I HAv London Borough of Havering ANNUAL REPORT OF THE MEDICAL OFFICER OF HEALTH For the Year 1969 INDEX Page INTRODUCTION PREFACE 1 COMMITTEE MEMBERS 5 STAFF OF HEALTH & WELFARE DEPARTMENT 6 GENERAL STATISTICS 10 CONTROL OF INFECTIOUS DISEASES 15 TUBERCULOSIS 18 SMALLPOX CONTACTS 18 VENEREAL DISEASES 18 IMMUNISATION & VACCINATION 20 OVERSEAS TRAVEL 21 PERSONAL HEALTH SERVICES 22 MATERNITY SERVICES 22 Antenatal Care 23 Mothercraft and Relaxation Classes 23 Midwifery 24 Dental Treatment for Nursing and Expectant Mothers 25 Unmarried Mothers 25 Family Planning 25 Cervical Cytology 26 Premature Births 26 CHILD HEALTH SERVICES 28 Congenital Malformations 28 Phenylketonuria 28 Children at Risk 29 Handicapped Pre-School Children 29 Clinics 29 Clinic Doctors 31 Health Visitors and Clinic Nurses 31 Speech Therapy 32 Day Nurseries 33 Nurseries and Child Minders 34 HOME NURSING 34 SICK ROOM EQUIPMENT 36 INCONTINENT LAUNDRY SERVICE 37 RECUPERATIVE HOLIDAYS 37 NURSING HOMES 37 i SCHOOL HEALTH SERVICE 38 Medical Inspections 38 Screening Tests 40 Cleanliness Inspections 40 Specialist Services 40 Child Guidance Clinic 41 Dental Clinics 41 School Clinic Sessions 41 Handicapped Pupils 42 REPORT OF THE CHIEF DENTAL OFFICER 44 Staff 44 School Dental Inspections 44 Dental Health Education 44 Fluoridation 45 Visit 45 Post Graduate Refresher Courses 46 Inspections 46 Attendance and Treatment 46 Dental Service for Expectant and Nursing Mothers and Children under 5 years 47 HEALTH EDUCATION 49 PREVENTION OF TUBERCULOSIS 51 CARE OF THE TUBERCULOUS 52 MILK FOR TUBERCULOUS PATIENTS 52 DOMESTIC HELP SERVICE Home Help Service 53 Night Attendant Service 54 Good Neighbour Service 55 CHIROPODY SERVICE 56 OCCUPATIONAL HEALTH 57 SOCIAL SERVICES PRINCIPAL WELFARE OFFICER'S REPORT 59 SERVICES FOR HANDICAPPED PERSONS 64 (i) Physically Handicapped 64 Number on Register 65 Adaptations to Homes 66 Purpose-built Dwellings 66 Adaptations to Houses for Home Dialysis Machines 66 Occupation Centre for the Physically Handicapped 66 Holidays 67 Residential Care for the Physically Handicapped 67 Special Aids 67 (ii) Blind and Partially Sighted 68 (a) Blind 68 ii (a) Blind 68 Number on Register 68 Employment 69 Handicraft Classes 69 Holidays 69 Residential Accommodation 69 (b) Partially Sighted 70 (iii) Deaf and Hard of Hearing 72 Number on Register 72 Special Aids 72 Social Clubs 72 Social Work 72 Occupational Facilities 73 (iv) Mentally Handicapped 73 Number of Patients under Care of Authority 74 Belford Junior Training Centre 75 Belford Senior Training Centre 75 Special Care Unit 75 Residential Care 75 Holidays 76 SERVICES FOR THE ELDERLY 77 Luncheon Centres 77 Meals on Wheels 77 Day Centres 77 Elderly People's Workshop 78 Entertainments 78 Holidays 78 Outings 78 Special Housing 79 Residential Accommodation 79 Old People's Clubs 80 MENTAL. HEALTH SERVICE 80 Case Work 80 Hospital Admissions 80 Hostel Accommodation 81 Thursday Club 81 HOMELESS FAMILIES 81 Prevention 81 Reception Centre and Rehousing Scheme 82 ENVIRONMENTAL HEALTH SANITARY CIRCUMSTANCES 83 FOOD HYGIENE 84 Food and Drugs Administration 84 Bacteriological Milk Sampling 85 iii Brucella Abortis 85 Ice Cream Sampling 86 Other Food Sampling 86 Pesticides Residues in Foodstuffs 87 Imported Food Regulations, 1968 87 Pharmacy and Poisons Act 1933 87 Artificial Sweeteners in Food Regulations. 1969 87 Soft Drinks (Amendment) Regulations 1969 87 Poultry Processing Plant 88 Liquid Egg (Pasteurisation) Regulations. 1963 88 Food Hygiene (Markets, Stalls and Delivery Vehicles) 88 Regulations, 1966 Food Hawkers 88 Milk Distributors 88 Milk (Special Designation) Regulations. 1963 88 Night Cafes 89 Refreshment Houses Acts, 1860 - 1967 89 Game Act. 1831 90 Food and Drugs Act. 1955 Section 16 90 Food Hygiene (General) Regulations, 1960 90 Meat Inspection 91 Slaughter of Animals Act. 1958 94 Diseases of Animals Act, 1950 94 Unsound Food 94 HOUSING SERVICES 96 New Houses 96 Local Authority Accommodation 96 Housing Priority on Medical Grounds 97 Houses in Multiple Occupation 97 Improvement Grants 97,98,99 Standard Grants 98 Special Grants 98 Qualification Certificates 100 Loans for Housing Repairs — Old Age Pensioners 103 Certificates of Disrepair 104 Housing Act 1957 Sections 17 and 18 105 Building Control 105 Land Charges Act. 1925 105 Water Supply 106 Caravans and Camping 107 Sewerage and Sewage Disposal 107 Streets Made up 110 Clean Air Act, 1956 110 Investigation of Atmospheric Pollution 113 iv Chimney Heights 114 Clean Air Act, 1968 114 Progress and Effects of Smoke Control in London 115 Conversion to Natural Gas 116 SHOPS ACTS 121 OFFICES, SHOPS AND RAILWAY PREMISES ACTS 122 Registration and General Inspections 123 Summary of Infringements 124 Accidents — Analysed by Workplace 125 Analysis of Reported Accidents 125 Notification of Accidents 126 Consumer Protection Act, 1961 126 Prosecutions 127 MISCELLANEOUS Noise Abatement 128 Civic Amenities Act, 1967 128 Dustbins 129 Refuse Collection 129 Street Cleansing 129 Litter Bins 129 Unwanted Vehicles 130 Rag Flock and Other Filling Material Act, 1951 130 Animal Boarding Establishments Act, 1963 130 Pet Animals Act, 1951 130 Riding Establishments Act, 1964 130 Performing Animals (Regulation) Act, 1925 130 Radio-active Substances Act, 1960 131 Rivers, Streams and Watercourses 132 Paddling Pools 13" Swimming Pools 131 Establishments for Massage or Special Treatment 134 Essex County Council Act, 1933 — Part VI 134 Scrap Metal Dealers Act, 1964 134 Hairdressers and Barbers 134 Burials and Cremations 135 Mortuary Facilities 135 Common Lodging Houses 135 Disinfection and Disinfestation 135 Rodent Control 136 Pigeons 137 Fouling of Footpaths by Dogs 137 Factories Act, 1961 138 Meteorological Information 139 Medical Arrangements for Long-Stay Immigrants 142 v Telephone Hornchurch 52555 Health & Welfare Department Billet Lane Hornchurch. To: The Mayor, Aldermen and Councillors of the London Borough of Havering Mr. Mayor, Ladies and Gentlemen, I present my report on the work of the health and welfare department of the Borough for the year 1969. During the year the eventual division of the department into two separate parts became inevitable as a result of the Government's acceptance of the Seebohm report. The future health department will include domiciliary midwifery, family planning, clinic services, health visiting, district nursing, the school health service, control of infectious disease and all the environmental health services. The welfare, mental health, home help services, the day nurseries and registration of child minders, etc., will transfer, together with the present Children's Department into a new Social Services Department. Since the foundation of the Borough one of my highest management priorities has been the co-ordination of services. An elderly, disabled or sick person should not be affected by administrative divisions. Co-ordination is required not only between health and welfare, but between the various Council departments, the three divisions of the National Health Service, other statutory departments, and the essential field of voluntary activity. I can but trust that the progress which has been made to this end will not be lost as a result of the separation of health from welfare. In other respects the year was one of continual financial stringency. The greatest pressures were for more purpose built accommodation for the elderly, more hostels for the mentally handicapped and for more staff, particularly district nurses, health visitors, speech therapists and social workers. Some 1 staff shortages result from the national lack of trained personnel, others from financial limitations. The Health of the Borough The birth and death rates and the illegitimacy rate showed no notable changes from the previous year. The infant mortality rate showed a satisfying drop on the rather high levels of the two previous years. There were fortunately no serious outbreaks of infectious disease. Influenza was particularly troublesome in the early part of the year. Only thirteen deaths were certified as due to influenza, but it is probable that considerably more were associated with this infection but certified to bronchitis, pneumonia, etc. There were no outbreaks of influenza in the residential homes for the elderly, probably as a result of the immunisation programme which was undertaken in this high risk group. The greatest number of deaths were again caused by disease of the heart and circulation, and cancer of the lung, which caused approximately half of all deaths from all types of cancer. These conditions are all associated with the smoking of cigarettes. Other factors are undoubtedly present, but the cigarette is by now indisputably identified as the greatest avoidable killer of our society. Primary immunisation and vaccination rates again reached some of the highest levels in the country; a very satisfactory state of affairs. Much less satisfactory are the lower rates of acceptance of the booster procedures which need to be undertaken at the ages of five and fifteen to maintain high protection levels. The baby's immunity gradually fades away if these repeat protections are not undertaken. Measles protection rates received a setback when one vaccine was withdrawn and by the end of the year not enough children to stop an epidemic had been immunised. Personal Health Services Domiciliary midwifery continues to decline as more deliveries take place in hospital, but this increase in hospital confinements is only possible because of the extension of early discharge home to the care of the community midwife. 2 New legislation by which child minders must be registered and approved came into effect at the beginning of the year. The large number of applications caused considerable stress upon my staff resources but by the end of the year the backlog had been dealt with. The demand for day nursery places for children in social or medical need continued and increased. Additional problems result from the fact that the day nurseries can be situated at distance from the home, and there are both financial and humanitarian limits on transporting very young children. The speech therapy services, which can be vital to both normal and handicapped children in the establishment of communication, also came under sustained pressure through the year because of difficulty in recruitment of scarce staff. The school health services shared a further extension of the successful selection procedure for medical examinations at the intermediate and final ages. Work on the subject of drug abuse, undertaken in conjunction with the Education and Children's Departments, Probation and police services, general practitioners and hospitals, began to show results during the year and a series of seminars, lectures and discussions were arranged so as to provide teachers and youth workers, together with the staff of my department and others, with the necessary basis to handle this problem. Domestic Help Service Some areas of the Borough are showing marked recruitment problems. It appears that the necessary future extension of this vital service could run into difficulties as the available labour force diminishes. The training programmes continued. Greater public recognition of the invaluable work of the home help is required. Welfare Services The most interesting aspect of the decentralisation of social work into area teams was the establishment of one team at the Health Centre where general practitioners and a full clinic team were already working; especially as it was possible 3 for the Children's Officer to detach an area team to work from the same centre. The need for additional homes for elderly persons was clearly shown throughout the year. The cessation of admissions of mentally handicapped persons to South Ockendon Hospital accentuated the need for more community hostel places. Environmental Health Services Although the concepts of conservation and control of pollution of the environment are beginning to receive some public attention, in general the work of this section is unobtrusive and unglamorous, yet remains a most important factor in the health and welfare of the residents of the Borough. The report describes the range of detailed work which is required. The improvement in the cleanliness of London's air shows what can be achieved. My thanks are due to the Chairman and Members of the Social Services Committee and the Council, to the staff of the Department 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. 4 HEALTH AND WELFARE COMMITTEE as at 31st December, 1969 His Worship the Mayor Alderman W.A. Smith, 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 F.A.J. Morley Councillor F.J Orrin Councillor Mrs A.L. Sharp Councillor C.J. Sherman Councillor Mrs. L.G. Sinclair Councillor M.J. Ward Councillor R.J. Whiting Councillor Mrs. W.L. Whittingham 5 HEALTH AND WELFARE DEPARTMENT STAFF as at DECEMBER, 1969 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, MB. Ch B., D.P.H., D.T.M & H Principal Medical Officer PAMELA AIHIE, M B., B.3., M.R.C.S., L.R.C.P. D.P.H. Assistant Medical Officeis JULIE C ALLARDICE, M.B., Ch 3. H.C. GUPTA, M B.. B.S., D.P.H. SYLVIA INGLIS, M.B., B.S. L.J. MARSHALL. M B.. B.S., LM.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. MRS S. SHILLITO, B.D.S. K. WRIGHT, L.D.S., R.C.S., B.D.S. 5 FULL TIME DENTAL SURGERY ASSISTANTS 2 PART-TIME DENTAL SURGERY ASSISTANTS Administrative Officer J.F.J. THOMAS, M.R.S.H. Deputy Administrative Officer E.W. GOWERS, A.R.S.H. Principal Administrative Assistants J.E. BLAY Environmental Health L.A. CROFT Welfare and Mental Health P. HANSEN Management E E. LAMB Persona! Health 17 Administrative Assistants 54 F/T Clerical Assistants and 3 Telephonists 7 P/T Clerical Assistants 6 F/T Shorthand/Audio Typists 1 P/T Shorthand/Audio Typist 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. 6 16 Public Health Inspectors 2 Meat Inspectors 1 Senior and 2 Shops and Offices Inspectors 3 Student Public Health Inspectors 2 Pest Control Officers/General Assistants 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. 3 Group Adviser Health Visitors 19 F/T Health Visitors 10 P/T Health Visitors 1 F/T Tuberculosis Visitor 1 P/T Tuberculosis Visitor 18 P/T Clinic Nurses 3 Student Health Visitors 4 Day Nursery Matrons 4 Deputy Matrons 4 Nursery Wardens 21 Nursery Nurses and Assistants 10 Student Nursery Nurses Non-Medical Supervisor of Midwives and Superintendent of Home Nurses MISS D.D.K. MARTIN, S.R.N., S.C.M. 25 F/T Midwives 2 P/T Midwives 31 F/T District Nurses and 1 District Nurse/Midwife 5 P/T District Nurses 2 F/T Nursing Auxiliaries Senior Domestic Help Organiser MRS. B. BIGNELL 4 Domestic Help Organisers 400 P/T Domestic Helps Chief Chiropodist L. BOLLAND, M.Ch.S.,S.R.Ch. 9 Senior Chiropodists 5 Sessional Chiropodists Senior Speech Therapist MRS. K. HILTON, L.C.S.T. 2 Speech Therapists 1 Sessional Speech Therapist Principal Welfare Officer MISS K.M. WELLS, A.I.M.S.W.,M.S.M.W.O. Deputy Principal Welfare Officer MISS E.M. TURNER SMITH. A.I.M.S.W. Senior Psychiatric Social Worker J. COOKE, A.A.P.S.W. 7 Senior Mental Welfare Officer F.G. DEAR. M.S.M.W.O. Senior Social Welfare Officer MISS M. GOWER, A I M S.W. 4 Mental Welfare Officers and 13 Social Workers 2 Welfare Assistants 3 Trainee Social Workers 1 Organiser, Workshop for the Elderly Old People's Homes 5 Superintendents 5 Matrons 1 Assistant Superintendent 5 Assistant Matrons 82 Attendants 64 Kitchen and Domestic Staff Luncheon Centres for the Elderly 9 Supervisors and 11 Kitchen Assistants Mawney Pensioners Day Centre 1 Warden and 2 Deputy Wardens Belford Adult Training Centre 1 Supervisor 1 Senior Instructor 1 Senior Assistant Instructor 11 Assistant Instructors 1 Driver/Assistant Instructor 1 P/T Clerical Assistant Belford Junior Training Centre 1 Supervisor 1 Senior Assistant Supervisor 6 Assistant Supervisors 2 Trainees 1 P/T Clerical Assistant 11 Kitchen, Cleaning and Caretaking Staff 5 Coach Guides Special Care Unit 1 Supervisor 1 Assistant Supervisor 2 General Duty Assistants 1 Female Driver/Assistant 1 Cleaner and 1 Meal Attendant 2 Coach Guides Furingdon Centre for the Physically Handicapped 1 Supervisor 1 Assistant Supervisor 4 Senior Instructors 1 Clerical Assistant 2 Drivers 8 Farin.gdon Centre for the Physically Handicapped Contd. 1 Kitchen Assistant and 1 Cleaner Westmarsh Lodge Hostel for Mentally Handicapped 1 Resident Warden 1 Deputy Resident Warden 2 Resident Assistant Wardens 2 Non resident Assistant Wardens 6 Kitchen and Domestic Staff Collier Lodge Hostel for persons recovering from Mental Illness 1 Resident Warden 2 Assistant Wardens 7 Kitchen and Domestic Staff Health Centre, Clinics, and Billet Lane Offices 49 Caretaking. Cleaning and Kitchen Staff 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.R.C.S..L.R.C.P. (Harold Hill area) Ophthalmologists P DAS GUPTA, M B.,B.S P LANCER. M.R.C.S.,L.R.C.P.,M B ,B.S. D.J.F N1COL, M.B..B S..D.O. 9 GENERAL STATISTICS Area in Acres 29,650 Population (Registrar-General's Estimate 252,860 for Mid 1969) Number of dwellings as at 31.12.69 79,993 Rateable value as at 31.12.69 £12,709,500 Estimated product of a Penny Rate £50,000 The natural increase in population (3,898 births less 2,186 deaths) gives a net figure of 1,712, but as the Registrar General's population estimate of 252,860 is only 570 higher than the 1967 figure, movement of population away from Havering, as compared with those who moved into the Borough, must account for the difference of 1,142. Of the 33 Authorities comprising the Greater London area, only 5 showed an increase in population over the previous year namely City of London, Bexley, Havering, Hillingdon and Sutton. The net 1969 population of the Greater London area — 7,703,410 — was 60,410 lower than the same figure for 1968, but this compares with a decrease of 149,780 between 1967 and 1968 and tends to indicate that the movement of population away from the London area may be slowing down. Possible confirmation of this is shown in the population figures for adjacent areas in Essex — Basildon U.D., Brentwood U.D. and Thurrock U.D., where the combined population rose by 7,080 between 1967 and 1968, but only increased by 4,490 between 1968 and 1969. Extracts from Vital Statistics for the Year (Figures for 1968 are given in parenthesis) Live Births Male Female Total Legitimate 1914 1777 3691 (3868) Illegimate 113 94 207 (202) Total 2027 1871 3898 (4070) Birth Rate per 1000 population 14.2 (148) Illegimate live births (percentage of total live births) 5 3% (5.0%) 10 Still Births Male Female Total Legitimate 26 20 46 (49) Illegitimate 1 1 2 (7) Total 27 21 48 (56) Total live and still births 3946 (4125) Still birth rate (per 1000 live and still births) 12.2 (13.3) Infant Deaths (under 1 year) Male Female Total Legitimate 36 27 63 (72) Illegitimate 1 - 1 (9) Total 37 27 64 (81) Infant Mortality Rates — Total infant deaths per 1000 total live births 16.4 (19.9) Legitimate infants per 1000 legitimate live 17.3 births (18.6) Illegitimate infants per 1000 illegitimate live births 4.8 (44.6) 11 Neo Natal Mortality Rate (Deaths under 4 weeks of age per 1000 10.5 (12.5) live births) Early Neo Natal Mortality Rate (Deaths under one week of age per 1000 10.0 (10.6) total live births) Perinatal Mortality Rate (Still births and deaths under one week of age combined per 1000 live and still births) 22.0 (23.8) Maternal Mortality (including abortion) Number of deaths 0 (0) Rate per 1000 live and still births — (—) Deaths Male Female Total 1140 1046 2186 (2256) Death rate per 1000 population 11.5 (10.5) 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 14.2 16.9 14.6 14.6 Illegitimate Live Births (percentage of total live births) 5.3 Not Available 8.3 11.0 Still Birth Rate 12.2 13.0 12.3 12.7 Infant Mortality rate 16.4 18.0 16.2 17.9 Neo Natal Mortality rate 10.5 12.0 10.8 11.7 Early Neo Natal Mortality rate 10.0 10.0 9.2 10.2 Perinatal Mortality rate 22.0 23.0 21.4 22.8 Maternal Mortality rate 0.0 0. 19 0.19 0.20 Death Rate 11.5 11.9 11.2 11.9 12 13 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE DURING 1969 Cause of Death ALL AGES Under 4 weeks 4 weeks & under 1 year AGE IN YEARS Total Male Female 1-4 5-14 15-24 25-r34 35-44 45-54 55-64 65-74 75 & over Cholera - - - - - - - - - - - - - - Typhoid Fever - — - - - - — — — - — — — - Bacillary Dysentery and Amoebiasis - — — - — — — - - - — — - — Enteritis and other Diarrhoeal Diseases 2 1 1 1 1 — — — — — — — — — Tuberculosis of Respiratory system 7 5 2 - - - - - - 1 2 2 Other Tuberculosis incl. late effects 2 2 — — — — — — — — — 1 1 — Plague _ — — _ — — - — — - — — _ — Diphtheria - - - - - - - - - - - - - - Whooping Cough — — — — — — — — — — — — — — Streptococcal Sore Throat & Scarlet Fever — — — — — — — — — — — — — — Meningococcal Infection 2 2 - — 1 — — — - — — 1 - — Acute Poliomyelitis - - — — - - — - - - — ' - - — Smallpox — — — — — — — — — — — — — — Measles - - - — - - — — — — - - — - Typhus and other Rickettsioses - — — - — — — - — — — — — Malaria — — — — — — — — — — — — — — Syphilis and its Sequelae 2 2 - - - - - - — - - 1 - 1 Other Infective and Parasitic Diseases 3 3 — — — — — — — — — 2 — 1 Malignant Neoplasm, Buccal Cavity, etc. 6 3 3 - - - - - - - 2 - 2 2 Malignant Neoplasm, Oesophagus 12 8 4 — — — — — — 1 1 2 5 3 Malignant Neoplasm, Stomach 50 26 24 — — — — — — 2 2 12 21 13 Malignant Neoplasm, Intestine 54 20 34 - - - - - - 1 8 14 15 16 Malignant Neoplasm, Larynx 1 — 1 — — — — — — — — 1 — — Malignant Neoplasm, Lung,Bronchus 150 118 32 - — — - — - 2 23 45 49 31 Malignant Neoplasm, Breast 45 - 45 - - - — - 2 3 9 14 8 9 Malignant Neoplasm, Uterus 8 — 8 — — - - — - - 2 2 2 2 Malignant Neoplasm, Prostate 14 14 — — — — — — — — — 1 6 7 Leukemia 18 10 8 — — 1 2 1 1 2 3 3 2 3 Other Malignant Neoplasms 126 56 70 - - - 1 2 3 3 21 36 30 30 Benign and unspecified Neoplasms 9 6 3 — — — — — 1 1 2 1 4 — Diabetes Mellitus 14 3 11 - — — — — 1 — 2 1 4 6 Avitaminoses and other Nutritional Deficiency _ _ _ _ _ _ — — — — - — - — Other Endocrine, etc. diseases 9 6 3 — 2 1 1 — — 1 — — 4 — Anaemias 2 - 2 — — — — — — — — 1 — 1 14 Other diseases of blood, etc. 1 - 1 — - - - - - - - 1 - Mental disorders 17 5 12. — — — 1 — 1 — 1 3 11 Meningitis 2 1 1 — 2 - — — — — — — - — Other diseases of Nervous System, etc. 41 23 18 — — 1 — 2 1 2 1 7 12 15 Active Rheumatic Fever — — - — — — — — — — — — - — Chronic Rheumatic Heart Disease 39 13 26 — — — — — — 3 7 7 8 14 Hypertensive Disease 35 14 21 - - - - - - 1 3 5 10 16 Ischaemic Heart Disease 562 353 209 - — - — 1 — 11 49 123 159 219 Other forms of Heart Disease 59 24 35 — — — — — 1 — 1 9 7 41 Cerebrovascular Disease 329 115 214 - — — - — — 2 12 30 81 204 Other Diseases of Circulatory System 57 29 28 - - - — — — 1 6 18 32 Influenza 13 4 9 - - - - — — - 2 2 2 7 Pneumonia 127 70 57 1 7 2 1 2 - - 4 11 27 72 Bronchitis and Emphysema 130 98 32 - - - - - - - 3 17 45 65 Asthma 8 — 8 — — — — - 1 2 1 1 3 — Other Diseaees of Respiratory System 17 10 7 - 5 1 1 - - -- 1 3 2 4 Peptic Ulcer 6 3 3 - — - - — — - - 1 2 3 Appendicitis 1 — 1 — - - - — — - — — — 1 Intestinal Obstruction and Hernia 7 4 3 — — — — — — — — 1 3 3 Cirrhosis of Liver 2 1 1 — — — — — — — — 1 1 — Other Diseases of Digestive System 19 9 10 - - - - 1 1 1 4 3 3 6 Nephritis and Nephrosis 5 2 3 - - - - - 1 - *«- - 2 2 Hyperplasia of Prostate 3 3 — - — — — — — — — 1 — 2 Other Diseases, Genito-Urinary System 16 5 11 - - - - - 1 - — 1 3 11 Diseases of Skin, Subcutaneous Tissue 2 — 2 — — — — — — — — — — 2 Diseases of/Musculo-Skeletal System 11 5 6 - - - - - — — - 5 — 6 Abortion — - - — — — — — — — — — — — Other complications of pregnancy, Childbirth and Puerperium. Delivery without mention of complication - - - - - - - - - - - - - - Congenital Anomalies 23 8 15 13 4 1 4 — 1 — — — — — Birth Injury, Difficult labour, etc. 16 13 3 16 — — — — — — — — — Other causes of Perinatal mortality 8 5 3 8 — — — — — — — — — — Symptoms and Ill-defined Conditions 16 6 10 - — - - - - - — 1 — 15 Motor Vehicle Accidents 24 17 7 — — — 1 9 1 1 — 6 3 3 All other Accidents 35 10 25 1 1 - 1 1 3 1 5 3 4 15 Suicide and Self Inflicted Injuries 14 3 11 — — — — — 4 3 1 4 2 — All other External Causes 5 2 3 1 - 1 - - - 1 1 - 1 - TOTAL ALL CAUSES 2186 1140 1046 41 23 8 12 20 23 46 171 389 557 896 CONTROL OF INFECTIOUS DISEASES The current list of notifiable infectious diseases is as follows:- 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 The following table shows the numbers of infectious diseases notified during 1969:- Disease Male Female Total Measles 480 469 949 Dysentery 14(9) 14 (7) 28 (16) Scarlet Fever 81 55 136 Whooping Cough 6 22 28 Infective Jaundice 50 22 72 Tuberculosis: Respiratory 8 9 17 Tuberculosis: Other 4 3 7 Acute Meningitis 1 1 2 Acute Encephalitis (Post (Infectious) 2 2 4 Typhoid Fever 1 — 1 Food Poisoning 87(8) 98 (10) 185 (18 Figures in () are confirmed cases of food poisoning and dysentery There was an appreciable decrease in the number of whooping cough cases notified viz. from 131 to 28, which probably reflects the high immunisation rates and the effectiveness of the improved vaccine in use during the year. No cases of diphtheria, tetanus, ophthalmia neonatorum, poliomyelitis, leptospirosis, paratyphoid fever, malaria, plague, cholera, anthrax, smallpox, typhus fever, relapsing fever, yellow fever or tuberculosis of the central nervous system were notified during the year. The typhoid case was of unusual origin. One usually associates this disease with holidaymakers returning from abroad but in this case the patient concerned was a laboratory assistant at a privately owned laboratory in London and contracted the disease whilst carrying out tests in the laboratory. The usual number of typhoid and paratyphoid contacts returning from holidays overseas required investigation and surveillance. There was an increase in the number of measles cases notified — 949 as against 351 last year — but nothing like the usual high number that could normally be expected during this ''epidemic year" which comes every alternate year. The forced reduction of the measles vaccination programme which came about in the early summer and continued throughout the remainderof the year — due to the withdrawal of one type of vaccine and the subsequent adverse publicity in the national press — must have had a bearing on this increase. At the end of the year measles notifications were rising sharply and the disease, which though minor in most children, carries a significant percentage of distressing and permanent side effects, may get out of control unless a higher proportion of the child population become immunised. Infective jaundice notifications also showed an increase from 23 to 72 but it could be that rather than an increased incidence of this disease there was a greater awareness amongst general practitioners following the publicity it received under the Public Health (Infectious Diseases) Regulations, 1968, and its subsequent promotion to a fully-fledged nationally notifiable disease as against its regional status of previous years. 16 A slight increase occurred in dysentery cases both as regards the. notifications received and the number confirmed bacteriologically but this increase is not considered to be of any great significance. There was a sizeable increase from 123 in 1968 to 185 in 1969 of notifications of suspected cases of food poisoning, but the number confirmed bacteriologically dropped from 28 to 18 over the two years. Apart from the routine advice given during the course of the daily work of the public health inspectors, and the special advice given during investigation of suspected cases, the series of training courses organised, together with the Havering College of Technology, continued through the year with the aim of improving the knowledge of managers and workers in the food industry. 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 co-operation:- * Salmonella Typhimurium 9 Salmonella Brandenburgh 2 Salmonella Dublin 2 Salmonella Enteritidis 2 Salmonella Panama 1 Total: 16 17 Specimens Submitted to the Pathology Department at Oldchurch Hospital Taken from Total No. of persons swabbed Total No. of swabs taken Negative Positive Shig. Sonnei Amoebic Colitis *Salmonella Staph, pyogens Food Handlers 37 48 47 1 - - - NonFood Handlers 258 343 310 14 1 *16 2 A table giving the age groups of the newly notified cases of Tuberculosis for 1969 is given below:- Tuberculosis Age group Male Female Respiratory Others Respiratory Others 2-14 - - - - 15 - 19 — — 1 — 20 - 24 — 1 2 1 25 - 34 — 1 3 - 35 - 44 2 — 2 - 45 - 54 2 1 — 1 55 - 64 3 1 — 1 65 - 74 — — 1 - 75 and over 1 - — — Total 8 4 9 3 This table confirms a highly satisfactory decline in new cases of respiratory tuberculosis between 1968, 57 cases, and 1969, 17 cases. However, the mortality figures — 7 deaths 1968 vs. 9 deaths 1969 remained more or less static. Smallpox Contacts Nine passengers who had arrived in this country from overseas were referred to the Department during the year for surveillance. These passengers had arrived at airports/ports in this country from declared smallpox epidemic areas and were not in possession of valid international certificates of vaccination against smallpox. The main reasons why these passengers were not vaccinated were on the grounds of age, medical exemption, objections on religious or other grounds. Surveillance and restriction on movement continues, in such cases, over the time of incubation of the disease. Venereal Diseases The number of new cases of infection included on the returns for 1968 received from the Treatment Centre at Oldchurch Hospital totalled 1130 compared with 879 in 1969 as follows. 18 Venereal Diseases Total Male Female 1969 1968 1969 1968 1969 1968 (a) Syphilis 10 13 7 8 3 5 (b) Gonorrhoea 119 129 93 94 26 35 (c) Other conditions 1001 737 686 537 315 200 TOTAL 1130 879 786 639 341 240 226 males and 72 females included under (c) on the previous page, were found to require no treatment in the Centre, compared with equivalent figures of 206 males and 45 females in 1968. The figures given 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 1968 figures being appended for comparative purposes:- 1969 1968 (a) Syphilis 6 4 (b) Gonorrhoea 60 54 (c) Other conditions 596 380 TOTAL 662 438 During the year as part of the Health Education Programme of the Council, publicity was given, in the form of advertisements in local papers, and by the distribution of leaflets from various Clinics and other Council premises, to the need for all who had taken risks to seek early advice. Details of the times of the Sessions held at the Treatment Centre at Oldchurch Hospital were given and this publicity may have played some part in the increased number of patients who attended the Centre in 1969 as compared with the previous year. 19 IMMUNISATION & VACCINATION Recommended Schedule of Vaccination and Immunisation Approximate Age 1 mmunisation During First Year of Life Diphtheria/Whooping Cough/ Tetanus (3 injections) together with Poliomyelitis vaccine (3 doses by mouth) During Second Year of Life Measles vaccination. Smallpox vaccination 5 Years Diphtheria/Tetanus booster. Poliomyelitis booster 13 Years Smallpox re-vaccination BCG vaccination (Tuberculosis) 15 — 19 Years Poliomyelitis booster. Tetanus booster. Smallpox re-vaccination This improved immunisation schedule, was fully introduced during 1969. Protection was available for children against diphtheria, whooping cough, tetanus, poliomyelitis, smallpox, measles and tuberculosis. Parents can take their children either to the Health and Welfare clinic or the family doctor. Immunisation rates at the end of the year were as tollows:- 1967 births: 1968 births: Whooping cough 86% 75% Diphtheria 93% 76% Poliomyelitis 94% 77% Smallpox 39% The lowering rates for 1968 births, and the decline in the smallpox rate from the previous figure of 50%, are probably purely artificial as the newly introduced schedule commences at six months of age instead of three months as previously. Next year's figures will reveal the true position. The high rates of protection for Whooping cough, diphtheria and poliomyelitis make the possibility of a sustained outbreak of any of these diseases most unlikely; a highly satisfactory state of affairs which must be maintained. 20 An improved whooping cough vaccine, giving better protection with fewer side effects, became available during the year and was immediately introduced into use. Smallpox protection rates are not high enough. Recent events have shown that rapid travel around the world can lead to wide-spread exposure to infection. Ring vaccination has successfully contained every potential outbreak in recent years, but it cannot be guaranteed that this will always be so. It must also be borne in mind that many travellers require vaccination in adult life to obtain International Certificates of Vaccination, when the risks of primary vaccination are much greater than during the second year of life. Detailed measles protection figures are not available but it is clear that rates are nothing like high enough to eradicate the disease, which is the final aim of the programme. Rates of acceptance of B.C.G. immunisation by 12 or 13 year old children are somewhat disappointing. The protection against tuberculosis goes on for many years — the first children to be routinely immunised over 15 years ago still show high levels of immunity. Fear of the trivial injection still plays a part in some children's reluctance. The procedure is carried out at school during the second year in secondary school, and parents are strongly advised to make sure that their children are protected. Overseas travel Overseas travellers are advised to obtain detailed advice from their travel agents on current vaccination requirements for the particular countries they are visiting. Apart from the legal requirements of smallpox or yellow fever immunisation applicable to certain areas travellers to all parts of the world, except Scandinavian countries and the U.S.A., would be wise to obtain protection against typhoid and poliomyelitis. Family doctors can give all vaccines except yellow fever, which is only available at Unilever House, Blackfriars, or the Hospital for Tropical Diseases, St. Pancras. Immunisation of adults for purposes of travel is not undertaken at the health and welfare clinics, although arrangements are made for the protection of parties of school children travelling overseas. 21 PERSONAL HEALTH SERVICES SECTION In a Borough the size of Havering, covering nearly 30,000 acres and measuring at its longest points some 10 miles by 8 miles, considerable difficulties would be experienced by members of the public requiring the services administered by the Department were it necessary for all enquiries to be made at the Central Offices in Hornchurch. Since 1965 therefore the clerical staff at the Health Centre at Harold Hill and at each of the nine purposebuilt Health Services Clinics have been required to provide information and to deal with all routine requests for services in the immediate area they serve. Apart from the Health Visitors, who were already based on these premises, Midwiyes, Home Nurses and other members of the field staff have been allocated to the clinic serving their area and all messages sent to them via the clinic clerks. In addition, applications and enquiries for many other services provided by the Department, including services for the elderly, the issue of small items of sick room equipment, etc. are also handled at these centres. Alterations which have been carried out in recent years at several of the clinics have included the provision of improved accommodation for these purposes. During 1969 arrangements were entered into for accommodation to be available for a Probation Officer at the Health Centre at Harold Hill and at the end of the year plans were well in hand for social workers, mental welfare officers and child care officers also to be accommodated at this Centre, thus providing a combined team of child care, social work and health service personnel to serve the surrounding estate. Lack of accommodation in the clinics has prevented similar combined teams being planned elsewhere. It now appears, however, that the Seebohm proposals recommending a separate Social Services Department and also the suggestions proposed for the transfer of the health services from local Authorities to area Boards, tend to make any further schemes for similar co-ordination of health and social workers in Units, a matter of uncertainty at present. MATERNITY SERVICES The Rush Green Hospital Maternity Liaison Committee, upon which consultants and midwives, general practitioners and 22 local authority doctors and midwives are represented, has continued to prove of great value and the co-operation of my colleagues is much appreciated. Antenatal Care The number of Antenatal Clinics staffed by medical officers of the Authority has continued to decline, as practically all antenatal work is undertaken by the hospital or general practitioner with whom the patient is booked. The Council's midwives continue to hold Antenatal Clinics in the Health Services Clinics, although a proportion of them hold their clinics in conjunction with general practitioners at the practitioners' surgeries. Figures relating to the Antenatal Clinics are given in the following table:— Antenatal and Post-natal Clinics Number of women attending Clinics Antenatal Post-n&tal Total 805 10 815 Doctor Midwife Total Number of Sessions 44 8 46 890 Comparative figures for 1968 were 987 sessions attended by 1,191 antenatal and 18 post-natal patients. The 1969 figures therefore represent a decrease of approximately one-third compared with the previous year. Mothercraft and Relaxation Classes These classes are held at the Health Centre, the nine purpose-built clinics and at a general practitioner's surgery where a health visitor is attached. The classes are particularly valuable to women expecting their first baby, but are of benefit to all expectant mothers and a number do attend during second and subsequent pregnancies. The numbers attending decreased from 896 in 1968 to 854 in the year under review, but this decrease reflects the fall in the total number of births and the number attending, when expressed as a percentage of the total number of births notified, shows only a slight reduction from 22 0 to 21.7. The number of women attending who were booked for hospital confinement rose marginally from 772 to 776, whereas 23 the largest change occurred for those booked for home confinements, where the numbers dropped from 124 to 78. As those expecting their first baby are regarded as priority for hospital confinement the latter figure relating to those booked for home confinement would include only women expecting their second or subsequent child. Details of the attendances in 1969 are given in the following table:— Mothercraft and Relaxation Classes Booked for Hospital Confinement Booked for Home Confinement Total Number of women attending 776 78 854 Midwifery At December 1969 25 full-time and two part-time midwives and one district nurse/midwife were in post, which is approximately the same number as-at the end of 1968. The pattern of the domiciliary midwifery service has shown considerable changes in recent years, but these changes have been accentuated in 1969 by the increase in the number of patients admitted to hospital for confinement only and also by the opening of the General Practitioner Unit at Rush Green Hospital. The percentage of hospital births again increased, the figure for 1969 being 78.5, an increase of 3.1 per cent over the previous year. The number of domiciliary confinements fell from 997 in 1968 to 850 in 1969, a decrease of 14.7 per cent. The number of patients delivered in hospital and discharged before the 10th day fell slightly from 2,359 to 2,315, but included in the figure of 2,315 were 1,516 patients discharged to the care of domiciliary midwives within 48 hours of confinement. This number of 48 hour discharges represents an increase of 50 per cent over the equivalent figure for the previous year. The Management Committee of the General Practitioner Maternity Unit, Rush Green Hospital, decided that from October 1969, domiciliary midwives would be able to undertake deliveries there. During the subsequent three months, domiciliary midwives attended seven deliveries in this Unit and no doubt this figure 24 will increase in the future. The new wing at Harold Wood Hospital was nearing completion at the end of the year and when opened will provide additional accommodation for maternity patients and will also include a General Practitioner Unit. The time appears to be approaching when the duties of the domiciliary midwife will consist principally of attending confinements in general practitioner units and in caring for mothers and babies discharged within 48 hours from maternity hospitals, and the former role of the domiciliary midwife, who used to be employed exclusively in attending home confinements, and caring for the mother and baby for the lying-in period, will be the exception rather than the rule. During the year, sixteen pupil midwives undertook their thirteen weeks district training on attachment to domiciliary midwives. Eleven were successful in their final examinations. Dental Treatment for Expectant and Nursing Mothers Details of the service provided for expectant and nursing mothers are included in the report of the Chief Dental Officer on Page 47, Unmarried Mothers The arrangement with the Chelmsford Diocesan Moral Welfare Association to provide (pare for unmarried mothers during the antenatal period and to arrange subsequent admission to Mother and Baby Homes, where necessary, continued as before. The total number of unmarried mothers from Havering who received help from the Outdoor Worker of the Association during the year was 54, compared with 70 in 1968. This figure represents approximately a quarter of all illegitimate births during the year. 36 of the 54 mothers were admitted to Mother and Baby Homes. Family Planning Family planning services, staffed by local authority doctors and nurses, were held at Hornchurch, Harold Wood, Upminster and Cranham clinics, and in addition a domiciliary family planning service was provided by Dr. J. Allardice in special cases following referral by health visitors or social workers. The service is free if provided on medical grounds. The Council also supports the Family Planning Association Clinic at 49 Eastern Road, Romford, by providing and maintaining 25 these premises. Advice and supplies are paid for by the Council in the existence of medical reasons for avoiding childbirth. Family planning advice is further available from family doctors, and specialist advice at hospital gynaecological outpatient departments. Cervical Cytology The local authority part of this service was provided at combined sessions with family planning at six clinics in the Borough. The number of smears taken at these clinics was 1813. Two suspicious results were found and the ladies concerned referred immediately for full hospital investigation. 182 minor conditions were revealed by these examinations. Hospital out-patient departments, family doctors and the Family Planning Association doctors also take-cervical smears. The total yearly number taken for Borough residents is around seven to eight thousand. Premature Births The Table below sets out the number of premature infants notified. These infants are all included in the children "At Risk" figures mentioned in a later paragraph. The number of premature live births notified — a total of 243 — was an increase of nearly 30 per cent, compared with a figure of 188 in 1968 and represents 6.2 per cent. of the total notified live births. This compares with a figure of 3.4 per cent. for the previous year but the number of notifications of premature births notified in 1968 is probably a low fluctuation as the 1969 figures compare closely to those of 1967, when there were 249 live premature births, a percentage of 61. For the notification of premature births a birth weight of 51b 8ozs. or less is fixed, irrespective of the period of gestation. The special baby care unit at the new Rush Green Maternity Hospital, under the direction of Dr. Nauth-Misir, Consultant Paediatrician, has considerably improved the resources available for the care of premature and other delicate newly-born children. 26 Notifications of Premature Births. 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 Weight, at birth Total births Died Total births Died Total births Died Bom within 24 hours of birth in l and under 7 days in 7 and under 28 days within 24 hours of birth in 1 day 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 8 4 2 - - - - - - - - 8 - 2. Over 21b. 3oz. up to and including 4lb. 6oz. 14 2 3 - - - - • 1 - 1 - 5 - 3. Over 31b. 4oz. up to and including 41b. 6oz. 36 3 5 - • - - • 1 - • - 5 - 4. Over 41b. 6oz. up to and including 4lb. 15oz. 52 - 2 - - - - - 3 - - - 3 - 5 Over 4lb. 15oz. up to and including 51b. 8oz. 116 2 3 - 11 - - - 1 • - - 6 - 6 TOTAL 226 11 15 - 11 - - - 6 - 1 - 27 - 1 - lOOOg or less. 2- 1001-1500g. 3 - 1501-2000g. 4 - 2001-2250g. 5 - 2251-2500g. 27 CHILD HEALTH SERVICES Congenital Malformations Both domiciliary and hospital midwives are required to report congenital malformations observed at birth on the notice giving notification of the birth. During the year 114 such malformations were reported and these related to 94 children. An analysis of the malformations is given in the table below. The 94 infants reported as suffering from congenital malformations is approximately 2 4 per cent. of the total notified births. This is an increase of 0 5 per cent. over 1968, when 76 infants were reported, but is less than that for 1967, when the figure was 106. The Registrar General has an early warning scheme to notify Medical Officers of Health of any untoward rise in the number of these notifications and the present number of notifications is within normal limits. Congenital Malformations Observed at Birth Malformation Diagnostic Group No. Reported 0 Central Nervous System 21 1 Eye, Ear 5 2 Alimentary System 10 3 Heart and Great Vessels 5 4 Respiratory System - 5 Uro-genital System 10 6 Limbs 35 7 Other Skeletal 6 8 Other Systems 15 9 Other Malformations 7 TOTAL 114 Phenylketonuria This is a rare metabolic disease which can cause mental handicap. During 1969 the Guthrie test, an improved screening test using blood obtained by heel prick, was introduced to replace the previous Phenestix urine test. This Borough had the benefit of having already commenced Guthrie screening in conjunction with the Maternity and Pathology Departments at Rush Green Hospital so that the staff were experienced in the 28 new procedures. Despite this, there were some early technical problems but these were quickly overcome. The Neonatal Screening Service of the Hospital for Sick Children, Great Ormond Street, provided the laboratory service, under the new arrangements, for the whole of the London area. Children "At Risk" The number of children considered to be "At Risk" due to various hereditary, antenatal or post-natal factors at the end of the year was 341, compared with a figure of 439 at the end of the previous year. Expressed as a percentage of the number of notified live births in the year the number of children under special observation at the end of the year was 8 8 per cent. compared with the 1968 figure of 11 per cent. All children "At Risk" are carefully followed up until such time as it is ascertained that proper progress is being maintained and that no abnormality is apparent. Handicapped Pre-School Children Parents of handicapped children undergo particular stress at the time of first diagnosis and both they and the children are in need of special help thenceforth. The range of professional persons available to provide this help is considerable so that there is a real problem of co-ordination. The young handicapped child also needs comprehensive assessment so that the most appropriate education can be arranged. At the end of 1969, 192 handicapped pre-school children were under regular review by doctors, health visitors, social workers, educational psychologists, etc., so as to attain these various aims. Clinics The various services provided at the main clinics and subclinics in the borough are charted overleaf. 29 CLINIC SERVICES - 1969 GENERAL CLINIC SERVICES SCHOOL HEALTH SERVICES Midwives Clinic Antenatal Relaxation Classes Family Planning Cervical Cytology Child Health Immunisation and Vaccination Chiropody Dental Medical Consultation and minor ailments Speech Therapy Ophthalmic Orthoptic Orthopaedic Phy siotherapy MAIN CLINICS Collier Row Clinic Hulse Avenue, Collier Row √ √ √ √ √ √ √ √ Cranham Clinic Avon Road, Cranham √ √ √ √ √ √ √ √ √ √ Elm Park Clinic Abbs Cross Lane. Elm Park √ √ √ √ √ √ √ √ √ √ √ √ Harold Wood Clinic Gubbins Lane, Harold Wood √ √ √ √ √ √ √ √ √ √ √ √ Harold Hill Health Centre Gooshays Drive, Harold Hill √ √ √ √ √ √ √ √ √ Hornchurch Clinic Westland Avenue, Hornchurch √ √ √ √ √ √ √ √ √ √ √ Rainham Clinic Upminster Road, Rainham √ √ √ √ √ √ / √ √ √ Romford Clinic Marks Road, Romford √ √ √ √ √ √ √ √ √ √ √ √ South Hornchurch Clinic South End Road, Rainham √ √ √ √ √ √ √ √ √ √ √ √ √ Upminster Clinic St. Mary's Lane, Upminster √ √ √ √ √ √ √ √ √ √ √ SUB-CLINICS Hilldene School Clinic Grange Road, Romford √ Heaton Way Congregational Church Chaucer Road, Romford √ √ Mardyke Social Centre Lowen Road. Rainham √ √ Congregational Church Nelmes Road, Hornchurch √ √ Park Lane Social Centre Park Lane. Hornchurch √ √ √ St. Augustine's Church Birkbeck Road. Rush Green √ √ St. Michael's Church Main Road. Gidea Park √ √ Tweed Way Hall Tweed Way, Rise Park √ √ Bower Hall Havering-atte-Bower √ √ 30 Clinic Doctors The doctors working in the clinics are available to give advice or arrange investigations of the wide range of developmental problems of children, with a particular emphasis on the early detection and management of handicapping conditions. They do not undertake medical treatment, which is the sphere of action of the family doctor, but have access to all the resources of the National Health Service in their preventive and advisory role. The doctors also work in the schools and day nurseries, arrange immunisations and vaccinations, staff the family planning and cytology service, and cover the Council's occupational health service. The establishment of eight doctors was complete at the beginning of the year but later recruitment difficulties meant that one clinic was without a doctor for a considerable time. Dr. Elizabeth Haga who had completed over twenty-five continuous years at Romford Clinic, retired in mid 1969 and was very much missed by the staff and the third generation of mothers who had benefitted from her advice. Health Visitors and Clinic Nurses Staffing The shortage of qualified staff continues to hold back development and put great strain on those in post. The demands on a health visitor's time are increasing as her role changes from that of an advisor only on problems affecting children to that of a general advisor, investigator and co-ordinator of all matters affecting the personal health of the young, the elderly, the handicapped and other members of the community. Ciinic nurses are employed to carry out those duties not requiring the health visitor's particular training and have provided invaluable support by undertaking school nursing, immunisation sessions and some visiting work. Training Two student health visitors completed training but for family reasons oniy one took up employment. Three students were sponsored by the Borough and commenced training in September. The Field Work Instructors take student health visitors for training. A great many students from other disciplines, including student nurses, teachers, social workers, also ask to accompany health visitors on their work and every endeavour is made to 31 accommodate them. Senior staff are also asked to help with inservice and full-time training of other professional groups. Regular staff meetings are used for discussion and dissemination of the latest information on current topics. Co-ordination One health visitor is attached to a group of family doctors and others have less formal liaison arrangements. Senior health visitors attend Oldchurch, Harold Wood and St. George's Hospitals on a regular basis to act as a link between hospital and community services. Co-ordination of the work of health visitors and social workers received particular attention through the year because of the importance of ensuring good communication between these key community workers. Home visits The bulk of the year's visits (16,681) were concerned with the health and development of children. Ninety-eight per cent. of children born during the year (3,818) were visited at home to find if the mother had any need of advice or help, most often needed by mothers having their first baby; but a great variety of other problems are dealt with; sometimes nothing whatever to do with the baby! 1,231 elderly persons were visited (at the request of hospital or family doctor in 316 cases), 136 persons were followed up after hospital discharge, 41 mentally handicapped or disturbed people were visited and 1,240 visits made for a wide variety of other reasons. The tuberculosis visitors made 692 visits. Speech Therapy Miss R. Brewitt, Senior Speech Therapist retired in August 1969 after 25 years service to children in the Hornchurch area. Her position was filled by Mrs. K. Hilton who has been employed as a Speech Therapist at local clinics since 1963. Another member of the Speech Therapy staff resigned during the year and two new appointments were made, one of which was on a part-time basis only. The general staffing situation at the end of the year was far from satisfactory and although a Speech Therapy service was maintained, it was necessarily limited and only the more urgent cases could be accepted for treatment. 281 children were newly referred for speech therapy during the year and 189 commenced treatment. 32 6,496 treatments were carried out. At the end of the year 258 children were currently under treatment and a further 79 awaited commencement of speech therapy. Day Nurseries Day Nurseries provide care for children up to the age of five years, either on a full day or sessional basis. Priority for admission is given to handicapped, deprived, neglected or socially isolated children who are likely to benefit from mixing with children of their own age group, and children whose mothers cannot look after them for any reason. Child development can be studied and assessments of various abilities made. The numbers of such children requiring priority admission is steadily increasing. The staff make considerable efforts through the year to increase the number of children receiving care and these efforts are reflected in the increased average daily attendance figures. Despite this, priority children had to wait for places to become available; in some cases for several months. The greatest pressure is on the 3 to 5 year age range. Two of the nurseries are specially equipped for children wearing hearing aids. All the nurseries are visited regularly by doctors and others with specialised knowledge of the needs of young children. Day Nursery Attendances and Waiting List Nurseries Places Average daily attendance over the year Waiting List on 31.12.69 Priority Non-Priority Elm Park 50 42:8 30 24 Romford 40 31:9 17 28 Collier Row 50 45:8 22 24 Rush Green 50 39:8 5 2 TOTAL 190 160:3 74 78 33 Nurseries and Child Minders Regulation Act 1948 At the end of 1969, 48 premises were registered, providing a total of 1,619 places, compared with 45 premises and 1,533 places at the end of the previous year. One factory day nursery providing full-time day care for 24 children is included in these figures. The remaining registrations relate in the main to playgroups held in church halls, community centres, etc. where the children attend for a few hours only each day. The number of child-minders registered rose from 30 to 91 during the year. This increase was largely due to new registrations effected as a result of the coming into operation of Section 60 of the Health Service and Public Health Act 1968, requiring persons caring for one or two children to be registered, whereas under the previous legislation registration was only required when more than two children were being cared for. As mentioned in my report for 1968, publicity concerning this change in the Law was given in the form of posters, advertisements in local papers etc., and resulted in a large increase in the work Staff involved in dealing with Applications for Registration. Apart from the Health Visiting Staff, Fire Prevention Officers and Public Health Inspectors are also concerned with inspecting the premises to ascertain their suitability and advise on measures to be taken to see that both fire precautions and environmental conditions are satisfactory. In addition, close liaison is maintained with the Planning Department to see that any Registrations effected do not contravene Town Planning Regulations. A booklet entitled "Day Care of Children under Five" has been produced by the Department, which gives useful information for Child-Minders and for Play Groups and Day Nurseries. This Booklet sets out in brief the requirements regarding Staff and premises, gives helpful advice regarding the care of the children, and also includes details of the recommended schedule of vaccination and immunisation, of the common infectious diseases, and commonsense safety precautions. Copies of the Booklet "Play with a Purpose" and "Not Yet Five" are also issued free of charge from the Department to all persons registered under this legislation. Home Nursing The work of the District Nurses, which goes quietly on every 34 day, enables a large number of patients to be satisfactorily nursed at home, thus obviating the need for hospital care in many instances, particularly amongst the elderly. On a national basis , the cost of providing the home nursing service by local authorities must be far less than would be the additional costs of inpatient treatment which hospital authorities would incur but for the work of the District Nurses. The effectiveness of the service is well appreciated by those concerned with its administration and, of course, by the patients themselves who know that the District Nurses will continue to visit and treat them regardless of adverse weather conditions or any other difficulties which may arise. In April 1969, two nursing auxiliaries (one male and one female) were appointed, whose duties are to undertake the bathing of patients in their homes, thus relieving the District Nurses of this duty and leaving them more time to undertake nursing work. Close co-operation is maintained between the District Nurses and the General Medical Practitioners and four District Nurses are fully attached to General Practice Groups. The number of patients nursed and the total number of visits paid continues to rise, as shown in the following table:— Home Nursing 1969 1968 Number of Persons Nursed:— Under 5 years of age 44 37 Ages 5 — 64 753 654 Age 65 and over 1,748 1,368 Total number of Persons Nursed 2,545 2,059 Number of Nursing Visits made during the year 82,794 79,713 It has long been the objective to have a whole nursing service staffed entirely by nurses holding the National Certificate in District Nurse Training. Many of the District Nurses already hold this Certificate and during the year five more nurses completed training and gained their Certificates. This is additional to the refresher courses which all District Nurses attend every five years. 35 Sick Room Equipment The loan of sick room equipment, free of charge, to persons being nursed at home is a necessary adjunct to the home nursing service and the number of articles loaned continues to increase in line with the number of cases attended. The following are the details of the various items issued during 1969:— 36 Sick Room Equipment Issued on Loan 1969 Article Quantity Air Rings 67 Back Rests 229 Bed Cradles 136 Bed Pans 206 Bed Pans (Rubber) 3 Bedsteads 29 Bed Tables 26 Commodes 399 Crutches 13 pr Draw Sheets 169 Feeding Cups 31 Fireguards 11 Foam Rings 236 Fracture Boards 15 Hoists 13 Mattresses 41 Pillow Covers 3 Plastic Sheets 291 Pole and Chain Pulleys 23 Rubber Sheets 2 Sani-Cushions - Sputum Mugs 1 Female Urinals 11 Male Urinals 120 Walking Aids — Quads 28 Walking Aids — Tripods 38 Walking Frames 105 Walking Sticks 119 Wheelchairs 352 TOTAL 2,717 In addition to the Sick Room Equipment listed above, disposable sheets and interliners and also plastic pants are issued free of charge for incontinent patients being nursed at home. Issues of sheets and interliners increased by almost 100% compared with the previous year, which would seem to indicate both that the number of incontinent patients being nursed at home has increased and that more use is being made of these items for sick patients. The figures are as follows:— 1969 1968 Disposable Sheets issued 89,400 45,500 Interliners 58,885 30,900 Plastic pants, pairs 385 318 Incontinent laundry service In addition to the issue of the disposable items for incontinent patients mentioned in the previous paragraph, the Department also provides an incontinent laundry service for sheets, night clothes etc., free of charge. Collection and delivery of the articles is undertaken twice perweek, the articles being laundered by arrangement with the Hospital Management Committee at St. George's Hospital, Hornchurch. The fact that in 1969 a total of 17,845 articles were laundered compared with a figure of 10,344 in the previous year, illustrates that the demand on this service, in common with the supply of disposable sheets etc., has greatly increased. Recuperative holidays 88 recommendations for recuperative holidays were received from Hospitals or General Medical Practitioners during the year. 62 adults and one mother and baby were sent to various private convalescent homes, the normal period being two weeks. The majority of the remaining 26 did not avail themselves of the facilities offered, but in one or two instances, e.g. in the case of very elderly persons, it proved impossible to find a suitable vacancy. Nursing homes Two private Nursing Homes are Registered in the Borough, both of which are regularly inspected by the staff of the Health and Welfare Department. These homes provide a total of 41 beds for acute and chronic sick patients. 37 SCHOOL HEALTH SERVICE 1969 The school population of the Borough continued to increase during the year to a total 44,138 (an increase of over 4% since the inauguration of the Borough in 1965). Two new schools were opened during the year, Towers Junior School in January and Brady Primary School in April. The school situation at the end of the year was as follows: — Primary Schools 84 (26,209 pupils) Secondary Schools 25 (16,080 pupils) (including Grammar Schools) Technical Schools 2 (1,496 pupils) Schools for Handicapped Pupils 3 (353 pupils) Total — 114 schools, 44,138 pupils Medical Inspections Periodic medical inspections of school pupils continue to play a fundamental part in the School Health Service. These take the form of a comprehensive screening examination; any defects detected being referred for investigation or treatment in consultation with the family doctor. The medical examinations also provide a useful opportunity for parents to discuss their children's health problems with the School Doctor, who is able to offer advice on matters varying from immunisation against infectious diseases to physical suitability for a chosen occupation. All children are given a routine medical inspection shortly after admission to the infants school but the trend in recent years has been for subsequent examinations to be on a selective basis, full examination being arranged only for those considered likely to be in need of medical attention. Selection is made by the School Doctor with the aid of previous medical records and information provided by the parents, teachers, health visitors and school nurses. A phased programme of selection for the intermediate age group (11 year old) has been developed in Havering over the past few years. The final phase was reached at the commencement of 38 the new school year in September 1969 since when the selective procedure is applied to all examinations in this age group. At the same time a pilot scheme of selection of the Secondary Leaver age group was commenced at three Secondary Schools. During 1969, 10,407 children were examined by the School Doctors at periodic medical inspections and a further 1,576 were found not to warrant a medical examination following the selection procedure. As a result of these periodic inspections 1,574 (15.1%) of the children were found to be suffering from 1,854 conditions requiring treatment (excluding dental defects). A further 5,277 conditions were found which needed to be kept under observation Defects found at periodic medical inspections included the following:— Condition No. of defects found requiring:- Treatment Obseryation Defective Vision 787 831 Squint 108 103 Defective Hearing 48 464 Nose and Throat conditions 120 562 Lung Conditions 26 229 Speech Defects 49 144 Developmental Abnormalities 78 361 Skin Diseases 158 403 Psychological Conditions 43 532 Orthopaedic Defects 266 853 Medical examinations by the school doctors are carried out at the School Clinics whenever required. Many of these are follow-up examinations resulting from periodic medical inspection in school, and others are arranged at the special request of the parent, teacher or school nurse. 39 1,765 follow-up examinations were carried out during the year in addition to 1,710 special examinations. 1,191 conditions were found to require treatment and a further 588 required to be kept under observation, including the following:— No. of defects found requiring:— Condition Treatment Observation Skin conditions 649 21 Defective vision 115 116 Hearing defects 40 80 Nose and Throat conditions 19 17 Speech defects 12 9 Orthopaedic defects 105 41 Psychological conditions 103 151 Screening Tests Vision and hearing screening tests by school nurses are part of the routine medical inspection programme and additional tests of children in the 7 to 8 year age group are also carried out. Colour vision is also tested at the intermediate or final medical inspection. Cleanliness Inspections Routine cleanliness inspections by school nurses include examination for head infestation and foot inspections. 21,618 inspections were carried out during the year and 76 cases of infestation were found. None of these were sufficiently serious to require a cleansing notice to be issued to the parent. Specialist Services Specialist Consultant and Treatment services for school children are provided at the Council's Health and Welfare Clinics by arrangement with the N.E. Metropolitan Regional Hospital Board, as follows:— a. Ophthalmic Specialist Sessions 3,669 pupils attended ophthalmic sessions held at 8 of the Council's Clinics, including 988 new referrals. 1,151 prescriptions for glasses were issued. 40 b. Orthoptic Treatment Sessions 148 pupils were referred for non-surgical treatment of squint to orthoptic sessions held at 2 of the Council's clinics. 712 treatments were provided during the year. c. Orthopaedic Specialist Sessions Orthopaedic Specialist sessions were held at 4 of the Council's clinics. 357 children, including 198 new referrals, made 874 attendances at these sessions. d. Physiotherapy Sessions In conjunction with the Orthopaedic Clinic, treatment by qualified Physiotherapists is provided at 5 of the Council's clinics. 733 children, including 308 new referrals made 1,727 attendances for physiotherapy treatment. Child Guidance Clinic 682 children attended the Child Guidance Clinic during the year, including 317 cases newly referred. Total attendances for treatment were as follows:— No. of interviews Psychiatrist 2,853 Psychiatric Social Worker 1,554 Educational Psychologist 987 At the end of the year 405 cases were under treatment and 61 patients awaited their first appointment. Dental Clinics Dental treatment is provided at 9 of the Council's Health and Welfare Clinics. 13,256 children were inspected in school by the School Dental Officers during the year and 5,081 pupils were treated at the Council's dental clinics. A total of 13,628 attendances for treatment were made. The report of the Chief Dental Officer appears on page 44, School Clinic Sessions Regular School Clinic Sessions, staffed by School Doctors and Nurses are held at each of the Health and Welfare Clinics and at the School Clinic situated at Hilldene Junior School. 41 3,417 attendances were made to see the School Doctors, including 1,765 follow-up examinations as a result of previous special or routine medical inspections. 7,803 other attendances, not requiring the doctor's attention, were dealt with by the nursing staff. Conditions treated included the following:— Skin diseases 1,462 Eye diseases 78 Diseases and defects of the ear, nose and throat 190 Miscellaneous minor conditions 799 Handicapped Pupils 112 children were ascertained as handicapped pupils during the year and 105 admissions to special schools were arranged. Regular visits to the Boroughs three schools for educationally subnormal pupils were made by School Doctors, Nurses and Speech Therapists. 351 pupils were on the roll of these schools at the end of the year. In January 1969 a Unit for Partially Hearing Pupils was opened at Hacton Junior School, staffed by a qualified teacher of the deaf (part-time) assisted by a full-time teacher. The two peripatetic teachers of the deaf were also available to provide additional teaching help and advice when required. The Unit started with 6 pupils but is intended to cater for up to 12 children of Junior School age. 10 were on the register at the end of the year. A similar Unit for Infant School age children has been opened at Eastbury School, Barking, and reciprocal arrangements exist with that Authority to accept children of each age group from either Borough. The peripatetic service to hearing impaired children was interrupted in the summer of 1969 owing to the resignation of both peripatetic teachers of the deaf. An appointment was made to fill one of these posts, commencing in January 1970. The following table gives particulars of ascertained handicapped pupils at the end of the year:— 42 43 Category Total number of pupils ascertained as handicapped at end of year Number of pupils newly ascertained during the year Number of pupils admitted to special schools during the year Total number of pupils attending special schools at end of year Day Residential Blind 4 - - - 4 Partially sighted 10 - - 7 1 Deaf 14 3 3 10 4 Partially hearing 35 4 7 31 3 Physically handicapped 45 10 10 28 10 Delicate 31 9 6 16 6 Maladjusted 33 10 7 1 18 Educationally subnormal 335 75 70 304 13 Epileptic 8 1 2 - 8 Speech Defects - - - - - TOTAL 515 112 105 397 67 ANNUAL REPORT OF CHIEF DENTAL OFFICER - 1969 1. Staff No year passes without some staff changes taking place and the year under review proved to be no exception. The dental auxiliary, appointed in April, 1968, resigned in April to take up a post in Health Education. During her stay she had shown the value of an operating auxiliary to the dental team, both in regard to the treatment of young children and in the sphere of dental health education. During August, a dental surgeon with some five years experience in children's dentistry was appointed to the vacant dental surgery in the Health Centre. This recruitment was balanced, unfortunately, by the dentist at Collier Row Clinic resigning in order to enrol full-time on a course of study leading to the newly-established Diploma in Dental Public Health. At the end of the year five full-time dentists were in post, with an additional four sessions per week provided on a contractual basis. This left the staffing ratio of just over 8,000 school children per dental officer in a similar position to the previous year. 2. School Dental Inspections The aim of inspections at school is to obtain a complete check on the dental health of every child in maintained schools and to ensure that no child fails to obtain any necessary treatment from one source to another, Inspections have again concentrated on primary schools and a further increase in the number inspected can be reported for the year. The total of 13,256 still falls far short of complete inspection of the school population. 3. Dental Health Education The dental auxiliary continued her visits to primary schools giving talks and demonstrations on dental health education until her resignation. A return visit of Pierre the Clown was arranged with the co-operation of the General Dental Council and the Fruit Producers' Council. He spent a week in the Borough and visited 24 Primary Schools in different areas giving dental health talks to some 9,000 school children. 44 While a visit of this nature is valuable, providing as it does a certain novelty of approach, the message put across needs to be kept fresh in young minds by repetition in class. Great importance should be attached to the need for dental health education as part of a regular course of personal hygiene in schools. 4. Fluoridation Twice during the year there was an opportunity for the Borough Council to approve the principle of fluoridation of the public water supply. The principle was rejected on both occasions. As it is some years sipce our neighbouring Boroughs voted in favour of fluoridation this rejection prevents the measure being being implemented over a wide area. Meanwhile, children s teeth decay and the treatment services are hard pressed to meet demands, not to mention actual needs. If the fluoride content of the water supply were to be raised to the optimum level, all children could be given the advantage previously available only to those fortunate to live in areas here natural fluoride in the water helps to prevent tooth deca\. In this country certain areas have entered their second decade with controlled fluoridation and the measure has proved itself fully in practice. No hazard to health has resulted In each case it has been followed by the expected improvement in dental health. In the light of this experience, it is to be hoped that when the issue is debated again, there will be a change of thought in Havering about one of the most important public health developments in recent years. 5. Visit During March, Mr. J.G. Potter, Dental Officer at the Department of Education and Science made his third visit to Havering to review the Borough's dental services. These visits by a member of the Joint Dental Staff are particularly valuable as they provide an opportunity for an evaluation to be made of the services provided. A comparative assessment is also possible with the School and Priority Dental Services nationally and this serves as a useful guideline for future effort. 1 The Fluoridation Studies in the United Kingdom and the results achieved after Eleven Years H.M.S.O. 1969. 45 6. Post-Graduate Refresher Courses Continuing professional education of the staff is an important aspect in all public health work, but opportunities remain few for attendance at refresher courses. Members of staff have attended two day courses on Dental Health Education, and Organisation and Efficiency in the Public Dental Service, both held in London. In addition, three members of staff gave up a Saturday to attend a Symposium on Orthodontics held at Whipps Cross Hospital. 46 The full annual statistics for the Dental Service are given in the following tables. Dental Inspections & Treatment of School Children Inspections (a) First inspection at school. Number of Pupils 13,256 (b) First inspection at clinic. Number of Pupils 3,933 Number of (a) 4- (b) found to require treatment 6,384 Number of (a) 4- (b) offered treatment 6,098 (c) Pupils re-inspected at school or clinic 859 Number of (c) found to require treatment 490 Attendance and Treatment Ages 5 to 9 Ages 10 to 14 Ages 15 & over Total First Visit 3,050 1,705 326 5,081 Subsequent Visits 4, 220 3,521 806 8,547 Total Visits 7,270 5,226 1,132 13,628 Additional courses of treatment commenced 437 212 29 678 Fillings in permanent teeth 1,859 3,668 1,072 6,599 Fillings in deciduous teeth 4,630 253 — 4,883 Permanent teeth filled 1,557 3,264 995 5,816 Deciduous teeth filled 4,353 238 — 4,591 Permanent teeth extracted 73 265 66 404 Deciduous teeth extracted 1,592 571 — 2,163 General anaesthetics 289 67 7 363 Emergencies 472 165 28 665 Number of Pupils X-rayed 604 Prophylaxis 1,050 Teeth otherwise conserved 1,097 Number of teeth root filled 104 Inlays 2 Crowns 20 Courses of treatment completed 3,573 Orthodontics Cases remaining from previous year 163 New cases commenced during year 62 Cases completed during year 78 Cases discontinued during year 13 Number of removable appliances fitted 154 Number of fixed appliances fitted 3 Pupils referred to Hospital Consultant 15 Prosthetics 5 to 9 10 to 14 15 & over Pupils supplied with F. U. or F. L. (first time) - - - Nil Pupils supplied with other dentures (first time) - 1 2 3 Number of dentures supplied — 1 2 3 Sessions Number of treatment sessions 2,251 Number of inspection sessions 120 Number devoted to Dental Health Education 44 47 Dental Service for Expectant and Nursing Mothers and Children under 5 years ] Children 0-4(incl ) Expectant & Nursing Mothers First Visit 548 66 Subsequent Visits 539 158 Total Visits 1087 224 Number of Additional Courses of Treatment other than the First Course commenced during year 46 3 Treatment provided during the year — Dental Service for Expectant and Nursing Mothers and Children under 5 years (cont'd.) Number of fillings 753 146 Teeth filled 704 145 Teeth extracted 115 68 General anaesthetics given 51 4 Emergency visits by patients 48 10 Patients X-rayed 6 21 Patients Treated by Scaling and/or Removal of Stains from the teeth 79 46 (Prophylaxis) Children 0-4(incl.) Expectant & Nursing Mothers Teeth otherwise Conserved 206 - Teeth Root Filled - 2 Crowns - 2 Number of Courses of Treatment Completed during the year 300 42 Prosthetics Patients Supplied with F.U. or F.L. (first time) 1 Patients Supplied with other dentures 8 Number of Dentures supplied 11 Inspections Children 0-4(incl.) Expectant & Nursing Mothers Number of Patients given First Inspections during year A.850 D.84 Number of Patients in A and D above who required treatment B. 393 E. 65 Number of Patients in B and E above who were offered treatment C.390 F. 65 Number of Dental Officer Sessions devoted to Maternity and Child Welfare Patients— for treatment 169 48 Health Education During the year the whole field of Health Education in the Borough was reviewed. The work falls into three sections: (1) Contacts with the general public by means of posters, talks, exhibitions, etc. (2) Contact with Ante-natal mothers and mothers of young children via Health Visitors and Clinics. (3) Contacts with schoolchildren, mainly by individual Health Visitors, members of the staff of the Health Education section, and some schoolteachers who are interested in the subject. The conclusions arising from this review were that only a very small section of the general public could be reached effectively on a local basis, and that possibly only large scale Health Education publicity on a national basis involving television, radio, and press coverage, has the power to influence the health habits of a significant proportion of the general public. The Health Education of mothers attending the clinic and seen by the Health Visitors has proved itself over the years in increasing awareness on the part of the mothers for proper standards of hygiene and child care. This section of Health Education presents few problems as new mothers are anxious to learn and the Health Visitors well qualified give them all the information they seek. With schoolchildren there is both the wish and the will to learn in nearly every instance. Once the child starts school there appears to be a tendency for the majority of children to accept the teaching in schools, whether it be from the schoolteachers or from Medical Officers, Dentists, Health Visitors, etc. in preference to what they are taught at home. In the long term, therefore, it appears that the greatest possibility of Health Education being really effective is to increase the teaching of this subject in schools. With the size of the school population it is obviously impossible for the Health Education and Health Visiting staff to reach more than a small proportion of the school population during the course of the year. It was decided, therefore, to endeavour to increase the interest of the teaching staff with a view to their including health education subjects in with general teaching — not necessarily as a separate subject, but as an item which can be introduced as and when opportunity occurs during normal lessons. Without making any radical changes, a start was made in this direction by advising all headteachers that various health education aids such as films, film slides, etc. could be borrowed from the Health Education section, and as a result in the second 49 half of the year, 94 requests for the loan of such items were received from the schools. The services of the health education staff were offered and accepted' on a number of occasions to schools for special projects and a close liaison between some of the individual teachers and the staff of the section was built up. Health Visitors and other members of the staff continued to give talks to classes in various schools on particular subjects as and when requested. All requests from local organisations for talks to be given to their members on health education topics were accepted and 80 such talks were given during the year, attended bv approximately 2,500 persons. In addition the Chief Public Health Inspector organised a series of Courses on Food Hygeine in conjunction with the Havering Technical College. Home safety continued to be an item to which a great deal of publicity was given by the health education staff, both as regards adult organisations, groups of scouts, guides, cubs, brownies and boys' brigade, and in the schools. To" stimulate interest in the schools, a Home Safety competition was held in the Primary Schools, the judging of which was undertaken by Miss A.I. Walker, a member of the Home Safety Panel. For Secondary Schools, the Home Safety quiz competition had its second season, and after a number of very closely fought matches between the various Schools, the semi-finals and finals were held at the Town Hall, Romford, in November, the winners of the Teskey Trophy for this competition being Brittons Secondary School. Members of the staff of the Department continued to take part in the pre-retirement Courses run at the North Havering College of Adult Education, following the pilot Course commenced in the previous year, have lectured pupil nurses and midwives at local hospitals, and have also continued to take part in many other similar activities in various professional disciplines. The Health Education section also prepared an exhibit illustrating all the various aspects of the work of the Health and Welfare Department which formed part of an exhibition organised by the Havering Council of Social Service which was held at the Central Library, Romford, for two weeks in May. 50 Prevention of Tuberculosis Mass Radiography Unit 6B of the North East Metropolitan Regional Hospital Board revisited the Borough during the year in order to complete the survey taken in 1968. A total of 3630 persons (1615 male and 2015 female) were examined at these sessions which were held at two factories and at five other locations in the Borough. In late September 1969 a regular weekly Chest X-Ray Service was instituted by this Unit being stationed at the Health & Welfare Department Offices in Billet Lane, Hornchurch on Mondays from 10.00 a. m. to 2.00 p. m. 14 of these sessions had been held by the end of the year at which 1206 persons (479 male and 727 female) had been x-rayed. Dr. Shoulman, Medical Director of the Unit, reports that at these weekly sessions two active cases of Tuberculosis were discovered, both male. In addition, three cases of Tuberculosis (one male and two female) requiring occasional supervision were also detected, and he points out that the rate of Tuberculosis cases detected at these regular sessions was much higher than those detected under the normal system of visiting Factories and holding public sessions in each area at intervals of two or three years. Dr. Shoulman adds that it will be interesting to see whether the yield of significant abnormalities is maintained in these regular sessions during 1970. 67 of the total of 4836 persons examined by the Unit were referred for further large film or clinical examination. The results of these further investigations were as follows:- M ale Female T otal Tuberculosis lesions Unilateral inactive post primary P.T. 5 1 6 Bilateral inactive post primary P.T. 1 6 7 Unilateral active post primary P.T. 2 1 3 51 Other abnormalities revealed Abnormalities of the bony thorax and soft tissues-acquired 1 1 Bacterial and virus infections of the lungs 2 2 4 Bronchiectasis 1 — 1 Emphysema 1 - 1 Pulmonary fibrosis — non-tuberculous - 1 1 Carcinoma of the lung and mediastinum 6 — 6 Metastases in the lung and mediastinum 1 — 1 Pleural thickening or calcification — non-tuberculous - 1 1 Acquired abnormalities of heart and vessels 7 4 11 Cases who failed to attend for further films or clinical examination 1 - 1 A.l(no abnormality detected on large film) 12 11 23 Totals 39 28 67 Care of the Tuberculous The arrangement whereby the Havering Tuberculosis Care Association provides after care assistance for patients suffering from Tuberculosis and for contacts of cases has continued. For this purpose, the Council make a grant to the Association which the Association augments by various appeals and fund-raising measures. The clerical work of the Association is carried out by the staff of the Health and Welfare Department, and members of the Council, Tuberculosis Health Visitors and representatives of various voluntary bodies form the Committee with the Chest Physicians acting as medical advisers. Milk for Tuberculous Patients Upon the recommendation of the Chest Physicians, the Council provide one pint of milk daily free of charge to patients suffering from Tuberculosis. 86 patients received milk during the year of whom 22 were new cases. These figures show a reduction on the previous year when the numbers were 103 and 34 respectively. 52 HOME HELP SERVICE This Service is supervised by a Senior Home Help Organiser and the Borough is divided into four areas with a Home Help Organiser responsible for the service allocated to each area. The Service is administered centrally, four clerical assistants being available to undertake the clerical work for each of the four areas. The Organisers' duties consist of assessment of need for the Service, the provision of help, and the supervision of the staff. The Domestic Help Organisers also undertake similar duties in respect of the Night Attendant Service and the Good Neighbour Service, details of which are given below. The statistics relating to the Domestic Help Service are given in the table below. The number of requests for assistance, the number of patients provided with help, and the total number of hours of service given were all lower than the equivalent figures for 1968, but the number of patients being provided with a Home Help at the end of the year was 1,791, compared with 1,678 at the end of 1968. Occasional difficulties have arisen in the recruitment of Home Helps in some parts of the area, but this has been overcome by using help from other parts of the Borough. The question of recruitment is a constant one, as there is a considerable turnover of staff among the 400 parttime Home Helps employed, but all requests for help, where need existed, have been covered. The assessment of the need for a Home Help and the degree of such assistance required is undertaken with the greatest care. Upon referral, the Organiser has to determine the ability of the patient to undertake certain tasks, the total amount of work required and the amount of work, including the time involved, for which the services of a Home Help are required. Some patients are unable to do anything around the house and therefore require maximum assistance, but others, who have some mobility, can do much for themselves and require help only for heavy cleaning tasks, shopping, etc. The Home Help Organiser, therefore, has to ensure that assistance is not given too generously as this would obviate the necessity for the patients to make an effort to do those things for themselves which they can accomplish. This policy has the effect of keeping the patient mobile and self-reliant as far as possible. It does, however, sometimes cause patients to compare the amount 53 of assistance they receive with others in similar circumstances, and to ask why, if their neighbour has a certain number of hours per week, they cannot have the same. The circumstances relating to various patients are rarely the same and the amount of help provided for any individual is decided upon in their own best interests, together with current resources. The amount of assistance provided is subject to review at regular intervals, or at any time when a change of circumstances is reported either by the patient, the Home Help or from any other source. The in-service training programme for groups of home helps, held at the College of Technology, continued through the year. Home Help Service Requests for help from new cases during the year 1097 Cases not eligible for assistance or not requiring services 335 New cases helped during the year 759 Persons being helped at the end of the year 1791 Total persons helped during the year 2673 Total number of hours of help provided during the year 305184 Night Attendant Service As previously reported, this Service is provided to give relief to relatives having to care for seriously ill patients being nursed at home. The number of requests for assistance varies considerably and the number of cases which could be helped is affected by the fact that the Marie Curie Memorial Fund provides a similar service in this area for terminal cases of carcinoma. The Marie Curie Scheme which is operated by the Health and Welfare Department acting as Agents for the Fund, provided Night Attendants for 27 cases, involving a total of 1977 hours during the year. Details relating to patients helped through the Council's Scheme, are as follows Night Attendant Service Number of Patients helped during the year 8 Number of hours for which attendants were supplied 513 Apart from the provision of nursingcare, as mentioned above, the Marie Curie Memorial Fund also gave assistance to four patients in the form of extra nourishment, clothing, bed linen, etc., and two patients were admitted to Marie Curie Homes. 54 Good Neighbour Service This Service is ancillary to the Home Help Service. Neighbours are enrolled to provide assistance to patients living nearby and who are who are living alone. The Good Neighbour is asked to see that the needs of the patient, such as attention to fires, provision of meals and settling down for the night, are met, whilst the Home Help is employed for set periods during the day to undertake normal housework, shopping, etc. This Service encounters difficulties in a number of instances in being able to recruit neighbours to undertake these duties. A small payment, not exceeding £2 per week, is made by the Council to the Good Neighbour, the actual amount depending upon the degree of attention required by the patient. Good Neighbour Service No. of patients provided with help under 11 the Good Neighbour Service No. of patients being assisted under the Scheme 10 at the end of the year. 55 CHIROPODY SERVICE The Chief Chiropodist, Mr. L. A. Bolland reports as follows:- Statistics relating to the service are as follows:- GROUP New Case s No. of Persons Treated Clinic Attendances Domiciliary Treatments Treatments Welfare Establishments 1. Pre—School Children 4 4 4 — — 2. School Children 88 133 232 56* - 3. Expectant Mothers 9 12 9 - - 4. Aged 995 5072 20027 9116 2035 5. Physically Handicapped 27 55 163 97 - 6. Others 23 24 145 35 — TOTAL 1146 5300 20 580 9304 2035 * Mentally Handicapped seen at the Training Centre and Westmarsh Lodge. The year showed an increase in the number of treatments given at Clinics and at Domiciliary visits. The number of persons applying for attention also increased, which has meant the period between treatments being extended in most cases. It should be remembered that Chiropody is mainly palliative, particularly in the case of the aged and treatment at fairly frequent intervals is necessary if comfort is to be maintained. Now that the service has reached the maximum with the present staff establishment each new case means the extension of the period between treatments for another patient. From April the 1st the establishment was increased by one Senior Chiropodist and this post was filled in September, the person appointed being placed at the Elm Park Clinic. This relieved the chiropodist from the South Hornchurch Clinic who had been attending for one day each week, and further enabled the Elm Park Clinic to operate every morning during the week. The chiropodist at Upminster and the part-time Contractor responsible for Domiciliary visiting in the Elm Park area were absent from duty during the early part of the year for twelve weeks. This placed a great strain upon the remainder of the staff. By rearranging duties it was possible to attend to all patients 56 considered "At Risk" e.g. Diabetics, and persons suffering from severe Circulatory Disorders, but unfortunately many other patients had to wait for a considerable period before it was possible for them to receive attention. Rainham and South Hornchurch are the only Clinics without a purpose built Chiropody room, but the rooms used are quite adequate, particularly so as the chiropodists at these Clinics have to spend each afternoon on domiciliary visiting and could not at present make full use of any room. The accommodation at the Park Lane Community Centre is far from satisfactory, but at present there seems to be no alternative available. The new Ring Road in Romford has meant difficulty for many of the aged in getting to the Romford Clinic. Some, especially those partly disabled find that a considerable walk is required to obtain a bus. Some also find the new traffic arrangements confusing, particularly in getting to the buses, though when the subways are completed and persons are more used to them it may be better. In an effort to help patients many have been temporarily placed upon the domiciliary visiting list or offered appointments at the Collier Row Clinic, which though meaning a longer journey does have the advantage of being at a bus stop on a well serviced route. In conclusion, the service has even with the recent increase of staff, reached its maximum, this is particularly evident in the Domiciliary service. OCCUPATIONAL HEALTH SERVICE This service provides medical screening of all prospective employees of the Council and also investigation of any medical matter affecting either an individual employee or a 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 57 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 below. Occupational Health Service Number of questionnaires scrutinised 1567 Number selected for full examination 89 Number found unfit for employment 6 Number recommended for further review 4 Medical examinations for other authorities 12 Number of full medical examinations of teachers and 308 prospective pupil teachers (carried out according to national requirements outside the Council scheme) Number of persons screened by chest X-ray 1009 (i.e. duties in contact with children) Number of persons screened for intestinal pathogens 566 (i.e. duties concerned with preparation of food) Number of special medical examinations 85 58 SOCIAL SERVICES Miss F. K. Wells, Principal Welfare Officer, reports as follows: The social work services were not able to develop and progress during 1969 as had been hoped, following the major changes the previous year and the gradual build-up of confidence and security among staff arising from the success of these changes. 1968 had seen the reorganisation of the social work in the department into area teams. This had later been strongly recommended by the Seebohm Report, whose main recommendations were later still largely incorporated into the 1970 Local Authority Social Services Act. So Havering, with a handful of other local authorities, had forecast and brought about a number of difficult internal staffing changes which all other authorities had still to plan. Unlike many other authorities, too, Havering run their residential welfare services within their main social work administration. This avoids a situation where dual services — residential and domiciliary—tend to go their separate ways, with separate standards, and separate attitudes towards training and the improvement of working skills. The factor preventing the social work services promoting themselves at last within the local community, thus helping more people more effectively, and also discovering in greater detail than before their greatest needs, so helping the authority to plan priorities with more knowledge of the real facts, was the damping down of resources. It became impossible to increase staff by so much as a single welfare assistant. Yet all the time the work increased. New cases came in almost as fast as before, in spite of no real promotion of any social work service for nearly five years. The staff often had to discontinue their contact with former cases much earlier than was helpful, in order to attend to new ones. But still numbers accumulated, and during 1969, 1364 new cases were opened, 1091 being closed. Further information on these new cases is given below. The feeling of staff that they were under such intense pressure that they were not being able to help those they were in touch with as well as they should was confirmed objectively by figures produced by the Department of Health and Social 59 Security. These showed the numbers of social workers employed in September 1969 in proportion to population. 30 of the 32 London Boroughs had more social workers per population than Havering —11 had at least twice as many — and only one Borough was worse off. Yet the reputation of the department's social work service remained high. An example of this was the many requests from universities, polytechnics and colleges to have their professional social work students receive part of their field work training in the section. By no means all could be accepted, but even so, seven of these professional students came to the department, most for nine months each, besides many others staying for anything from a day or so to six weeks on visits of observation. New Cases During 1969, 1364 new cases came to the attention of the social work section (the 1968 and 1967 figures were 1468 and 1498 respectively). The individuals, or families, concerned were said to need, primarily, the following services when first coming to the notice of the Department: (1968 figures in brackets) Services for the physically handicapped— 248 (247) A place in one of the Department's— 240 (253) old peoples' homes Families with problems with housing,— 182 (231) including some who were homeless After-care for mental health problems— 120 (133) Requiring admission to psychiatric hospital— 70 (76) Services for the blind or partially sighted— 69 (82) Services for the mentally handicapped— 57 (44) A place in one of the Department's mental— 25 (21) health hostels Services for the deaf or hard of hearing— 5 (20) Families and individuals needing help for a variety of reasons other than those mentioned above— 315 (273) (178 (142) being elderly people) In addition, 33 (57) new cases were referred to the social workers for investigation or reports; 20 (45) of these concerned situations involving mental health problems. 60 Work of the Social Workers The social workers were occupied, as formerly, in five different ways: 1. Investigation, and giving continuing help where necessary, to all new cases that came to the social work section. 2. Investigation, and giving continuing help where necessary, to reopened 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. 5. Office duty and meetings; correspondence and cases recording; liaison with other agencies; case conferences, etc. During 1969 the Borough's Management Services Unit examined the work of the section, which involved everybody, and especially senior staff, in a good deal of additional work. Social workers carry out most of their work during interviews with families and individuals. A note was kept during 1969, as in previous years, of the places where the department's social workers carried out any interview which lasted longer than 15 minutes. There were 17,707 such interviews (compared with 17,760 in 1968 and 16,830 in 1967) and they took place as follows: (1968 figures in brackets). 11,898 (11,835) in people's own homes 1,244 (1,324) in the Billet Lane offices 1,213 (1,044) in hospitals, particularly Warley Psychiatric Hospital 440 (365) in the department's old people's homes 375 (293) in Collier Lodge or Westmarsh Lodge, the department's mental health hostels. 260 (269) in the department's Adult and Junior Training Centres for the mentally handicapped, and in the Special Care Unit for the severely handicapped. 242 (261) in the Faring don Centre, the department's Occupational Centre for the physically handicapped 120 (214) in the department's temporary accommodation for homeless families 1,915 (2,095) in other places 61 Social Work Staff No new posts were allowed the section during 1969. The vacancy created by the death of one of the social workers, Miss Mary Truran, was converted to 2 welfare assistant posts, at the request of her area social work team. One of these assistants joined her team, one another team, but though the arrival of these workers went some way to ease pressures in the service, there was no money available to give the third area team a welfare assistant too. So work in this last area continued to be done by social workers which could well be dealt with by an assistant. By the end of the year, then, there was 1 fewer social work post than in 1968, but 2 new posts of welfare assistant. The 3 welfare trainees were all on full-time courses leading to the certificate in social work. 13 of the 24 social workers were professionally qualified. The position on 31st December, 1969 was as follows: Principal Welfare Officer 1 Applied Social Studies Certificate Deputy " " " 1 Medical Social Work Certificate Area Social Workers 2 One with Mental Health Certificate one with Medical Social Work " Senior Mental Welfare" 1 Certificate of Recognition of Experience in Social Work Social Workers (4 Mental 19 One with Medical Social Work " welfare officers 15 7 with Certificates in Social Work, social welfare officers) 1 with Degree in Social Work, 3 with Home Teacher for the Blind. Certificates (these included two officers who hold the Certificate of Recognition of Experience in Social Work, and 1 qualified as an Occupa tional Therapist) Two others with Certificate of Recognition of Experience in Social Work Total 24 Welfare Trainees 3 Welfare Assistants 2 One vacancy at this time, for an area social worker, was filled in February 1970 with a social worker having the Applied Social Studies Certificate. 62 During 1969 Mr. A. K. Huddle stone, Deputy Principal Welfare Officer, left to become Social Services Officer in Northumberland. Mr. John Gill, a family caseworker, left for a more senior post in Hertfordshire, and Mrs. R. M. Oldham moved to Leeds. Miss Mary Truran, who earned so much affection and respect during the short time she was in the department, died. In April 1969 Miss Eileen Turner Smith, Deputy Principal Welfare Officer, was elected Chairman of the Executive Council of the Institute of Medical Social Workers, one of the largest and oldest of the professional social work organisations. She has been helping to wind up the affairs of the Institute, which is giving place, with six other similar social bodies, to the newly formed British Association of Social Workers, and is now on the Council of the B.A.S.W. Two other social workers in the department, Miss Margaret Guth and Miss Kay Wells, also serve on it at national level on standing committees. 63 SERVICES FOR HANDICAPPED PERSONS 1. Physically Handicapped The number of persons whose names were added to the register of physically handicapped persons during the year was 91 compared with a figure of 161 in 1969. In consequence the total number of persons on the register at the 31st December, 1969 was 1,171, 30 less than at the end of the previous year. This is the first year since the formation of the Borough that the number of persons on the register has decreased. Details of those on the register are given in the following table:- Register of Physically Handicapped Persons Handicap No. of Persons on Register at 31.12.69 No. of persons whose names were added to the register during year ended 31.12 69 Deaf with Speech 37 - Deaf without Speech 58 1 Hard of Hearing 37 3 General Classes of the Physically Handicapped 1039 87 TOTAL 1201 91 The age groups of persons on the register together with an analysis of those in the general classes are set out overleaf:- 64 Handicaps and Ages of Persons on Registers of Physically Handicapped 31st December, 1969 Handicap under 16 16-29 30-49 50-64 65 Total Deaf with Speech 2 7 14 3 11 37 Deaf without Speech 2 13 26 17 2 58 Hard of Hearing 2 5 2 3 25 37 General Classes (1) Amputation _ 5 13 16 34 (2) Arthritis or Rheumatism - 4 17 71 284 376 (3) Congenital Malformation or Deformity 3 1 2 2 2 10 (4) Diseases of Digestive and genito-urinary systems, of the heart or circulatory system (other that Tuberculosis of the skin) - 6 8 38 92 144 (5) Injuries of the head, face, neck, thorax, abdomen, pelvis or trunk Injuries or diseases (other than Tuberculosis) of the upper and lower limbs and of the spine. - 12 15 22 35 135 (6) Organic nervous diseases — epilepsy, disseminated sclerosis, poliomyelitis, hemiplegia, sciatica, etc. 13 54 84 92 65 308 (7) Neurosis, psychosis, and other nervous and mental diseases not included in 6 1 1 2 5 6 15 (8) Tuberculosis (Respiratory) - - 1 1 1 3 (9) Tuberculosis (Non-respiratory) - 1 - - 2 3 (10) Diseases and injuries not specified above 2 - 3 4 2 11 TOTALS 37 107 184 284 559 1171 65 Adaptations to Homes Where necessary the Council carry out a variety of adaptations in the homes of physically handicapped persons. During the year 70 such adaptations were carried out in homes, and these varied from small items such as handrails on stairs and ramps for wheelchairs, to quite large alterations to provide toilet facilities, etc., on the ground floor. Purpose-built Dwellings By the beginning of 1969. four purpose-built dwellings had been built by the Borough Council for physically handicapped persons, and three further dwellings were completed during the year. Further accommodation, consisting of two 2-bedroomed bungalows and two 1-bedroomed flats were either under construction or in the final planning stages by the end of the year, and these should be ready for occupation during 1970. Adaptations to Houses for Home Dialysis Machines Five Home Dialysis Machines have been installed in houses in the Borough prior to 1969. During the year five further patients were referred to the Department for installation to be effected. Close co-operation with the London Hospital Dialysis Unit, and with the Borough Architect is required as alterations can be extensive. Delays have been occasioned due to the unsuitability of the patient's home in one or two instances, and these have involved either lengthy negotiation to secure major repairs to the structure of the house or arrangements for the patients concerned to be rehoused in alternative accommodation. At the end of the year two installations were being proceeded with, one was being installed without financial assistance from the Council, and one installation was still under consideration. In the remaining case the patient died soon after the question of a home dialysis machine was referred to the Department. Occupation Centre for the Physically Handicapped The Faringdon Occupational Centre for the physically handicapped provides facilities for 60 persons per day. Some who have their own transport attend daily, but the majority have to be transported to and from the Centre in the special ambulance vehicles which are fitted with lifts to enable physically handicapped persons to be transported in their wheelchairs. Those that are transported attend twice per week on average. At the 66 end of the year 178 persons were on the register at the Centre. This number could be increased considerably if more accommodation could be made available there. Plans for extending the Centre, however, are still in abeyance. Holidays Holidays for the physically handicapped were provided in three ways during 1969. The largest section was catered for by taking over the Little Oyster Holiday Camp for a week. This provided accommodation for 75 handicapped persons and for 25 helpers. A further 46 handicapped persons were provided with holidays arranged through various voluntary organisations catering for specialised handicaps, and the Council also assisted financially 10 other handicapped persons who made private arrangements for holidays. Residential Care for the Physically Handicapped At the end of the year 13 physically handicapped persons were accommodated in Residential Accommodation provided by the Council, and in addition 16 handicapped persons were in accommodation provided on behalf of the Council by voluntary organisations. Special Aids Apart from articles listed under the Sick Room Equipment which are detailed elsewhere in this report, a large number of special aids are issued on loan by the department to assist physically handicapped persons in their own homes. The following is a list of special aids which were issued during the year. Article Quantity Helping Hands 76 Bath Boards 132 Bath Mats 196 Bath Rails 129 Bath Seats 165 Long Handled Brush & Pans 2 Thick Handled Knife, fork, spoon 2 sets Jacobs Ladders 7 67 Article Quantity Lazy Tongs 11 Geriatric Chairs 5 Nelson Knives 7 Plate Surrounds 7 Sock Puller-on 5 Stocking Aids 36 Suction Egg Cups 6 Tilting Teapot Stands 2 Ext. Toilet Seats 50 Toilet Surrounds 22 Trolleys 6 Wall Can Openers 5 2 Blind and Partially Sighted (a) Blind The number of resident blind persons in the Borough is given in the following table:- No. of Registered Blind Persons Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65 + M 2 - - - - 1 9 12 F - - - - - 3 22 25 Total 2 - - - - 4 31 37 Additions to the register of blind persons during the year numbered 37 as compared with 44 in the previous year. The ages of these persons were as follows Ages of Persons Added to Blind Register in 1969 Sex AGE GROUPS Total 0 - 1 2-4 5-15 16 - 20 21-49 50-64 65 † M 2 _ _ _ _ 1 9 12 F - - - - - 3 22 25 2 - - - - 4 31 37 68 Employment 28 Blind persons were in employment at the end of the year, 3 being in special workshops, 4 in home workers schemes and 21 in open employment and their various occupations were as follows:- Occupation of Blind Persons in Employment Proprietors, Managers & Executive Workers 2 Typists, Shorthand Typists, Secretaries 6 Telephone Operators 3 Working Proprietors, Shop Managers 1 Farmers, Farm Workers, etc. 1 Machine Tool Operators 2 Boxers, Fitters, Packers 2 Basket Makers 2 Boot & Shoe Repairers 1 Piano Tuners 2 Labourers 2 Domestic/Canteen Workers, Caretakers, etc. 4 28 Handicraft Classes 3 Handiwork classes are run by Social Welfare Officers who also give braille/moon lessons and handicraft instruction to blind persons in their own homes. In addition the Social Welfare Officers visit the blind to give advice and guidance on a variety of matters and assist them in obtaining free wireless sets, white walking sticks, etc., and also provide help when necessary in connection with claims for Supplementary Benefit, financial assistance with holidays, etc. Holidays Ten blind persons were provided with holidays in 1969 under the Council scheme. These holidays were arranged individually through voluntary associations for the blind. Residential Accommodation The details of blind persons in residential accommodation as at 31st December, 1969 are as follows overleaf:- 69 Blind Persons in Residential Accommodation M F Residential Accommodation provided under Part 111 of the National Assistance Act 1948 (a) Homes for the Blind 4 10 (b) Other Homes 5 15 Residential Homes other than above - - In Hospitals for Mentally 111 - 4 In Hospitals for Mentally Subnormal 2 1 Other Hospitals 2 8 Total 13 38 (b) Partially Sighted At the end of the year 125 persons were registered as partially sighted which was the same figure as recorded at the end of 1968. The age groups of those on the register are given in the following table. Number of Partially Sighted Persons on Register as at 31.12.69 Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65 + M - - 7 2 15 5 20 49 F - - 5 2 10 8 51 76 Total - - 12 4 25 13 71 125 Details of those newly registered as partially sighted during the year are as follows:- Persons Newly Registered as Partially Sighted during the year Sex AGE GROUPS Total 0-1 2-4 5-15 16-20 21-49 50-64 65 M - - — 2 — 3 5 F - - - - 2 12 14 - - - 2 2 15 19 70 Included amongst those removed from the Register were six persons admitted to the Blind Register, and 3 who were decertified due to improved visual acuity. 44 out of 125 persons on the Register were near or prospectively blind. Nine of these were in employment, and the remaining 35 were not available for, or incapable of work, all being over 65 years of age.Details of the other 81 persons on the register who were mainly industrially handicapped, requiring observation only, or under the age of 16 years are as follows:- Registered Partially Sighted Persons other than those near or prospectively blind AGE GROUPS Total Mainly Industrially Handicapped 16-20 21-49 50-64 65- Employed: Male 1 9 3 - 13 Female - 4 4 - 8 Available for and capable of training for work: Male — — — - — Female - 1 - - 1 Not available for work: Male - 1 — 5 6 Female - 1 - 3 4 Requiring observation only: Male — - - 7 7 Female - 3 3 21 27 Children, 16 and over, still at school: Male 1 _ — — 1 Female 2 - - - 2 4 19 10 36 69 Children under 16: AGE GROUPS Attending Special Schools: 0-5 5-16 Total Male - 7 7 Female - 3 3 Attending other Schools: Male — — — Female - 2 2 Not at School - - - - 12 12 71 3. Deaf and Hard of Hearing A total of 132 deaf or hard of hearing persons were on the register of handicapped persons at the end of the year. Details of these are as follows: AGE Under 16 16-29 30-49 50-64 65 and over Total Deaf with Speech 2 7 14 3 11 37 Deaf without Speech 2 13 24 17 2 58 Hard of Hearing 2 5 2 3 25 37 6 25 40 23 38 132 Four persons were added to the register during the year, one deaf without speech and three hard of hearing. Special Aids Special aids for these classes of handicapped persons are principally connected with providing help in communication. For the deaf, visual door bell units are supplied and for the hard of hearing, special loud ringing door bells are provided. Also available through the Post Office are special loud ringing telephone bells and amplification attachments to enable the hard, of hearing to communicate by telephone. Social Clubs There are two Social Clubs, one for the deaf and one for the hard of hearing. Both meet weekly and financial assistance is given by the Council as and when necessary. Social Work The Social Welfare Officers’ principal work with the deaf is concerned with helping those who may be isolated from the community due to their handicap or help with problems that may arise in the family. So far as the hard of hearing are concerned, the Social Worker helps them to acknowledge their increasing loss of hearing and to accept the use of amplification by hearing aids issued on medical grounds. Another important aspect of the Social Workers’ duties is concerned with helping the family to understand the difficulties involved with loss of hearing so that they can adjust to the problems involved. 72 Occupational Facilities The Social Worker is also concerned with endeavouring to see that the deaf and hard of hearing avail themselves where possible of the facilities provided for the aged and physically handicapped and liaises with the Old People’s Workshop and the Faringdon Centre for the physically handicapped with regard to the placement and subsequent supervision of deaf and hard of persons in these Centres. 4. Mentally Handicapped The number of persons under the care of this Authority at the end of 1969 was as shown in the table overleaf. A total of 241 persons were referred to the Department during the year from the following sources:- General Practitioners 123 Hospitals 18 Local Education Authority 15 Police and Courts 10 Other Sources 75 The majority (198) were suffering from mental illness. Ten were children under the age of sixteen suffering from mental subnormality, all of whom were referred by the Education Department having been ascertained through the Social Health Service. Early diagnosis of these sub-normal children is achieved by admission to a day nursery class at an early age. Following a period of observation, case conferences are held to decide whether the child should be ascertained ineducable. In this event, the parents are offered admission to the Junior Training Centre, or in cases of severe subnormality to the Special Care Unit. 73 2 Number of Patients under the care of the Authority as at 31.12.69 Mentally 111 Elderly Mentally infirm Psychopathic Subnormal Severely Subnormal Total GRAND TOTAL under 16 over 16 under 16 over 16 under 16 over 16 under 16 over 16 Attending day training Centre/ Workshop - - - - 70 130 23 15 93 145 238 Awaiting entry thereto - - - - 2 - 4 - 6 - 6 Receiving/Awaiting home trining - - - - - - - - - - - Resident in Local Authority Home/Hostels - 10 - - - 6 - - - 16 16 Awaiting admission thereto - - - - - 7 - - - 7 7 Resident at Local Authority expense in other residential Home /Hostels - - - - 1 6 4 3 5 10 15 Resident at Local Authority expense by boarding out in private household - - - - - - - - - - - Receiving home visits 4 215 - 5 27 102 6 22 37 344 381 TOTALS 4 226 - 5 100 251 37 40 141 522 663 Belford Junior Training Centre This Centre provides places for 72 sub-normal children and the accommodation was almost fully occupied towards the end of the year when 71 of the places were filled. Belford Senior Training Centre This Centre provides places for 146 mentally handicapped men and women. They are engaged on various manufacturing and assembling processes including contract work both for various firms and for the Council. The Centre provides paid work, recreational activities and social education for the trainees. In April arrangements were made for this Centre, which hitherto had been closed during the School Holiday periods in line with the Junior Centre, to open all the year round apart from Bank Holidays. This step was taken in order to bring the Centre more in line with industrial undertakings and to avoid delays in dealing with contracts received from firms. Plans to erect a new Adult Training Centre to replace the Belford Centre were well under way by the end of the year and this new building was completed in the early part of 1970. Special Care Unit The Special Care Unit was opened in April 1969. This Unit has been housed temporarily in a building formerly used as a Day Nursery, but with the completion of the new Adult Centre it is hoped that this unit will be transferred to the premises at present occupied by the Adult Training Centre, when the necessary building alterations to provide adequate Special Care Unit facilities have been carried out. The Special Care Unit in its temporary building can accommodate 30 persons and since opening. the the number on the register has remained fairly constant at 28. This Special Care Unit is also open all the year, and does not close for school holidays as is the case with the Junior Training Centre. Residential Care Residential accommodation for 30 mentally handicapped men is provided at Westmarsh Lodge. This hostel has continued to function to full capacity throughout the year, the majority of those resident attending the adjacent Adult Training Centre. Two or three of the residents have been found suitable employment 75 with outside employers. At holiday times when some residents are away from the hostel temporary vacancies are offered to persons in the community, thus enabling their families to obtain some relief. Holidays Holidays for the trainees attending the Adult Training Centre were arranged at Rogerson Hall Holiday Camp, near Lowestoft and a total of 104 attended for a period of a week. For those attending the Junior Centre a holiday was arranged at Pirate Springs, Dymchurch, and 39 were provided with a week's holiday at this home. In addition 8 severely handicapped attending the Special Care Unit were provided with a holiday. 76 SERVICES FOR THE ELDERLY Luncheon Centres The nine luncheon centres which have been functioning in the Borough for some years have continued to provide mid-day meals for the elderly. These centres were listed in my Annual Report for 1968, and showed no change during the year although due to the pending demolition of Laurie Hall, arrangements had been made for the luncheon cantre held there to be transferred to St. Edward’s Parish Hall in Church Lane, Romford at the end of the year. The total number of lunches served during the year from the nine centres was 199,540, an average of 3837 per week. This was a slight increase on the figures for 1968 when a total of 197,371 meals were provided. Meals-on-Wheels 30,492 meals were served to old people in their own homes by the “Meals-on-Wheels Service” averaging 582 per week. This again showed an increase over 1968 when the total number of meals served was 28,192. The meals are provided from two sources — the Marley Kitchen and St. George’s Hospital — and the actual distribution is undertaken by voluntary workers from the W.R.V.S. mainly in the Romford area and the Havering Old People’s Welfare Association in the remainder of the Borough. Some changes took place in the administration of the service during the year, as the arrangement of routes, and visiting of those recommended to ascertain need, etc., which had previously been carried out by voluntary organisations themselves was transferred to the staff of the Health and Welfare Department. More than half of those receiving meals have them three times a week, whilst the remainder have five meals a fortnight i.e. three meals one week and two the next. Day Centres The Council have one day centre for the elderly at Mawney Road, Romford. This is a purpose-built centre where the elderly can meet for social events such as whist drives, bingo, etc. or at other times of the day for a quiet read, chat or a cup of tea, etc. At Hornchurch the Havering Old People’s Welfare Association's Day Centre “H.O.P.W.A. House”, a purpose-built centre providing accommodation for a large number of social activities, is used by a number of elderly people from a wide of the Borough. Transport is provided to enable handicapped people to get to the Centre and the Association have their own 77 transport for this purpose. On those Saturdays when parties for the housebound are held at the Centre, the special ambulance vehicles, owned by the Council and used during the week transporting the handicapped to. the Faringdon Centre, are made available to transport the housebound to attend these parties. Plans for a further Day Centre to be provided by the Council at Rainham have been completed and it is hoped this Centre will be erected in the near future. Elderly People's Workshop This workshop provides light employment for the elderly in a light and happy atmosphere. 32 attend each day in two shifts, and simple contract work is carried out for a number of firms to whom we are indebted for ensuring that a continuous supply of such work is available. Entertainments Tickets were again made available by local operatic and dramatic societies for performances of their productions, and in some instances special performances were given for. old age pensioners. The tickets made available to the Department were distributed to Old People’s Clubs’, and coaches were hired by the Council to transport those attending. The total number of persons who attended these entertainments during the year was 4281. Holidays Holidays for the elderly were provided as in previous years by booking the Rogerson Hall Holiday Camp, near Lowestoft for a period of seven weeks. This provided accommodation for 2012 persons. In addition accommodation for a further 400 was booked at Ramsgate in various private hotels. The charge made to those taking part was £3.12s.0d. each inclusive of transport. Outings For those unable to avail themselves of the holiday arrangements mentioned in the last paragraph, one day coach outings were arranged. A total of 954 elderly persons were conveyed to Felixstowe or Westcliff-on-Sea by coach, and provided with a lunch and tea at a restaurant tor an inclusive charge of 7s.6d. each. 78 Special Housing for the Elderly 614 purpose-built dwellings for the elderly had been provided by the Havering Council by the end of 1969, including nine warden controlled complexes comprising of 256 flats. At each of these complexes the tenants have an individual flat but also have the use of a communal lounge, laundry, etc., all suitably furnished by the Council and all of which are enjoyed and put to good use by the tenants. Alarm systems are in operation to enable the tenants to call the warden in case of emergency. In addition to the wardens employed at these complexes, the Council also employ itinerant wardens in places where elderly persons predominate. The duties of these latter wardens consist of regular visits to the elderly living on Council estates. In addition to the above under control of the Havering Council Housing Department, the Greater London Council have a total of 308 old persons’ dwellings on the Harold Hill Estate. Approximately 135 of these are in three warden supervised complexes. Residential Accommodation The five residential homes for the elderly maintained by the Council provide a total of 381 places, and details of the number of places and the admissions in 1969 are given below. As, however, “The Willows” is shared with the London Boroughs of Barking, Redbridge and Waltham Forest, the total number of places available for Havering residents is approximately 300. Old People's Homes Run by the Department Places ADMISSIONS 1969 Permanent from own Home From Hospital Short Stay The Grange 61 16 5 14 Hillside 63 15 6 42 The Manor 51 3 4 5 Ravenscourt 48 6 1 20 The Willows 158 *22 *24 *19 TOTALS 381 62 40 100 *Havering residents only. 79 The number of those admitted permanently in 1969 was 13 fewer than in 1968, but a larger number were admitted direct from hospitals (40 compared with 34). Short-stay admissions usually for two weeks whilst the family was on holiday, increased from 75 in 1968 to 100. Old People’s Clubs There are 36 old people’s clubs in the Borough, the majority of which meet on one or two afternoons each week, and the total membership of these clubs is approximately 3,500. In addition to these clubs and to the Day Centres mentioned earlier in this report, the Romford War Memorial Club own purpose-built premises in Eastern Road, Romford, which provide facilities equivalent to a Day Centre. Membership of this club, which is open daily, is limited to Romford residents only, but there is no restriction on the number of members who may join. The Havering Council assist old people’s clubs financially where necessary, all applications for grants being considered by a panel appointed for that purpose. Membership of the panel consists of members of the Social Services Committee and representatives of voluntary organisations in the Borough connected with old people’s welfare. MENTAL HEALTH SERVICE Case Work Apart from their statutory duties, the social workers in the Department authorised under the 1959 Mental Health Act as mental welfare officers, carry out social work with patients in their homes, in hospitals and at hostels. They also maintain close liaison with the staff in hospitals and hostels, attending group meetings for sub-normal residents held fortnightly at Westmarsh Lodge Hostel, the weekly out-patients’ clinic at Harold Wood Hospital, weekly meetings of the Senior Citizens’ Club at the Ingrebourne Centre, and twice-weekly after-care sessions at Warley Hospital, in addition to the monthly case conferences with the Consultant Psychiatrist, Dr. Vincenzi, which are held at Colliei Lodge and Westmarsh Lodge Hostels. Hospital Admissions The mental welfare officers dealt with the following admissions to psychiatric hospitals:- 80 Mental Health Act 1959 Section 25 8 Section 26 1 Section 29 108 Section 60 2 Informal Admissions 40 Total 159 This total compares with a figure of 177 admissions in 1968, which were either dealt with by order or assisted informally. The total number of admissions from the Borough to Warley Hospital during 1969 was 575 compared with 682 in the previous year. Hostel Accommodation The Council maintain Collier Lodge, a 26-bed residential unit offering short-stay accommodation for the mentally ill. The majority of those accommodated are in full-time employment, and with assistance from psychiatric, social work and residential staff, are able to rejoin society in due course. In view of the short term nature of the stay in this Hostel, total occupancy varied throughout the year, the average number of places occupied being 20. At the 31st December, 1969, 21 patients were resident in the Hostel. Plans were being formulated at the end of the year to open a Group Home for four ex-residents from this Hostel, where they could be totally self-supporting. Thursday Club This social club, which meets once a week at the Belford Centre, was established for ex-psychiatric patients and friends. It provides opportunities for social contact to the unattached and isolated, as well as for those who attend with their partners or friends. Mental welfare officers and a social worker from Warley Hospital attend regularly, and the majority of those attending are referred from Warley Hospital. HOMELESS FAMILIES Prevention The social work connected with preventive work forms a heavy case load. The work is organised on a joint basis between 81 the Health and Welfare, Children’s and Housing Departments. Close co-ordination is involved in seeing that information concerning families having difficulties which might lead to possible homelessness, are referred to social workers with aview to effective preventive care being initiated. Reception Centre and Re-housing Scheme 30 families were admitted to the Reception Centre of the Health and Welfare Department during the year. This compares with an average of just over 20 during the three preceding years. The Reception Centre, opened in June, 1967, provides accommodation for six families in self-contained flats in two converted houses. The number of homeless families in Havering was equivalent to one family to approximately 8,300 population, whereas the the figure for all London Boroughs averaged approximately one family to 2,100 population. The reception and re-housing scheme administered jointly between the Health and Welfare and Housing Departments, with the Children’s Department closely involved, only deals with those truly homeless who have no other form of accommodation, and then only covers families with children. Those admitted to the Reception Centre, following intensive social work, and if unable to obtain housing accommodation themselves, are in due course re-housed by the Housing, Department. 82 ENVIRONMENTAL HEALTH Sanitary Circumstances The general sanitary supervision in the Borough has been well maintained during the year and in this connection some 33,499 inspections have been made under the following headings:Clean Air Act 4,989 Public Health Acts 7,324 Food & Drugs Acts 5,281 Prevention of Damage by Pests Act 3,447 Offices, Shops & Railway Premises Act, 1963 2,092 Shops Acts 2,362 Infectious Diseases 1,142 Housing Acts 757 Sampling 1,789 Factories Act 502 Noise Abatement 337 Diseases of Animals Act 51 Miscellaneous 1,308 Slaughterhouses & Meat Inspection 1,898 (not including the inspections of 2 Authorised Meat Inspectors based permanently at slaughterhouses) Consumer Protection Acts 220 33,499 As a consequence of these inspections 729 intimation notices were served and in 110 instances these were followed up by statutory notices as follows:- Informal Statutory Public Health Acts 209 109 Housing Acts Nil Nil Food & Drugs Act 72 ” Shops Act 212 ” Offices, Shops & Railway ” ” Premises Act, 196 3 206 ” 83 Factories Act 20 ” Prevention of Damage by Pests Act 6 1 Landlord & Tenant Act 2 Nil Rent Act 1 ” Agriculture Act 1 ” In 4 cases it was found necessary to go to court to enforce notices served under the Public Health Act, 1936, 30prosecutions were taken for infringements and non-compliance of notices served under the Offices, Shops and Railway Premises Act, 1963, and 2 prosecutions under the Shops Act, 1950. FOOD HYGEINE Food & Drugs Administration A total of 491 samples (82 formal and 409 informal) were taken during the vear and examined by the Public Analyst. One formal sample and two informal samples of sausages contained more preservatives than permitted and warnings were sent to the manufacturers concerned. Five informal samples had faulty labelling and the necessary remedial action has been taken with the manufacturers concerned. One informal sample of yogurt was found to be deficient in butter fat and a formal follow-up sample was taken which proved to be satisfactory. Included in the above figures are 54 food complaints which were referred to the Public Analyst. 146 other food complaints were dealt with without reference to the Analyst. Six prosecutions were taken, details of which appear below. One prosecution is pending. Complaint Result of Proceedings String in bread roll Absolute discharge, £10 costs. String in bread roll. £15 fine. £4. 4s. costs. Mouldy Sausages £25 fine. £3 costs. Piece of wire in bread £20 fine. £6 costs. Maggots in chocolate £20 fine. £5 costs. Maggots in figs £20 fine. £5 costs. The commodities involved in the 200 food complaints are summarised as follows:- 84 Bread 41 Milk and Milk Products 25 Flour Confectionery 15 Confectionery 14 Canned Fruits 14 Fresh Vegetables 9 Canned Vegetables 6 Dried Fruit 3 Fresh Meat 7 Cooked Meat & Meat Products 25 Canned Meats 4 Bacon & Ham 4 Poultry 2 Fish 7 Butter & Cheese 5 Ice Cream 2 Cereals 5 Pickles 5 Soft Drinks 3 Alcoholic Drinks 2 Tea 1 Miscellaneous 1 The number of food complaints received was higher this year than last year, in fact, the highest number in any year since the Borough was formed. I think that this is due to the ever increasing public interest in food hygiene. Bread complaints due to mould were also more numerous this year due to the long spell of warm, humid weather. Bacteriological Milk Sampling 273 milk samples were submitted for bacteriological examination during the year with results as follows:- Pasteurised 239 207 passed the methylene blue test. 24 failed and 8 were declared void. All passed the phosphatase test. Sterilised 15 All satisfied the turbity test. Ultra Heat Treated 19 All satisfied the U.H.T.test. Included in the above totals were 64 samples from vending machines. 54 satisfied the methylene blue test and 10 failed. All satisfied the phosphatase test. The number of failures was higher than the previous year and they were caused mainly by a fault at one of the Processing Dairies outside this Borough which was rectified as soon as possible. Fourteen samples were also submitted to the Public Analyst for chemical examination and all proved satisfactory. Twelve of these samples were also tested for the presence of anti-biotics and all proved negative. Brucella Abortis No samples of raw milk have been examined as all supplies of milk in this Borough are heat treated. 85 Ice Cream Sampling - Bacteriological Examination During the year 234 samples of ice cream were submitted for bacteriological examination with results as follows:- Grade Mobile Shops Total Soft Other Soft Other 1 (satisfactory) 24 33 3 101 161 2 (satisfactory) 9 13 1 14 37 3 (poor) 6 8 2 6 22 4 (unsatisfactory) 6 2 1 5 14 45 56 7 126 234 In addition 9 ice lollies were taken for bacteriological examination and all proved satisfactory. The results were in general satisfactory and it should be noted that although more samples were taken last year the number of unsatisfactory results did not increase. In addition 11 samples of ice cream were submitted to the Public Analyst for chemical examination and all proved 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 68 Cream Cakes 64 Cooked Meats 71 Meat Pies and Sausage Rolls 15 Other Meat Products 8 Shellfish 11 Fruit and Cream 1 Buttermilk 1 Total 239 The survey on ice cream which was mentioned in the 1968 report was carried out during 1969. Samples were submitted to the Public Health Laboratory Service and the results submitted to the Working Party on the hygiene and production of fresh cream. It is to be hoped that the recommendation of the Working Party will be made known without undue delay. 86 Apart from the cream samples the results of the other foods are generally satisfactory. It is necessary for retailers to make certain that expiry dates on cartons or other packaged foods are strictly adhered to and advice to this effect is constantly being given. Pesticide Residues in Foodstuffs Two samples were taken during the year. Both samples proved genuine and free from pesticide residues. The national interim report for the second year’s results (1968) have not yet been received. Details of the first year’s results (1967) were included in last year’s report. Imported Food Regulations, 1968 Inspection of imported food is mainly the concern of the Port Health Authority but under the above Regulations it is now permitted for appropriately sealed food containers to be examined at the place of destination. In this District there are four Meat Depots which receive these containers, mostly from the Republic of Ireland. During the year notifications were received regarding 160 containers consigned to these Depots and the necessary inspections were carried out. Pharmacy and Poisons Act, 1933 8 names were added to the list during the year and 25 were removed. At the end of the year 92 persons were entered on the poisons list involving some 157 premises. One sample was taken during the year and a satisfactory report was received. One prosecution was necessary in respect of the administration of this legislation during the year. The offender, an unlisted Market Stallholder, was fined £10 for the sale of Part II poisons (Tolylene Diamines). Artificial Sweeteners in Food Regulations, 1969 Soft Drinks (Amendment) Regulations, 1969 These Regulations prohibit the sale of food or drink and artificial sweetening tablets containing cyclamates as from 1st J anuary, 1970. All shopkeepers concerned were therefore requested to check with their suppliers that such stocks coming within the ambit of these Regulations were free from cyclamates. 87 The Regulations require that the labels of soft drinks containing saccharin will be required to declare the presence of “saccharin” specifically. In order to provide the necessary time for labels to be changed the term “permitted artificial sweetener” will be allowed until 31st December, 1970. The labelling of foods other than soft drinks which contain saccharin are being dealt with in the new Labelling of Food Regulations which will be made in 1970. 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 and Delivery Vehicles) Regulations, 1966. One ice cream vendor was prosecuted during the year under Regulation 13 (failure to display name and address on vehicle); and Regulation 9 (failure to wear sufficient clean and washable over clothing). The defendant was at the same time convicted of an offence under the Noise Abatement Act. Essex County Council Act, 1952 — Section 103 During the year under review two new applications for registration as hawkers of food were granted. Milk Distributors There are nine registered milk distributors, with 19 dairy premises within the Borough. In addition, 189 shopkeepers are registered for the sale of milk from their premises. There are four vending machines sited in the Borough. 88 Milk (Special Designation) Regulations, 1963 — As Amended The number of licences granted by the Council of the London Borough of Havering during 1969 in respect of each designation together with the total number in force as at the 31st December, 1969 are shown in the following table:- Designation Licences issued in 1969 Total number in force at end of year Untreated Milk - 61 Pasteurised Milk 6 175 Sterilised Milk 5 138 Ultra-heat Treated Milk 5 54 All these licences are valid until 31st December, 1970. Greater London Council (General Powers) Act, 1968, Part VIII — Night Cafes. The Council resolved that the above-mentioned legislation relating to night cafes be brought into operation in the Borough on 1st March, 1969. With certain exceptions, night cafes are defined in the Act as any premises in the Borough which are kept open for public refreshment at any time between the hours of 11 o’clock in the evening and 5 o’clock in the morning, or any premises which are used by a club, organisation or body and which, if they were kept open to the public, would be such a cafe. During the year 3 such applications were received but had not been finalised at the end of the year. This particular statute has considerable advantages over the Refreshment House Acts, 1960 to 1967, in that it enables the Council to enforce the provision of satisfactory means of lighting, sanitation and ventilation, certain fire precautions, conduct or management of the premises plus the fact that the premises must be structurally suitable for the purpose. It should be mentioned that certain premises which one would expect to fall within the scope of this Act are however, controlled by the terms of a justices on-licence to sell intoxicating liquors. There are 12 restaurants and clubs falling within this latter category. The three cinemas in the Borough also have exemption. Refreshment Houses Acts, I860 — 1967 The administration of this legislation was passed to the Department in conjunction with the Night Cafes and during the year 11 licences were issued in respect of refreshment houses enabling them to keep open until 11 o’clock at night. During the year various acts in this connection were consolidated into the Late Night Refreshment Houses Act, 1969, which comes into force on 1st January, 1970. 89 Game Act, 1831 4 licences authorising certain local Shopkeepers to buy game from any person authorised to sell game by virtue of this Act were renewed during the year and 2 licences lapsed. Food & Drugs Act, 1955 — Section 16 During the year 16 applications for registration of premises for the manufacture, storage or sale of ice cream, and 3 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 1/70 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 them including the following information for each category:- 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 13 13 13 13 Butchers 130 130 130 130 Cafes and Restaurants 88 88 88 88 Confectioners (Bread),etc. 63 63 63 63 Confectioners (Sugar) 192 184 184 184 Fish Shops 45 45 45 45 Grocers 243 243 243 243 Greengrocers 113 113 113 113 Ice Cream Manufacturers 3 3 3 3 Clubs (On Licence) 14 14 14 14 Clubs (Private) 60 60 60 60 Public Houses 74 74 74 74 School Canteens 92 92 92 92 Staff Canteens 88 88 88 88 Off Licences 69 69 58 58 NOTE: Regulation 16 deals with the provision of wash-hand basins and Regulation 19 with facilities for washing food and equipment. 72 notices were served under these Regulations during the year. No statutory action was required in connection with these notices. 90 In connection with the operation of the Food Hygiene (General) Regulations, in Chinese Restaurants where the language barrier created certain difficulties a Chinese translation of the Regulations were provided by the Hong Kong Government Office as a gesture of thanks to Public Health Inspectors for the cooperation they gave during a survey of the Hong Kong Chinese community in this country undertaken by the Hong Kong Government during 1968. It is hoped that the translation will be of assistance to all concerned in the maintenance of hygienic standards. Whilst unfortunately this translation does not have any force in law it was circulated to all Chinese restaurants in the Borough and is intended solely as a guide to assist Chinese proprietors of restaurants or other food business and Chinese employees who handle food to understand in Chinese the general purport of the Regulations. Meat Inspection The Meat Inspection Regulations, 1963, made it obligatory for the local authorities having slaughterhouses within their districts to ensure that 100% meet inspection was carried out in accordance with the detailed instructions contained in the Regulations. In order to carry out this 100% inspection it is essential for an Inspector to be on duty at the slaughterhouse for the whole of the time that slaughtering is in progress. To ensure that this is done it is necessary to have two Public Health Inspectors and two Authorised Meat Inspectors on meat inspection duty each week. In this Borough there are 4 licensed slaughterhouses, two of whom hold consents to carry on offensive trades, i.e. gut scraping and fat rendering:- a) A small slaughterhouse situated at Havering Green at the rear of a butcher’s shop. The throughput here is small as they only kill for their own retail trade. b) One large slaughterhouse situated at Hall Lane, Upminster. This slaughterhouse has a large throughput of cattle and sheep for the whole sale trade and also slaughters for the Kosher trade. c) Large slaughterhouse in Oldchurch Road, Romford, where cattle, sheep and pigs are slaughtered for the wholesale trade. d) Another large slaughterhouse adjoining (c) in Oldchurch Road, Romford. This slaughterhouse deals mainly in sheep for persons of the Muslim religion. 91 The total throughput of animals for all the slaughterhouses during 1969 was 116,100, a slight increase on the previous year's figures: For this meat inspection service the Council make a charge as follows:- Cattle and Horses 2/6d. each Calves and Pigs 9d. each Sheep and Goats 6d. each The total income from this source during the year was £4,904. 10s. 6d. The Order made by the Council in 1966 controlling the hours of slaughter at all slaughterhouses within the Borough, namely from 8 a.m. — 6 p.m. Monday to Friday and 8 a.m. — 12 noon on Saturday was confirmed by the Minister of Agriculture, Fisheries and Food to come into effect in August 1968 in respect of one slaughterhouse and in November 1968 in respect of two of the other slaughterhouses. It was soon apparent that these controlled hours were not in favour with the slaughterhouse occupiers and the occupier of one slaughterhouse continually made applications to be enabled to slaughter lambs on Sundays for continental orders and for evening extensions in order to meet demands from shipping agents. The occupier of another slaughterhouse made continual appeals to the Minister of Agriculture, Fisheries and Food to be able to slaughter on Sundays and the Minister eventually varied the Order relating to this particular slaughterhouse so as to extend the hours of slaughtering to 4 p.m. on Saturdays. The occupiers of all three large slaughterhouses were still very discontented and made repeated appeals to the Council and the Ministry for the hours to be extended alleging that their throughput was being severely curtailed. There was also a certain amount of friction and the cooperation between the occupiers and the Inspectors began to deteriorate. In this connection two unsuccessful prosecutions were made regarding slaughtering after permitted hours and in another instance recourse had to be made to the rather lengthy procedure of obtaining an order from a Justice of the Peace in order to condemn two carcases. During September 1969 official consultations were commenced with the occupiers of the slaughterhouse to determine the hours that would be acceptable and at the same time to ensure 92 that Inspectors would always be available to carry out 100% meat inspection according to the Regulations. It was eventually agreed that the hours of slaughter should be from 7 a.m. to 6 p.m. Mondays to Fridays and from 7 a.m. to 2 p.m. Saturdays and Sundays. The Minister raised no objection to this arrangement as all the slaughterhouse occupiers had signed an agreement to abide by these hours. The new hours come into operation on the 1st January, 1970. Carcases Inspected and Condemned The following table shows the post-mortem inspection of during the year 1969 at the four slaughterhouses in the Borough: Total 116,100 116,100 380 28,743 25.08% Tuberculosis Only: 1 130 0.11% 5 - - Goats 39 39 - - - - - - - - - Horses 84 84 - 14 16.66% - - - - - - Pigs 29,824 29,824 77 3,133 10.76% - 130 0.48% - - - Sheep and Lambs 68,388 68,388 242 17,982 26.65% - - - - - - Calves 2,844 2,844 6 79 2.99% - - - - - - Cattle 14,921 14,291 55 7,535 53.55% 1 - 0.006% 5 - - Number Killed Number Inspected All Diseases except Tuberculosis and Cysticercosis: Whole Carcases Condemned Carcases of which some part or organ was condemned Percentage of number affected Whole Carcase Condemned Carcases of which some part or organ was condemned Percentage of number affected Cysticersosis Only: Carcases of which some parts or organs were condemned Carcases submitted to treatment by refrigeration Generalised & totally condemned Total Meat condemned: 71 tons: 9 cwt 93 Slaughter of Animals Act, 1958 59 Slaughter mens licences were issued during the year, of which 10 authorised the holders to slaughter or stun horses as well as other animals, 22 were in respect of the ritual slaughter of animals by the Jewish method, and 3 by the Mohammedan 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. Diseases of Animals Act, 1950 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. 16 licences to operate boiling plants at local piggeries remained in force at the end of the year. These licences are issued under the Diseases of Animals (Waste Food) Order, 1957, which requires the effective sterilisation of all pig swill in properly constructed boiling plants and equipment which has been tested and satisfies us as to its efficiency for doing this particular job. Unsound Food During the year the following amounts of food were voluntarily surrendered to the Public Health Inspectors as being unfit for human consumption:- 94 Commodity Weight (in lbs.) Meat (Wholesale) 27,794 Meat (Retail) 3,219 Meat (Tinned) 3,620 Fish (Tinned) 666 Fish (Raw) 3,850 Offal 2,950 Poultry 529 Sausages 141 Tinned Fruit 4,797 Other Tinned Fruit 1,410 Miscellaneous Foodstuffs 4,042 Butter 22,400 TOTAL 75,418 Frozen Foods 25,103 Packets 95 HOUSING SERVICES Number of new houses erected during the year 651 units (530 by private enterprise and 121 by other authorities) were erected during the year. In addition the London Borough of Havering erected 529 units of accommodation consisting of the following: — 1 bedroom bungalow 1 2 bedroom house 1 3 bedroom houses 100 4 bedroom houses 4 1 bedroom flats 117 2 bedroom flats 281 3 bedroom flats 19 4 bedroom flats 6 Total for 1969 529 Within the above total are 5 flats designed specifically for disabled persons, viz: 4 one bed/two person ground floor flats and one three bed/five person ground floor flat. Local Authority Accommodation The following statistics for 1969 have been very kindly supplied by the Housing Manager: — Properties under Management A further 529 new dwellings were taken over during the year bringing the total number of properties under management of this Department to 11,160 as at 31st December. The 529 new dwellings included 4 multi-storey blocks of two-bedroomed flats and 71 elderly person flats in two complexes, each controlled by a resident warden. During the year the last of the Council's prefab bungalows were demolished following the rehousing of the tenants. Waiting List As at 31st December the Housing List consisted of 3,151 applications on the Main List with a further 684 on the engaged couples list and 223 on the supplementary list, a total of 4,058 applications. During the year 1,576 new applications were registered. 96 Lettings A total of 1,219 new tenancies were granted, including 580 to applicants from the waiting list and 306 to tenants transferred to alternative accommodation. 159 mutual exchanges were granted. 29 families were moved from hostel accommodation and 24 potentially homeless families from the waiting list were rehoused as a result of Court Orders requiring them to vacate privatelyowned premises. The rehousing of 17 families from 3 sites required for redevelopment was completed and 3 families were rehoused from properties the subject of Demolition or Closing Orders. Housing priority on medical grounds Applications for priority on medical grounds dealt with during the year numbered 482. 388 of these were in respect of new applications for rehousing and 94 were from existing tenants requiring transfer. Houses in multiple occupation There has been no change in the situation as outlined in my report for 1967. During the year, however, the Ministry of Housing and Local Government prepared a leaflet in English, Urdu, Bengali, Punjabi, Hindi, Gujerati, Greek and Turkish on shared houses which is handed to all immigrants at their port of entry to this country and in which is outlined the special laws governing houses occupied by more than one family or let in lodgings. Improvement Grants During the year members of my staff liaised with the staff of the Borough Engineer and Surveyor in connection with 169 applications for improvement grants. The main provisions of the 1969 Housing Act came into operation on the 25th August, 1969. They implement the main recommendations contained in the White Paper "Old Houses into New Homes" (Command 3602) which was published last year. The Act contains increased Improvement Grants and more flexible powers for dealing with the improvement of old houses. This legislation should speed up considerably the rate of house improvement. One of the main innovations is the provision of a grant to improve the environment. 97 The main features of the grants are as follows: — Standard Grants Standard Grants will help meet the cost of providing homes with any missing standard amenities. The Council can grant half of the costs, including professional fees, up to a maximum of £200 if all amenities are provided. The following are the standard amenities showing the maximum amounts payable for each item. Fixed Bath/Shower £30 Wash-Hand Basin £10 Sink £ 15 Water Closet £50 Hot and Cold Water Supply at Bath/Shower £45 Hot and Cold Water Supply at Hand Basin £20 Hot and Cold Water Supply at Sink £30 These standard grants are a right but the house must have been provided on or before 2nd October, 1961, and the standard amenities must be for the exclusive use of the occupants. The Council must also be satisfied that after improvement, the house will be in a good state of repair and will be fit for habitation for at least another 15 years. Improvement Grants Improvement grants will help owners improve old houses to a high standard. They are made at the Council's discretion, meaning that the Council must be satisfied on certain conditions. The amount of grant payable by the Council can be up to one half of the estimated cost (including professional fees) to a maximum of £1,000 for each house or dwelling provided; and in the case of flats and buildings over three storeys the maximum grant is £1,200 for each flat. To qualify for an improvement grant a dwelling must, after improvement, meet a 12 point standard. If a standard grant has been received an improvement grant can still be granted. Special Grants Special grants are for houses occupied by more than one family where the standard amenities are shared and where there 98 is no immediate prospect of conversion into permanent dwellings. The grant is made at the Council's discretion and the amount for the standard amenities are based on the provision of the standard grants. Fuller details of these activities are given in the following table: — Improvement Grants — 1969 (A) Standard Owner/Occupiers Tenanted Standard Standard 5 point 3 point: 5 point 3 point 1. Number of applications received 108 - 19 - Number of applications approved 102 - - - Number of applications refused 7 - - - 2. Number of dwellings improved 69 - - - 3. Amount paid in grants £5.606. 8s. 5d 4. Average grant per house £84. 18s. 11d 5. Number of amenities provided (a) fixed bath/shower 30 (b) wash hand basin 44 (c) hot water supply (to any fittings) 54 (d) water closet within dwelling 48 (e) food store 15 (B) Discretionary Owner/Occupiers Tenanted 1. Number of applications received 71 12 2. Number of applications approved 55 - 3. Number of applications refused 10 - 4. Number of dwellings improved 34 - 5. Amount paid in grants £10,989 6. Average grant per house £323. 4s 2d 99 Qualification Certificates Part III of the Housing Act, 1969, which came into force on the 24th August, 1969, provides for the conversion of controlled tenancies into regulated tenancies under the Rent Act, 1968, where the dwelling to which the tenancy relates is certified by the Local Authority on the application of the landlord to be provided with all the standard amenities for the exclusive use of its occupants, to be in good repair having regard to its age, character and locality and disregarding internal decorative repair, and to be in all other respects fit for human habitation. The 'Fair Rent' procedure under the 1968 Rent Act, then becomes applicable to the tenancy. The Local Authority may only entertain an application for a Qualification Certificate where: — 1. The dwelling has at all times since the commencement of the Act been provided with all the standard amenities; or 2. Any of the standard amenities previously lacking were provided by means of works begun before the commencement of the Act; or 3. The application is made, whether or not in conjunction with a standard or discretionary Improvement Grant application, before any works are begun for providing the dwelling with the standard amenities which it lacks. The application must state the name of the tenant under the controlled tenancy, what works are required to satisfy the qualifying conditions, and must be accompanied by plans and specifications of those works. The Local Authority must send a copy of the application to the tenant and in case 1. and 2. above, must give the tenant the opportunity of making representations that the dwelling does not satisfy the qualifying conditions. After considering any representations, the Local Authority must either issue the Qualification Certificate, or refuse to do so and must in either event notify both the applicant and the tenant. In case 3. mentioned above, if it appears to the Local Authority that the dwelling will satisfy the qualifying conditions when the works specified in the application have been carried out, they shall approve it provisionally and notify both the applicant and the tenant. A landlord whohas obtained a Certificate of provisional approval may then apply for a Certificate of fair 100 rent, and on being satisfied that the dwelling satisfies the qualification conditions, and on production of the Certificate of fair rent, the Local Authority shall issue the Qualification Certificate and send a copy to the tenant. The Act contains provisions for the Registration of rent after the issue of a Qualification Certificate. If an application for a Qualification Certificate or a Certificate of provisional approval is refused, the Local Authority must give the applicant a written statement of their reasons for the refusal, and both the applicant and the tenant are given rights of appeal to the County Court, the former in the event of refusal of a Qualification Certificate and the latter in the event of the granting of a Qualification Certificate. Where a Qualification Certificate is issued following an application in cases 1. and 2. aforementioned, the controlled tenancy of a dwelling in Greater London will not become a regulated tenancy before the following dates (The Rateable Values are those on 23rd March, 1965): — 1st January 1971 in respect of a dwelling of a rateable value of £90 or more. 1st July 1971 in respect of a dwelling with a rateable value of less than £90 but not less than £60. 1st January 1972 in respect of a dwelling of a rateable value less than £60. Where the consent of the tenant is necessary to enable the landlord to carry out works in order to satisfy the qualifying conditions, there are provisions enabling the landlord to apply to the County Court for an order empowering him to enter and carry out the works in the event of the tenant refusing his consent. The Court may, however, only make such an order in certain circumstances, and in particular they may not do so if not earlier than six months before the hearing the Rating Authority for the area have certified that the tenants income is within the limits for rate relief. The circumstances in which the Rating Authority shall issue such a Certificate, (which must apparently be signed by the Clerk to the Authority) are specified in the Act. 101 The standard amenities laid down by the Housing Act, 1969, are as follows: — 1. Fixed bath or shower. 2. A hot and cold water supply at a fixed bath or shower. 3. A wash-hand basin. 4. A hot and cold water supply at wash-hand basin. 5. A sink. 6. A hot and cold water supply at the sink. 7. A water closet. It should be noted that a sink has now been included in the standard amenities, but the food-store previously included has been omitted. The return of Qualification Certificates under the Housing Act, 1969, as requested in Ministry of Housing and Local Government Circular 66/69 for the period 25th August to 31st December, 1969, is reproduced herewith: — Improvement cases No. of applications for qualification certificates under section 44(2) under consideration at end of period 2 No. of certificates of provisional approval issued - No. of qualification certificates issued under section 46(3) - Standard amenities already provided No. of applications for qualification certificates under section 44(1) under consideration at end of period 188 No. of qualification certificates issued under section 45(2) in respect of: — (i) dwellings with rateable value of £90 or more in Greater London or of £60 or more elsewhere - (ii) dwellings with rateable value of £60 to less than £90 in Greater London or of £40 to less than £60 elsewhere 1 (iii) dwellings with rateable value of less than £60 in Greater London or less than £40 elsewhere - Exemption for low income tenants from section 54 No. of certificates issued under section 55 - 102 Loans for Housing Repairs — Old Age Pensioners During the year the Council considered a report which dealt with the question of loans by the Council to assist old age pensioners to carry out urgent and essential repairs to properties which they own and occupy. Their attention was drawn to evidence of an increasing number of elderly owner/occupiers who, living on the reduced income which follows retirement, are unable to find the capital required to meet the cost of necessary works at their homes, such as the repair of a leaking roof or gutters, electrical rewiring or renewal of a furred hot water system. The Council have power to make grants for the improvement of private dwellings amounting to up to half of the approved cost of carrying out the intended improvements, and such grants may now cover some items of repair which are needed for the purpose of making an improvement fully effective provided that the cost of the repair work is not more than half of the total approved cost. This assistance is only available where improvements (other than repairs, renewals or replacements) are required at a dwelling but an elderly owner/occupier is unlikely to be wanting to carry out grant aided improvements, or improvements may not be required. There are also powers available to the Council to make mortgage loans for altering, enlarging, repairing or improving houses but such loans are made in accordance with the terms of the Council's scheme for house purchase and other advances, which requires that the loan should be repaid by, or very shortly after, the borrower's 65th birthday. The Council agreed to an extension of the present scheme for mortgage advances to provide for small loans to be made to persons over 65 years of age to enable them to meet the costs of repair works. By making loans to people of advancing years, the Council will be relying very much more on the security of the mortgaged property and it has been suggested that, at present, the maximum loan should be £300, although this limit may need to be reviewed in the light of experience and the high cost of certain repair works. Loans would be made only in respect of properties which are either not in mortgage or are already mortgaged to the Council. It appears unlikely that repair problems will be serious in the case of owner/occupiers who have recently retired and, in the first instance, it was agreed that the scheme should be 103 restricted to persons aged 70 years and over subject to review periodically. The Council were of the opinion that assistance of this nature to elderly owner/occupiers who require it would minimise their worries and, at the same time would help to prevent properties which are otherwise sound from falling into disrepair and thus posing a problem for the Council. Rent Act, 1957 (Rent Act, 1968) Certificates of Disrepair The following is a copy of a return made under the Rent Act, 1957 (Rent Act, 1968) to the Ministry of Housing and Local Government for the year 1969. The Ministry has now decided that after this year this return may now be discontinued. They may however ask for this information from time to time in respect of a particular Local Authority and the records from which these returns are prepared will continue to be kept by the department. 104 PART I - Application for Certificate of Disrepair 1. Number of applications for certificate 12 2. Number of decisions not to issue certificates 1 3. Number of decisions to issue certificates: — a. in respect of some but not all defects 1 b. in respect of all defects 2 4. Number of undertakings given by landlord under paragraph 5 of first schedule 6 5. Number of undertakings refused by local authority under proviso to paragraph 5 of first schedule Nil 6. Number of certificates issued 3 PART II — Applications for Cancellation of Certificates 7. Applications by landlords to L.A. for cancellation 2 8. Objections by tenants to cancellation of certificates Nil 9. Decision by L. A. to cancel despite tenants objection Nil 10. Certificates cancelled by Local Authority 2 Housing Act, 1957 — Sections 17 and 18 During the year the Council made 6 demolition orders and 1 closing order following representations by the department. This action will result in the rehousing of 6 families totalling 15 persons. Bui Id ing Control During the year observations were submitted in respect of 288 deposited plans referred to the department by the Borough Engineer and Surveyor. Land Charges Act, 1925 Under this Act enquiries concerning the sale of properties in the Borough are received by the Town Clerk. Liaison is maintained with the Land Charges Section of the Town Clerk's Department in the form of details of all addresses where notices are served by the Environmental Health Inspectorate together 105 with such other relevant information regarding properties in existing or proposed Clearance, Improvement or Smoke Control Areas. Water Supply The water supply of the whole of the Borough — supplied by the South Essex Waterworks Company — has been satisfactory in quality and quantity. No action has been necessary in respect of any form of contamination. The number of dwelling houses supplied as at 31st December last, was 81,610 and the population as obtained from theRegistrar General was 252,860. I am not aware of any houses being supplied with water from standpipes. No fluoride determinations were made but on the basis of past results, the fluoride content of the supplies is put at 0.25 p.p.m. which is one quarter of the amount necessary to protect children's teeth. 20 samples were taken by the Department from the main water supply during the year. 10 were submitted for chemical examination and 10 for bacteriological examination. All were found to be satisfactory. 106 Caravans and Camping Site licences issued under the provisions of the Caravan Sites and Control of Development Act, 1960, in full during the year were 5 individuals and 2 multiple, the total number of caravans involved being 208. One of the multiple sites is subject to conditions for a progressive reduction of the caravans during the year. The Council own and administer — through the Housing Department — a residential site consisting of 66 vans plus a site shop. The temporary site for gypsies which the Council established last year at the southern end of Stubbers Outdoor Pursuits Centre, Dennises Lane, North Ockendon, is now known as the South Park Caravan Site and the responsibility for running this site was assumed by the Housing Department during the year. The decision on the provision of a permanent site for gypsies had not been resolved by the Council at the end of the year. The Council own the Outdoor Pursuits Centre at Stubbers, North Ockendon, which includes a tented camping site for 450 tents. This Centre is administered by the Education Department. Sewerage and Sewage Disposal In last year's report I outlined the details of the closure of Bretons Farm Sewage Works and the diversion of the sewage flow to the Riverside Works, Manor Way, Rainham. A six million pound scheme to cope with the increased main drainage for parts of Dagenham, Hornchurch and Romford was completed by an extension of the Riverside Sewage Disposal Works in the early part of the year, and the works have operated satisfactorily throughout the year. The following is the background to the above-mentioned extension: — In the late 1930's a drainage scheme for Dagenham, Romford, Hornchurch and part of Brentwood was under consideration. After the war increased restrictions by the Port of London Authority on discharging into the Thames caused the then Dagenham Council to consider extending their Riverside Works and at the same time the regional drainage scheme was reviewed. 107 In the late 1950's it became clear that the Bretons Farm Works at Hornchurch would be unable to cope with any further extension of building development in the Romford and Hornchurch areas which it served and this was reviewed by all the authorities concerned. Consulting Engineers accordingly prepared a scheme for Dagenham Council . which envisaged the extension of the Riverside Works to enable it to cope adequately with flows from Dagenham and to accept the drainage from Romford and Hornchurch, the cost being shared by the three authorities. Prior to this stage the Brentwood Council and the Essex River Board opted out of this regional scheme. Work on the scheme commenced in August 1964, and was substantially completed in the autumn of 1968 at which time it took the whole of the flow from Bretons Works. With the establishment of the new London Boroughs in 1965 these costs were borne by the Barking and Havering Councils. However, all sewage disposal works and costs became the responsibility of the Greater London Council on the 1st April, 1969. This vesting of works in the G.L.C. also resulted in our Eastern Outfall Works at Bury Farm being placed under their control. I understand from the G.L.C. Department of Public Health Engineering that these works have achieved a consistently high standard of effluent since take over. The present arrangements for domestic sewage disposal at the Riverside Works are adequate but it is anticipated that some difficulty may be experienced with the proposed connection to the works of some trade effluents. This aspect may require further extensions. Experimental work has been proceeding at Riverside on the feasibility of biologically treating the industrial sewage which is at present receiving sedimentation treatment only. It is considered that apart from the desirability of eventually sewering the Clay Tye Road area and perhaps North Ockendon the arrangements for sewerage and sewage disposal in the Borough are reasonably adequate. The following schedule gives details of new sewers 108 structed in improvement of the sewerage systems, Ferry Lane, Rainham and Church Lane, Warley, being the only extensions of the systems. Foul Sewers The following works have been completed Ferry Lane Trade Effluent Sewer (12" dia.) 1368 yds. Dury Falls Close (relaying) (9" dia.) 130 yds. Rom Valley Sewer Stage II, Part I, Section II, (under Ring Road) (45V33" dia.) 200 yds. Church Lane, Warley Street — Treatment Plant and Sewer (6" dia.) 213 yds. Spenser Crescent outfall reconstruction (River crossing) (9"/6" and 4") 100 yds. Work will commence shortly on Cranham foul sewerage (removal of surface water connections). Barton Avenue Pumping Station — renewal. Surface Water Sewers The following works have been completed Allendale Road/Craigdale Road (relaying) (9" dia.) 50 yds. Mcintosh Road (12"/15" dia.) 80 yds. Moor Lane (near Nightingale Avenue) (12" dia.) 60 yds. Work has commenced on Osborne Road Douglas Road Work will commence shortly on Erith Crescent/Collier Row Lane Front Lane (near Iris Drive) N.B. Havering Road/A12 outfall and Abbs Cross Lane (outfall at railway) have been deferred due to the reaction of land owners. The Programme for 1970/71 comprises Rom Valley Sewer Stage II, Part II at High Street (deferred for traffic reasons) London Road Surface Water Sewer (outfall) Sheila Road Surface Road Water Sewer Ravensbourne Stream Improvement (Stage II). 109 Streets Made-up and Taken Over I give below details of streets adopted by the Council during the year of which that part of the list from Abbey Wood Lane to Lime Avenue inclusive was the result of private street works action by the Council. Name of Road Length Sheridan Close 620' Abbey Wood Lane — Part 7l0½' Berwick Road 1,224' Thorn Lane 1,215' Mygrove Road 604' Alder Avenue 404' Aspen Grove 284' Hornbeam Avenue 508' Lime Avenue 552½' Bates Road 1,110' Sexton Close 263' Sorrel Walk 273' Abbs Cross Gardens / Part (now all adopted) 1,316½' Victor Approach 303½' Victor Close 362½' Victor Walk Footpath only No Carriageway Total Length of Roads in Feet — 9,750½' Clean Air Act, 1956 The Havering (No.5) Smoke Control Order — comprising mainly the G.L.C.'s Harold Hill Estate — was duly confirmed by the Ministry of Housing and Local Government and became operative on 1st November, 1969. Apart from 200 dwellings where the G.L.C. themselves proposed to instal integral gas ignition to comply with the Order the remainder of their tenants were given freedom of choice — with certain limitations — to go ahead with conversions to more modern appliances at the tenant's own expense. At the end of the year 729 applications for proposed works of adaptation had been dealt with and in 620 instances the necessary works had been carried out to the satisfaction of the London Borough of Havering and the claims paid. 110 Following requests from the Government for Local Authorities to restrict expenditure on the grounds of national economy the Council deferred consideration of the proposed No.6 Smoke Control Order for 12 months — until 1971 — consequently the latest date for completion of our smoke control programme is now 1975 and this will only be achieved if present progress is maintained and there are no further curtailments. The following table gives details of Smoke Control Orders which were in operation at the end of the year: — 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 1ll Smoke Control Area No.of dwellings Boundaries Operative Date 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 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. Romford/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 112 Smoke Control Area No. of dwellings Boundaries Operative Date Havering 4 (Contd.) 4,564 E. Nags Head Lane/ Hall Lane 1st November 1968 W. Southend Arterial Road (A. 127) / Wingletye Lane Havering 5 7,829 N: Noak Hill Road 1st November 1969 S. Colchester Road (A. 12) E. Borough Boundary (Weald Brooke) W. Straight Road 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 continued to be maintained during the year. Our findings from the operation of these instruments are forwarded monthly to Warren Spring Laboratory, Ministry of Technology, for publication with National figures. Perusal of these figures show that the atmosphere in this Borough is comparable, if not better than, most of the country despite the fact that we have a large industrial area — motor works, chemical works, power stations and cement works — adjacent to the southern part of the area. This very satisfactory state of affairs reflects the interest and support which the Council have given to our smoke control programme assisted by the recent legislation mostly contained in the Clean Air Act, 1968, and coupled with the work of the Public Health Inspectors when carrying out inspections of premises coming within the scope of this Act, and the cooperation of owners of these premises when receiving technical advice from the Inspectors. The readings of our smoke filters are carried out with the aid of an electronic reflectometer. 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. 113 Clean Air Act, 1968 — Chimney Heights During the year ten applications for approval of the height of chimneys serving a furnace or furnaces were received. In eight instances the chimney heights were approved but in two cases conditions were imposed in order to comply with statutory requirements. Clean Air Act, 1963 The outstanding provisions of the Clean Air Act, 1968, came into operation on the 1st October, 1969. From then it became an offence to emit dark smoke, from any industrial or trade premises including premises on which material is burnt in connection with any industrial or trade processes. Dark smoke from chimneys is already being controlled by the terms of the Clean Air Act, 1956. Other sections of the Act brought into operation concerned the fitting of plant to prevent grit and dust emissions from furnaces. At present furnaces burning pulverised fuel or large furnaces burning solid fuel have to be fitted with Local Authority approved arrestment plant. This requirement will be extending to smaller furnaces and to those burning oil and gas. In addition the Minister is empowered to apply the Grit and Dust Provisions of the Clean Air Acts to fumes, e.g. smallerthan-dust solid particles which are given off by certain processes in industrial premises. The law relating to air pollution is now becoming somewhat complex and I feel that a few notes on this subject will be informative. The principal legislation is contained in the Clean Air Acts, 1956 and 1968. The 1968 Act supplements, extends and in part repeals the provisions of the 1956 Act, known as the principal Act. The Minister of Housing and Local Government has also exercised the powers conferred on him by these Acts by making numerous Orders and Regulations. Several amendments to the Domestic (Smoke Control Area) Provisions of the principal Act were included in the Housing Act, 1964. 114 Fumes and gases from industrial processes are controlled through the Alkali etc. Works Regulation Act, 1906, administered by the Alkali Inspector. Under the Clean Air Acts, smoke, dust and grit emission from certain scheduled processes are also the responsibility of this Inspectorate. Apart from the Clean Air Act it should be noted that action may be taken with regard to smoke or other nuisance from air pollution under common law procedure, and this can be used to secure both damages and an injunction. Pollution from road vehicles is not controlled under any of the Clean Air legislations but through the Road Traffic Act and Motor Vehicle Instruction and Use Regulations. Progress and Effects of Smoke Control in London Over six million pounds has been spent by the London Borough Councils on cleaning up the capital's air in the 13 years since the Clean Air Act came into operation. the progress in smoke control orders made by the London Boroughs has been rapid, relative to progress in the rest of England and Wales, and has substantially reduced the emission and concentration at ground level of a major air pollutant, smoke. It is now possible to assess the advantages of these smoke control activities and to produce a balance sheet. On the credit side are the following items: — 1. The cost to the community has been roughly 3 shillings per head per annum, of which the London Boroughs have met approximately one shilling and fourpence. 2. Smoke concentrations have decreased by 80 per cent. since 1958 in central London. 3. Sulphur dioxide concentrations have decreased by 40 per cent. since 1958 in central London. 4. Sunshine in central London has increased by 70 per cent. since 1958. 5. Winter visibility has increased threefold since the Act came into force. 6. 138 bird species can now be seen in London, compared with less than half that number ten years ago. 115 At the present rate of progress the whole of Greater London should be subject to Smoke Control Orders by 1978 Measurement of the Reducing Effects of the Atmosphere The Department have co-operated with the Central Electricity Generating Board by fixing some equipment adjacent to the inlet pipe of the volumetric sulphur dioxide apparatus sited in the Environmental Health Section. This equipment which deals with the measurement of the reducing effects of the atmosphere consists of a wall mounting unit with a zinc reference can placed on the unit and exposed to the atmosphere. Conversion to Natural Gas Whilst on the subject of Clean Air one of the main topics of conversation in the community — not only because it is an approved smokeless fuel but because of the large scale conversions which are now taking place in the Borough and its general implications on our environmental conditions — is the conversion of various domestic appliances from town to natural gas. In this connection I feel that the following notes kindly supplied by North Thames Gas will go a long way to reassure the general public about change over to natural gas and what this entails from the consumers point of view:— "There are many thousands of customers in the Borough and for ease of working conversion areas are sub-divided into small manageable sectors that can be isolated from the existing town gas distribution supply and fed with natural gas. Each sector will vary in geographical size and the number of. customers which may include schools, factories, hospitals, etc. as well as domestic dwellings, has so far been limited to a maximum of about 1,000 customers. Each sector is numbered and first survey and then actual conversion is carried out progressively sector by sector until the whole of the area is changed over from town gas' to natural gas. Survey Some 20 weeks or so prior to conversion of a given area on a progressive basis sector by sector, a personal letter 116 will be sent to every customer in the area advising them of our intentions to supply natural gas. This will be followed by a call by a Survey Representative who will record details of appliances and discuss the conversion procedure as it effects the particular customer. A subsequent letter giving three or four weeks notice will advise customers of the exact date of intended conversion and further reminder will be sent approximately 48 hours prior to the date. It is known that many thousands of different appliances are in use throughout the country. Accurate identification of appliances is a vital pre-requisite of an efficient and successful conversion operation. During the period between survey and actual conversion the important information obtained by survey is collated, operations work in terms of man hours, transport etc. is planned and the necessary conversion materials and replacement appliances will be obtained and stored prior to delivery before conversion. Consumers are requested by letter to advise the Board of any additional appliances that they may have had installed privately after survey as the conversion teams would not be able to undertake conversion of an appliance found on the premises for which no conversion set had been ordered. In the majority of cases the conversion of appliance burners is not practicable from an economic or technical point of view due perhaps to the age or condition of the burner and the cost in terms of labour charge necessary to make the alteration and so, where possible, replacement burners are designed. Conversion of the majority of domestic appliances will, therefore, take the form of a straight exchange of components, i.e. burners, thermostat, pilots, etc. However, there will still be many old obsolete appliances which will need to be converted and in certain cases where a conversion set is not available an ad hoc conversion will be carried out. In certain cases it will be necessary to remove an appliance for conversion work to be carried out in a special workshop set up by the Conversion Unit. If needs be, customers will be loaned a replacement appliance while their own is away at the Workshops. 117 Where conversion on ad hoc basis is uneconomical or impracticable possibly because of the design or condition of the appliance North Thames may offer to replace it with as comparable a model as possible at no charge to the customer. Operations The general pattern of a fitter's work during the cycle of conversion will be to call at about 8 a.m. on the first day and after testing for soundness and visually testing of appliances for correct operation he will turn off the gas at the meter. Distribution Engineers will then begin the turn in procedure of purging the mains of towns gas and feeding in natural gas. While this is going on fitters will be carrying out the work of conversion of gas appliances in the customer's home. Fittings for these conversions will have been delivered a few days previously. The conversion of as many essential appliances as possible will be completed on the first day. Other appliances will be converted during the second day or so. On the first day of conversion customers will be without gas for a time which will vary from sector to sector but the Operations staff will try to make this as short a period as possible. If possible where an appliance cannot be converted on the premises customers will be loaned a replacement appliance while their own is away at the workshops. The time spent in each house will depend upon the number and the type of appliances to be converted. The average non-current cooker i.e. model of up to 15 years old takes about 90 minutes to convert whereas most modern multi gas burners appliances are likely to take considerably less. The aim is to cause as little inconvenience to the customer as possible. If, for any reason, we cannot gain entry on the first day of conversion it will be necessary in the interests of safety, to cut off the gas supply to the premises. If that happens, as soon as we learn that the customer has returned home, we shall arrange to convert the appliances and restore the supply of gas as quickly as possible. The effect of conversion is to replace the working parts of most appliances and therefore from the operational point of view a converted area is to all intents one populated 118 entirely by new or modified appliances, and there will inevitably be instances where the customer is not satisfied with results of the work that has been carried out, and because we know that for various reasons some appliances may require a number of calls before achieving a satisfactory result, we make special arrangements to deal with requests for service after conversion. We are required to convert an extensive variety of appliances, about 5,000 different domestic appliances have so far been identified, some more than 30 years old, and many in a state of disrepair which need all our ingenuity to make them work satisfactorily after conversion when they may not have done so beforehand. Natural Gas needs a more perfect mixture for ignition and combustion, adjustment is therefore more critical. The principles underlying this are fully understood, it is a matter of engineering to achieve satisfactory performance with natural gas on an enormous variety of individual appliances being used in widely varying conditions in the home. The immediate problem after conversion lies in organising to deal with customer problems which arise not only from conversion but those which would have existed even though conversion had not yet been carried out. To enable customer's to obtain service easily a Mobile Report Centre is stationed in each sector for 3 weeks after conversion. Customers are advised by letter of the exact location. A pre-paid post card addressed to the local service centre is also provided to each customer who can of course telephone their usual service centre if the matter is urgent. Special teams of Post Conversion fitters are employed by the Conversion Unit to deal with requests for service and Home Service Advisors are on call to assist the elderly or disabled in particular. From the housewife's point of view the main difference between the two types of gas will be in the appearance of the flame. The natural gas flame is softer in outline. It is flexible like towns gas and it will give a simmering flame but until the housewife gets accustomed to it, it may be 119 necessary when turning the gas right down from "high" to "simmering" to turn the tap more slowly than she has been used to and to watch the flame size as she does so. Natural gas takes a fraction of a second longer to ignite than towns gas. After conversion the price of gas is reduced by ½d per therm for all customers and those using gas for central heating can apply for the new Gold Star Tariff which reduces the price by a further 1½d per therm. If, during the programme of conversion, the Board converts a customer's appliance to bum natural gas and subsequently the customer moves to an area where towns gas is supplied, the Board, at the new address will undertake to convert an appliance from natural gas to towns gas burning in order that the customer may continue to use them. Should a customer move from a towns gas area into an area to which natural gas is being supplied the necessary conversion of appliances will be undertaken by the Board. Under these circumstances no charge will be made to the consumer." 120 SHOPS ACTS The Shops Acts 1950 — 1965 deals with closing hours, working hours for young persons, and also makes provision for meal intervals, weekly half-holidays and holidays in lieu of Sunday employment of all employees within scope of the Acts. Similarly, the Young Persons (Employment) Acts 1938 — 1964 regulates the employment of 'young persons' otherwise than in shops, e.g. carrying messages or running errands outside the place of business; the operation of a hoist or lift connected with mechanical power; the operation of cinematograph apparatus; attendance on persons resorting to a public swimming bath, bathing place or turkish bath. The Sunday Trading requirements are currently under consideration but all attempts to rationalise the law have so far been frustrated. The protagonists for change continue in their efforts. Inspection visits to shops and other premises have to be made on weekends as well as during and after normal working hours. Contraventions are listed below:- Early Closing Day Failing to exhibit an early closing day notice 48 Failing to close for the "serving of customers" 2 Failing to observe the Regulations 30 Sunday Trading Failing to close for the "serving of customers" 4 Failing to observe the Regulations 32 Evening Closing Hours Failing to close shop for the "serving of customers" 2 Conditions of Employment Failing to exhibit notice specifying the day of Assistants' weekly half-holiday 122 Failing to allow Assistants weekly half-holiday 5 Failing to allow intervals for meals and rest 19 Failing to give young persons at least eleven hours consecutive rest to include 10 p.m. and 6 a.m. 1 Failing to exhibit an Abstract of the Act and to keep records of hours worked by young persons 129 121 Conditions of Employment (Cont'd.) Failing to keep a record of Sunday employment 45 Failing to allow a holiday in lieu of Sunday employment 16 OFFICES, SHOPS & RAILWAY PREMISES ACT 1963 The general application of this expanding Act has proceeded steadily and has brought many improvements in the safety, health and welfare of those workers employed in the Borough. Employers, in the main, have appreciated the advice given to them by the Council's Inspectors and comment hopefully that their competitors' premises have not escaped inspection. During the year one very important Regulation came into force concerning safety, namely, the Offices, Shops and Railway Premises (Hoists and Lifts) Regulations 1968. The Regulations impose strict requirements as to the construction, maintenance and examination of lifts. Owners are required that a lift shall be examined by a competent person at least once in every period of six months. The competent person is required to give the owner a report of the result of the examination. Where the examination reveals non-compliance with the Regulations a copy of the report must be sent to the enforcing authority. The inspector has the duty to ensure that the defects are remedied before the lift may again be put into use, and also has the duty of inspecting this machinery for general compliance with the safety requirements and to check examination reports. The application of this new Regulation has already revealed that some lifts in the Borough were in a state liable to cause accidents to the employees or to members of the public. A routine visit to one shop revealed a very dangerous practice of placing a piece of wood in the lift interlocking device, which allowed the gates to be opened while the lift was in motion. Under the Act it is an offence for any person to interfere with equipment likely to endanger the health and safety of persons employed to work in shops and offices. At the end of the year, 2,024 premises were registered and showing 13,373 persons employed. 122 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 the year (4) Number of Registered Premises Receiving a General Inspection during the year Offices 38 517 52 Retail Shops 101 1326 346 Wholesale Shops, Warehouses 9 39 7 Catering Establishments open to public, Canteens 9 135 33 Fuel Storage Depots - 7 - TOTAL 157 2024 438 Visits by Inspectors to Registered Premises TOTAL 2035 123 Summary of Infringements Section Details Number 4 Cleanliness 17 5 Overcrowding 4 6 (1) Temperature 6 6 (2) Thermometers 41 7 Ventilation 15 8 Lighting 7 9 Sanitary Conveniences (insufficient or lacked proper maintenance) 37 10 Washing Facilities (insufficient or lacked provision of running hot water) 35 11 Drinking Water 4 12 Clothing Accommodation 7 13/14 Sitting Facilities 1 15 Eating Facilities 2 16 (1) Floors, Passages and stairs 17 16 (2) Handrails and guarding of open sides 29 17 Fencing Machinery 6 20 Hoists and Lifts 2 22 Dangerous conditions and practices 6 24 First Aid Provisions 59 48 Failing to report accident 1 49 Failing to register 52 50 Abstracts 80 124 Accidents - Analysed by Workplace Workplace Number Reported Total Number Investigated Prosecutions Offices 5 2 1 Retail Shops 69 49 - Wholesale shops, warehouses 6 6 - Catering establishments open to public, canteens 6 5 - Fuel storage depots - - - 86 62 1 Analysis of Reported Accidents Offices Retail Shops Whole sale warehouses Catering establishments open to public canteens Fuel storage depots Machinery - 1 - - - Transport - - l - - Falls of persons 4 18 - - - Stepping on or striking against object or person - 12 - 2 - Handling goods — 21 2 2 — Struck by falling object — 2 3 1 - Fires and explosions — — — 1 — Electricity — — — — — Use of hand tools - 12 - - - Not otherwise specified 1 3 — — — TOTAL 5 69 6 6 - Comparison 1968 2 67 19 - - 125 Notification of Accidents Employers are required to notify the "appropriate authority" of accidents occuring within the premises. In 1969, 86 accidents were reported to this authority as against 88 in 1968, 109 in 1967 and 65 in 1966, an average of 87 accidents a year which indicates no appreciable fall in the accident rate. The problem, generally, is to find and educate those persons who cause accidents to others. Unwittingly most of us are in this category. No fatal accidents were reported to this authority but it must be pointed out that falls account for most of the fatal accidents occuring in workplaces. One accident could easily have been fatal. It concerned a man of middle age. This employee returned to his place of work, after an absence due to illness, in the early morning when it was still dark. Whilst he had been absent, internal alterations to the building had been commenced which included the removal of a staircase and lighting points. The employee was familiar with the general layout of the building and proceeded to where the staircase had been to switch on the lights. Feeling for the light switch, in its previous position, he fell into the staircase well, landing on the floor of the basement. This employee was concussed and badly bruised, and was detained in hospital. His employers were prosecuted for not providing suitable and sufficient lighting and failing to properly fence an opening in a floor. The Magistrates rejected the employers' submission that all due diligence had been exercised. The employers stated that the employee had not informed them that he would be returning to work on the day of the accident. 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. Routine visits and some sampling have been carried out in shops where oil heaters, nightdresses, stands for carry-out, toys (celluloid or lead paint content), electric fires and other appliances are sold. Some nightdresses were withdrawn pending the attachment of a warning notice "Keep away from Fire". The Act together with the Regulations, since coming into force has undoubtedly made an impact, particularly on the manu- 126 facturer of shoddy goods. Retailers and wholesalers, in particular, are now more particular in seeing that goods comply with the standards laid down. Generally, the Regulations have been observed by retailers thus safeguarding the interests of the customer. PROSECUTIONS Act Section Offence Result 1. Offices, Shops & Railway Premises Act, 1963 16 Obstructions of floors, passages and stairs £20 fine 2. „ 6(4) Thermometer £5 fine 12(l)a Clothing accommodation £5 fine 12(l)b Means of drying clothing £5 fine 13 Sitting facilities £10 fine 24 First Aid £5 fine 49(1) Abstract of Act £5 fine Shops Act, 1950 17(2) Assistants' half-holiday notice £1 fine 3. Offices, Shops & Railway Premises Act, 1963 8 Lighting £30 fine 16(4) Fencing-opening in floor £50 fine 4. Shops Act 1950 17(2) Assistants' half-holiday notice £1 fine Offices, Shops & Railway Premises Act, 1963 10(1) Washing facilities — running supply of hot or warm water £20 fine 9(2) sanitary conveniences not kept clean £20 fine Five employers were prosecuted for alleged offences under the Acts. In one case, summonses were withdrawn on the date of hearing. In the second of the cases listed above sixteen summonses were dismissed by the magistrates on the grounds that at the time of the offences the part of the premises concerned was not within the scope of the Act. Costs of £37.5.0.were awarded to the Council in respect of four cases. 127 MISCELLANEOUS Noise Abatement Scheme There was a slight reduction in the number of noise complaints received during the year which is rather surprising when one considers the local and national publicity which is given in this matter. 34 complaints were investigated and each case was resolved without resort to any formal action. 11 of these complaints referred to industrial and commercial premises, and as usual were mostly concerned with noise from the operation of plant and machinery. A total of 337 visits were made by the Public Health Inspectors, the majority of these being of a routine nature and not the subject of complaint. In addition 4 cases were brought to our notice concerning chimes from ice cream vans and in 3 instances prosecutions resulted — 2 under Section 2 of the Noise Abatement Act, 1960 (Sounding Musical Chimes after 7 p.m.) and 1 under Section 147 of the Hornchurch Urban District Council Act, 1936 (Sounding Musical Chimes on a Sunday). Convictions were obtained in all cases and total fines of £9 plus £5 costs were imposed. An activity which caused a considerable amount of annoyance to nearby residents was the establishment of weekly Speedway Racing mostly in the evenings at the Romford Football Club Stadium at "Brooklands". These complaints required a considerable amount of late night investigation and whilst the football club and the speedway promoters were most co-operative the Department were never in a position to invoke the existing inadequate legislation in this respect and were unable to achieve complete satisfaction for all concerned. As mentioned last year the Department keeps pace with modern technology and uses an electronic noise meter which is fitted with a wide range octave band filter and an accoustic calibrator wherever possible in the investigation of these complaints. Civic Amenities Act, 1967 This Act gives Local Authorities much greater power for dealing with the problem of the dumping of litter on roadsides, open pieces of land, hedges, ditches, etc. than the Litter Act of 1958.. During the year the Council prosecuted 15 persons under Section 19 of the Civic Amenities Act for "abandoning rubbish 128 without authority in the open air". 12 of these prosecutions were successful, the other three being adjourned generally. Fines totalling £135 were imposed plus £16 4s. Od. costs. Dustbins The Council adminstera 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. As a result of this provision the Council have resolved that dustbins should be of British Standard Specification with a capacity of either 2Vi or 3% cubic feet. Refuse Collection Approximately 100,000 dustbins are emptied each week by 110 collectors, using 30 vehicles of the most up-to-date, rear loading compressor type. In addition, approximately 250 special collections are made each week for bulky household items. Some materials, such as builders' rubbish, garden refuse, rubble and fencing are not collected, but such items can be taken by residents' own private transport to the disposal site in Gerpins Lane, Rainham. This Site and all other refuse disposal operations are now controlled by the Greater London Council. Street Cleansing The work of cleaning over 300 miles of roads is carried out by 20 teams each normally consisting of 2 sweepers and an electric truck with operator. In addition there are some 40 street orderlies equipped with hand barrows. 5 mechanical sweeper collector machines are employed on carriageways, but increases in the number of parked vehicles in the streets is making the use of mechanical machines less ef fective and there is a serious recruiting problem affecting this service. Trade refuse and waste is by arrangement collected by the Council for which a charge ot l/6d. per bin is made. Traders may themselves deposit such refuse under payment at the G.L.C. Destructor, Frizlands Lane, Dagenham, but it should be noted that no trade refuse is accepted at Gerpins Lane Tip, Rainham. Litter Bins The Council has incurred expenditure on attractive litter bins which are sited in the various shopping centres but it is to be regretted that the general public do not take advantage of this 129 amenity and in the main seem to prefer throwing their odd pieces of paper, ice cream cartons, cigarette packets and the like on the ground. Unwanted Vehicles The Council have an arrangement for the disposal of unwanted cars and motor cycles for which a charge of £2 is made in respect of each vehicle collected. Alternatively owners can take their unwanted vehicles to the G.L.C. tip at Frizlands Lane, Dagenham, during the hours of 8 a.m. to 4 p.m. on weekdays or 8 a.m. to 12 noon on Saturdays. It should be stressed that when owners of unwanted vehicles ask the Council to collect them or if they take them direct to the G.L.C. tip the car log book must be handed in and a form of indemnity completed and ownership transferred to the Greater London Council. Rag Flock and Other Filling Material Act, 1951 Routine inspections were made of the three registered premises and five 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 During the year 9 licences were issued authorising the keeping of Boarding Establishments for animals (defined by the Act as cats and dogs) authorising a total boarding capacity for 510 dogs and 195 cats. Pet Animals Act 1951 During the year 22 licences were renewed and 6 new licences were issued. One new licence and 3 renewals were in respect of stalls in Romford Market. Riding Establishments Act, 1964 All 8 licences for Riding Establishments were renewed during the year. Performing Animals (Regulation) Act, 1925 There are no current registrations under this Act. 130 Radio-active Substances Act, I960 This Act is concerned with the control of the accumulation and disposal of radio-active waste and, as from 1st December, 1963, persons keeping or using radio-active material will unless exempted be required to register with the Ministry of Housing and Local Government and obtain authorisation for the accumulation or disposal of radio-active waste. The Minister in turn shall send copies of certificates of registration and authorisation to Local Authorities. During the year under review there 'were 4 premises in the Borough where radio-active materials are stored and/or used. One of these certificates was the subject 6f revision. In addition a large commercial undertaking has installed a radio-active lightning conductor which is exempt from- the registration and requirements of the Act althoughthe authorisation provisions will have to be adhered to when the radio-active source is disposed of. Paddling Pools 9 samples were taken during the year and all were reasonably satisfactory. Not all the paddling pools were in use and those that were only functioned at weekends during the school summer holiday. Swimming Pools A total of 35 bacteriological and 35 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 remains unchanged at 13. Regular sampling was carried out to these pools — 56 bacteriological and 57 chemical samples being taken. These were satisfactory except for only four samples which were not entirely satisfactory. The necessary remedial measures were taken. 131 Rivers, Streams and Watercourses As mentioned in last year's report the principal river in the area is the Thames, which forms the southern boundary of the Borough. Two tributaries of the Thames (Ingrebourne River and River Rom) traverse the district from north to south, and in the case of the Rom is joined by the Ravensbourne River in the southern part of the Borough to form the Beam River. The Ravensbourne River where it passes through Harrow Lodge Park has been dammed to form a boating lake and during the year work at the Eastern end of this boating lake was carried out by the Council to remove a considerable amount of silt which, during the course of the years, has been washed downstream. This work was executed by contractors early in the summer and although some local residents complained regarding the disposal of the silt, this matter has now been satisfactorily resolved. It is anticipated that during next year work will be carried out to widen this river. Mention was made in last year's report of the steps taken to maintain adequate water supplies to the Ford Factory. The temporary scheme for the diversion of effluent from Riverside Sewage Treatment Works to supplement the normal Beam River intake has continued to operate during the year. In connection with the scheme to maintain the industrial water supply in the Riverside area investigation has continued into the major scheme for the reuse of effluent from the Riverside Works in the Purfleet Industrial Area. This envisages giving the Riverside effluent tertiary treatment at Rainham, pumping this to the head of the Mardyke system for further dilution by the normal flow in this watercourse and abstracting it for industrial use at Purfleet. For the first 12 months experimental work on the tertiary system was carried out, but during 1969 these filters have been supplemented with two high rate percolating filters and the comparative results are being assessed. A new gauging station was constructed by a direct labour force of the Essex River Authority during the year on the River Ingrebourne at Gaynes Park. The Scheme of Sea Defence Works for improving the standard 132 of the tidal defences between Purfleet and Coldharbour Point, (Cunis's Tip) has been virtually completed. The scheme which involved the construction of a lightweight parapet in heavy duty corrugated asbestos cement was carried out by the Essex River Authority's own labour force under the direction of the Southern Area Engineer. Havering Sluice has been largely reconstructed by direct labour in order to achieve a higher standard of tidal defences; to insure a higher factor of safety against the accidental entry of salt water and also to facilitate future maintenance of this sluice. This work combined with the reconstruction of Beam River sluice the previous year and the appointment of Resident Sluice Keepers at Rainham rates a major improvement in safeguarding the low-lying areas against flooding both by fresh and salt water. During the year under review a survey of the River Ingrebourne showed the quality of the river within the Borough area to be generally better than previous years. This was no doubt due to the near completion of the Nags Head Lane sewage disposal works and the greatly improved effluent being discharged therefrom. A survey of the Beam River in June showed minor pollutions from farm drainage in the upper reaches, but these were generally local in effect and were subsequently stopped. Through the urban area slight deterioration of quality obtained but this can be expected in built-up areas. The river below Bretons Farm continued to show great improvement in quality over previous years. Several instances of pollution to standing water from refuse tips arose, but in each case arrangements were made for the disposal of this water sithout significant pollution to streams. One instance of heavy oil pollution to the River Rom resulted from vandals damaging oil storage tanks on a small industrial estate in Romford. In this case, swift action by the Police and Council workmen helped to reduce the effects of oil contamination of river banks downstream. The radio-activity level (Beta-activity) and the bacterial count (E. Coli) were both checked frequently in both rivers and were found to be at a low and safe level at all times. 133 Establishments for Massage or Special Treatment The 18 licences to carry on establishments for massage or special treatment under Part 4 of the Essex County Council Act, 1933, were renewed for the year. These licences are in respect of 15chiropodiSts, 1 physiotherapist and two beauticians. However, during the year 1 chiropodist and 1 beautician ceased to practice. Essex County Council Act, 1933 — Part VI 24 licences to carry on employment agencies were issued during the year. The categories concerned were:- Secretarial and Clerical Staff 11 Technical and Clerical Staff 1 Domestic, Cleaning, Office and Shop Employment 3 Commercial,Professional, Technical and Domestic Staff 2 All except Entertainments and Nursing Staff 2 Artists and Musicians 3 Model Agency 1 Cost and Industrial Accountants 1 TOTAL 24 Theatrical Employers Registration Act, 1925 — 28 No new registrations were made in the Borough during the year although a further 11 with the Essex County Council came to light making a grand total of 16 at the end of the year. Scrap Metal Dealers Act, 1964 This Act came into operation on the 1st April, 1965. Of the 68 original registrations 60 did not apply for re-registration at the end of the 3 year period — 31st March, 1968. However, 12 new entries were made during 1968 and 8 renewals effected. During 1969 these figures were 2 and 4 which together with 1 registration made in 1967 gave a total of 2.7 entries for the register at the end of the year. Hairdressers and Barbers At the end of the year under review 163 certificates of registration under Section 21 of the Greater London Council (General Powers) Act, 1967, were extant. This figure included 1 new registration and 8 Changes of a tenancy during 1969. 134 Copies of the Council's Bye-laws made under Section 77 of the Public Health Act, 1936, relating to Hairdressers and Barbers are issued to all new hairdressers. Burials and Cremations There are 4 cemeteries at present being operated by the Council. During the year there were 839 interments in these cemeteries, 469 at Romford, 98 at Hornchurch, 89 at Rainham and 183 at Upminster. In addition a total of 2 9 still-born children were interred during the year. In addition to these facilities the Council is a constituent member of the South Essex Crematorium Joint Committee who maintain a modern crematorium at Corbets Tey. During 1969 there were 2,476 cremations compared with 2,375 in 1968. 1,203 of these were from Havering, an increase of 62 on the previous year. Mortuary Facilities The arrangement with the Romford Group Hospital Management Committee for the Council to use the mortuary and post mortem facilities at Oldchurch Hospital continued during the year. The Council pay the Hospital Management Committee the sum of £2 in respect of each body received into the mortuary and for this sum the H.M.C. provide all necessary labour, services and equipment which may be required. A total of 299 bodies were received during the last financial year. Common Lodging Houses There are no common lodging houses in the Borough. Disinfection and Disinfestation There has been no change in the arrangements outlined in last year's report. The Council still take advantage of the disinfecting and cleansing services provided by the London Borough of Hackney at their Millfields Road Cleansing Station, Clapton, London, E.5. The majority of the cases are either verminous persons or persons suffering from scabies and six such cases were dealt with during the year. 135 Rodent Control There is considerable evidence at the present time to the fact that rats and mice are becoming increasingly resistant to Warfarin and the Ministry of Agriculture, Fisheries and Food are doing their utmost to find another suitable poison. The majority of Local Authorities are reluctant to use "direct poisons" although this would seem to be the only alternative unless the Ministry come up with some other adequate bait. It is important for members of the public to remember that apart from being a menace to our health, rats and mice eat and foul food and do a lot of damage to buildings and to service installations such as sewers and electricity cables, therefore it is in everybody's interest that we should get rid of these pests. If householders do not wish to deal with this matter themselves they should contact this Department where we employ skilled men who will visit and deal with infestations of rats and mice in houses or gardens free of charge. It is also important to bear in mind that rats and mice only flourish if they have access to a supply of food. Carelessness with food storage or refuse disposal will encourage rodent infestation. The baiting of sewers is carried out by the Borough Engineer & Surveyor. The following is an extract from the Ministry of Agriculture, Fisheries and Food 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, 1969. NonAgricultural Premises Agricultural Premises 1. Total number of properties (including nearby premises) inspected following notification 4,512 - Number infested by: (a) Rats 3,414 — (b) Mice 1,098 - 136 2. Total number of properties inspected for rats and/or mice for reasons other than notification 5,495 232 Number infested by:- (a) Rats 21 3 (b) Mice 3 1 Pigeons The Council's two Pest Officer/General Assistants received instruction in pigeon destruction during the year and the Department now carries out its own activities in this connection instead of employing a specialist firm as here to for. Various equipment has been purchased and licences issued by the Ministry of Agriculture, Fisheries and Food authorising these two officers to use stupefying bait for taking wild birds. These licences are issued by the Ministry of Agriculture, Fisheries and Food in pursuance of Section 10 of the Protection of Birds Act, 1954, for a period of twelve months, and certain conditions must be observed such as stupefying bait being of aspecific kind, 10 days' notice in writing being given to the Ministry in respect of each treatment, bait can only be laid on land or any buildings to which members of the public either have no access or only limited access and only during the early hours of the morning. Several treatments were carried out by the Department during the year and it is hoped that it will be possible to adhere to a fixed programme during the forthcoming year in order fto keep our increasing pigeon population under control. Fouling of Footpaths by Dogs The Council have made a "Good Rule and Government Byelaw" regarding dogs fouling footways. This Bye-law states:"(1) No person, being in charge of a dog, shall allow the dog to foul the footway of any street or public place by depositing its excrement thereon. Provided that a person shall not be liable to be convicted of an offence against this Bye-law if he satisfied the Court that the fouling of the footway by 137 the dog was not due to culpable neglect or default on his part. (2) For the purposes of this Bye-law the owner of the dog shall be deemed to be in charge thereof, unless the Court is satisfied that, at the time when the dog fouled the fpotway, it had been placed in, or taken into the charge of some other person". It will be seen from the wording of this Bye-law that it is a very difficult one to enforce and I cannot help feeling that the lack of prosecutions — not only by the Council but by the police — must be due to this ambiguity. This menace to health is reaching such large proportions that some more stringent national legislation may be required. When complaints are received from members of the public concerning "free range" dogs the Department endeavour to arrange for the Public Relations Officer to issue warning notices for display in the area of complaint so that dog owners are made fully aware of their responsibilities. Factories Act, 1961 The following is a copy of the prescribed particulars on the administration of the Factories Act, 1961, as required by Section 153(1) of the Act and Appendix II of the Department of Health and Social Security Circular 1/70 being in the form of the table requested by the Secretary of State for Employment and Productivity. Premises Number on Register Number of Inspections Written Notices Occupiers Prosecuted (1) (2) (3) (4) (5) (1) Factories in which Sections l,2,3,4and6 are to be enforced by Local Authorities 38 34 - - (11) Factories not included in (1) in which section 7 is enforced by the Local Authority 602 331 18 - (111) Other premises in which section 7 is enforced by the Local Authority (excluding out-workers' premises) 29 42 2 - TOTAL 669 407 20 - 138 Particulars Number of cases in which defects were found Number of cases in which prosecutions were instituted Found Remedied Referred To H.M. Inspector By H.M. Inspector (1) (2) (3) (4) (5) (6) Want of cleanliness(Sl) 16 10 - - — Overcrowding (S2) - - - - - Unreasonable temperature (S3) - - - - - Inadequate ventilation (S4) 2 - - 1 - Ineffective drainage of floors (S6) - - - - - Sanitary Conveniences (S7) (a) Insufficient 4 2 — 4 - (b) Unsuitable or defective 14 7 - 8 - (c) Not separate for sexes - - - - - Other offences against the Act (not including offences relating to Outwork) - - - - - TOTAL 36 19 - 13 - Outwork - Sections 133 and 134 Nature of Work Number of Outworkers in August list Wearing apparel — making, etc. 6 Meteorological Information The table overleaf shows the amount of rainfall recorded at 4 stations in the Borough during the year:- 139 For comparison with local figures details of rainfall at the London Weather Centre are given in the following table. This table also gives details of sunshine. Averages quoted are for the 10 year qeriod 1958 — 1967. LONDON WEATHER CENTRE 1969 Month RAINFALL SUNSHINE Total in. Percentage of Average Wettest Day No. of dry days Total hours Percent age of Average Sunniest Day Date in. Date hrs. Jan. 1.76 114 28 0.39 15 38 79 31 6.7 Feb. 1.18 99 20 0.41 18 75 131 10 8.3 Mar. 1.92 144 11 0.48 20 69 61 28 10.6 Apr. 0.52 28 24 0.15 23 197 158 5 11.8 May 1.61 93 6 0.32 12 167 86 28 12.2 June 0.97 43 23 0.49 23 270 130 10 14.8 July 2.87 144 29 1.51 26 227 120 4 14.6 Aug. 2.77 123 3 1.10 16 146 81 7 12.4 Sept. 0.16 7 15 0.05 25 119 78 20 10.1 Oct. 0.19 8 25 0.12 28 121 109 5 9.1 Nov. 2.83 135 14 0.49 12 66 115 1 8.1 Dec.* 1.66 73 14 0.27 16 19 41 15 6.8 Year* 18.44 80 29th July 1.51 234 1514 102 10th June 14.8 A dry day is defined as one with less than .01 inch of rain during the 24 hrs. *Provisional 140 Month Hornchurch Rainham Romford Upminster Amount in inches No. of days in which rain fell Amount in inches No. of days in which rain felt Amount in inches No. of days in which rain fell Amount in inches No. of days in which rain fell January 2.07 18 2.05 18 1.97 22 1.72 21 February 1.95 16 1.62 16 1.96 18 2.38 17 March 2.11 12 2.20 10 2.11 12 2.24 12 April 0.66 12 0.49 8 0.56 9 0.68 12 May 1.87 18 1.85 17 1.94 18 1.84 19 June 1.20 9 1.46 8 1.09 9 1.14 12 July 3.80 8 3.85 7 3.83 7 3:28 7 August 3.43 14 2.63 13 2.84 13 2.89 16 September 0.30 6 0.20 7 0.27 6 0.22 5 October 0.19 3 0.14 3 0.16 3 0.15 4 November 3.17 19 2.86 16 3.04 21 3.06 21 December 2.20 18 2.08 16 2.04 18 1.99 18 TOTAL 22.95 153 21.43 139 21.81 156 21.59 164 141 Medical Arrangements for Long-Stay Immigrants During the year advice notes were received from various Port Health Authorities in respect of 77 immigrants who were said to be proceeding to addresses in the Borough, a decrease of 21 on last year. In 42 cases successful contact was made and appropriate advice given on health matters. The difference in numbers is mainly due either to the immigrant not being known at the address given or the destination is a local hospital or Doctor's residence and therefore not requiring a visit by us to explain the National Health Service. 142