the year ending 31.12.68, there were 19 admissions and 11 discharges, a total of 21 remaining at the end of the year. In spite of supportive help a resident may suffer a relapse, and need further help in hospital. There is provision for this as the Unit works in full co-operation with the local psychiatric hospital. Monthly case discussions between Dr. Vincenzi the Borough Consultant Psychiatrist, a Warley Hospital Psychiatrist, resident and social work staff continue, and fortnightly group meetings with residents and social work staff are held. A new innovation this year was the setting up of an entertainments committee organised by the residents. In addition to the assistance offered by the Warden and his staff, a resident has a social worker from whom she or he may seek additional help and advice. It is hoped to develop the “bridge” aspect of the community mental health work by enlisting the help of a small group of land-ladies taking residents from Collier Lodge. In return a social worker-pontact would be available, and re-admission to Collier Lodge arranged if necessary. 75 76 TABLE 40 Patients Referred During 1968 Referred by Mentally I11 under 16 over 16 Psychopathic under 16 over 16 Subnormal under 16 over 16 Severely Subnormal under 16 over 16 Total under 16 over 16 GRAND TOTAL General Practitioners - 33 - - 5 - 2 - 7 33 40 Hospitals on discharge from in-patient treatment - 120 - - - - - - - 120 120 Hospitals, after or during out-patient or day treatment - 6 - - - - - - - 6 6 Local Education Authorities - - - - 10 - 3 2 13 2 15 Police and Courts - 3 - - - - - - - 3 3 Other Sources - - - - 3 25 - 12 3 37 40 TOTALS - 162 - - 18 25 5 14 23 201 224 TABLE 41 Number of Patients under the Care of the Authority as at 31.12.68 Mentally I11 under 16 over 16 Elderly Mentally Infirm P s ycho pathic Subnormal under 16 over 16 Severely Subnormal under 16 over 16 Total under 16 over 16 GRAND TOTAL Attending day training Centre/ Workshop - - - - 48 93 39 52 87 145 232 Awaiting entry thereto - - - - - - - - - - - Receiving/Awaiting home training - - - - - - - - - - - Resident in Local Authority Home/Hostels - 18 - - - 3 - - - 21 21 Awaiting admission thereto - - - - - - - - - - - Resident at Local Authority expense in other residential Home/Hostels - - - - 5 - 1 7 6 7 13 Resident at Local Authority expense by boarding out in private household - - - - - - - - - - - Receiving home visits - 204 - - 45 25 3 31 48 260 308 TOTALS - 222 - - 98 121 43 90 141 433 574 77 SECTION IV GENERAL ENVIRONMENTAL HEALTH SERVICE This section contains statistics regarding the notification and control of infectious diseases, together with details supplied by Mr. M.F.G. Randall, Chief Public Health Inspector, on the environmental health services. At the end of the year the inspectorate consisted of 18 Public Health Inspectors, two Meat Inspectors, three pupil Public Health Inspectors, two Rodent Officers, and four Shops and Offices Inspectors. TABLE 42 Notification of Food Poisoning and Infectious Diseases Disease Male Female Total Acute Encephalitis - 1 1 Dysentery 7(5) 9(5) 16(10) Food Poisoning (or suspected food poisoning) 62(11) 16(17) 123(28) Infective Jaundice 16 7 23 Measles 175 176 351 Ophthalmia Neonatorum - 1 1 Paratyphoid Fever 2 1 3 Scarlet Fever 76 64 140 Tuberculosis: Respiratory 41 16 57 Other 2 7 9 Whooping Cough 55 76 131 Erysipelas * 1 4 5 Pneumonia * 4 1 5 Peurperal Pyrexia * - 2 2 Figures in are confirmed cases of food poisoning and dysentery. * As from 1st October, 1968, these deseases were no longer notifiable No cases of Poliomyelitis, Diphtheria, Smallpox, Anthrax or Typhoid Fever were notified during the year. However, the number of Tuberculosis cases notified showed an increase over the previous year, respiratory cases increasing from 40 to 57 and non-respiratory from 2 to 9. The number of 78 deaths from this disease remained the same as the two previous years, namely 7 (6 respiratory, 1 other). The age group and sex distribution of these 7 deaths were:— Respiratory: Males — 45+ ; 55+ (3); 75 +; Female — 65+; Other: Male — 55+. N o deaths were attributed to any other infectious or notifiable diseases during the year. A table giving the age groups of the newly notified cases of Tuberculosis is given below:— TABLE 43 Tuberculosis Age Group Male F emale Respiratory Others Respiratory Others 2-14 - - 1 - 15-19 2 - 2 1 20-24 1 - - - 25-34 4 - 4 1 35-44 6 1 3 1 45-54 2 - 3 3 55-64 17 — 1 - 65-74 6 1 1 — 75 and over 3 - 1 1 TOTAL 41 2 16 7 The last quarter of the year would normally have shown the beginning of the two year measles cycle, but only 155 cases were notified, as against approximately 1500 cases expected. Only 351 cases were notified during the whole year. This vast reduction must almost certainly be attributed to the immunisation programme which started in May, 1968. The number of cases of food poisoning and dysenteryshowed a considerable reduction. Fourteen of the twenty-eight confirmed cases of food poisoning were members of a wedding breakfast 79 which took place in a neighbouring Borough, the causative organism being a staphylococcus. The following table shows the number of specimens submitted to the Pathology Department at Oldchurch Hospital, and once again my thanks are due to Dr. E. Atkinson, Consultant Pathologist and his staff for their full co-operation. TABLE 44 Taken from Total No of persons swabbed Total No of swabs taken Negative POSITIVE Shig. sonnei Salmonella *** Staph. pyogens S.paratyphi. B Food Handlers 20 30 29 - 1 - - NonFood Handlers 235 264 226 8 13 14 3 *** Salmonella enteritidls 3 Salmonella- typhimurium 5 Salmonella dublin 1 Salmonella vickow 3 Salmonel la derby 1 Salmonel la (unidentified) 1 Total 14 No outbreaks of food poisoning originating in the Borough during the year required special reports to the Department of Health & Social Security in accordance with Memorandum 188/MED. The Public Health (Infective Jaundice) Regulations, 1968 came into operation on 15th June, 1968, only to be revoked by the Public Health (Infectious Diseases) Regulations, 1968 on 1st October, 1968. The former Regulations applied to Infective Jaundice, the provisions of the Public Health Acts, 1936 and 1961 relating to notifications of disease and prevention of its spread. These Regulations applied throughout England and Wales, and superseded the Jaundice Regulations, 1943 which were limited to the eastern region of the country including the London Borough of Havering. The Minister of Health considered that general notification would assist Medical Officers of Health to obtain more precise information concerning the incidence of Infective Jaundice and the circumstances in which its various forms are spread. In this connection a Consultant Physician 80 drew attention to a number of cases of hepatitis, all of whom had visited a tattooist who practices in the area. Investigations showed that the premises were clean and in good repair. The tattooist’s personal hygiene and his equipment and methods appeared to be satisfactory. No formal action can be taken by the Department, but it is possible that continued inspection will have the effect of maintaining a good standard of hygiene. On 1st October, 1968 the Public Health (Infectious Diseases) Regulations, 1968 came into operation. The Principal changes brought about by these Regulations were:— (a) All provisions governing the notification of infectious disease and food poisoning are now to be found in Sections 47 to 49 of the Health Services and Public Health Act, 1968 and the Public Health (Infectious Diseases) Regulations 1968. (b) The infectious diseases now to be notified to the Medical Officer of Health are:— Acute encephalitis Ophthalmia neonatorum Acute meningitis Paratyphoid fever Acute poliomyelitis Plague Anthrax Relapsing fever Cholera Scarlet fever Diphtheria Smallpox Dysentery Tetanus (amoebic or bacillary) Tuberculosis Infective jaundice Typhoid fever Leprosy Typhus Leptospirosis Whooping Cough Malaria Yellow fever Measles (c) Notification of the diseases listed below is no longer required:— Acute influenzal pneumonia Erysipelas Acute primary pneumonia Membranous croup Acute rheumatism Puerperal pyrexia. 81 (d) Responsibility for notifying a case, or suspected case of food poisoning or infectious disease rests exclusively on the medical practitioner attending the patient unless he believes that another practitioner has already notified the case. By an Order made under Section 50 of the Health Services and Public Health Act, 1968 the notification fee was increased from 2/6d. to 5/-d. as from 1st October, 1968. MEDICAL ARRANGEMENTS FOR LONG-STAY IMMIGRANTS During the year advice notes were received from various Port Health Authorities in respect of 98 immigrants who were said to be proceeding to addresses in the Borough, an increase of 23 on last year. In 63 cases successful contact was made and appropriate advice given on health matters. Twenty-eight of the remainder were coming to this country to work and live at local hospitals, so were therefore not visited. This left seven we were unable to trace and it might well be that accommodation addresses were being used in these cases. SMALLPOX CONTACTS Fourteen passengers who had arrived in this country from overseas were referred to the Department during the year for surveillance. These persons had come from areas where Smallpox was said to be endemic and did not hold valid certificates of vaccination against Smallpox. The ports of entry were London (Heathrow), Southampton and the Port of London. FOOD & DRUGS ADMINISTRATION A total of 478 samples (80 formal and 398 informal) were taken during the year and examined by the public analyst. Two formal samples of pork sausages contained slightly less than the meat content considered appropriate for pork sausages. Warnings were sent to the manufacturers concerned. Regulations concerning the meat content of sausages and other meat products will come into force on 31st May, 1969 when it will be required for the minimum meat content of pork saugages to be 65% and that for beef sausages 50%. It is not envisaged that many manufacturers will fail to reach these standards, as samples taken over the past few years have, in the main, been at or above the required levels. 82 Six informal samples of food had faulty labelling, but the manufacturers were informed and the necessary remedial action was taken. One informal sample of dried skimmed milk contained slightly less than the stated quantity of skimmed milk equivalent. A formal follow-up sample was taken, but proved to be genuine. Two other informal samples, one of mincemeat flavoured with brandy and the other a processed cheese were unsatisfactory Formal follow-up samples were taken and proved to be genuine. Included in the above figures are 40 food complaints which were referred to the public analysts. Ill other food complaints were dealt with without reference to the analysts. Seven prosecutions were taken, details of which appear below:— Complaint Result of Proceedings Mouldy fish Fine £20 Costs £5.5.0d. Bandage in Chipolata sausage Fine £5.5.0d. Costs £3.3.0d. Mouldy cakes Fine £25 Costs £5.5.0d. Potato in milk bottle Fine £25 Costs £5.5.0d. Paper in bread Fine £20 Costs £2.2.0d. Sour sausages Adjourned sine die Mice contamination in butter Fine £10 Costs £5.5.0d. The commodities involved in the 151 food complaints are summarised as follows:— Bread 28 Jellies 1 Fresh Meat 9 Vegetables 3 Cooked meats and meat productsl4 Eggs 1 Confectionery 8 Butter 2 Canned Meats 9 Canned Vegetables 4 Flour Confectionery 16 Fresh Fruit 6 Milk and milk products 20 Poultry 5 Soft Drinks 2 Cheese 2 Frozen Foods 5 Fresh Fish 3 Canned Cereals 2 Medicines 1 Canned Fish 5 Sugar 1 Pickles 3 Dried Fruit 1 83 BACTERIOLOGICAL MILK SAMPLING A total of 230 milk samples were taken during the year and submitted for bacteriological examination with results as follows:— Pasteurised— 207 -201 passed the methylene blue test, 6 failed. All passed the phosphatase test Sterilised— 10 -All satisfied the turbidity test Ultra heat treated— 13 -All satisfied the U.H.T. test Included in the above totals were 63 samples from vending machines. 59 satisfied the methylene blue test and 4 failed. All satisfied the phosphatase test. The number of failures were comparatively few and were mostly caused by the failure of the retailer to keep a proper stock rotation. Twenty-one samples of milk were also submitted to the public analyst for chemical examination and all proved satisfactory. Eight of these samples were also tested for the presence of anti-biotics and all proved negative. ICE CREAM SAMPLING—Bacteriological Examination During the year 155 samples of ice cream were submitted for bacteriological examination with results as shown:— Mobile Shops Total Grade Soft Other Soft Other 1(satisfactory) 17 51 5 36 109 2(satisfactory) 1 5 1 4 11 3(poor) 5 10 1 5 21 4(unsatisfactory) 6 1 4 3 14 Total 29 67 11 48 155 In addition to the ice cream samples, six ice lollies were taken for bacteriological examination and all proved to be satisfactory. Results of this yea’s sampling were much about the same as last year and in the cases where unsatisfactory results were received appropriate action was taken. 84 In addition nine samples of ice cream were submitted to the public analysts for chemical examination and all proved to be satisfactory. OTHER FOOD SAMPLING-Bacteriological Examination Bacteriological examination of other food products was carried out during the year in respect of the undermentioned commodities:— Cream — 67 Cream Cakes — 34 Cooked Meats — 57 Meat Pies & sausage rolls 23 Other Meat products — 32 Shellfish — 6 Bread Roll — 1 Egg - 1 Yoghourt — 1 Coconut — 1 In general the results of the examination of these samples were good, but some of the fresh cream samples were not entirely satisfactory. Lack of a definite bacteriological standard gives rise to some difficulty and during 1969a survey will be conducted by the Public Health Laboratory Service to give clear guidance on this matter. In the case of the samples which were not entirely satisfactory, the retailers attention was drawn to the fact that the expiry date on the cartons must be strictly adhered to. PESTICIDE RESIDUES IN FOODSTUFFS Eighteen samples were taken during the year, this being the second year of the national survey into this matter. All samples proved genuine and free from pesticide residues. The national interim report for the first year's results (1967) has now been issued and shows that traces of residues were present in a significant number of samples, following a pattern that corresponded with the known use of pesticides upon certain crops. According to the present state of knowledge there would appear to be no short term hazard associated with the amount found so far. Certain standards have been worked out for some 85 pesticides by an international committee, but there are a number with no prescribed level. PHARMACY & POISONS ACT, 1933 Fifteen names were added to the list during the year and 19 were removed. At the end of the year 109 persons were entered on the poisons list involving some 176 premises. On 6th December, 1968 the Poisons (No.2) Rules, 1968 came into force and these increased the fees - the first increase since 1933— to £1.5.0d. (7/6d.) for having the name entered on the list in respect of each set of premises and 15/-(5/-) for renewal of entry. A fee of 5/-(1/-) is now payable for any alteration on the list in respect of premises. The amount in brackets is the old fee. Two samples were taken under this Act during the year and in each case a satisfactory report was received. No prosecutions were necessary in respect of the administration of this legislation during the year. POULTRY PROCESSING PLANTS There are no poultry processing plants 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. FOOD HYGIENE(MARKETS, STALLS & DELIVERY VEHICLES) REGULATIONS, 1966 Seven persons were summonsed, in each case for smoking. In six cases convictions were obtained and fines totalling £44 were imposed. Costs amounting to £12.12.0d. were awarded to the Council. In the other case it was not possible to serve the Summons on the “itinerant defendant”. ESSEX COUNTY COUNCIL ACT, 1952 - Section 103 During the year under review eight new applications for registration as hawkers of food were granted. 86 MILK DISTRIBUTORS There are nine registered milk distributors, with sixteen dairy premises within the Borough. In addition, 200 shopkeepers are registered for the sale of milk. MILK (SPECIAL DESIGNATION) REGULATIONS, 1963 As amended The number of licences granted by the Council of theLondon Borough of Havering during 1968 in respect of each designation together with the total number in force as at the 31st December 1968 are shown in the following table:— TABLE 45 Designation Licences issued in 1968 Total number in force at end of year Untreated Milk 12 64 Pasteurised Milk 25 168 Sterilised Milk 19 133 Ultra-heat Treated Milk 20 51 All these licences are valid until 31st December, 1970. GAME ACT, 1831 The six licences authorising certain local Shopkeepers to buy game from any person authorised to sell game by virtue of this Act were all renewed during the year. FOOD & DRUGS ACT, 1955-Section 16 During the year 17 applications for registration of premises for the manufacture, storage or sale of ice cream, and 11 applications for registration of premises for the manufacture of sausages or potted, pressed, pickled or preserved food intended for sale were granted. FOOD HYGIENE (GENERAL) REGULATIONS, I960 The Department of Health and Social Security Circular 1/69 requests details of the number of food premises which are subject to the provisions of the Food Hygiene (General) Regulations, 1960 grouped in categories of trade carried on in 87 them and including the following information for each category:— TABLE 46 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 9 9 9 9 Butchers 131 131 131 131 Cafes 92 92 92 92 Confectioners (Bread) etc. 63 63 63 63 Confectioners (Sugar) 196 188 176 176 Fish Shops 49 49 49 49 Grocers 255 255 255 255 Greengrocers 113 113 113 113 Ice Cream Manufacture rs 3 3 3 3 Clubs 18 18 18 18 Public Houses 72 72 72 72 School Canteens 90 90 90 90 Staff Canteens 76 76 76 76 Off Licences 39 39 28 28 NOTE: Regulation 16 deals with the provision of wash hand basins and Regulation 19 with facilities for washing food and equipment. 155 notices were served under these Regulations during the year, and no formal or statutory action was required in connection with these notices. Two prosecutions were, however, taken under these Regulations in respect of handlers of food who did not refrain from the use of tobacco. In each case the defendant was fined £5 and the Council awarded lgn. costs. ROMFORD MARKET The Public Health Inspectors who are responsible for the enforcement of the Food Hygiene (Markets, Stalls 8s Delivery Vehicles) Regulations, 1966—have suggested that the practice of hiring out stall covers without the use of a Council stall be discontinued, as these loose covers tend to get dirty as a result of coming into contact with the ground. 88 The Council approved plans for the reorganisation of the market—due to be implemented on 1st January, 1969—but some of the traders have indicated their dissatisfaction with the positions they have been allocated and other traders complain of insufficient space. However, the allocation of stalls is under continual review and every endeavour will be made to solve these problems. These plans were discussed with the traders at a series of meetings which were held during the year and the Council's endeavour has been to keep the disturbance of traders to a minimum, and as far as possible to give stallholders sites close to their original positions. It is anticipated that eventually the new lay-out will enable about 600 stalls to be provided in the Market Place, instead of the existing 500. Most of these stalls will be on a four-weekly licence. It is also anticipated that about 10% of the total market spaces will be available to stallholders on a casual daily basis. These will be allocated early each market day on a 'first come, first served' basis. The Council have been most anxious to ensure the continuation and improvement of the prosperity and success of this market. MEAT INSPECTION There are four privately owned slaughterhouses in the Borough, one of which is a modern type, completed during 1960. Two of these slaughterhouses also hold consent to carry on offensive trades—gut scraping and fat rendering. In addition to the Public Health Inspectors who carry out meat inspection on a rota basis, the Council employ two full time Authorised Meat Inspectors who are based permanently at the slaughterhouses. In 1966 the Council resolved to make Orders under the Meat Inspection (Amendment) Regulations, 1966 restricting the days and times of slaughter in the slaughterhouses in the district to come into effect as and when approved by the Minister. Prior to these Orders being confirmed, the Council had no 89 control over the days or times of slaughter, consequently slaughtering used to continue until late in the evenings and usually on Saturdays and Sundays. This naturally meant a considerable amount of overtime being worked by the Public Health Inspectors and Meat Inspectors in order to maintain 100% meat inspection. The occupiers of the slaughterhouses were granted a period of 28 days in which to appeal to the Ministry of Agriculture, Fisheries & Food against the requirements of the Orders. One slaughterhouse owner did not appeal, as he only slaughtered sufficient for his own retail shop and was, therefore able to comply with the requirements of the Order. The other three owners, however, being either wholesalers or contractors for the wholesale trade, lodged appeals with the Ministry on various trade and religious grounds—ritual slaughter taking place in two of these slaughterhouses. They requested that the ban on Saturday and Sunday slaughtering should be removed. The Ministry's officers dealt with each case individually and had meetings with the appellants and their solicitors and with the Council's officers. The proceedings were rather lengthy and the first Order confirmed came into effect on 9th August, 1968. The Minister varied the Council’s Order by permitting slaughtering to take place on Saturdays from 8.0 a.m. to 12 noon in addition to 8.0 a.m. to 6.0 p.m. on Monday to Friday. Orders affecting the other two slaughterhouses came into operation on 14th November, 1968. The Minister also varied these Orders so as to permit slaughtering on Saturdays from 8.0 a.m. to 12 noon. Under the Regulations the Council are permitted to suspend the Orders or grant exemptions in the case of emergency or during religious holidays and festivals. During December, 1968, exemptions were granted to all slaughterhouses, permitting slaughtering to take place on the two Sundays prior to Christmas in order to meet the increased demand for the holiday period. At the end of the year one of the slaughterhouse owners had submitted a further appeal to the Minister in order to be allowed to slaughter on Sundays. The result of this appeal is awaited. 90 Under the meat Inspection Regulations, 1963, the Council are required to provide a 100% meat inspection service to be performed in accordance with the Regulations, and for this service the local authorities are permitted to make a charge for this inspection as follows:— Cattle and Horses — 2/6d each Calves and Pigs — 9d ” Sheep and Goats — 6d ” In this respect the Council make the maximum charge, the total income for the year being £4,721.10.Od. 91 92 Cattle Calves Sheep and Lamps Pigs Horses Goats Total TABLE 47 Carcases Inspected and Condemned Number Killed 15,303 3,535 73,793 23,129 33 48 115,841 Number Inspected 15,303 3,535 73,793 23,129 33 48 115,841 All Diseases except Tuberculosis and Cysticercosis: Whole Carcases Condemned 18 5 219 79 2 - 323 Carcases of which some part or organ was condemned 6,314 101 17,526 2,202 5 1 26,149 Percentage of number affected 42.37% 3.0% 24.04% 9.86% 21.21% 2.08% 22.85% Tuberculosis Only: Whole Carcases Condemned - - - - - - - Carcases of which some parts or organs were condemned - - - 199 — — 199 Percentage of number affected - - - 0.86% - - 0.17% Cysticercosis Only: Carcases of which some parts or organs were condemned 7 - — - - - 7 Carcases submitted to treatment by refrigeration — — — — - - - Generalised and totally condemned — - - - - - - Total meat condemned: 58tons: 12cwt: 2Mb. The following table shows the post-mortem inspection of animals during the year 1968 at the four licensed slaughterhouses in the Boroueh:— SLAUGHTER OF ANIMALS ACT, 1958 54 Slaughtermens licences were issued during the year, of which 8 authorised the holders to slaughter or stun horses as well as other animals, and 23 were in respect of the ritual slaughter of animals by the Jewish method. The remainder were for slaughtering or stunning cattle, sheep, swine and goats using captive bolt pistol and/or electrolethaler. In the case of the slaughtermen holding licences in respect of horses, the licence is only in force in this Borough, whereas licences authorising persons to slaughter or stun the other categories mentioned are valid in the district of any other local authority. PUBLIC HEALTH ACT, 1936 - SECTION 107. Offensive Trades During the year the Council gave their consent to the establishment of an offensive trade— gut cleaning— which takes place in an existing building at one of the slaughterhouses. The offensive trade consent in respect of one of the other slaughterhouses— fat extractor— was also renewed for the year. These consents operate for the same period as the slaughthouse licences. SLAUGHTERHOUSES (HYGIENE) REGULATIONS, 1955 Legal proceedings were taken during the year against one of the slaughtermen for failing to refrain from the use of tobacco whilst working in the slaughterhouse. In addition, this person was charged with obstructing an authorised officer, under Section 105(1) of the Food & Drugs Act, 1955. The magistrates gave the defendant a conditional discharge in respect of the first offence but a fine of £5 was imposed in respect of the latter. DISEASES OF ANIMALS ACT, 1950 In last year's report I outlined the action taken during the latter part of that year in connection with the outbreaks of Foot & Mouth Disease and the Government’s action in declaring the whole of the country to be a “Controlled Area”. As from 14th February, 1968 the Minister issued the Foot & Mouth Disease (Controlled Areas) Special Order No.4, the effect of which was to release certain parts of England and Wales— 93 which included our Borough— from Foot & Mouth Disease Controlled Area restrictions. For the period that these restrictions were in force, i.e. from 16th November, 1967 to 13th February, 1968, a total of 1,630 movement licences were issued by the department involving the following number of animals:— Cattle 9,339 Calves 2,246 Sheep & Lambs 34,140 Pigs 11,980 Goats 1 Total 57,706 During the whole of the year the Regulation of Movement of Swine Order, 1959 remained in force and many movement licences were issued and received in connection with our local pig breeders sending their animals to market and the return traffic of pigs from local market to slaughterhouses in our district. These licences require:— (a) that any swine moved to a bacon factory or slaughterhouse shall be detained there until slaughtered; and (b)that swine moved to other premises must be detained and kept separate from all other swine for 28 days from the date of their arrival, but they may be moved during that period for slaughter. The Order does not prohibit the movement of any carcase slaughtered in the premises during the 28 day period. Five licences to operate boiling plants at local piggeries were cancelled during the year, the total number remaining in force at the end of the year being 16. These licences are issued under the Diseases of Animals (Waste Food Order) 1957. Very briefly, this Order requires the effective sterilization of all pig swill in properly constructed boiling plant and equipment which has satisfied us as to its efficiency for doing this particular job. 94 UNSOUND FOOD During the year the following foods were voluntarily surrendered to the Public Health Inspectors as being unfit for human consumption:— TABLE 48 TONS CWTS LBS Tinned Meat 2 12 98 Tinned Fruit 2 — 70 Tinned Fish — 4 67 Tinned Milk — — 22 Offal from Wholesale Depot 1 5 20 Poultry mainly from Wholesale Depot - 9 89 F ish - 13 75 Other Food 1 6 106 Cream — — 32 Sausages - - 31 Retail Meat 2 8 41 Wholesale Meat 1 18 12 13 0 103 In addition many packets of frozen food were voluntarily surrendered as a result of electricity breakdowns to frozen food cabinets. PADDLING POOLS Fifteen samples were taken from the Council’s 11 paddling pools during the year.Three samples were not wholly satisfactory and steps were taken to remedy this. For the majority of the summer these paddling pools were only in use at the week-ends. SWIMMING POOLS A total of 41 bacteriological and 34 chemical samples were taken from the three public swimming pools during the year and in each case a satisfactory report was received. The total of school swimming pools is 13. One new school pool was opened during the year. This was a Purley Olympic 4, measuring 33’0” x 17’0”. A filtration plant is provided with automatic water chlorinator. Changing accommodation divided into two rooms— one for girls and one for boys— is provided 95 adjacent to the pool. The pool is heated by an oil-fired boiler. It is hoped eventually to roof the pool to provide all the year round swimming. Regular sampling (bacteriological and chemical) was carried out to the school pools— 54 bacteriological and 51 chemical in all being taken. These were satisfactory with the exception of one school where at times results were not entirely satisfactory. The necessary remedial measures have been taken and it is hoped that a satisfactory standard will be maintained in the future. WATER SUPPLY The domestic water supply in the whole of the Borough— provided by the South Essex Waterworks Co.— has been satisfactory both in quality and quantity. No action has been necessary in respect of any form of contamination. The number of dwelling houses supplied at the end of the year was 80,662 and the population as obtained from the Registrar General was 252,290. The total number of houses supplied by standpipes is insignificant. The Waterworks Co. do not make frequent fluorine determinations, but on thfe basis of past results the fluorine content of the supply to this district is put at 0.25 parts per million. Eighteen samples were taken from the main water supply during the year. Seven were submitted for chemical examination and eleven for bacteriological examination only. All were found to be satisfactory. 96 METEOROLOGICAL INFORMATION The following table shows the amount of rainfall recorded at 3 recording stations in the Borough during the year: TABLE 49 Month Raphael Park, Romford Spring Farm, Rainham Upminster Amount in inches No. of days in which rain fell Amount in inches No. of days in which rain fell Amount in inches No. of days in which rain fell January 2.29 15 1.97 16 2.48 22 Febru ary 1.10 15 1.25 14 1.20 16 March 1.18 13 1.17 13 1.03 13 April 2.10 13 2.06 8 2.28 14 May 1.75 16 1.87 15 2.11 21 June 2.44 19 1.78 12 1.89 16 July 2.56 11 3.04 10 3.14 14 August 2.90 17 2.43 13 3.01 18 September 5.54 20 6.20 17 6.35 22 October 2.48 15 2.40 12 2.36 18 November 1.45 18 1.62 15 1.51 17 December 2.00 12 2.12 9 2.10 13 TOTAL 27.79 184 27.91 154 29.46 204 For comparison with these local figures, those for rainfall at Kew Observatory are shown in the following table, together with details of sunshine:— 97 98 TABLE 50 Kew Observatory 1968 Month RAINFALL SUNSHINE Total inches Percentage of Average Wettest Day No. of Dry Days Total hours Percentage of Average Sunniest Day Date inches Date hours January 2.28 105 8 0.63 13 43 93 11 5.9 February 0.96 62 5 0.32 18 68 107 25 9.1 March 0.91 62 30 0.13 18 144 127 26 10.9 April 2.22 123 17 0.38 18 186 116 26 12.8 May 2.52 139 18 0.54 16 1.67 84 28 14.1 June 2.03 117 27 0.44 13 166 78 12 14.9 July 2.83 116 10 0.93 21 147 74 3 15.3 August 3.06 136 8 0.55 15 123 65 12 11.6 September 4.82 245 15 1.69 7 135 95 3 10.9 October 203 91 11 0.40 17 77 79 14 8.9 November 1.50 61 29 0.38 20 43 81 24 6.5 December* 2.79 136 17 1.05 23 33 82 21 5.4 Year * 27.95 117 15 th Sept 1.69 199 1332 88 3rd July 15.3 A dry day is defined as one with less than .01 inch of rain during the 24 hours. * Provisional RIVERS, STREAMS & 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. The scheme for raising the level of the tidal defences on the west bank of Rainham Creek in earthworks is now completed between Redbridge Sluice and Frog Island Road. This was an interim scheme to provide a reasonable standard of protection pending a decision on proposals for a major permanent scheme. The flow into the Beam River from Bretons Farm Sewage Treatment Works has now ceased, and in order to maintain adequate water supplies to the Ford factory a temporary scheme to divert effluent from the Riverside Works to augment water in the Beam River is now in operation. In order to maintain the industrial water supply in the Riverside area, a pilot tertiary treatment has been in operation at the Riverside Works since July, 1968, consisting of three sand filters. Evaluation of performance is expected to be completed in May, 1969. Investigation and design are proceeding on the main scheme to reclaim up to 8,000,000 gallons per day of Riverside Works effluent and to discharge the treated water to the Beam and Mardyke Rivers for industrial abstraction. Early in the year under review the restriction of building development in the Borough was removed in view of the impending diversion of sewage from the Bretons Farm Works to the Riverside Works. Complete diversion of the sewage was effected during the year, resulting in the abandonment of the Bretons Works and the cessation of the discharge to the Beam River from the works. A survey of the Beam River carried out in November showed the upper and central reaches to be generally clean. Below the abandoned sewage works the river was much cleaner than for many years past. Last year I referred to the pollution caused to the Ingrebourne 99 River as a result of the reconstruction of the Nags Head Lane Sewage Works. This pollution continued during the beginning of this year and complaints were received during the summer concerning smell nuisance arising from the state of this river. Towards the end of the year the reconstruction was nearing completion and considerable improvement in the quality of this river water is expected during 1969. Several cases of accidental minor pollution of the Rivers Beam, Rom and Ingrebourne by oil sewage and trade effluent occurred and were investigated during the year by the River Authority, appropriate remedial action being applied in each case. The levels of radio-activity (beta-emission) in the rivers Beam and Ingrebourne have been checked regularly and show very little change from that found in previous years. The levels varied between nil and 24 picocuries (strontium 90) per litre of water and as such are considered to be satisfactory low and harmless. CARAVANS & CAMPING The Caravan Sites and Control of Development Act, 1960 confers on local authorities powers for the control of caravan sites and in addition to improved planning powers it provides for a system of site licensing with certain conditions enforceable by the local authority. Site licences in force during the year in the Borough were five individual and two multiple, the total number of caravans involved being 249. One of the multiple sites is subject to conditions for reducing the number of caravans The Council own and administer— through the Housing Department— a residential site consisting of 66 vans and a site shop. The Council also own an Outdoor Pursuit Centre which includes pitches accommodating in the region of 450 tents. This Centre is controlled by the Education Department. Reference was made in last year's report to the problem 100 created by large numbers of gypsies and during the year under review— following investigation by the Council of a number of sites— the Council established one of a temporary nature at the southern end of Stubbers Outdoor Pursuit Centre, Dennises Lane, North Ockendon. At the end of the year the Council were still actively pursuing the question of the establishment of a permanent site for gypsies. NUMBER OF HOUSES ERECTED DURING THE YEAR 463 units of accommodation were erected by private enterprise during the year. In addition 421 units of accommodation were erected by the Council consisting of the following. 51—2 Bed Houses 62 — 1 Bed Flats 161 — 3 Bed Houses 3 — Bedsitters 6 — 4 Bed Houses 81—2 Bed Flats 5 — 3 Bed Bungalows 30—2 Bed Maisonettes 22—3 Bed Maisonettes 223 198 Total — 421 units In addition the Council acquired 19 other properties in the course of the year, four being purchased for various development and three being purchased in return for rented accommodation. LOCAL AUTHORITY ACCOMMODATION The provision of housing accommodation adequate in quantity and quality is a primary factor in contributing to the health and well being of the community and in this regard the Council are to be congratulated in their comprehensive programme. The following statistics for 1968, kindly supplied by the Housing Manager are of interest:— Termination of Tenancies (i) Termination by tenants — 335 (ii) Evictions by Council for rent arrears — 15 Of the 335 terminations at (i) 17 tenants obtained mortgage advances from the Council. 101 Local Authority Accommodation (contd.) Families Housed (a) From Housing List — 565 To new dwellings 126 To re-let dwellings 439 565 (b) Transfers (excluding transfers from redevelopment sites) — 391 To new dwellings 191 To re-let dwellings 200 391 (c) Transfers from redevelopment sites To new dwellings 22 (i) Prefabs — 56 To re-let dwellings 34 (ii) Other redevelopment 56 sites — 25 (d) Homeless Families (included in (a) above) (i) Housed on eviction — 12 (ii) Housed from Suttons Hostel — 5 (iii) Housed from 42/44 Brentwood Rd. — 12 (e) Reciprocal exchanges with other Authorities — 7 (f) G.L.C. nominations from Inner London — 120 (g) Mutual Exchanges — 134 (h) Demolition or Closing Orders — 6 (i) Service tenancies — 19 (j) Nominated to G.L.C. (sons/daughters of Harold Hill tenants) - 41 102 Local Authority Accommodation (contd.) Properties Sold To sitting tenants — 40 Miscellaneous properties sold with vacant possession — 5 45 One of the problems of modern life is the availability of parking facilities for private cars. During the year the Council provided 345 lock-up garages on their estates, plus 209 parking spaces. UNOCCUPIED HOUSES The Council resolved as from 1st April, 1968 to rate empty property under the provisions of Section 17 and Schedule 1 of the General Rate Act, 1967. This has resulted in considerable liaison being maintained with the staff of the Borough Treasurer in cases where a landlord claims exemption from the payment of 'unoccupied' rate on the grounds that the property is uninhabitable. These cases necessitate a comprehensive inspection by the Public Health Inspector and the submission of an appropriate report to the Borough Treasurer. HOUSING PRIORITY ON MEDICAL GROUNDS Applications for priority on medical grounds dealt with during the year numbered 449. 268 of these were in respect of new applications for rehousing and 181 from existing tenants requesting transfer to other accommodation. Some of these cases have to be visited and investigated by either a Social Welfare Officer, a Health Visitor or a Public Health Inspector, not to mention liaison with the Childrens Department. It can be seen that a considerable amount of time is given to this aspect of certain applications. HOUSES IN MULTIPLE OCCUPATION There has been no change in the situation as outlined in last year's report. Fortunately there is relatively only a small 103 number of such premises in the Borough. IMPROVEMENT GRANTS During the year members of my staff liaised with the staff of the Acting Borough Engineer 8t Surveyor in connection witlj 128 applications for improvement grants. Full details of these activities are given in the following table. 104 TABLE 51 Improvement Grants A Standard Owner/Occupiers Tenanted Standard Standard 5 point 3 point 5 point 3 point 1. Number of Applications Received 86 - 4 - „ „ Approved 79 - 1 — „ „ Refused 7 - - - 2. Number of dwellings improved 50 - 1 - 3. Amount paid in grants £4230. 5s. 9d. 4. Average grant per house £ 84.12s. Id. 5. Number of amenities provided (a) fixed bath/shower 26 (b) wash hand basin 32 (c) hot water supply (to any fittings) 41 (d) water closet within dwelling 41 (e) food store 12 B Discretionary Owner/Occupiers Tenanted 1. Number of applications Received 39 1 2. „ „ Approved 37 - 3. „ „ Refused - - 4. Number of dwellings improved 42 - 5. Amount paid in grants £14,016 6s. Id. 6. Average grant per house £ 333.14s. 5d 105 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, 1968. Part I— Application for Certificate of Disrepair (1) Number of applications for certificates 8 (2) Number of decisions not to issue certificates — (3) Number of decisions to issue certificates:— (a) in respect of some but not all defects 4 (b) in respect of all defects 1 (4) Number of undertakings given by landlords under para 5 of the first schedule 3 (5) Number of undertakings refused by local authority under proviso to para 5 of the first schedule — (6) Number of certificates issued 5 Part II — Applications for Cancellation of Certificates (7) Applications by landlords to local authority for cancellation 2 (8) Objections by tenants to cancellation of certificates — (9) Decision by local authority to cancel despite tenants objection — (10) Certificates cancelled by local authority 2 HOUSING ACT, I9S7- SECTIONS 17 & 18 Number of demolition orders made 1 Number of closing orders made 2 The above mentioned orders necessitated the re-housing of three families totalling 6 persons. VENTILATED FOOD STORES The question of the modern practice of building .houses without a ventilated larder has received attention. Building bye-laws have been relaxed in this connection, presumably because of the general use of domestic refrigerators. The point arises, however, of the new tenant moving into a house without a ventilated food store and not in possession of a refrigerator. Certain foods are not suitable for storage in refrigerators 106 and warnings to this effect are usually displayed on the labels. In addition certain cooked foods ordishes prepared by hot processes have to be placed somewhere to cool, and if a cool, well ventilated and fly protected food store is not available, contamination could well occur. The Ministry of Health’s official memorandum on food poisoning (188/MED) refers to certain foods which can easily become dangerous under adverse conditions of domestic storage though they would remain comparatively free of risk if stored under ideal conditions. Although the inference here is probably a reference to the lack of a refrigerator, this might not be exclusively so. There is an increasing school of thought that a house without a cool, ventilated larder is inadequate, particularly where the storage of fresh unwrapped bread, greengrocery, etc., is concerned. BUILDING CONTROL During the year observations were submitted in respect of 254 deposited plans where the Acting Borough Engineer & Surveyor thought that these fell within the scope of our activities. SEWERAGE AND SEWAGE DISPOSAL Commencing at the beginning of April, 1968 the sewage flow was diverted from the Bretons Farm Sewage Works to the Riverside Works of the London Borough of Barking— sited in the southern part of our Borough— in three instalments, the final diversion being made in October, 1968. At the end of the year the only operation being carried out at Bretons was the pumping of sludge brought in by road tankers from our Bury Farm Works plus that stored at Bretons, to the Riverside Works. This sludge was then pumped from the Riverside Works to the Beckton Sewage Treatment Works of the Greater London Council for eventual disposal at sea. The amount of sludge transported by road tanker from Bretons Farm to the Riverside Works during the first quarter of the year was 3,141,900 gallons and from Bury Farm was 1,068,400 gallons the latter figure being for the whole year. So far as is known, the Riverside Sewage Works is adequate 107 108 to deal with the flow from its new combined catchment area, and the Bury Farm Works has ample capacity and is discharging an excellent effluent to the Mar Dyke. The implementation of the above mentioned works— which is part of the regional scheme— plus the completion of Stage 1 of our Rom Valley Sewer project, has marked a notable step forward in the improvement of the general sewerage system, but there has been no further progress on the later stages of the Rom Valley scheme or the Corbets Tey Sewer, due to capital expenditure cuts. Several major surface water sewerage schemes have also suffered deferment. The following is a schedule of sewerage schemes completed during the year 1968. Ferry Lane and Western Road/Mercury Gardens surface water sewers and Como Street are the only true extensions of the system— the others being renewals and improvements to the existing sewers. Foul Sewers The following works have been completed: Rom Valley Sewer Stage I (Bretons Farm to Ravensbourne) (54’ dia.) 1300 yds. Rom Valley Sewer Stage III (part) at Mercury Gardens. (18” dia.) 175 yds. Rom Valley Sewer Stage II Part I Section I Waterloo Road (48”/45” dia.) 725 yds. Crow Lane (extensive .repair) (9” dia.) 110 yds. Work has commenced on: Ferry Lane Trade Effluent Sewer Dury Falls Close (relaying) Rom Valley Sewer Stage II Part I Section II (under Ring Road). Surface Water Sewers The following works have been completed: Western Road/Mercury Gardens (36”/24”dia.) 610 yds. Havering Road/Moray Way flood plain and sewers (27” dia.) 230 yds. Hornchurch Central Area Sewers (Stage III) (36” dia. and 15” dia. foul) 180 yds. Surface Water Sewers (contd.) The following works have been completed: Como Street extension (9” dia.) 60 yds. Boscombe Avenue (Langtons outfall) (9”dia.) 110 yds. Fairholme Avenue enlarged outfall (9”/12” dia.) 60 yds. North Street (Parkside) (48”/36” dia.) 240 yds. Mawney Road (N) (Part of new outfall) (30” dia.) 80 yds. Work will commence shortly on: Allendale Road/Craigdale Road (relaying) Mcintosh Road Havering Road/A.12 (outfall) Abbs Cross Lane (outfall at railway) Erith Crescent/Collier Row Lane. 1969/70 Programme Foul Sewers Rom Valley Sewer Stage II Part II High Street Cranham Foul sewerage Church Lane, Warley Street— Treatment Plant and Sewer Spencer Crescent outfall reconstruction Barton Avenue Pumping Station— renewal. Surface Water Sewers Osborne Road Douglas Road Moor Lane (near Nightingale Avenue). Stream Improvements Wantz Stream ) Have again been deferred. Ravensbourne Stream— Stage II ) STREETS MADE UP AND TAKEN OVER The following streets were made up and taken over during the year ended 31st December, 1968. Name of Road Length Cardinal Way 716½ ft Elmer Close 233 ft Jubilee Avenue (Extension) 304½ ft 109 Streets made up and taken over (contd.) Name of Road Length Jubilee Close 223 ft Kerry Drive (Part) (Road now all adopted) 140 ft Livingstone Terrace (Footpath) 151½ ft Marlborough Gardens (Part) (Now all adopted) 483½ ft Meadowlands 227¼ ft Sackville Crescent (Part) (Now all adopted) 609 ft South Drive 389 ft Stoke Road (Part) (Road now all adopted) 633½ ft Surridge Close 379 ft Total length of roads in feet — 4,543¼ ft (Excluding Livingstone Terrace which has no carriageway) CLEAN AIR ACT 1956 The Havering (No.4) Smoke Control Order became operative on the 1st November, 1968, and at the end of the year 1,245 applications for proposed works of adaptation had been dealt with and in 1,065 instances the necessary works had been carried out to the satisfaction of the Council and the claims paid. The figures in respect of No.3 Area were 1,374 applications and 1,263 claims paid. The Havering (No.5) Smoke Control Order — which is comprised mainly of the G.L.C's Harold Hill Estate, was made by the Council on the 13th December, 1968, and if confirmed by the Ministry of Housing and Local Government will become operative on 1st November, 1969. Details of this area are as follows:— 1,790 acres An area commencing at Gallows Corner at the junction of StraightRoad and Colchester 7,829 dwelling Road (A. 12) proceeding in a northerly houses direction along the eastern side of Straight (7,311 G.L.C. Road to the junction of Noak Hill Road. 518 private) Then proceeding in a north-easterly direction along the southern side of Noak Hill Road and Chequers Road to the junction of the eastern boundary of the Borough. 110 Then proceeding in a southerly direction along the eastern boundary of the Borough to Colchester Road (A.12). Then proceeding in a south-westerly direction along the northern side of Colchester Road (A.12) to Gallows Corner, the point of commencement. The following table gives details of Smoke Control Orders which were in operation at the end of 1968:— TABLE 52 Smoke Control Areas Smoke Control Area No. of dwellings Boundaries Operative Date Hornchurch 1 260 N. Roseberry Gardens 1st September 1959 S. Brunswick Avenue E. Roseverry Gardens W. Front Lane Hornchurch 2 1,810 N. Wood Lane 1st November 1960 S. Ford Lane E. Southend Road W. Rainham Road Hornchurch 3 3,764 N. Ford Lane 1st July, 1962 S. River Thames E. River Ingrebourne W. Borough Boundary Hornchurch 4 4,966 N. District Railway Line 5th November 1962 S. Wood Lane E. River Ingrebourne W. Rainham Road Hornchurch 5 4,644 N. High Street/Upminster Road 1st August, 1963 S. District Railway Line E. Upminster Bridge Railway Station W. River Ravensbourne Romford 1 519 N. Borough Boundary 1st December 1963 S. Collier Row Road E. River Rom W. Borough Boundary Romford 2 1,486 N. Borough Boundary 1st December 1963 S. Collier Row Road E. Clockhouse Lane W. River Rom 111 TABLE 52 (contd.) Smoke Control Areas Smoke Control Area No. of dwellings Boundaries Operative Date Hornchurch 6 7,274 N. Brentwood Road 1st July, 1965 S. High Street/Upminster Road E. Romford/Upminster Railway Line W. River Rom Havering 1 3,505 N. Collier Row Road 1st July, 1966 S, Eastern Avenue (A. 12) E. Collier Row Lane W. Borough Boundary Havering 2 4,960 N. Southend Arterial Road (A. 127) 1st November 1966 S. Romford/Upminster Railway Line E. Wingletye Lane W. Rom ford/Harold Wood Railway Line Havering 3 3,800 N. London Road (A.118) 1st November 1967 S. Borough Boundary E. River Rom/South Street W. Borough Boundary Havering 4 4,564 N. Colchester Road (A. 12) 1st November 1968 S. Emerson Park/ Upminster Railway Line E. Nags Head Lane/Hall Lane W. Southend Arterial Road (A, 127)/Wingletye Lane INVESTIGATION OF ATMOSPHERIC POLLUTION The seven sites in the Borough where instruments are installed for the daily measurement of smoke and sulphur dioxide in the atmosphere were all maintained during the year. The results of findings from the operation of these instruments are forwarded monthly to the Warrtn Spring Laboratory of the Ministry of Technology for publication with the national figures. The Council continue to be represented on the National Society for Clean Air and the Standing Conference of Co-operating Bodies for the Investigation of Atmospheric Pollution. CHIMNEY HEIGHTS AND INSTALLATION OF FURNACES Six notifications were received in accordance with Section 112 3 of the Clean Air Act, 1956 in respect of new furnace/boiler installations and in each case the determination of chimney heights under Section 10 of the Act was also dealt with. In the latter case four chimney heights were agreed but alterations were required in two instances. THE CLEAN AIR (MEASUREMENT OF GRIT AND DUST) REGULATIONS, 1968 These Regulations, which came into operation on 1st May 1968, prescribed the requirements — including the provision of sampling points in a chimney — which must be observed by occupiers of buildings in which certain furnaces are situated who, under the Clean Air Acts, 1956 and 1968 are directed by the local authority to make and record measurement of the grit and dust emitted from the furnace. These Regulations will, therefore, be applied during the “submission of plans” stage to new plant of a capacity equivalent to 100— 50,000 lbs/hr. Our existing liaison with the Building Control Section of the Director of Technical Services will enable this additional commitment to be carried out as a routine measure. CLEAN AIR Another important administrative feature during the year in connection with smoke control areas was the fact that direct electric space heaters became eligible for grant in smoke control areas. Grants for electric fires were withdrawn some years ago because it was feared that their use would encourage the demand for electricity at peak times when there was a shortage of capacity. Now there is ample capacity to meet all loads, and the Ministry of Housing and Local Government say that they are satisfied that this class of appliance no longer imposes strain on the country's electricity supply system. Electric storage radiators using 'off peak' electricity have always been included in the list of appliances eligible for grant under the Clean Air Act and they will, of course, continue to do so. Grants for direct electric space heaters up to £18 may now 113 may now be approved. In addition, reasonably necessary costs of removing the coal burning appliances qualify for grant in the usual way. Seven tenths of the cost of the work approved by the local authority is repayable to the householder. In conclusion one must stress the fact that there must be no let-up in efforts to obtain 100% smoke control in our Borough. This is most important when one considers that domestic smoke, characterised by its high tar content and low level emission, and concentrated during the worst sort of weather for polluting the air, is now the most serious single constituent of the air pollution problem in the country. 85% of the total smoke now emitted is of domestic origin. It will be seen, therefore, that the remedy lies very much in the hands of local authorities, who should proceed as quickly as possible with their smoke control programme and the householders who eventually will come into these smoke control areas. Clean air is now becoming accepted by the public — like pure water — as one of the simple bare necessities of life, and ratepayers are beginning to protest when they do not get it. This is an amazing state of affairs when one considers the opposition found to early Smoke Control Orders. However, it reflects the far sightedness and wisdom of the Council in giving its support to these measures and it is hoped that despite present financial restrictions this support for this very important aspect of the health of the community will continue. All this century we have had pure water supply and the public are beginning to realise that they are entitled to air of quality and purity equivalent to that of water. Over the years of the Clean Air programme the proportion of hours of sunshine in London in relation to hours of sunshine outside, which is associated with the smoke concentration has changed considerably. In 1900 — 1930 London had a mere 15% — 30% of the available sunshine, but since the Clean Air Act, London has enjoyed upwards of 70%. The last figure recorded was actually 95%. It might well be, therefore, that in years to come, instead of local authorities and other organisations having measuring 114 apparatus to ascertain the amount of pollution in the atmosphere they will start measuring sunshine, which at the moment seems to be completely the prerogative of the Meteorological Office. At this stage it might well be convenient to repeat the Council of Europe's Declaration of Principles on Air Pollution Control which reads:— “As air is essential to life, its natural quality must be maintained in order to safeguard man's health and well-being and to protect his environment. This natural quality of air may be affected by the introduction of a foreign substance or by a significant variation in the proportion of its components. Air is deemed to be polluted when the presence of a foreign substance or a variation in the proportion of its components is liable to have a harmful effect or to cause nuisance”. This vast improvement in atmospheric conditions which has resulted from a considerable diminution of smoke from domestic, industrial and railway sources as a result of the operations of the Clean Air Act, has brought into prominence other forms of air pollution— fume, effluvia, smoke, dust and grit from processes other than combustion and not covered by the Clean Air Act, Alkali Acts or other specific legislation. The number of complaints in this connection is increasing and these nuisances — some of which arise from the uncontrolled burning of waste and intensive farming methods in the more rural parts of the area — can in the main be summarised under the following headings:— Fumes, (smells mainly of a chemical nature), Effluvia (smells mainly of organic origin) Smoke, dust and grit. One important piece of legislation which might well have effect of remedying some of these nuisances, is the Clean Air Act, 1968. CLEAN AIR ACT, 1968 Several sections of this Act will come into force from 1st 115 April, 1969 following an Order made by the Minister of Housing and Local Government — they are sections 2, 6, and 8—15 inclusive. Section 2 gives the Minister power to make Regulations prescribing maximum permissible rates of emission of grit and dust from furnace chimneys. Existing controls over emissions from furnaces burning solid fuel will be applied to those burning oil and gas. Section 6 extends local authorities powers of control over the heights of furnace chimneys. This will include new chimneys serving furnaces in shops and offices as well as in factories. The advantage of this measure was mentioned in my Annual Report for the year 1966. Section 8 empowers the Minister to direct any local authority which is failing to tackle the problem of smoke control energetically to draw up a programme for his approval, or alternatively for the Minister himself to prepare a programme and direct the local authority to carry it out. Section 9 deals with the sale of unauthorised fuel in smoke control areas, making it an offence to buy bituminous coal for use in a smoke control area or to sell or deliver it to premises in such an area unless there is some special exemption. Section 11 removes the responsibility local authorities had regarding dark smoke, grit and dust emissions and smoke nuisances from works scheduled under the Alkali Act and places the whole of the responsibility in this matter on the Alkali Inspectorate. The remaining sections deal with procedural amendments to the 1956 Act and the relationship between the Clean Air Acts and the Alkali, etc. Works Regulations Act, 1906. NOISE ABATEMENT There was a considerable reduction in the number of noise complaints investigated during the year, 35 being dealt with as against 53 in 1967. although the number of visits increased from 174 to 344. All cases were resolved informally. Nineteen of these cases referred to industrial and commercial premises and were 116 mostly concerning noise of machinery, etc. from factories. Typical of the type of investigation undertaken were three specific complaints necessitating a considerable number of visits and observations concerning, in two instances, the noise from ‘beat groups’ who played in the evenings at two Youth Clubs attached to local schools, plus the alleged nuisance caused by bird scaring equipment in a local farm. Although not denying that the intermittent explosion caused some nuisance to nearby occupiers, when measured by our sound meter it was considerably less than that of the traffic in the adjoining road. Whilst bye-laws exist in this regard, they only stupilate that the scarers should not be used during the hours of darkness. In this latter case, therefore, there was no possibility of any successful action. In the former cases— apart from the fact that the activities complained of were taking place in premises under the control of the Education Committee— and despite the fact that in one instance we had the assistance of the Scientific Branch of the Greater London Council, the volume of noise recorded was not such as to be considered a ‘nuisance’ within the meaning of Part III of the Public Health Act, 1936, as amended by the Noise Abatement Act, 1960. In the other case the group found other accommodation, thereby abating the alleged nuisance. The bulk of our complaints are of the ‘one man’s noise is another man’s music’ category and can only be classified as a ‘noise’ if it is the wrong sound at the wrong time. It is this individual reaction which makes it such a complex problem. In this electronic and alleged ‘noisy’ age it becomes almost essential to obtain details of ‘noise’ by instrumentation, as any other attempt to measure noise levels is very unreliable— individual aural facilities varying to a large degree and being completely unreliable, especially under crossvexamination in a Court of Law. Added to this is the fact that a persons ‘noise memory’ would be very susceptible in this age of technology. For this reason the Department acquired a wide range octave band filter and an accoustic calibrater for use with our existing noise meter. This enables the operator to analyse and 117 classify sounds in relation to other sounds, so making any observations much more reliable. Several of the Public Health Inspectors have attended courses of instruction in connection with noise abatement and it is anticipated that several more will receive training as and when vacancies on courses become available. 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 Number Clean Air Act 6,850 Public Health Acts 7,613 Food & Drugs Act & Regulations 5,102 Prevention of Damage by Pests Act 4,769 Offices, Shops & Railway Premises Act 2,794 Shops Act 2,737 Infectious Diseases 674 Housing Acts 845 Sampling 1,582 Factories Act 613 Noise Abatement 348 Diseases of Animals Act 272 Miscellaneous 1,456 Slaughterhouses and Meat Inspection 1,836 Consumer Protection Acts 438 Notices Served Enactment Informal Statutory Public Health Acts 424 211 Housing Acts 3 — Food & Drugs Act 155 — Shops Acts 256 — Offices, Shops & Railway Premises Act 472 - Factories Acts 32 - Prevention of Damage by Pests Act 5 — Noise Abatement Act 1 — Landlord & Tenant Act 1 - 118 PUBLIC HEALTH ACTS,1936/1961-NUISANCES During the year Court proceedings were instituted against the owners of twelve properties following non-compliance with Statutory notices served under these Acts. In nine cases appropriate Orders were made and fines totalling £32 were imposed, with costs totalling £22.1.0d. In three cases the summonses were withdrawn, work having been carried out prior to the Court hearing. PIGEONS As in previous years the considerable increase in the pigeon population received the attention of the department and the Council's practice of employing a specialist firm to deal with this problem was continued. The firm concerned—assisted, as and when necessary, by the Council's pest control staff—carried out an extensive trapping programme at the following locations:— Laurie Square, Romford Stones Store, Market Place, Romford The Brewery, High Street, Romford Odeon Cinema/Romford Station, South Street, Romford Clockhouse Lane, Collier Row. The initial trapping was only partially successful and narcotic treatment was later carried out at Laurie Square (twice), the Brewery and the Odeon Cinema/Romford Station Area. The firm concerned carried out a simultaneous programme at nearby Oldchurch Hospital on behalf of the Regional Hospital Board, and in addition British Railways co-operated with a large scale eradication exercise at Romford Station and the adjoining railway arches. FOULING OF FOOTPATHS BY DOGS In addition to the nuisance from pigeons droppings, a further public health nuisance which does not seem to receive the same publicity is the fouling of pavements, gardens, grass verges and other open spaces by dogs. In warm weather the excreta attracts flies and becomes a health risk, apart from being aesthetically objectionable. There is a local bye-law in force in the Borough and it is necessary that dog owners fully realise their responsibilities. 119 BEE SWARMS A problem which confronts the department as well as ratepayers at certain times of the year is the swarming of bees. An arrangement has been made with the Secretary of the Essex Beekeepers Association for local members of his Association to visit the site in question and take the swarms away. Names and addresses of these beekeepers are kept in the department. DUSTBINS The Council run a scheme for the provision of dustbins to householders, for which they make an annual charge of 7/6d payable with the rate demand each April. With the amount of new property which is being built in the district an increasing variety of dustbin sizes appear as a result of new residents moving into the Borough. The Council have, therefore, resolved that dustbins should be of British Standard Specification with a capacity of either 2½ cubic feet or cubic feet. RAG FLOCK AND OTHER FILLING MATERIALS ACT, 1951 Routine inspections of our two-registered premises were made during the year and four samples of filling material were taken for examination by the prescribed analyst. In each case a satisfactory report was received. ANIMAL BOARDING ESTABLISHMENTS ACT, 1963 This Act, which came into operation on 1st January, 1964 prohibits the keeping of a boarding establishment for animals (defined by the Act as cats and dogs) except under licence granted by the local authority. Licences are granted subject to conditions attaching thereto. During the year, eight such licences were issued, authorising a total boarding capacity for 478 dogs and 194 cats. In accordance with the power conferred upon them by the Miscellaneous Fees (Variation) Order, 1968, the Council decided to increase the annual licence fee for these establishments from 10/- to £2. 120 PET ANIMALS ACT, 1951 During the year twenty licences were renewed and four new licences were granted. Three of the renewals were in respect of stalls in Romford Market. With effect from 1st April, 1968 the Council agreed to the fees for these annual licences being increased from 10/- to £2. RIDING ESTABLISHMENTS ACT, 1964 This Act, which revoked the Riding Establishments Act, 1939, provides for the licensing and inspection of riding establishments by the local authority. Licences are granted subject to conditions attaching thereto and in addition to the inspections carried out by the Public Health Inspectors, annual visits are made by the Council's duly authorised Veterinary Officers and also by the Fire Prevention Branch of the London Fire Brigade. The Miscellaneous Fees (Variation) Order, 1968 increased the annual fee for these establishments from 10/- to £10, this latter amount being obligatory. This increase is obviously designed to take into account the cost to the local authority of the Veterinary Surgeon's report, which in some cases varies from 4gns. to 8gns. per establishment, depending on the time taken by the Veterinary Surgeon to carry out the inspection of the animals and the premises. Eight such establishments were licensed during the year. PERFORMING ANIMALS (REGULATION) ACT, 1925 There are no current registrations under this Act. The Miscellaneous Fees (Variation) Order, 1968 increased the maximum fees which maybe prescribed by the Minister concerned from 1gn. to £3. ESTABLISHMENTS FOR MASSAGE OR SPECIAL TREATMENT Two new licences to carry on establishments for massage or special treatment under Part IV of the Essex County Council Act, 1933 were issued during the year and 18 existing licences were renewed. These licences are in respect of 16 chiropodists one physiotherapist and three beauticians. During the year one chiropodist ceased to practice. 121 ESSEX COUNTY COUNCIL ACT, 1933 - PART V Twenty two licences to carry on Employment Agencies were issued during the year. THEATRICAL EMPLOYERS REGISTRATION ACT, 1925 & 1928 One new registration was effected under this Act during the year. A total of five registrations have now been made in the Borough, four of these having been made originally with the Essex County Council. During the year the fee for this registration increased from £2 to £6. SCRAP METAL DEALERS ACT, 1964 This Act came into operation on 1st April, 1965 and required persons carrying on business as scrap metal dealers to be registered with the Council. Any such entry is automatically cancelled by the local authority at the end of the period of three years unless before the end of that period the dealer applies to the authority for the registration to be continued for a further period of three years. Of the 68 registrations made originally 60 have not applied for re-registration. However, 12 new entries were made in the register during 1968 and eight renewals effected. A total of 28 entries remained on the register at the end of the year. LITTER ACT, 1958 Five persons were prosecuted under Section 1 of this Act during the year for depositing and leaving rubbish in a public place. Fines totalling £35 were imposed by the magistrates and costs amounting to 3gns. were awarded to the Council. It is difficult to understand why people lay themselves open to prosecution in this regard when the Council will help residents to get rid of their rubbish. For bulky household items such as easy chairs, pianos, etc. householders can take advantage of the Council's scheme and have these items collected and and disposed of free of charge. Alternatively, private residents may themselves take refuse to Gerpins Lane Tip, off Aveley Road where containers are available outside the tip at all times. Old cars will be collected by the Council at a charge of £2 or they may be taken, without charge, to Frizlands Lane Depot, Dagenham, during the hours of 8.0 a.m. to 4.0 p.m. weekdays and 122 8.0 a.m. to 12 noon on Saturdays. Trade waste requires a charge of l/6d a bin if collected by the Council. Trade waste may be taken for a charge to the G.L.C. Tip at Frizlands Lane, Dagenham, but not to Gerpins Lane Tip. RADIOACTIVE SUBSTANCES ACT, 1960 The Council were notified by the Ministry of Housing and Local Government of the issue during the year of revised certificates of authorisation for the disposal and accumulation of radioactive waste in respect of two of the four premises in the Borough where radioactive materials are stored and/or used. In addition, the Ministry notified the Council of the installation by a large commercial undertaking in the Borough of a lightning conductor incorporating closed sources of radioactivity and containing 0.46 millicuries of radium 226. In this instance conditional exemption is granted to the firm concerned under the Radioactive Substances (Attachments to Lightning Conductors) Exemption Order, 1963, but the Minister thinks it desirable for the local authority to be informed of the whereabouts of such conductors in its area. HAIRDRESSERS AND BARBERS The Council adopted Section 21 of the Greater London Council (General Powers) Act, 1967 which requires that any person carrying on the business of a hairdresser or barber on any premises in the area of the Council must be registered by the Council in respect of those premises. Failure to register could result, on conviction, to a fine not exceeding £25 and a daily fine not exceeding £5. At the end of the year Certificates of Registration had been issued to 162 hairdressers or barbers. The Council also made Bye-laws under Section 77 of the Public Health Act, 1961 relating to hairdressers and barbers within the Borough and these were confirmed by the Minister of Housing and Local Government on 22nd August, 1968 and came into operation on 1st October, 1968. All persons registered by the Council must keep a copy of 123 the Registration Certificate and of the Bye-laws prominently displayed in the registered premises. To enable this to be done copies of these Bye-Laws were circulated to all the registered hairdressers and barbers. BURIALS AND CREMATION There are four cemeteries at present being operated by the Council, namely; Romford (29 acres) Upminster ( 9 acres) Hornchurch ( 8 acres) Rainham ( 2 acres) During the year under review there were 942 interments in these cemeteries, 503 at Romford, 106 at Hornchurch, 110 at Rainham and 223 at Upminster. These figures apply to new purchase graves, re-opened graves and common graves. The new purchase graves during the year were:— Romford — 221 Hornchurch — 5 (childrens section only) Rainham — 56 Upminster — 128 Allowing for the average number of new graves over the past three years it is estimated that the approximate life of these cemeteries is as follows:— Romford — 28 years Upminster — 17 years Rainham — 10 years Hornchurch — Already closed for adult new purchases, but a childrens section is still operating. In addition to its cemetery facilities the Council, as a constituent member of the South Essex Crematorium Joint Committee, helped to maintain the modern crematorium at Corbets Tey. 124 During 1968 there were 2,375 cremations at the South Essex Crematorium compared with 2,078 in 1967. 1,141 were from Havering, an increase of 160 on the previous year. Nationally equal numbers of people are buried and cremated, but in Havering 62% are cremated. The crematorium and garden of peace at Corbets Tey has been extensively improved since the building was first opened in 1957. The crematorium now has two chapels— the second one being opened in September, 1968—a Hall of Memory and a Chapel of Repose, and work is almost complete on a new car park capable of taking 150 cars. MORTUARY FACILITIES The arrangement with the Romford Group Hospital Management Committee for the Council to take advantage of the Mortuary and post-mortem facilities at Oldchurch Hospital continued in force throughout the year. The Council pay the H.M.C. the sum of £2 in respect of each body received into the mortuary. The Hospital Management Committee undertake to keep the mortuary and post-mortem rooms in good repair and condition, and provide all necessary labour and services and equipment which may be required for the reception of any body in and out of the mortuary. A total of 271 bodies were received during the last financial year. Removal of Human Remains The Department was represented at three local cemeteries during the removal of human remains in order to see that the conditions of the appropriate Home Office licence were complied with and to take any other action that appeared to be necessary in the interests of public health. COMMON LODGING HOUSES There are no common lodging houses in the Borough. DISINFECTION AND DISINFESTATION Advantage is taken of the disinfecting and cleansing services provided by the London Borough of Hackney at their Millfields Road Cleansing Station at Clapton, London, E.5. in respect of the disinfection or disinfestation of clothing and bedding from premises and persons in this Borough. Conveyance of persons, clothing and bedding is undertaken by Departmental transport. A fee of 36/- per case is charged for this service by Hackney and paid by this council. 125 The majority of cases dealt with are verminous persons and persons suffering from Scabies. Typical of the kind of cases dealt with are itinerant gypsies, persons sleeping rough and occasionally school children. Advice is normally given by the Public Health Inspectors in cases of infestation by insects, etc. including ants, bed bugs, cockroaches, fleas, carpet beetles, wood lice, clover mites, fire brats, larder beetles and silver fish, although in certain circumstances in particular, old age pensioners) the Department carry out the disinfestation on behalf of the tenant. Identification of our insects is sometimes made by the British Museum (Natural History) staff. As and when the occasion demands use is made of the steam disinfector at Rush Green Hospital, although the use of these facilities is mostly confined to the disinfection of bedding and/ or clothing after the occurrence of infectious or contagious disease. Articles of clothing, etc. for export and requiring an official certificate are dealt with at the Department by means of spraying with a 40% Formalin solution. The Department will always assist in the most difficult cases. RODENT CONTROL The following is an extract from the Ministry of Agriculture, Fisheries and Food's form I.R.31—Annual report on rats and mice under the Prevention of Damage by Pests Act, 1949 for the year ending 31st December, 1968:— TABLE 54 Properties Inspected for Infestation by Rats and Mice N onAgricultural Premises Agricultural Premises 1. Total number of properties (including nearby premises) inspected following notification 3,657 - 126 TABLE 54 contd. Properties Inspected for Infestation by Rats and Mice NonAgricultural Premises Agricultural Premises Number infested by: (a) Rats 2.748 — (b) Mice 909 - 2. Total number of properties inspected for rats and/or mice for reasons other than notification 4,682 233 Number infested by: (a) RaTS 9 - (b) Mice 1 - The majority of treatment is carried out with a 'Warfarin' bait which contains 0.025% Warfarin. Warfarin is a poison with cumulative effect that kills rats, mice and voles painlessly by causing internal haemorrhage. Rodents become affected after feeding for three to ten days and no bait shyness or prejudice is created. When dealing with private property the bait (4—6oz for rats, 9oz. for mice and voles) is placed on a bait tray and protected from other animals and from the elements. The bait is inspected daily and replenished where necessary. Untouched bait is moved to more favourable places or to points where heavy feeding has taken place. Householders are advised as to the necessary precautions to prevent access to the bait by children or animals, particularly cats and dogs. If a human being had accidently eaten Warfarin bait, a heaped teaspoonful of salt in a glass of warm water should be given and repeated until the stomach has been emptied by vomiting and medical treatment obtained. The department is represented on the London No.l (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 Acting Borough Engineer & Surveyor. FACTORIES ACT, 1961 Prescribed particulars on the administration of the Factories Act, 1961, as required by Section 153(1) and Ministry of Health Circular 1/69. 127 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 87 50 - - (2) Factories not included in (1) in which section 7 is enforced by the local authority 569 375 32 - (3) Other premises in which section 7 is enforced by local authority 35 45 - - TOTAL 691 470 32 - 2. Cases in which Defects were found: Parliculars Found Remedied Referred to H.M. Inspector Referred by H.M. Inspector Prosecutions Want of Cleanliness (S.1.) 11 4 - 7 - Overcrowding (S.2.) - - - - - Unreasonable temperature (S.3.) - - - - - Inadequate ventilation (S.4.) 7 3 - 2 - TOTAL 18 7 - 9 - PART VIII OF THE ACT OUTWORK - SECTIONS 133 and 134 Nature of Work Number of outworkers in August list Wearing apparel—making, etc. 3 128 SHOPS ACTS Shop Opening Hours: The Shops Acts 1950—1965 deal with closing hours, Sunday Trading restrictions, working hours for young persons; meal intervals and weekly half-holidays, holidays and Sunday employment, have developed over many years. Due to a change in social behaviour and attitudes with full employment, it is now argued that the Shops Acts no longer need to protect workers by restricting the hours of opening and closing The Consumer Council favours the removal of all restrictions on Sunday trading subject to a statutory limitation of the staffs' total hours work. The Prices and Incomes Board also recommend the abolition of the statutory restrictions on shop opening hours. However, The Union of Shop Distributive and Allied Workers are strongly opposed to abolition of restriction and on this issue are well supported by shopkeepers' organisations. A Bill to amend the Sunday Trading provisions of the Shops Act, 1950, based on the recommendations of the Crathorne Committee of Enquiry on Sunday Trading and Employment failed to reach the statute book. A third attempt to rationalise the Sunday Act is currently under consideration. The Home Office recommendation is that there is need for a limitation on the hours worked in shops by young persons to prevent exploitation, to enable regular attendance at educational courses and to give an adequate amount of leisure at suitable times of the day. Two cases confirm the need for control:— (a) A youth of 17 years was employed every day of the week with no half-day, or time off in lieu of Sunday employment. There were no specific arrangements for meal times and his working week was grossly in excess of 48 hours. (b) Another seventeen year old was employed on a shift system; on one day he worked from 2.00 p.m. until midnight and the next day 6.00 a.m. until 2.00 p.m. The boy was seen to be very tired and obviously feeling the strain of working without a proper rest period. Inspection visits to shop premises have to be made on 129 weekends as well as during and after normal working hours. Contraventions are listed in Table herewith. In some cases, warnings were issued and in others prosecutions were instituted. TABLE 56 Shops Acts Infringements Early Closing Day Failing to exhibit an early closing day notice 52 Failing to close for the "serving of customers" 12 Failing to observe the Regulations 8 Evening Closing Hours Failing to close for the "serving of cutomers" 6 Sunday Trading Failing to close for the "serving of customers" 9 Failing to observe the Regulations 35 Conditions of Employment Failing to exhibit notice specifying the day of Assistants' weekly half-holiday 186 Failing to allow Assistants a weekly half-holiday 4 Failing to allow intervals for meals and rest 6 Failing to exhibit the Abstract of Act and to keep records of hours worked by young persons 138 Failing to keep a record of Sunday employment 14 Failing to allow holidays in lieu of Sunday employment 5 OFFICES. SHOPS AND RAILWAY PREMISES ACT, 1963 This Act, the main provision of which came into force on the 1st August, 1964, has done much to safeguard employees in shops and offices in matters of safety, health and welfare. At the end of the year, 1,926 premises were registered including 195 new registrations. 130 TABLE 57 Registration and General Inspections (1) Class of Premises (2) Number of Premises Registered during the year (3) Total Number of Registered Premises at the end of year (4) Number of Registered Premises Receiving a General Inspection during the year Offices 47 419 143 Retail Shops 132 1328 638 Wholesale Shops, Warehouses 8 33 9 Catering, Establishments open to public, Canteens 8 139 51 Fuel Storage Depots - 7 - TOTAL 195 1926 841 Visits by Inspectors to Registered Premises TOTAL 2451 TABLE 58 Summary of Infringements Section Details Number 4 Cleanliness 90 5 Overcrowding 16 6(1) Temperature 13 6(4) Thermometers 111 7 Ventilation 52 8 Lighting 28 9 Sanitary Conveniences (insufficient or lacked proper maintenance) 117 10 Washing Facilities (insufficient or lacked provision of running hot water) 92 11 Drinking Water 31 12 Clothing Accommodation 5 13/14 Sitting Facilities 7 15 Eating Facilities 4 16(1) Floors, passages and stairs 106 16(2) Handrails and guarding of open sides 40 17 Fencing Machinery 31 22 Dangerous conditions and practices 10 24 First Aid provisions 148 48 Failing to report accident 5 49 Failing to register 66 50 Abstracts 208 131 Notification of Accidents Employers are required to notify the "appropriate Authority" of accidents occuring within the premises. In 1968, 88 accidents were reported to this authority as against 109 in 1967 and 65 in 1966. It is thought that these figures indicate more complete reporting of accidents rather than any increase in actual numbers. TABLE 59 Analysis of Reported Accidents Offices Retail Shops Wholesale Warehouses Catering Ests. open to Public, Canteens Fuel Storage Depots Machinery - 4 2 - - Transport - 1 5 — — Falls of Persons 1 19 2 — — Stepping on or striking against object or Person 1 9 3 - - Handling Goods - 17 6 — - Struck by Falling Objects - 2 1 - - Fires and Explosions - - - - - Electricity — — — — — Use of Hand Tools — 14 — — — Not otherwise Specified - 1 - - - TOTAL 2 67 19 - - TABLE 60 Accidents—Analysed by Workplace Workplace Number Reported Total No. Investigated Action Recommended No Action Prosecution Formal Warning Inf. Advice Offices 2 2 - - 1 1 Retail Shops 67 54 - 1 23 30 Wholesale Shops, Warehouses 19 13 - - 4 9 Catering Estabs open to Public, Canteens - - - - - - Fuel Storage Depts. - - - - - - TOTAL 88 69 - 1 28 40 132 There was one accident reported of an unusual occurrence. It concerned a youth of 15 years who was found unconscious with multiple injuries in a yard adjoining the premises where he worked. Apparently the youth decided at the end of the working day to leave the building via the flat roof and he knew that on the other side of the parapet wall was some temporary scaffolding. It was dark at the time. He climbed on to the roof of an out-building and jumped as he thought towards the scaffolding but missed it and landed on the ground 20 feet below. This accident taught him a lesson but nearly cost him his life. Annual Report to Secretary of State for Employment and Productivity As required by Section 60 of the Act a copy of the prescribed report sent is available at the Town Hall for public inspection. Future Legislation It has been suggested that the Factories Act, 1961, and the Offices, Shops and Railway Premises Act, 1963, be amalgamated and extended in scope to cover most employments and other safety measures with local authorities being responsible for "commercial premises". There is also a suggestion of modifications in the working hours of all young persons. The Under Secretary of State for the Department of Employment and Productivity has announced the possibility of new legislation dealing with safety, health and welfare. Offensive or Toxic Materials In the present Offices, Shops and Railway Premises Act, 1963 no provision is made in dealing with offensive or toxic materials or substances. During the year a complaint was made to the Department that nylon dress net kept for sale in a shop was causing irritation of the eyes, nose and throat. A laboratory stated "the smell was identified as free formaldehyde and subsequent tests confirmed this. It is not toxic to any great extent as a health hazard, but the pungent odour and concomitant eye irritation are enough to make the fabric unmerchantable". H.M. Medical Inspector of Factories says of this material — "In our experience this chemical is normally used in the treatment of cotton materials to give a crease resistant finish. It will, however, cause irritation 133 to the eyes, nose and throat, and may in certain cases cause dermatitis". H.M. Deputy Superintendent Inspector of Factories concludes — "This emphasises the point that there may be grounds for including requirements regarding toxic materials or irritant substances in any future legislation covering retail shops. 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. A watchful eye has been kept on all the appliances or materials coming within the Regulations. These include secondhand oil heaters, nightdresses, toys and fire guards. 102 nightdresses were withdrawn from sale as there was no warning notice "Keep away from Fire". The campaign to rid every unsuitable oil heater used in dwelling houses within the borough has proved very successful and up to the end of the year 122 heaters had been collected and broken up by the Council's officers. Arising from the publicity given, several other local authorities have sought information on the scheme. 134