Add.4.v.68 AC.43368 KEN 76 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA ANNUAL REPORT ON THE HEALTH AND WELFARE OF THE BOROUGH FOR THE YEAR 1967 J . H. WEIR M.D., B.S., B.Hy., D.P.H. MEDICAL OFFICER OF HEALTH ARRANGEMENT OF SECTIONS SECTION 1 VITAL STATISTICS AND INFECTIOUS DISEASES 2 PERSONAL HEALTH SERVICES 3 SCHOOL HEALTH SERVICE 4 DENTAL SERVICE 5 MENTAL HEALTH SERVICE 6 ENVIRONMENTAL HEALTH SERVICES 7 WELFARE SERVICES 8 MISCELLANEOUS SERVICES (Full index at back of the Report) THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA ANNUAL REPORT ON THE HEALTH AND WELFARE OF THE BOROUGH FOR THE YEAR 1967 J . H. WEIR M.D., B.S., B.Hy., D.P.H. MEDICAL OFFICER OF HEALTH 1 THE ROYAL BOROUGH OF KENSINGTON AND CHELSEA Telephone: 01-937 5464 Health and Welfare Department, 25A Kensington Square, London, W.8. 1st September, 1968. To: The Mayor, Aldermen and Councillors of the Royal Borough of Kensington and Chelsea. My Lord, Ladies and Gentlemen, I have much pleasure in presenting the Annual Report on the state of the public health and welfare in Kensington and Chelsea for 1967. The Minister of Health has requested (Circular l/68) that the Report should be generally in the same form as has been the case for some years past. This is the third of the new series of Reports following the amalgamation of the former boroughs of Kensington and Chelsea in accordance with the London Government Act, 1963. The first Report in 1965 was, in some respects, not complete for the full year as the new borough's services did not start to operate until 1st April, 1965. Moreover, the first year's working was affected by the necessity to build up a new department from fragments of three other authorities. The problems resulting from the reorganisation of London Government have mainly been solved, and the present Report can, however, fairly be compared with that of the previous year. Where applicable, the figures for the two years are indicated in this Report. It is pleasing to report that the statistics in this Report show that the health and welfare services available to the residents of the new borough were continued without diminution of extent or efficiency. Population. For the purpose of this Report, the population for 1967 has been estimated by the Registrar-General to be 213,310. The estimated population figure for the previous year was 215,210. Birth Rate. The number of live births per 1,000 population of the borough was 14.88 in 1967, which compares with the figure of 15.8 for the previous year. The birth rate for England and Wales was 17.2. Death Rate. The number of deaths per 1,000 population in 1967 was 10.26, which compares with the figure of 10.42 for the previous year. The death rate for England and Wales was 11.2. Area Comparability Factors for Birth and Death Rates. Comparisons of crude birth and death rates between local areas are not strictly valid since these rates take no account of the varying composition of the populations of the different areas by sex and age. 2 In order to compare the borough's birth and death rates with England and Wales as a whole, the Registrar-General has, in the case of death rates since 1934 and in the case of birth rates since 1949, supplied area comparability factors (A.C.Fs.). The Registrar-General has supplied, for use in Kensington and Chelsea in 1967, the figures 0.60 for births and 0.99 for deaths. The crude birth and death rates for the borough should be multiplied by the appropriate factor, and when so adjusted the results are comparable with the crude rates for England and Wales or with the corresponding adjusted rates for any other area. The following table gives the adjusted Kensington and Chelsea birth and death rates compared with the provisional rates for London and for England and Wales for the year 1967:- Kensington and Chelsea adjusted Greater London England and Wales No. of births per 1,000 population 8.93 15.81 17.2 No. of deaths per 1,000 population 10.16 10.91 11.2 Infant Death Rate. This rate for 1967 was 25.3, and was higher than the rate for the previous year (22.1). The provisional rate for Greater London was 18.4 and for England and Wales was 18.3. Maternal Death Rate. No death of a mother due to childbirth was recorded in 1967. (The provisional maternal mortality rate for Greater London was 0.33 and for England and Wales the figure was 0.20). Infectious Diseases. There was no serious outbreak of infectious disease in the borough during 1967. The total number of notifications received was 1,109 in comparison with 818 in 1966. The difference is almost entirely due to the increase in the number of cases of measles notified in 1967 compared with the previous year. In presenting this Report, I should like to express my grateful appreciation of the kind co-operation which I have received from The Worshipful the Mayor, the Chairmen and Vice-Chairmen of the various Committees, and all Members of the Council. My sincere thanks are also given to the staff of the Health and Welfare Department for their loyal and efficient service during the year. In October, Dr. D.J. Sheerboom, the Deputy Medical Officer of Health left the Council's service to take up the position of Medical Officer of Health for the Borough of Epsom & Ewell. Dr. Sheerboom had been my Deputy for the past seven years and I am happy to place on record my appreciation of all the help he gave me, especially during the long period of reorganising the health and welfare services in the new borough. I must also acknowledge with grateful thanks the assistance which the other Chief Officers and their staffs have been so ready and willing to give at all times. I have the honour to be, Your obedient Servant, J. H. WEIR, Medical Officer of Health. 3 MEMBERSHIP OF THE HEALTH COMMITTEE (as at 31st December, 1967) The Mayor (Councillor J. Elliott Brooks, J.P.) The Deputy Mayor (Councillor Miss Barbara Hulme, B.A.) Alderman H.L.A. Burgess " Lady Petrie (Chairman) " Mrs. John Walford, J.P. Councillor Richard Bing, B.Sc. " Miss E.M. Christmas (Vice Chairman) " David Collenette, M.C. " Charles Hopkins, B.A., A.R.I.C.S., A.M.T.P.I. " A.R. Jinkinson, B.A. " P. O'Hea " S.L. Tanner " Miss DorBen M. Weatherhead (One Vacancy) Non Council Member Dr. J.F.L. King (Inner London Local Medical Committee) MEMBERSHIP OF THE WELFARE COMMITTEE (as at 31st December, 1967 ) The Mayor (Councillor J. Elliott Brooks, J.P.) The Deputy Mayor (Councillor Miss Barbara Hulme, B.A.) (Vice Chairman) Alderman Lady Petrie Councillor Mrs. J.A. Albert " Mrs. Geoffrey Buxton " Mrs. J. Coleridge " Mrs. Janet M. Davies " Mrs. Patricia Dumont, B.A. " Henry Hayter " Charles Hopkins, B.A., A.R.I.C.S., A.M.T.P.I. " L.A. Kenny " A.G. Morkill, O.B.E. " D.H. Piper (Chairman) " Mrs. Olive Wilson, O.B.E. Non Council Member Lady Rosula Glyn 4 PRINCIPAL AND SENIOR OFFICERS OF THE HEALTH AND WELFARE DEPARTMENT AS AT 31ST DECEMBER, 1967 Medical Officer of Health and Principal School Medical Officer DR. J.H. WEIR Deputy Medical Officer of Health VACANT Principal Medical Officers DR. W.T.D. RAY : DR. H.E.E. GUNN Medical Officers (Whole-time) DR. S.C. CAMERON : DR. J. MARTIN DR. P.M. FLEURY DR. K.G. CASEY : DR. F.M. GASKELL Principal Dental Officer MR. M.C. DOWNER Dental Officers (Whole-time) MISS E. GRIVINS : MRS. J. MILNE MRS. B. ODGERS Public Analyst DR. H. AMPHLETT WILLIAMS Chief Welfare Officer MR. S.A. BIDDLECOMBE Deputy Chief Welfare Officer MISS A. BARKER Principal Nursing Officer MISS E. ROBINSON Deputy Principal Nursing Officer MISS J.A. RAINEY Assistant Nursing Officers MRS. J. HARRIS MISS R. ALFORD 5 Principal Mental Welfare Officer MR. D.T. BALEWIN Assistant Principal Mental Welfare Officer MR. K. CHAMBERS Supervisors of Training Centres MRS. K.A. BAILEY : MR. R.F. POTTER Supervisor of Day Centre MISS L.P.M. STAUNTON Principal Social Worker (Health Services) MISS J.F. FEELY Assistant Principal Social Worker (Health Services) MISS M. FRENCH Senior Home Help Organiser MISS F.I. BARKER Chief Chiropodist MISS H. DUKE Chief Public Health Inspector MR. H. HOYIAND Principal Public Health Inspector MR. D.C. DRAPER Specialist Housing Inspectors MR. A.F. STANDISH : MR. A.E.F. SILLS Chief Disinfector MR. J.W. NOBLE ADMINISTRATIVE STAFF Chief Administrative Officer MR. J.S. WHEELER Deputy Chief Administrative Officer MR. G.A. PICKIS Principal Administrative Officers MR. C.G. LEGGE MR. J.M. MURPHY MR.,I.M..THOMSON (Finance) (Personal Health) (Environmental Health) MR. B.C. DRIVER (Welfare) VITAL STATISTICS AND INFECTIOUS DISEASES Section 1 7 1967 VITAL STATISTICS AREA The area of the borough is 2,950.7 acres. POPULATION Census 1961 218,528 Estimate of Registrar-General at mid-year 1967 213,310 Average density of population per acre 72.3 RATEABLE VALUE Rateable value of the borough at 1st April, 1967 £26,204,924 Estimated net product of a penny rate 1967/68 £101,351 Estimated number of separately assessed dwellings at 1st April, 1967 60,448 LIVE BIRTHS Males Females Total Legitimate 1,222 1,270 2,492 Illegitimate 370 302 672 Totals 1,592 1,572 3,164 Crude birth rate per 1,000 of the estimated population 14.88 Adjusted birth rate for comparative purposes (Area comparability factor = 0.60) 8.93 STILLBIRTHS Total (11 males and 23 females) 34 Rate per 1,000 live and stillbirths 10.63 DEATHS Total (970 males and 1,218 females) 2,188 Crude death rate per 1,000 population 10.26 Adjusted death rate (Area comparability factor =0.99) 10.16 INFANT MORTALITY Infant deaths (all deaths of liveborn children under one year) Males Females Total Legitimate 35 29 64 Illegitimate 7 9 16 42 38 80 8 Death rate of all infants per 1,000 livebirths 25.28 Death rate of legitimate infants per 1,000 legitimate livebirths 25.68 Death rate of illegitimate infants per 1,000 illegitimate livebirths 23.81 Death rate of male infants per 1,000 male livebirths 26.38 Death rate of female infants per 1,000 female livebirths 24.17 Neonatal deaths (under 4 weeks of age) (24 males and 28 females) 52 Males per 1,000 male livebirths 15.08 Females per 1,000 female livebirths 17.81 All infants per 1,000 livebirths 16.43 Early neonatal deaths (under 1 week of age) (16 males and 27 females) 43 Males per 1,000 male livebirths 10.05 Females per 1,000 female livebirths 17.17 All infants per 1,000 livebirths 13.59 Perinatal mortality (deaths under 1 week plus stillbirths) (27 males and 50 females) 77 Males per 1,000 live and still male births 16.84 Females per 1,000 live and still female births 31.33 All infants per 1,000 live and stillbirths 24.08 MATERNAL DEATHS Maternal deaths Nil Maternal mortality rate per 1,000 live and stillbirths - DEATHS FROM CERTAIN CAUSES Tuberculosis of respiratory system 6 Other forms of tuberculosis 1 Respiratory diseases (other than tuberculosis) (Code Nos. 22 - 25) 279 Cancer (Code Nos. 10 - 14) 445 Heart and circulation diseases (Code Nos. 18-21) 766 Suicide 65 9 SUMMARY OF VITAL STATISTICS FOR KENSINGTON AND CHELSEA in 1967 (Compared with previous ten years) Year Total Population Total Deaths Crude Death Rate Total Births Crude Birth Rate Total Infant Deaths Infant Mortality Rate 1957 218,500 2,500 11.44 3,503 16.03 94 26.83 1958 215,890 2,389 11.07 3,732 17.28 92 24.71 1959 216,020 2,380 11.01 3,748 17.35 87 23.48 1960 216,380 2,386 11.03 3,774 17.44 76 20.16 1961 217,570 2,456 11.29 3,958 18.19 85 21.47 1962 220,570 2,464 11.17 4,020 18.27 92 22.89 1963 220,220 2,548 11.57 3,912 17.76 94 24.03 1964 219,190 2,196 10.02 3,861 17.61 95 24.61 1965 216,810 2,346 10.82 3,666 16.91 81 22.09 1966 215,210 2,242 10.42 3,394 15.82 75 22.09 1967 213,310 2,188 10.26 3,164 14.88 80 25.28 10 CAUSES OF DEATH AT DIFFERENT PERIODS OF LIFE IN 1967 Cause of death All Ages Under 1 yr. 1 yr. and under 5 5 yrs. and under 45 45 yrs. and under 65 65 yrs. and over Respiratory tuberculosis 6 - - - 2 4 Other forms of tuberculosis 1 - - 1 - - Syphilis 5 - - - 1 4 Diphtheria - - - - - - Whooping Cough 1 1 - - - - Meningococcal infections - - - - - - Acute poliomyelitis - - - - - - Measles - - - - - - Other infective diseases, etc. 3 - - - 3 - Cancer (all forms) 445 - - 25 158 262 Leukaemia, aleukaemia 9 - - 1 7 1 Diabetes 17 - - 2 2 13 Vascular lesions of nervous system 250 2 - 5 39 204 Coronary disease, angina 409 - - 10 96 303 Hypertension with heart disease 17 - - - 2 15 Other heart disease 230 - - 16 21 193 Other diseases of circulatory system 110 - - - 13 97 Influenza 6 - - - - 6 Pneumonia 144 12 - 2 11 119 Bronchitis 111 2 - 2 21 86 Other respiratory diseases 18 1 - 1 2 14 Dicer of the stomach 13 - - - 1 12 Gastritis, enteritis and diarrhoea 9 1 1 1 - 6 Nephritis and nephrosis 8 * - 1 2 5 Hyperplasia of prostate 8 - - - - 8 Pregnancy, childbirth and abortion - - - - - - Congenital malformations 27 17 3 4 3 - All other diseases 200 44 3 11 41 101 Motor vehicle accidents 16 - 1 6 4 5 All other accidents 58 - - 27 13 18 Suicide 65 - - 32 22 11 Homicide and operations of war 2 - - 1 - 1 TOTALS 2,188 80 8 148 464 1,488 11 ILLEGITIMACY During the past three years, Kensington and Chelsea has had the highest proportion of illegitimate births per 1,000 live births of all towns in the United Kingdom with over 100,000 population. The figures ares 1965 - 201; 1966 - 201; 1967 - 212. Advance information kindly supplied by the Registrar-General shows that the 1967 figures compare with the provisional rate for England and Wales of 84, and with that for Greater London of 114. The Greater London Boroughs with the next highest rates are:- City of Westminster 188 Camden 171 Lambeth 170 Hammersmith 167 Brent 146 Compared with cities having a population exceeding 400,000, the figures are:- Manchester 150 (1966) Birmingham 117 (1967) Leeds 116 " Bristol 106 " Liverpool 103 " Sheffield 85 " The Kensington and Chelsea rates of illegitimacy per 1,000 live births over the past 100 years are illustrated in the accompanying graph. Those for England and Wales and the former Administrative County of London are given for comparison. It will be seen that, in the decennia after the First World War, the rates rose steadily, but after 1950 they abruptly accelerated to the present figure. In comparison with some of the former Metropolitan boroughs and two of the Middlesex boroughs the rates since 1950 are as follows:- ILLEGITIMATE BIRTHS PER 1.000 LIVE BIRTHS 1950 1955 1960 1961 1962 1963 1964 London Boroughs 1965 1966 1967 Kensington Chelsea 101 116 166 182 197 196 201 Kensington & Chelsea 201 201 212 61 96 142 136 123 117 146 Paddington St. Mary- lebone Westminster 129 144 221 215 254 240 232 Westminster 188 186 188 137 92 115 121 124 103 126 105 111 116 128 154 149 150 Hampstead 93 86 116 137 146 146 151 Camden 156 172 171 Holbom 100 138 135 106 149 148 133 St.Pancras 108 105 137 133 155 146 147 Fulham 76 86 97 101 118 127 137 Hammersmith 148 158 167 Hammersmith 68 78 119 135 157 156 169 Lambeth Wandsworth 83 81 151 158 173 175 166 Lambeth (Lambeth and part Wandsworth) 165 157 170 57 70 94 108 118 120 149 Wembley 28 32 38 50 64 63 70 Brent 139 150 146 Willesden 59 77 121 156 176 177 173 London A.C. 70 77 114 127 141 142 143 Greater London 108 109 114 England and Wales 51 ^7 54 60 66 69 72 77 79 *84 * Provisional 12 Of the 3,918 live births notified to me by the local Registrars, 794 were illegitimate. (These figures relate only to births actually occurring in the borough. They do not, as in the case of the RegistrarGeneral's figures, include births to residents occurring outside the borough or exclude births to persons normally non-resident). They were notified in the five districts as follows:- Total Live Births Illegitimate Rate per 1,000 Kensington North Sub-District 715 193 269.9 Kensington South Registration District 534 59 110.4 St. Mary Abbots District 1,456 3^9 253. 4 Chelsea Registration District: No. 1 40 2 50.0 No. 2 1,173 171 145.7 TOTALS 3,918 794 202.6 It has been possible to review 540 of these illegitimate births. In 191 cases, the parents were in regular cohabitation, in 114 the relationship was casual. In 74 cases, the mother was pregnant on arrival in the borough. In 40 cases, she left the borough immediately after confinement, and in 134 cases trace was lost and no further information was obtainable. The Welfare Section received application for acceptance of responsibility for residential care in 153 cases. Of these, financial responsibility was accepted by the borough in 102 cases, by other authorities in 17 cases; 31 were withdrawn, and 3 made other arrangements. 51 of the 153 became pregnant outside London. Their countries of origin were:- England, Scotland & Wales 72 Ireland 41 Commonwealth countries, colonies and protectorates 18 Europe 17 Africa 3 America 1 Unknown 1 The reasons for this excessively high rate in the Royal Borough are partly those applicable to the rise in rate in the country as a whole, and partly those of local application. Nationally, the so-called "permissive society"; the fact mentioned in a "Times" leader that "modern society exerts great pressures on the young to conform to a promiscuous sexual standard; that is true of some advertising, some newspapers, some films, and some television"; the loss or reduction of many former deterrents - public opinion, social stigma, loss of employment, poverty, homelessness, abandonment, unaided responsibility. The fear of contracting venereal disease with the prospect of a two-year course of treatment for syphilis, together with the possibility of terrifying long-term consequences, or, in the case of gonorrhoea, prolonged and often ineffectual treatment, with the possibilities of acute septicaemia, acute abdominal catastrophe, or sterility. The fear of obstetrical complications during pregnancy or parturition. All these have been reduced or abolished by such agencies as the permissive society, the welfare state, the ready availability of abortion, modern drugs and modern medical or obstetrical treatment. 13 So far as London and some other large centres of population are concerned, many unmarried pregnant women come in search of the refuge and anonymity of a crowd. Kensington and Chelsea has certain local factors in addition. The highest rate in relation to other London boroughs is partly statistical. As a result of the amalgamation of metropolitan and outer London boroughs when London government was reorganised, some boroughs joined with those of substantially greater or lesser population and/or illegitimacy rates. In consequence, some had their combined rates reduced, some had them increased. Kensington and Chelsea, in common with some other former metropolitan boroughs, derived no statistical benefit from the amalgamation. Although the smallest and most densely populated of all the London boroughs, Kensington and Chelsea is one of the most convenient, accommodating, and attractive boroughs to those from the provinces or abroad who want a pied a terre from which to join in the gaiety and attractions of London. For these there exist a large number of local meeting places - cafes, clubs, coffee bars, cinemas, discotheques and dance-halls. It is the wealthiest non-commercial residential London borough, and has one or more of the reputations of being fashionable, Bohemian, "swinging" and cosmospolitan - overall, 27$ of the population were born outside the United Kingdom, and in one ward this rises to 38%. So far as accommodation is concerned, the borough has large numbers of hostels, hotels, lodging houses, clubs, flats, bedsitters, shared accommodation, and houses in multiple occupation. As a result of the large numbers of shops, offices, colleges, hospitals and educational institutes in or adjacent to the borough, the population includes large numbers of unmarried girls students, office workers, shop assistants, hotel employees, au pair girls living away from home, often with scanty means. It also includes substantial numbers of male visitors and temporary residents in search of, and able to afford, a gay time. Nationally, about 80% of all illegitimate births occur to women below the age of 29, including 34% to those between the ages of 18 and 21, 33% to those between 20 and 24 years, and 17% between 25 and 29 years. In Kensington and Chelsea, examination of the population age structure (1961 Census) shows that in round figures 7% of the female population was aged between 15 and 19 years, 13% between 20 and 24 years. 9% between 25 and 29 years, and 29% between 15 and 29 years. The comparable figures with some other inner London boroughs are:- Female Population Approximate Percentage 15-19 years 20-24 years 25-29 years 15-29 years Kensington and Chelsea 7 13 9 29 Westminster 6 9 7.5 23 Camden 6.5 10 8 25 Hammersmith 6.5 8 6.5 21 Lambeth 6 7 6 19 London Administrative County 6 8 7 21 England and Wales 7 6 6 19 14 Ln addition, the population in the 15 - 29 age group constitutes a much higher percentage of the total female population (28.7%) than the national average (18.5%) and the London Administrative County percentage (21.3%). Also, the percentage of single females in the 15 - 29 age group at 73.5% is significantly higher than the percentage for England and Wales (51$), or London Administrative County (58$). In four wards in Kensington the figure is over 80%. Thus, the Kensington and Chelsea population includes a significantly higher percentage of those to whom illegitimate births occur. Another contributory factor is temporary residence. Of the 540 cases of illegitimate births reviewed, at least 174 could not be traced within a short time after confinement. A special mother-and-baby unit for unmarried girls located in the King's Mead institution remained in operation until 1967. There are six maternity units in or adjacent to the borough. In these, several thousand births occur. Apart from temporary residence during pregnancy and childbirth, there is a large annual population turn-over, in some wards of the order of 25$ or more. There is also the matter of regular cohabitation without marriage. As previously noted, in 191 of the 540 cases investigated, the parents were in regular cohabitation, presumably unmarried either by choice; because of legal obstacles; or because of their non-acceptance of formal marriage as a social custom. On the last, however, I am advised that, in general, this is diminishing owing to resultant complications and deprivation of benefits with official departments. In fact, in at least one of the registration districts, the number of legitimation applications consequent upon the marriage of the parents has increased enormously. The question of illegitimacy was the subject of comment by a perspicacious predecessor, Dr. Louis C. Parkes, Medical Officer of Health for Chelsea. In addition to prescient comments on the health aspects of London locomotion, he advised the Royal Commission on Divorce in 1912 that Bank Holidays should be abolished as "One frequently sees a number of births returned within about nine months after the Bank Holidays. The workhouses and 'lying-in institutions in Chelsea were full of Bank Holiday babies sired by fugitive fathers". The greatest single cause of maternal death is no longer sepsis or haemorrhage. It is abortion which accounts for about 20% of such deaths and, in the majority of cases, is the result of unskilled interference. In this connection, a 1966 Report by the Council of the Royal College of Obstetricians and Gynaecologists comments that termination of pregnancy is a second best. "The unwanted or harmful pregnancy should not occur. Here is a field in which preventive medicine has an important place If advice on contraception and the necessary materials were made freely available to all who seek them, by way of the hospital, general practitioner, or local health authority services, the need for therapeutic abortion would not arise so frequently. The Council takes the view that such arrangements should be made, and made on the scale now necessary to satisfy the public demand". In the light of this, the local situation and the Government's legislation and directives regarding family planning, the Council have made arrangements whereby advice is freely available to all married or unmarried persons through the medium of the Family Planning Association. 15 INFECTIOUS DISEASE There was no serious outbreak of infectious disease in the borough during 1967. The total number of notifications received was 1,109 in comparison with 818 in 1966. The difference is almost entirely due to the increase in the number of cases of measles notified in 1967 compared with the previous year. Notifications. The following tables show (1) the number of cases of infectious disease notified during the year 1967 with the comparative figures for the previous five years; (2) the number of notifications divided into age groups; and (3) the number of cases notified in each ward of the borough:- NOTE: Cases of mistaken diagnosis are excluded from the above table. TABLE 1 Notifiable disease Number of cases notified 1967 1966 1965 1964 1963 1962 Diphtheria - - - - - - Dysentery 11 30 31 40 93 124 Encephalitis - - - - - 1 Enteric fever 1 - 5 8 9 3 Erysipelas 3 4 2 4 2 7 Food poisoning 12 20 15 40 33 20 Malaria 4 1 1 4 3 3 Measles 847 515 1,084 428 1,296 332 Meningococcal infection 2 3 4 1 4 1 Ophthalmia neonatorum - 2 2 3 4 3 Pneumonia 11 5 4 19 17 21 Poliomyelitis: Paralytic - - - - 1 3 Non-paralytic - - - - - 1 Puerperal Pyrexia 48 54 73 90 76 106 Scarlet fever 15 18 27 19 16 18 Tuberculosis (all forms) 77 97 139 129 178 186 Whooping cough 78 69 34 43 103 28 TOTALS 1,109 818 1,421 828 1,835 857 16 TABLE 2 Notifiable disease Number of cases notified in 1967 (Age groups in years) Age unknown Under 1 1-2 3-4 5-9 10 - 14 15 - 24 I 25 and over Diphtheria - - - - - - - - Dysentery - 1 - 3 2 - 2 3 Encephalitis - - - - - - - - Enteric fever - - - 1 - - - 1 Erysipelas - - - - - - - 3 Food poisoning - - 2 - 2 - 3 5 Malaria - - - - 3 - - 1 Measles 18 34 214 249 294 9 16 13 Meningococcal infection - - - - - - 2 - Ophthalmia neonatorum - - - - - - - - Pneumonia 1 - - 1 - - - 9 Poliomyelitis - - - - - - - - Puerperal pyrexia 1 - - - - - 24 23 Scarlet fever - - 2 2 6 4 1 - Tuberculosis (all forms) 1 - - 1 3 - 8 64 Whooping cough 2 7 15 21 28 3 1 1 TOTALS 23 42 233 277 338 16 57 123 Disease Total cases notified in each Ward in 1967 TABLE 3 St. Charles Golborne Norland Pembridge Holland Earl's Court Queen's Gate Redcliffe Brompton North Stanley South Stanley Church Cheyne Hans Town Roya'l Hospital Diphtheria — - — - - - - - - - - - - - - Dysentery 2 3 2 1 1 - 1 1 - - - - - - - Encephalitis - - - - - - - - - - - - - - - Enteric fever - - — - - - - - - 1 - - - - - Erysipelas - - 1 1 - - - - - - - - - - 1 Food poisoning 1 - 1 3 2 - - 3 - 1 - 1 - - - Malaria 1 - - - 3 - - - - - - - - - - Measles 143 84 64 78 92 58 18 59 19 47 67 42 26 24 26 Meningococcal infection - 1 - - - 1 - - - - - - - - - Pneumonia 1 2 1 - 1 1 2 1 - - - - - 1 1 Poliomyelitis - - - - - - - - - - - - - - - Puerperal Pyrexia - - - - - - 41 - - 7 - - - - - Scarlet fever 3 1 - 3 - 1 1 1 - 1 - 1 1 1 1 Tuberculosis (all forms) 8 7 1 13 6 7 7 6 7 4 3 5 1 1 1 Whooping cough 13 10 8 11 13 - 2 - - 4 3 11 - 3 - 17 - 18 - Diphtheria. This year was the sixth consecutive year that no cases of this disease were notified in the borough. Dysentery. Eleven cases of dysentery were notified during the year, of which one was classed as Sh.flexner and the remainder Sh.sonne. Generally, the cases were of a mild type, and there were no deaths. Encephalitis. The last instance of a case of encephalitis being notified in the borough was in 1962. Enteric fever. During the year, one case of typhoid was notified by a hospital in the borough, and concerned a woman who resided in Hammersmith. The local Medical Officer of Health was informed and he arranged to carry out the necessary investigation of contacts and tracing of the source of infection. One contact, working in Hammersmith but resident in this borough, was found to be a typhoid carrier and, after unsuccessful treatment, was removed to hospital. Malaria. Four cases were reported during the year and investigations indicated that the illnesses were contracted abroad. Food Poisoning. Twelve cases of food poisoning were notified during the year, and seven other cases were reported. The following table gives an analysis of the casess:- 16 salmonella typhimurium 1 salmonella blockley 1 salmonella senftenberg 1 unknown Poliomyelitis. It is now four years since a case of this disease was notified in the borough. Ophthalmia neonatorum. The occurrence of this disease has been very much reduced over recent years and, in fact, no cases were notified during 1967. Smallpox. No cases were reported in the borough during 1967. Information was received during the year from port authorities of 172 persons intending to stay in the borough and who could not produce valid certificates of vaccination, after leaving countries which were declared local infected/endemic areas. Of these, 104 were kept under observation for the surveillance period and remained quite well. Five were found to have moved to other areas and the local Medical Officers of Health were notified. The staff of the department were unable to trace the remaining sixty-three persons at the addresses given by the port authorities. - 19 - The Ministry of Health's memorandum on vaccination against smallpox recommends that persons likely to have to deal with cases of smallpox at short notice should be regularly revaccinated at not more than yearly intervals. During the year, 66 members of the staff of the department were vaccinated or revaccinated. Tuberculosis. During the year, 77 new cases of tuberculosis were notified, of which 67 were respiratory and 10 were non-respiratory. In addition, 35 other cases were reported, mainly by other borough councils, of persons moving into this borough. These figures again show a decrease in cases. In addition to the above new cases on the register, there were those who were removed from the register, either through moving out of the borough, dying, being cured or moving without trace, and the final figures in the register at the end of the year were as follows:- Respiratory Non-respiratory Total Male Female Male Female 526 326 28 53 935 Every effort has been made by Public Health Inspectors and Health Visitors to visit all newly-notified cases (and those transferred in or changing address in the borough) with the object of tracing the source, preventing the spread, and removing conditions favourable to infection. Particular attention was given to the home conditions in addition to the dissemination of advice to prevent the transmission of infection to contacts. Incidence of tuberculosis amongst Kensington and Chelsea residents who originated from areas outside England, Scotland and Wales Country of origin Period (in years) between entry to U.K. and notification of disease Total 1 2 3 4 5 6 7 8 9 10 France 2 - - - - - - - - - 2 Africa 2 1 - - - - - - - - 3 Spain - -> - 1 - - - - - - 1 Turkey 2 - - - - - - - - - 2 Ireland 1 1 - 1 1 - 1 - - 2 7 Tasmania 1 - — - — — — - - — 1 Australia 1 - 1 - - - - - - - 2 Haiti 1 — - - - - - - - - 1 Gibraltar - 1 - - - - - - - - 1 India 1 - - - 1 - _ - - - 2 Phillipines 1 - - - - - - - - 1 TOTAL 12 3 1 2 2 - 1 - - 2 23 In a further nineteen cases, information concerning origin could not be obtained. - 20 - Since 1952 investigations have shown that, of the new cases and "inward transfers" reported in the borough, the proportions who were immigrants contracting the disease in the first ten years of arrival were as follows Year Proportion per cent 1952 16 1953 10 1954 16 1955 17 1956 15 1957 16 1958 23 1959 20 1960 20 1961 11 1962 20 1963 27 1964 23 1965 19 1966 15 1967 21 This year, fifty-one per cent (1966 - twenty-eight per cent) of the infected immigrants contracted the disease within one year of arrival in this country; sixty-nine per cent (1966 - thirty-eight per cent) contracted within three years of arrival. Persons born in the Republic of Ireland were regarded as immigrants for this purpose. INTERNATIONAL CERTIFICATES. In order to prevent the spread of infectious diseases, certain countries require that visitors should be vaccinated or inoculated against specific diseases. International certificates have been prescribed for smallpox, cholera and yellow fever. When completed by a medical practitioner, the certificate must be authenticated by the Medical Officer of Health. During the year, 7,812 of these certificates were authenticated. In addition, 11 special certificates were issued to travellers who refused vaccination on medical or religious grounds. IMMUNISATION AND VACCINATION. Immunisation of children against poliomyelitis, diphtheria, whooping cough, smallpox and tetanus has continued to be carried out by the Council and general practitioners. The numbers of completed courses of immunisation are all lower than those for 1966 but those for booster doses show, in the main, considerable increases. There is still an unsatisfactory response from parents to all forms of encouragement to have their children immunised at recommended ages. Attention was drawn by the Chief Medical Officer of the Ministry of Health in November, 1967, to the "disquietingly large variation in the acceptance rates" for prophylaxis of children born in 1965 in different areas as recorded in his Annual Report for 1966, and to the need to raise these rates. - 21 - The percentage figures given for this borough as compared with the national average were:- Borough Eng. & Wales Whooping cough 60 72 Diphtheria 67 73 Poliomyelitis 55 68 Smallpox 34 38 Although a written invitation is issued personally by health visitors to the parents on a visit to the parental home shortly after the birth of the child, and despite a continuous programme of health education which includes personal persuasion by health visitors in their day-to-day contact with families, and written reminders, the number of completed primary courses of immunisation is lower than the drop in the number of live births would lead one to expect. The low number of completed primary courses is not due entirely to parental apathy. Population movement is of importance. The Annual Abstract of Greater London statistics shows that, in 1966, about twenty per cent of the population of this borough had been living outside the borough a year previously, and more than thirty per cent five years before. The converse is true and this is particularly the case with young families. Inquiry into the reasons for this exodus from Kensington and Chelsea has shown that, whilst many young childless married couples make their first homes in the borough, once a child is born they move out of the borough to areas where family accommodation is easier to obtain. These "first-child" families are replaced, in the main, by childless couples or single people, and the process is continuous. Thus, the ratio of children aged 0-5 years immunised to the number of children born to parents living in Kensington and Chelsea appears to be disproportionately low compared with other areas where housing accommodation is more suited to "moderate income" family life. The population in the age group referred to in such areas tends to be more static, resulting in a situation which should encourage a higher ratio of immunisations of children aged 0-5 years to the number of children born than it is possible to expect in this borough under present circumstances. The high illegitimate birth rate is a contributory factor, as many of these children are placed direct for adoption outside the borough. The number of children moving into the borough is not enough to offset the number moving out. The effect of migration on this situation was that of the corrected number of live births in 1965 (3,666), 1,152 children moved from the borough during 1965/66, and 84 deaths occurred under one year; against this, 258 children moved into the borough during the same period. This resulted in a potential 2,688 children for complete courses of immunisation. On this basis, the percentage for completed courses in 1965 and 1966 of children born in 1965 and resident in the borough when the course was completed were:- Whooping cough 81.5 Diphtheria 91.0 Poliomyelitis 75.2 Smallpox 47.5 Of children notified as being born in the borough in the year 1966, approximately twenty per cent had moved out within five months of birth. - 22 - This movement of parents with young families does not have the same effect on booster doses which, in practice, largely relate to the number of school places available in the borough to new entrants. Another factor operative is the low recorded rate of immunisation by general practitioners (e.g., in poliomyelitis only 20% of all immunisations as compared with 23% to 66% in England and Wales). This also is more apparent than real. Where the immunisation was carried out as part of the family doctor service, the department only receives records for which fees are payable, originally by this department and, more recently, by the Executive Council. It is known that, in many cases, doctors have carried out immunisations privately or have not submitted a record and claimed the appropriate fee. In such circumstances, the department has no accurate information as to the immunisation rate by practitioners. The Council continued to take part in the Medical Research Council's Trial of Measles Vaccine. It has not been necessary to make arrangements for vaccination against anthrax as there were no establishments in the borough in which employees would be at risk. The scheme for offering BCG vaccination to thirteen-year-old school children and contacts of tuberculosis was continued. POLIOMYELITIS IMMUNISATION. In my previous Annual Report I expressed concern at the fall in numbers of primary courses of immunisation and this trend has continued in 1967. Booster doses have, however, increased. The degree of protection in the community remains at an unsatisfactorily low level, but fortunately there have not been any cases of the disease during the year. Total primary courses completed Total reinforcing doses 1967 1966 1967 1966 At Council clinics - Salk 2 13 Nil 4 Sabin 2,324 2,812 2,414 1,432 By general practitioners - Salk Nil 22 Nil 9 Sabin 384 509 160 136 TOTAL 2,710 3,356 2,574 1,581 - 23 - DIPHTHERIA IMMUNISATION. Completed primary courses are less in number than for 1966, but booster doses have increased. The degree of protection in the community remains below a satisfactory level. No case of the disease has occurred. Total primary courses completed Total reinforcing doses 1967 1966 1967 1966 At Council clinics 2,186 2,605 4,213 3,678 By general practitioners 390 530 510 473 TOTAL 2,576 3, 135 4,723 4,151 WHOOPING COUGH IMMUNISATION. The numbers of completed primary courses and booster doses have both fallen below the 1966 level. Cases of the disease are still occurring. Total primary courses completed Total reinforcing doses 1967 1966 1967 1966 At Council clinics 1,788 1,989 1,284 1,391 By general practitioners 360 503 372 354 TOTAL 2,148 2,492 1,656 1,745 TETANUS IMMUNISATION. The number of primary courses are less than for 1966 but booster doses are higher. Total primary courses completed Total reinforcing doses 1967 1966 1967 1966 At Council clinics 2,195 2,670 3,940 3,512 By general practitioners 397 537 519 476 TOTAL 2,592 3,207 4,459 3,988 - 24 - SMALLPOX VACCINATION. Primary vaccinations were fewer than in 1966 and revaccinations have fallen to a very low level. At Council clinics By general practitioners Total 1967 1966 1967 1966 1967 1966 Primary vaccinations Under 1 year 24 33 37 38 61 71 1 year 955 975 180 203 1,135 1,178 2-4 years 369 407 61 102 430 509 5-14 years 41 61 21 27 62 88 15 years and over 14 34 1 1 15 35 TOTAL 1,403 1,510 300 371 1,703 1,881 Revaccinations Under 1 year Nil Nil Nil Nil Nil Nil 1 year 6 6 Nil Nil 6 6 2-4 years 9 29 15 Nil 24 29 5-14 years 5 72 52 17 57 89 15 years and over 7 101 7 3 14 104 TOTAL 27 208 74 20 101 228 TUBERCULOSIS (BCG VACCINATION). Thirteen-year-old school children. The acceptance rate for this protective measure is lower than for 1966 but is still at a satisfactorily high level and the number of children included in the scheme has increased. The rise in positivity rate noted in my previous Report has continued. The skin test used is Mantoux (10 TU). 1967 1966 Schools visited 12 10 Number of eligible children l,86l 1,309 Number of acceptances 1,458 1,091 Acceptance rate 78% 83.4% Number skin-tested and read 1,119 784 Number given BCG vaccination 1,019 717 Number of positive reactors 98 64 Positivity rate 9.6% 8.2% Contacts. The numbers of contacts of cases of tuberculosis dealt with at chest clinics has fallen considerably. Positivity rate normally high in this group has also fallen. 1967 1966 Number skin-tested and read 144 305 Number found negative 73 141 Number given BCG vaccination 81 144 Number found positive 71 164 - 25 - MASS RADIOGRAPHY. The Central Mass X-ray Centre at the Western Hospital, S.W.6., together with the South West and North West London Mass X-ray Services, continued to provide chest X-ray facilities for the borough during the year. Mobile units made thirty-three visits to large establishments within the borough and, in addition, men in the over-45 years of age group were invited to use a six-monthly service which provides a regular chest X-ray in an effort to detect cases of lung cancer. In this connection, a mobile unit made two visits to Manresa Road. In the year under review, a total of 102,220 people were examined by the X-ray units. 156 cases of active pulmonary tuberculosis were referred to chest clinics for treatment. In addition, 110 cases were detected requiring occasional out-patient supervision. 135 malignant neoplasms were discovered, of which 121 were primary carcinomas, and a further 835 cases were dealt with under the heading of "non-tuberculous conditions", which were referred for further investigation and necessary treatment. (Kensington and Chelsea residents are included in these figures, but separate details for individual boroughs are not available). Section 2 PERSONAL HEALTH SERVICES - 27 - PERSONAL HEALTH SERVICES CARE OF MOTHERS AND YOUNG CHILDREN Maternity and Child Welfare There has again been a fall in the total number of births in the borough, In 1967, 3,188 births were notified compared with 3,454 in 1966 and this fall of 7.7% continues the trend observed in 1966. when notified births fell by 7.5% from the 1965 figure. With this steady fall in the total births, there has been a gradual rise in the proportion which take place in hospital. Thus, in 1965, 91% of the total births took place in hospital. In 1966, this had risen to 93% and in 1967, 3,023 out of 3,188 or 95% were hospital confinements. This relatively high and increasing proportion of hospital confinements is due partly to the ready availability of hospital accommodation in this area and partly to the general acceptance of both medical and lay opinion that babies should be born in hospital. Since the introduction of the maternity 'catchment areas' in 1964. this part of London has been particularly well endowed with beds. With the fall in the number of births, there has been a reduction in the number of 'priority' cases and more beds have been released for, and have been taken up, by women who would have otherwise been considered suitable for home confinemento As might be expected with fewer births, the attendances at ante-natal clinics have fallen and at one centre where attendances were particularly low one weekly session was discontinued. Attendances at the Council's child welfare centres have also fallen. In 1966, the fall in attendances was restricted to children under one year old, but in 1967, the three year decline in the number of births has been reflected in the higher age groups and attendances by children over one year and at the special 'toddler' sessions have also been reduced. In addition, many children are now attending clinics held at the surgeries of general practitioners to whom the Council's health visitors have been attached. Thus, in mid-1966, a health visitor was attached to a group practice in the South Kensington area and throughout 1967, she saw at the surgery, an average of 25 children a week, who would previously have attended the Council's centre. 1967 1966 Ante-natal and post-natal clinics: Total number of sessions 692 779 Total attendances 3,737 4,722 Number of women attending during year - Ante-natal 1,073 1,340 Post-natal 6 23 Child Welfare clinics: Total number of sessions (infant welfare and toddlers) 1,420 1,401 Total attendances 26,269 29,913 Number of children attending during year- Born in 1967 2,289 2,540 Bom in 1962/66 3,819 4,252 Total attendances at special Toddlers Clinics 2,778 2,976 - 28 - Council Day Nurseries Throughout the year the demand for day care of young pre-school children gave rise to some concern regarding the waiting list of children in the priority groups, A survey of the available day nursery accommodation made it possible to increase the approved number of places from 302 to 312, and the numbers on the "weighted registers" from 329 to 347. At the same time, the allocation of accommodation as between age groups was revised to meet the need to organise the care of children in mixed age groups. This system provides for very young babies to be segregated into separate nursery rooms and later assimilated into groups of older children according to their developmental needs. The allocations became 30 places for babies and 282 for mixed age groups weighted to 317. The re-organisation took effect from the beginning of 1968. The average daily attendance during the year was 243. compared with 239 during 1966, and the total of daily attendances was 61,691 compared with 59,27l. The special arrangements were continued for children with aural or visual handicaps to attend day nurseries for the purpose of assisting them to adapt to a normal environment with other children. During the year, two children with aural and two with visual defects were admitted. Staff Kensal House Day Nursery was approved by the Ministry of Health for the training of student nursery nurses with effect from 1st April, 1967. This brought the number of nurseries so approved in the borough to three, and provided an additional stabilising element in nursery staffing. The number of staff nursery nurses on duty during the year fluctuated but was always lower than was desirable, All of the students sponsored by the Council were successful at the National Nursery Examination Board examination held during the year. Occasional Creches At child welfare centres, the Council provide occasional creches where children can be cared for while the mothers attend hospitals or clinics, or do their shopping, etc. At the beginning of the year, a total of nineteen sessions was held each week at four Centres (including the Violet Melchett Centre), At the end of the year, the service was extended to two more Centres and increased to a total of twenty-three weekly sessions. The number of sessions in 1967 was 1,009, compared with 907 in 1966, and the total attendances was 12,308 in the year, compared with 10,288 in 1966. Private Day Nurseries and Child Minders During the year, the proprietors of some private day nurseries and nursery schools have made increased provision for the care of children, with the result that the overall number of places available in premises registered with the Council under the Nursery and Child Minders Regulation Act, 1948, has increased considerably. On the other hand, there has been a decrease in the number of children authorised for reception by child minders because some have moved out of the borough area and others have taken up employment. Further, child minders newly registered during the year have been approved for smaller groups of children. - 29 - The scheme for the voluntary registration of persons caring for not more than two children has continued at about the same level as the previous year. Supervision is undertaken by the Council's officers and the standard of private care has generally remained consistently satisfactory,. Registered Day Nurseries and Child Minders 1967 1966 Number of registered day nurseries at 31st December 22 21 Number of places 678 574 Number of child minders registered at 31st December 22 23 Number of children authorised 106 133 Voluntary Registration of Child Minders 1967 1966 Number registered at 31st December 18 19 Number of children authorised 32 33 Play Groups The interest in and demand for this particular type of care for the pre-school child continued to increase, particularly in the North Kensington area. These groups satisfy a real need in the community and some of the larger ones are registered by the Council as day nurseries under the Nurseries and Child Minders Regulation Act, 1948. Many, however, are open only for short daily periods and therefore are not required to be registered; nevertheless, advice is frequently given at the request of the organisers. There have been instances of group organisers intending to increase their play group facilities by extending the hours of opening, only to find that they would then require to be registered as day nurseries but are, unfortunately, unable to meet the Council's standards owing to structural or economic difficulties affecting the premises. ADOPTION AND BOARDING OUT OF CHILDREN Adoption Persons proposing to adopt children are required to submit medical certificates as to their health before a child is placed with them. These certificates are verified by the Council's medical officers before consent is given. Similarly. the medical records of the children to be adopted are scrutinised by my department and the Children's Officer advised on the child's suitability for adoption. Should the reports reveal any medical defects, inheritable disease or handicap in the child, further enquiries are made and, in the case of inheritable disease in the natural parents, the prospective parents are interviewed by their own practitioner. - 30 - Boarding Out The medical examination is given in accordance with the Boarding Out of Children Regulations, 1955, and includes the Wasserman and/or Kahn tests except where the child is over school leaving age or is boarded out in an emergency or in accordance with Part III of the Regulations. Again, the results of these medical examinations are scrutinised in my department and the Children's Officer informed as to their suitability. The following is a summary of the cases dealt with in 1967:- 1967 1966 Adoption cases Children suitable for adoption 29 22 Children suitable for adoption subject to certain conditions - 1 Children unsuitable for adoption 1 - Couples suitable to adopt children 21 12 Boarding Out Cases Children suitable for boarding out 20 15 HANDICAPPED CHILDREN AND CHILDREN "AT RISK" The Council's Handicap and Observation Register of children with known handicaps or "at risk" of developing a handicapping condition is compiled from several sources, and all cases are reviewed at regular intervals. The total number of children on the register at the end of the year was 823 compared with 957 for 1966. The following is a summary of handicapped children who were on the register at the end of the year:- Handicapping Defects Number of children 1967 1966 Defects of vision 6 8 Defects of hearing 5 4 Cerebral Palsy, orthopaedic defects, and defects of the central nervous system 41 40 Cardiac defects 37 22 Epilepsy 6 9 Mental retardation 23 20 Other handicaps 26 11 Multiple handicaps 47 52 TOTAL 191 166 Notification of Congenital Malformations (Corresponding figures for 1966 are shown in brackets) During the year, 56 (80) children were notified to the RegistrarGeneral as having congenital defects apparent at birth according to information given by doctors and midwives on notifications of births. These included 4 (6) stillbirths, 6 (14) children showing more than one defect, and 2 (4) with multiple abnormalities and gross defects. The following is a summary of defects as classified by the RegistrarGenerals:- - 31 - Defects Total number 1967 1966 Central nervous system 8 9 Eye and ear 1 5 Alimentary system 4 13 Heart and great vessels 4 6 Respiratory system Nil 1 Urogenital system 5 7 Limbs 30 40 Other skeletal defects 2 6 Other systems and malformations 7 10 Multiple malformations 2 4 DOMICILIARY MIDWIFERY The Council's arrangements for providing domiciliary midwifery service have continued unaltered throughout 1967. Home confinements have been attended by the Council's six midwives and the midwives of Queen Charlotte's Hospital. "Early discharges" have been nursed by the midwives of the Kensington District Nursing Association in the north of the borough, and by the Council's midwives in the Chelsea and South Kensington areas. The falling birth rate and the increasing popularity of hospital confinements have again resulted in fewer births taking place at home, In 1967, there were 139 domiciliary deliveries as against 236 in 1966, a fall of 4l%. Of the total, 100 cases were attended by the Council's midwives and, of these, only 4 had to be dealt with as emergencies because no doctor had been booked or other arrangements made for ante-natal care or confinement. The number of "planned early discharges" in 1967 was 112, compared with 131 in 1966. Hospitals generally are not in favour of sending patients home early in the puerperium. They accepted the early discharge scheme as a matter of expediency when there was a shortage of maternity beds, rather than as a desirable practice. Now that there is no pressure on maternity beds. it is possible that patients are not being encouraged to return home so soon after delivery. "Unplanned early discharges" also show a reduction in numbers from 70 in 1966 to 63 in 1967, a trend which it is hoped will continue. - 32 - Domiciliary Confinements and Nursing of Early Discharges Cases booked with a doctor Cases not booked with a doctor 1967 1966 1967 1966 Council's midwives 96 163 4 4 Hospital midwives TOTAL 19 18 20 51 115 181 24 55 Planned early discharges Unplanned early discharges 1967 1966 1967 1966 Nursed by Council's midwives 24 18 25 23 Nursed by Kensington District Nursing Association Nursed by hospital 76 104 35 44 midwives TOTAL 12 9 3 3 112 131 63 70 General Practitioner Maternity Unit In May 1967, it was proposed by the Consultant Obstetrician at St, Mary Abbot's Hospital, that a small unit should be opened within the hospital, where women could be admitted for delivery by their general practitioner obstetricians. Following negotiations between this Council and the hospital authorities, it was agreed that the Council's midwives would also participate in this scheme and would attend and deliver their own patients in the Unit, working with the general practitioners in the same way. The general practitioner unit,, a five bedded ward with a labour room attached to the maternity department of the hospital, is intended only for those patients who are medically and obstetrically normal and who are expected to have a normal confinement. Women who wish to be confined in the Unit are requested to attend the hospital ante-natal clinic early in pregnancy. If considered suitable,, they are booked and then referred back to their own doctors and midwives for ante-natal care. A further visit is made to the hospital clinic at the thirtysixth week of pregnancy. Delivery and after care of the patients in the Unit is the responsibility of the general practitioner and midwife, the hospital supplying only such attention and service as would be provided at home by the patient's relatives, friends or "home help". It was intended that the length of stay in the Unit should be four to five days, but this is varied to suit special needs. The Unit was opened in September 1967 and four cases were attended there by this Council's midwives during the last quarter of the year. It is not yet possible to assess how great a part such a Unit might be expected to play in the maternity services of the future, but it is obvious that it holds advantages for all concerned. It - 33 - increases the scope of practice of both general practitioner obstetricians and midwives at a time when the number of home confinements is declining year by year and may yet reach a level too low to maintain the skills of those concerned„ Above all, for the patient, it provides the security of delivery within the precincts of a hospital combined with continuity of care throughout the whole of the pregnancy. labour and puerperium. Training of Pupil Midwives In 1965, this borough agreed to accept four pupil midwives every three months for midwifery district training; three from Fulham Maternity Hospital and one from Paddington General Hospital. Each pupil is required by the Central Midwives Board to attend at least ten domiciliary confinements, but with the falling number of home births, it became increasingly difficult to provide the necessary number of cases, Consequently,, in November, 1966, the number received from Fulham Maternity Hospital was reduced from three to two. During 1967, there was still difficulty in providing ten cases for each pupil and it was felt that a further reduction would have to be made. The projected closure of Fulham Maternity Hospital meant that no pupils were received from that source, and since September, 1967, only one pupil has been received from Paddington General Hospital. This pupil continues to be attached to one particular midwife for administrative purposes, but undertakes deliveries with other midwives whose districts are accessible to her. Obstetric Nurse Training Nurses in training at St. George's and St® Mary Abbot's Hospitals are allowed to attend puerperal nursings and ante-natal clinics with the Council's midwives, but because there have been fewer home confinements, it has been necessary to restrict these activities to ensure that no mother should be visited more than once for teaching purposes® Midwives Act, 1951 The Council are the local supervising authority for the purposes of the Midwives Act, 1951, and have a duty to inspect and supervise all midwives practising in the area. The following table gives details:- 1967 1966 Notifications received from midwives of intention to practice 125 102 Refresher courses attended by midwives in accordance with Section 9 of the rules of the Central Midwives Board 12 7 Fees paid to medical practitioners called in by midwives in emergency Nil 2 HEALTH VISITING The staffing position was maintained, although the number of health visitors which, in full-time equivalents, was 33.4 at the beginning of the year had dropped to 31.4 at the end. Because of the increased load on the nursing officers, which resulted from the - 34 - considerable movement of health visitors, whereby a large proportion had been for only two years or less in post with the authority, an additional Assistant Nursing Officer was appointed. She became responsible for health education, in-service training,, facilities for students and visitors, and co-operation between the health visiting and general practitioner services. The 1966 Rules for the Training of Health Visitors imposed a further responsibility on nursing officer staff by providing for a continuous period of supervised practical work extending over approximately three months following the examination, and in addition to the practical work undertaken in the academic year. The new appointment enabled this responsibility to be met. The Council for the Training of Health Visitors defined the duties of the health visitor whom they described as "a practitioner in her own right, detecting cases of need on her own initiative as well as acting on referrals. She has skills and knowledge particular to her work drawn from her nursing background and from the additional preparation in her health visitor course", From this, it follows that she is competent to extend her work with families beyond the needs of mothers and young children. Health visitors now make special inquiry into the situation of old people, particularly old people living alone in the borough, with the object of enlisting any needed services on their behalf. Another form in which their scope is extended is by attachment to general practitioner practices. Arrangements were made at the request of the doctors concerned for the part-time attachment of a health visitor from the Campden Hill welfare centre to a group practice of four general practitioners. The health visitor has continued to work at and from the welfare centre but devotes four sessions a week to the group practice,, maintaining telephone contact with the doctors and attending regular surgery meetings. Her work lies mainly in a well-baby clinic and she visits patients on the doctors' lists whether or not they are in her normal area. She also visits, as requested,, elderly persons with medical conditions requiring periodical assessment. A similar attachment has existed since 1962 in respect of another health visitor at the same centre. A further arrangement has been in operation since 1965 involving a health visitor at the South Kensington welfare centre. In the course of visiting particular attention is given to the risk of hypothermia, both in the elderly and very young. The following table records some of the visits made by health visitors. The number of unsuccessful visits remains high,, but a comparison with the figure for 1966 does not indicate a serious deterioration in the position:- 1967 1966 First visits to - Children born in 1967 2,987 3,283 Children born in 1962/66 7,784 7,420 Persons aged 65 or over 183 152 Mentally disordered persons 63 67 Persons discharged from hospital (other than mental hospitals) 18 34 Tuberculous households 160 280 Infectious households (other than tuberculous) 30 13 Unsuccessful visits 11,925 11,102 Total successful visits 35,851 36,858 - 35 - In the former Chelsea area, tuberculosis visitors from Brampton Hospital visited thirteen households. In the remainder of the borough, the Council's district health visitors made visits to 160 tuberculous households. This gives an aggregate of 173 for the borough as a whole, compared with 298 in 1966, In-Service Training This was continued throughout the year,, the subjects dealt with being the battered baby, alcoholism, autistic children, mental disturbance, and rehabilitation of the elderly. In addition, a special feature of a combined talk, demonstration and film dealing with resuscitation was organised, with the co-operation of the London Ambulance Service, and was repeated on two occasions. Staff have also attended courses run by the London Boroughs' Training Committee. Students and Visitors Madame Sunay, the wife of the President of the Republic of Turkey, visited establishments in the department and expressed her interest in the maternity and child welfare services. Six other visitors - five from the USA, one from Denmark - made visits of observation to the welfare centres and day nurseries and spent some time in the public health nursing section. A total of 305 students from the nurse training schools at St. Stephen's, St. Charles's, St. Mary Abbot's and St. Mary's Hospitals visited the department and were given insight into public health work. Visits of observation were arranged for 113 students from Wellgarth Training College, the Froebel Institute, North Western Polytechnic, Queen Elizabeth College and the West London Family Service Unit, two district nurse students, one social service student and ten doctors taking the Diploma in Public Health. Ten student health visitors from the North Western Polytechnic, the Royal College of Nursing and the University of Surrey were given practical work experience during the year under the supervision of fieldwork instructors. HOME NURSING At the beginning of the year, the service was being provided by the Kensington District Nursing Association and the Chelsea District Nursing Association. Negotiations for the amalgamation of the two Associations were proceeding and, from 1st April, 1967, the Kensington District Nursing Association assumed responsibility for the home nursing service for the whole borough. Miss E.M. Evans, S.R.N., S.C.M., M.T.D., was appointed Superintendent of the amalgamated Association. The Chelsea District Nursing Association has continued in being to administer its funds, the income from which will be used for the activities of the Kensington Association within the Chelsea area. This Association has disposed of the lease of its former headquarters. Arrangements were begun during the year to move to No. 1 Redburn Street, S.W.3., generously offered to the Association at a peppercorn rent by the Earl of Cadogan. This will constitute an admirable centre for district nursing in Chelsea. The Council continues to reimburse 93% of net approved expenditure incurred in providing the service. As a result of the amalgamation, the Supervising staff employed at 31st December, 1967. consisted of one Superintendent and two Assistant Superintendents as compared with two Superintendents and one Assistant at 31st December, 1966. Other home nursing staff employed at 31st December, 1967. were as follows:- - 36 - State registered nurses 30 State enrolled nurses Nil Total full-time equivalent 29.5 Students 4 The figures of patients nursed for the year, compared with the previous year, are as follows:- 1967 1966 Number of patients attended 2,659 2,710 Total visits paid 86,932 95,433 Average number of visits to a patient 32.6 35.2 Number of patients attended for at least 3 months 329 239 (or 12.4%) (or 9.2%) Further details of cases, visits and treatments appear in the following tables Types of case Number of new cases undertaken Percentage of Total 1967 1966 1967 1966 Medical 1,692 1,721 80.0 79.6 Surgical 280 261 13.3 12.1 Tuberculosis 14 19 0.7 0.9 Maternity - early discharge from hospital 118 149 5.6 6.9 Maternity - complications 6 11 0.3 0.5 Mental ill-health TOTAL 3 2 0.1 Less than 0.1 2,113 2,163 100 100 Visits for At patients* homes Elsewhere Total Percentage of total 1967 1966 1967 1966 1967 1966 1967 1966 Injections only 20,106 21,707 785 838 20,891 22,545 23.9 23.6 Injections plus other treatment 1,996 2,223 Nil 17 1,996 2,240 2.3 2.3 Other treatment only 64,040 70,629 5 19 64,045 70,648 74.1 74.1 TOTAL 86,142 94,559 790 874 86,932 95,433 100 100 Age distribution of patients (new cases undertaken) Number of patients Percentage 1967 19 66 1967 1966 0-4 years 97 78 3.6 2.9 5-64 years 1,029 1,116 38.2 41.2 65 years and over TOTAL 1,533 1,516 58.2 55.9 2,659 2,710 100 100 - 37 - Nursing treatments. 1967 1966 Total number of completed treatments 2,147 2,355 Total number of patients being nursed at end of year 675 656 LITTLE SISTERS OF THE ASSUMPTION. A grant of £100 was made to the Little Sisters of the Assumption in respect of the domiciliary nursing service provided by the Order. NURSING HOMES. There were no cancellations of registration during 1967, and no new homes were registered, but the total accommodation in these homes was increased by six beds. One home, which takes surgical and acute medical cases, provided five additional beds for patients in rooms where staff had formerly been accommodated; and in another home, which takes only medical cases, one additional bed was provided. Routine visits of inspection were made by one of the Council's Principal Medical Officers on nine occasions. On eight of these, she was accompanied by the Principal Public Health Inspector. Three further visits were made by the latter and, on these occasions, he was accompanied by an officer of the Borough Engineer and Surveyor's Department for the purpose of inspecting means of escape in case of fire. 1967 1966 Number of homes registered on 1st January 9 10 Number of registrations cancelled during the year Nil 1 Number of homes remaining on the register at 31st December 9 9 Total number of beds at 31st December 227 221 Registered for medical patients only 182 181 Registered for medical or surgical patients 38 33 Registered for medical or maternity patients 7 7 Registered for surgical or maternity patients Nil Nil Inspections by medical officer and/or public health inspector 12 22 WELFARE OF THE BLIND AND PARTIALLY SIGHTED. The number of applications for registration as blind or partially sighted under the provisions of the National Assistance Act, 1948, has continued at about the same level as for 1966, but there have been fewer certificates submitted by hospital and private ophthalmologists. The Council continued to employ two consultant ophthalmologists for medical examination and assessment. Details of examinations and findings are as follows:- - 38 -  1967 1966 Number of examinations by Council's ophthalmologist 123 126 Number of hospital certificates accepted 22 44 Number of new cases registered blind 47 66 Number of new cases registered partiallysighted 38 39 Re-examinations - Number previously registered blind and now found to be partially sighted 2 2 Number previously registered partially sighted and now found to be blind 5 14 Number previously registered blind or partially sighted and now found to be not registerable Nil 1 Number examined and no change found in category 52 45 CERVICAL CYTOLOGY. Throughout 1967, clinics for the taking of cervical smears have been held fortnightly at three of the Council's welfare centres in the north, centre and south of the borough respectively, The number of sessions held has been adequate to allow of early appointments being given to all who seek them but, despite publicity, both locally and nationally, and the efforts of pressure groups and health educators, attendances throughout 1967 have been disappointing. At the sixty-eight sessions, each designed to accommodate twelve to fifteen, held during the year, between 800 and 1,000 women could have been examined, but only 390 attended, an average of only six per session. It seems that women, especially those in the "high risk" groups, are reluctant to come forward for examination. The poor response is not confined to this borough, but appears to be nation wide and some local authorities have had to discontinue clinics where attendances have been very low. 1967 1966 Total number of sessions held 68 54 Total number of women examined 390 433 Total number of negative results 388 375 Total number of positive results 2 6 Both women found to have positive cervical smears were referred immediately to their own doctors for further investigation and subsequently underwent surgical treatment in hospital. Apart from women examined at the Council's centres, there are others who attend cytological clinics provided by the Royal Marsden Hospital, or the Family Planning Association, or have the smear taken by their own general practitioners. There are also those who have routine smears taken when attending hospital gynaecological and ante-natal clinics. - 39 - RECUPERATIVE HOLIDAYS. The provision of recuperative holidays for persons classified as "other adults", who are mainly elderly persons, continued to show the increasing trend noted last year. There has additionally been a sharp increase in the number of holidays provided for children, mainly for those of school age. This increase occurred during the first half of the year and is probably a consequence of the biennial measles epidemic which occurred during the 1966/67 winter months. Admissions to holiday homes were as follows:- 1967 1966 Expectant and nursing mothers 5 6 Other adults 86 75 Children under five years of age 17 11 School children 76 44 CHIROPODY. Difficulties continued to be experienced in keeping the level of staff needed for the number of sessions to meet the demand for treatment and to maintain a reasonable interval between treatments of individual patients. The staffing establishment of five full-time chiropodists would have been adequate, but it was not possible to secure any degree of permanency of appointment to three of the positions. Originally, the establishment provided for a chief chiropodist, one senior chiropodist and three chiropodists but, as much of their work was carried out on their own responsibility at separate establishments, this was varied to one chief chiropodist and four senior chiropodists. This provided an opportunity of offering more attractive remuneration. Four appointments were made during the year, none of which lasted for more than six months, and the three regraded positions have virtually remained unfilled. Sessional staff have been employed but, even so, it was not possible to meet the deficiency in full. It was necessary for two centres to be completely closed at various times, totalling five weeks in all. A further strain on staffing resources arose out of the need to provide service for patients living in the Earls Court area. The private chiropodist who was providing treatment at his surgery in that area for patients referred by the Council gave up his practice in January, 1967. and a new clinic attended by one of the Council's chiropodists was then opened in accommodation in a welfare services establishment at 144 Earls Court Road. This clinic opened with one session weekly, and was later increased to two. Details of attendances are as follows:- 1967 1966 Total number of sessions held 2,130 1,983 New cases 634 571 Total attendances 13,908 13,836 Analysis by age-groups of treatments given at clinics - Children Under 4 years 8 2 5-14 years 321 388 Males 15-64 years 1,360 1,323 65 years and over 1,349 1,304 Females 15 - 59 years 4,416 4,706 60 years and over 6,454 6,110 - 40 - HOME HELP SERVICE. There continued to be a heavy demand for this service and greater than could be met in full by the staff available, although every eligible applicant has been given service. The heaviest demand is still from old people,, who now comprise 79% of all households assisted, compared with 77% in 1966. Details of the home help work carried out are as follows:- 1967 1966 Number of households assisted 1,752 1,701 Number of new applications received 820 803 Details of households assisted - Maternity 59 72 Tuberculosis 11 17 Old people 1,385 1,305 Chronic sick 128 138 Early morning and evening help 20 16 Special help (problem families) 2 4 Mental disorders 5 6 Miscellaneous 142 143 Staff details - Number of home helps employed at end of year 149 140 Equivalent of whole-time staff 127.96 119.26 No charge is made for home help service in the households of expectant mothers suffering from toxaemia of pregnancy and who are required by a medical practitioner to rest at home or in hospital. Service was given in six such cases during 1967. FAMILY PLANNING. All family planning services in the borough have continued to be provided by the West London branch of the Family Planning Association, who hold clinics in their own centre at Telford Road, W.10., at St. Stephen's Hospital, S.W.l0., the Violet Melchett Infant Welfare Centre, S.W.3., and one of the Council's welfare centres. Following the increase in publicity throughout the borough last year, the number of women treated under the Council's scheme increased from 64 women referred, of whom only 32 attended in 1966, to 126 referred, of whom 73 attended in 1967. The discrepancy between the number referred and those attending for advice continued to be an unsatisfactory feature,, Some of these defaulters were undoubtedly women who at first agreed to accept advice, but on further consideration decided against it on ethical or emotional grounds. Others were dissuaded by their husbands and, lastly, there were many, often from overcrowded homes and problem families, who simply lack the necessary resolution to keep the appointment or who find it difficult to make arrangements for the care of young children in their absence. A "ferry service" scheme was introduced by the Family Planning Association in 1966 to help women in this situation by providing transport, an escort, care for any children who might otherwise be - 41 - left unattended, and any other assistance needed. Although the scheme has not had the effect that was hoped, it has certainly been helpful as 22 out of the 73 women attending were assisted under it. Following receipt of Ministry of Health Circular 15/67, the Health Committee agreed in principle to the provision of family planning services, both on medical and social grounds, and that for this purpose recommendations by medical officers of the Family Planning Association be accepted. At the instance of the Family Planning Association who were concerned in the interest of administrative efficiency and economy to have a uniform arrangement for payment by the London Boroughs for the Association's services, the Council asked the London Boroughs' Association to consider the matter with the object of formulating a suitable arrangement. This was still under consideration at the end of the year. In the meantime, the Council agreed and advised the Association that at those clinics conducted by the Association on Council premises, the Association should be free to provide services to all who seek them. The arrangement whereby the Association provides services (paid for by the Council) for those married women resident in the borough recommended on medical grounds by the Council's medical officers continued during the year. The fees payable by the Council were reviewed and, from 1st April, 1967, were as follows:- General Advice Fee - First year £2.2s.0d. Second year £1.5s.0d. Plus one year's supplies in both instances Oral Contraceptive Advice Fee - First year £2.2s.0d. Second year £1.5s.0d. Plus one year's supplies in both cases Intra Uterine Device Fee, insertion and two years' check visits £5.5s.0d. The total numbers of patients (including non-borough residents) dealt with at the Family Planning Association's clinics in Kensington and Chelsea during the year are summarised as follows:- No. of new patients during year Total number of patients (old and new) Total clinic sessions Total doctors' sessions North Kensington Marriage Welfare Centre, Telford Road 2,760 6,019 860 1,195 Kensington Clinic, 9 Holland Street 197 437 48 48 Chelsea Clinic, Violet Melchett 208 235 51 51 Chelsea Clinic, St. Stephen's Hospital 814 1,560 99 249 - 42 _ MARRIAGE GUIDANCE. Grants were again made by the Council to the under-mentioned organisations in respect of their work with residents of the borough during the year:- £ London Marriage Guidance Council 65O Catholic Marriage Advisory Council 375 The London Marriage Guidance Council have been trying to find accommodation to enable counselling sessions to be held in each of the Inner London Boroughs so that their services may be readily available to those requiring them. In the course of 1967, facilities were made available free of charge at the Lancaster Road Welfare Centre, 63 Lancaster Road, W.ll., and at the South Kensington Welfare Centre, 10 Redcliffe Street, S.W.10., for a weekly session in each case. LOAN OF HOME NURSING EQUIPMENT. Under Section 28 of the National Health Service Act, 1946, the Council provides, on loan, articles necessary for the efficient nursing of patients in their own homes. Such equipment is normally lent only in instances where the patient is under active medical treatment. The equipment remains with the patient as long as the medical need exists and no charge is made for the service. A supplementary service is provided by the British Red Cross Society. During the year, the Council gave the Society a grant of £125 towards this work. In 1967, 219 issues on loan were made by the Borough Council, and 711 by the British Red Cross Society. Ministry of Health Circular 14/66 commended to local health authorities the provision of incontinence pads to an extent ensuring that they, and associated articles, are made available to all who can benefit from them. Although this Council was already supplying them widely and had not restricted provision to persons receiving home nursing,, the effect of the Circular was to increase the demand considerably. A total of 126 dozers incontinence pads, plus associated articles, issued in 1966 was further increased to 2,059 dozens in 1967. FIREGUARDS. Fireguards continue to be available on loan without charge to necessitous households where there are children under twelve years of age, or elderly, handicapped or blind people. Thirty-eight were issued during 1967, compared with twenty-five in 1966. Some of these were of a type specially designed for use with oil heaters and others of nursery pattern suited to meet circumstances in particular homes. BOROUGH CO-ORDINATING COMMITTEE. The Borough Co-ordinating Committee met three times during 1967 and, in addition, held a special meeting to discuss a family with - 43 - problems of outstanding difficulty. Subjects affecting the authorities and departments represented on the Committee were considered, including the Joint Circular from the Ministry of Health (Circular 20/66), Home Office and Ministry of Housing & Local Government on temporary accommodation for homeless families, the desirability of extending creche facilities in North Kensington, the possibility of setting up a homemaking group at Lancaster Road Welfare Centre, and the Lord Privy Seal's survey of "Services Provided for Young People". Fourteen case conferences took place, at which problems of eightytwo families (forty-eight of these for the first time) were considered and steps were taken to enlist the help of the appropriate social, welfare or other statutory or voluntary services. Nineteen of the families were referred to the department's family caseworkers for intensive casework. Towards the end of the year, the number of families requiring casework help exceeded the capacity of the caseworkers and the case conference was greatly helped by the West London Family Service Unit, who provided the necessary service for one family. At the end of the year, the two full-time family caseworkers were working with thirtytwo families and the deputy principal social worker was working for part of her time with two families. Support to families and individuals in need of help continued to be given by the West London Family Service Onit and the Family Welfare Association whose co-operation is much appreciated. As in previous years, grants of £2,230 and £1,470 respectively were made to these two bodies. Details of their work undertaken in respect of families resident in the borough are as follows:- On 1st January 1967 Added during year Withdrawn during year On 31st December 1967 Family Service Unit Family Welfare Association No. of families with whom caseworkers were working No. of children in families No. of families with whom caseworkers were working No. of children in families 53 224 91 134 14 62 112 155 16 78 118 176 51 208 85 113 Section 3 SCHOOL HEALTH SERVICE 45 SCHOOL HEALTH SERVICE IN KENSINGTON AND CHELSEA Annual Report by Dr. J.H. Weir, Borough Medical Officer of Health and Principal School Medical Officer The Inner London Education Authority is responsible for the school health service but, by virtue of an agreement required by Section 32 of the London Government Act, 1963, there is joint use by the Authority and the Borough of professional staff, premises and equipment. The Medical Officer of Health is the Principal School Medical Officer of the Inner London Education Authority for the area, and responsible to that Authority for the day-to-day running of the service. It is with pleasure that I submit the following summary of the work of the School Health Services undertaken in the Royal Borough of Kensington and Chelsea during the year ended 31 st December, 1967. Where relevant, comparable figures relating to the previous year are shown in brackets. Under the ordinary jurisdiction of the Authority, 10,158 (10,134) children were accommodated in thirty primary schools, while 7,008 (7,239) pupils of secondary school age attended eleven secondary schools. In addition, 172 (172) children of nursery school age were catered for, and spastics of infant age were cared for by the Cheyne Hospital School. ROUTINE MEDICAL INSPECTIONS Conditions governing the medical examination of all school children remain the same as in previous years. Children are examined on entry to the infant school at about five years of age, on entry to the primary school at about eight, on entry to the secondary school at eleven-plus, and finally during the term immediately preceding the end of their school life. During the year 7,000 (6,830) children were examined in 777 (751) sessions. Defects which were noted for treatment or observation were found in 2,912 or 41.6% (2,910 or 42,6%) and 896 or 12.8% (977 or 14.3%) were actually referred for treatment. The parents of 51.8% (52.3%) of the children exercised their right to be present at the examination of their children, and this relatively low number seems to indicate that there are many parents who fail to realise the benefits that may accrue from their presence. Care Committee representatives were present at 80.9% (81.7%) of the examinations held. SPECIAL MEDICAL INSPECTIONS At any time during school life, a child exhibiting hitherto unnoticed physical or mental abnormalities may be specially examined at the request of teachers, parents or other interested partiesDefects discovered at routine medical inspections may also result in special medical examinations of the children concerned. During the year children thought to be in need of education in special schools were referred from various sources and included 89 (77) for the statutory E.S.N, examination. A total of 92 (74) statutory examinations was carried out resulting in 49 (34) recommendations for education at an E.S.N. school. The remainder included - 46 - 21 (18) recommended for open-air schools. Other examinations included 396 (314) secondary pupils seeking employment and 513 (1,026) wishing to go on school journeys. HANDICAPPED PUPILS There are no special schools for the education of handicapped pupils in the area, but a total of 288 (238) children requiring special educational treatment attend appropriate schools in other boroughs, and 86 (86) are placed in boarding schools. Included in these numbers are 22 (30) physically handicapped children in attendance at day schools and 9 (10) in boarding schools. Attending ordinary schools are 53 (55) epileptic children 82 (69) with orthopaedic and postural defects, 13 (23) suffering from diabetes, 22 (20) from rheumatism, 127 (99) from asthma, 10 (8) cerebral and spastic cases, and 15 (9) with eye diseases other than refractions and squints. The number of maladjusted children referred to the Problem Case Conference was 124 (120). Of this number, 45 (65) were referred to Child Guidance Clinics. Two tutorial classes for maladjusted children are in being, and the number recommended for them from Case Conference was 36• CLINICS Vision 189 (173) sessions were held during the year. Total attendances numbered 2,648 (2,636). New cases attending during the year numbered 1,236 (1,372). 1 (1) totally blind child is being educated in a boarding establishment and 11 (3) children with partial sight in a special school. Hearing Audiometry - during the year 4,813 (4,975) children in ordinary schools were given the "sweep" test by the nursing sisters. Details of the results are shown in the following table Boys Girls Total Sweep Test Number tested 2,622 2,191 4,813 Number passed 2,478 2,091 4,569 Number failed 144 100 244 Pure Tone Test of Sweep Test failures Number tested 165 142 307 Number passed 45 40 85 Number failed and referred to Otologist 113 96 209 Other Pure Tone Tests * Number tested 283 189 472 Number passed 143 109 252 Number failed and referred to Otologist 129 75 204 * Includes Hospital Cases - 47 - At present 13 (20) children attend schools for the deaf, and 12 (9) attend Partially Hearing Units Ten children who wear hearing aids attend various other schools Viz. six in ordinary schools, two in Physically Handicapped School, two in school for E.S.N. Audiology - the total attendances at the 41 sessions held numbered 382. New cases attending during the year totalled 184. In addition a deaf register, reviewed at regular intervals by a designated medical officer, is kept in the principal social worker (Health Services) section, where a social worker is responsible for maintaining liaison with the special services provided for deaf children, some of whom may be attending audiology clinics other than those referred to above and a number of whom are in boarding schools,. Ear, Nose and Throat 94 (121) sessions were held during the year. Total attendances numbered 836 (960). New cases attending during the year numbered 281 (389). Special Investigation Children with a wide variety of problems attend the Special Investigation Clinics. While during the last year there have been referrals because of debility and poor general physique, the majority of children have come on account of overweight or enuresis. At the 116 (113) sessions held, 129 (H6) new cases were seen, while the total attendances amounted to 909 (770). Minor Ailments 138 (144) sessions were conducted by medical officers who examined 748 (857) new cases. Nursing sisters held 899 (876) sessions and saw 5(416 (3.506) new cases. All together, the total attendances at these clinics numbered 18,584 (16,342). Speech There are 3 (4) clinics in the area staffed by 3 (5) speech therapists who, between them, conducted 9 (14) sessions per week, Attendances at clinics covered by the first four headings shown above are arranged through the principal social worker (Health Services). With the exception of two of the clinics included in the first heading, social workers attend clinic sessions and provide the doctor with appropriate information on the social aspects of each case- They also act as liaison (working in co-operation with the school care committee) between the child's parents, the school and the clinic to ensure that all necessary facilities are available for the child to benefit fully from treatment recommended, PERSONAL HYGIENE 16,170 (15,498) children were seen during comprehensive surveys and 231 (110) were found to be verminous- Inspections during selective surveys numbered 7,200 (9,134) and on 199 (226) occasions children were found to be verminous. The number of individual children found to be verminous was 271 (176). - 48 - BATHING CENTRE Children attended the bathing centre on 315 (214) occasions, when 72 (47) cases of scabies and 155 (98) verminous cases were treated. During the year no cases of impetigo were treated as opposed to two cases during the preceding year. The significant increase of the number of verminous and scabies cases as shown by the foregoing figures indicates the need for both constant and persistent watchfulness on the part of all concerned. REMEDIAL FOOT CLASSES With the continued co-operation of the head teachers, remedial foot classes were held in six primary schools. 176 (150) children were treated by teachers who have attended special classes at the College of Physical Education. Overall supervision was afforded by a medical officer who visited each class at regular intervals. IMMUNISATION Details concerning immunisation will be found in the table below:- Quarter Ended 31st Mar. 30th June 30th Sept. 31st Dec. Total 1967 1966 1967 1966 1967 1966 1967 1966 1967 1966 Completed Primary Smallpox primary vaccination 7 13 16 32 16 30 23 13 62 88 Immunisation: Triple 4 9 9 1 2 6 3 6 18 22 Diph. 92 93 69 131 23 43 68 49 252 316 Tetanus Diph. 4 2 1 1 Nil 1 Nil 2 5 6 Tetanus 5 12 9 10 2 6 3 Nil 19 28 Polio: Salk Nil 8 Nil Nil Nil Nil Nil 4 Nil 12 Sabin (Oral) 163 167 176 70 55 138 85 99 479 474 Reinforcing Smallpox revaccination 4 10 7 19 22 57 24 3 57 89 Immunisation: Triple Diph. 36 44 52 25 54 51 13 15 155 135 Tetanus 723 445 742 546 544 445 552 388 2,561 1,824 Diph. 121 87 99 131 28 52 42 24 296 294 Tetanus 4 8 10 5 7 12 9 9 30 34 Polio: Salk Nil 6 Nil 4 Nil Nil Nil Nil Nil 10 Sabin (Oral) 940 367 652 315 509 352 410 346 2,511 1,380 - 49 - B.C.G. Vaccination for 13-year-old. Children A medical officer, together with a clerical assistant, visited 12 (10) schools throughout the year. 1,861 (1,309) children were found eligible for B.C.G. vaccination. The parents of 1,458 (1,091) children gave their consent and, of this number. 1,119 (784) were skin-tested and read. 1,019 (717) children were given B.C.G. vaccination and 98 (64) positive reactors were found. INFECTIOUS ILLNESS The following table shows the number of cases of infectious illness reported from the schools by head teachers during 1967:- Disease Total Chicken-pox 249 Dysentery ) 29 Diarrhoea ) Enteritis ) Food Poisoning 1 German Measles 43 Influenza 12 Impetigo 7 Jaudice * 17 Measles 262 Mumps 124 Ophthalmia ) 2 Conjunctivitis ) Ringworm (Scalp) 1 Ringworm (Body) 3 Scabies 6 Scarlet Fever 15 Sore Throat 4 Tonsillitis 71 Whooping Cough 18 * Includes 4 cases of Infective Hepatitis Section 4 DENTAL SERVICE - 51 - DENTAL SERVICE STAFF. Mr. M.C. Downer, the Principal School Dental Officer, took up his duties on 3rd July, 1967. On 31st December, 1967, the borough's professional dental staff consisted of a Principal Dental Officer and three full-time Dental Officers. This compares with one full-time and three part-time Dental Officers on 31st December, 1966. The Dental Officers were assisted by four Dental Surgery Assistants, of whom two are on the National Register of Dental Surgery Assistants. The clerical establishment was increased by one during the year. PREMISES. Four clinics were in use during the year, each comprising one surgery. One, at the Wa'lmer Road Welfare Centre, is new and of a high standard. The second, at Westbourne Grove School Treatment Centre, is satisfactory but it is not well sited in relation to the schools served. The third, at the Chelsea School Treatment Centre - a converted dwelling house - is not entirely satisfactory owing to the inadequate space available, and it is planned to replace it by a double surgery clinic at the Violet Melchett Centre. The fourth surgery, at the North Kensington School Treatment Centre, is situated in premises of unsatisfactory standard and consideration is being given to its replacement. INSPECTIONS AT SCHOOLS. Full scale routine dental inspections, giving priority to infant schools, were resumed in September, 1967, and it is hoped to examine every school child at least once a year. By the end of the year, fourteen infant and two junior schools and departments were dealt with. Slightly over sixty per cent of the children inspected required treatment. The percentage varied from eighty-nine per cent in one junior school in a more socially depressed neighbourhood to thirty-one per cent in an infant school in a more prosperous area. The fact that only fourteen schools or departments were inspected during the first term in which the programme was in operation out of a total of sixty-nine in the borough is an indication both of the demand for treatment from the service and of the amount of treatment required by individual children. Routine dental inspections in nursery schools and nursery departments of infant schools also serve to draw the attention of parents to the importance of dental care in the under fives. Two such inspections were carried out during 1967. TREATMENT. A policy of conservation is followed which extends to decayed primary teeth as well as permanent teeth. This is important in order to avoid orthodontic problems arising in the maturing child - 52 - due to overcrowding of the permanent teeth through early loss of the primaries, and to provide for efficient mastication of food during these important years of development. Dental Officers are being encouraged to treat the more everyday orthodontic cases in their own clinics. The ratio of filled to extracted teeth in the children treated is not as favourable as might appear from the statistics because, since regular general anaesthetic extraction sessions were only held in one clinic in the borough during the year, the practice in the remainder was to refer patients to the hospital service for necessary extractions. SCHOOL DENTAL SERVICE Kensington and Chelsea ILEA 1967 1966 1967 1966 Number of sessions Inspection 25.0 17.0 1,449.2 558.0 Ordinary treatment 1,285.3 1,228.0 27,185.4 26,453.0 General anaesthetic 10.0 13.0 532.9 496.3 Total sessions 1,320.3 1,258.0 29,167.5 27,507.3 Inspections First inspection at school 2,070 857 124,379 34,500 First inspection at clinic 2,716 2,896 47,886 49,420 Percentage found to require treatment 73.5 62.8 65.5 69.8 Reinspection at school or clinic in 1967 559 288 16,181 20,653 Percentage found to require treatment 65.3 60.4 62.4 64.9 Ordinary treatment sessions New Cases - Number of appointments given 6,836 6,368 132,511 151,497 Number of attendances by appointment 3,065 3,029 72,727 74,328 On-treatment cases Number of appointments given 7,685 6,151 180,263 171,459 Number of attendances by appointment 5,705 4,761 133,830 128,446 Other attendances (emergencies) 282 168 4,069 4,119 General anaesthetic session attendances 117 188 7,605 7,783 Total attendances 9,169 8,146 218,231 214,696 Number of first visits for treatment 2,234 1,667 56,551 54,642 Number of additional courses commenced 204 139 8,012 7,680 Treatment given Number of fillings Permanent teeth 4,132 3,512 72,897 89,095 Temporary teeth 2,796 1,740 65,766 54,362 Number of extractions Permanent teeth 141 72 5,148 5,468 Temporary teeth 598 480 20,921 20,727 Other operations (prophylaxis, X-rays, inlays, crowns, etc.) 910 1,175 51,390 50,932 - 53 - MATERNITY AND CHILD WELFARE DENTAL SERVICE. The Ministries recommend that approximately eleven per cent of chairside time in the local authority dental service should be devoted to treatment of the priority classes - children under five years, nursing and expectant mothers. During 1967, the apportionment of equivalent full-time treatment sessions was 8.6 per cent for this service and 91.4 per cent for the school dental service. This represents an improvement over the 1966 figure when the apportionments were 7.3 and 92.7. One aim of the dental service is to inculcate good habits of dental health and care in children at a very early age. Mothers are encouraged to introduce their children to the dental surgery when they are still toddlers so that they become accustomed to the environment of the surgery through regular examination and the carrying out of necessary minor treatment. Fear of visiting the dentist in later life is thus minimised, defects are detected and corrected early. Dental decay is frequently seen in very young children whose teeth are particularly vulnerable, invariably as the result of bad dietetic habits, poor oral hygiene or the use of undiluted vitamin syrups. The worst cases are usually due to a combination of all three. The other main effort of this service is directed to the care and dental treatment of expectant and nursing mothers who require healthy mouths to be able to consume a good nourishing diet. They are also particularly susceptible to certain gum conditions (pregnancy gingivitis) so careful observation should be kept on their mouths to take preventive action early. The improvement in the number of mothers seeking examination and treatment during 1967 was gratifying. Walmer Road Centre houses both dental and welfare clinics. As a result, mothers can readily seek advice for themselves and their young children from the dental surgeon and attendances are better than is the case elsewhere. The other Welfare Centres refer patients to neighbouring dental clinics, but, because patients have to travel to a different clinic for their dental treatment, attendances are low. - 54 - Nursing or Expectant Mothers Children under 5 1967 1966 1967 1966 Number of appointments Number of attendances By appointment Other Number of patients given first inspections during year Number of patients above found to require treatment Number of patients above offered treatment Visits for treatment - Number of first visits Number of subsequent visits Treatments given Number of fillings Number of teeth extracted Number of patients X-rayed Prophylaxis (number of patients) Number of courses of treatment completed during year Number of patients supplied with dentures (full upper or full lower) first time Number of patients supplied with other dentures Number of dentures supplied Total sessions in year (combined) 158 81 1,108 973 82 47 757 613 Nil Nil 8 9 31 23 326 192 31 22 165 111 30 21 164 110 24 16 157 152 47 26 417 399 41 22 277 189 17 7 52 61 2 Nil Nil Nil 22 8 7 4 13 5 355 284 3 1 Nil 2 6 3 1967 1966 124.3 99 DENTAL HEALTH EDUCATION. Dental health education is very important. Although many parents ensure that their children receive regular dental care, others, through apathy, ignorance or lack of information about the importance of dental health and the availability of facilities, appear to ignore this important aspect of their children's health. Dental health education talks and demonstrations were given in schools by the department's staff and Mrs. Thomas, the Dental Health Education Officer of the ILEA, visited seven schools in the borough during the year and talked to 1,530 children. The services of Pierre the Clown (Mr. Pierre Picton), who is sponsored by the Fruit Producers Council and who has the full approval of the General Dental Council, were available for a week in November. He is able to convey the message of dental health education in a form which is particularly acceptable to both infant and junior school children. He visited twenty-nine schools or departments in the borough and spoke to some 5,000 children - each was given an apple and enrolled in the "Apple Club". Section 5 MENTAL HEALTH SERVICE - 55 - MENTAL HEALTH SERVICE Mr. D. T. Baldwin Principal Mental Welfare Officer The mental health service continued to expand during the year the total referrals from all sources being 1,447, representing an increase of twenty-one per cent over the referrals for 1966. Referrals from hospitals, both general and psychiatric, increased by forty-seven per cent, whilst the number referred by general practitioners remained substantially the same as in 1966. The increase in the number of referrals from hospital sources may be accounted for by the continued availability of the services of mental welfare officers at psychiatric out-patient clinics and the resultant increase in referrals for community care of patients discharged from hospitals,, Since the passing of the Mental Health Act, 1959, much publicity has been given by way of the press and television to the problems of mental health and facilities available for treatment. The consequent awareness of these matters by the public and their increasing willingness to avail themselves of the facilities available is, no doubt, reflected in the increasing use that is made of the service. STAFF The staff, in addition to the Principal Mental Welfare Officer and his Deputy, consists of seven Senior Mental Welfare Officers/Social Workers, three Mental Welfare Officers/Social Workers and two Trainee Social Workers. During the year under review one Senior Mental Welfare Officer successfully completed a one-year course for the Certificate in Social Work at the National Institute for Social Work, and a Mental Welfare Officer was seconded by the Council in September, 1967. for a two-year course for the Certificate at the Sheffield College of Technology. A student from Bedford College of the University of London spent one month in the department for the purpose of obtaining practical experience in connection with her course for the Diploma in Social Studies. EMERGENCY CALL ARRANGEMENTS A twenty-four hour service for emergency cases is maintained by the department in conjunction with the Borough of Hammersmith's Mental Health Service and this, together with the emergency call arrangements jointly operated by this Council and the City of Westminster, continued to meet the calls made on the department at night, weekends and public holidays. PSYCHIATRIC DAY CENTRE The Ladbroke Day Centre is now functioning satisfactorily, with a capacity attendance of twenty-three persons. During the year five persons improved sufficiently to return to work and are now maintaining themselves in the community. A further three went to work and on relapse returned to the Day Centre, thus obviating their admission to hospital. The Supervisor maintained a steady flow of light industrial work for commercial firms and was thus able to keep the members of the centre fully occupied. - 56 - ADMISSIONS TO HOSPITAL Of the 1,381 persons referred during the year 470 were admitted to hospital by Mental Welfare Officers under statutory provisions. Of these 155 were admitted informally under arrangements made by Mental Welfare Officers, in addition to those whose informal admission was arranged by their general practitioner and in respect of whom no record is held by the department. COMMUNITY CARE As will be seen from the accompanying statistics, the Mental Welfare Officers visited 547 persons during the year, consisting of 367 mentally ill and 180 mentally subnormal. The average case load per officer was 54.66 persons in addition to their emergency work. This figure excludes the trainee who has a training case load of 17. SOCIAL CLUB The psychiatric social club continued to function under the auspices of the Notting Hill Social Council. This Council makes an annual grant of £60 towards the cost of the club, and the Mental Welfare Officers attend voluntarily to assist in the running of the club. THE MENTALLY SUBNORMAL During the year 102 new cases were referred for appropriate action, e.g. community care, residential care or admission to Training Centre. The Special Clinic for children under five years continued to be held alternately at the Campden Hill and St. Quintin Welfare Centres, and sixteen children were examined during the year. Eighteen mentally subnormal children were placed in permanent residential care and 20 children and adults were provided with shortterm care in hospitals or private establishments either because of family crises (illness or mother, etc.) or to give temporary relief to parents from the strain of caring for a subnormal child. TRAINING CENTRES At the Junior Training Centre, one of the Council's Medical Officers was able to give more time to the re-examination of the children than has hitherto been the case. In addition, groups of suitable children were formed to enable formal educational methods to be used. As a result five children were found to be suitable for transfer to schools for the educationally subnormal. One child has already been transferred to an E.S.N, school for the deaf, and four are now awaiting vacancies. An Assistant Supervisor obtained, during the year, the Diploma in the Montessori Method of Education. Two members of the staff are now so qualified. The Council are still awaiting sanction from the Ministry of Health for the Special Care Unit to be attached to the Junior Training Centre and it is still hoped that this will be completed during 1968. There are now three children accommodated at the Council's expense at the Special Care Unit provided at St. John's Wood by the Westminster Society for Mentally Handicapped Children. In May 1967, the annual organised holiday at Dymchurch, New Romney, was held for the trainees of the Inner London Boroughs. The camp was, as usual, under the supervision of Mr. R.F. Potter of the North Kensington Centre. During the holiday a visit was paid to the camp by the Chairman of the Health Committee, Alderman Lady Petrie. - 57 - The men of the adult centre had their usual summer outings to Parliament Hill Fields and to Richmond Park. Their last outing took the form of a Sports Day at Richmond. There was the usual number of visitors both from this country and abroad, and at the junior centre facilities were provided for two students to obtain practical experience in the work of the centre in connection with their diploma courses. SPECIAL UNIT FOR SUBNORMAL CHILDREN In my report for 1966 I mentioned the Special Unit for retarded children between the ages of three and five years and said that there was reason to believe that this unit would be of value in preparing for training centre admission many mentally retarded children whose future placement might otherwise have been in doubt. During the year. two children have been transferred to the junior training centre, one to a normal school and one to a school for the physically handicapped. There are ten children in the unit at the present time. - 58 - MENTAL HEALTH STATISTICS 1967 Quarter ended Total Total 1966 1.4.67 1.7.67 30.9.67 30.12.67 1. Numbers referred by (i) Hospitals (inpatients ) 137 105 75 78 395 441 (ii) Hospitals (outpatients) 67 65 53 68 253 (iii) General practitioners 50 65 69 61 245 239 (iv) Police or Courts 5 5 5 7 22 45 (v) Other non-medical 115 145 137 135 532 470 TOTALS 374 385 339 349 1,447 1,195 2. Mental category of above (i) Mentally ill 350 350 320 325 1,345 1,129 (ii) Sub-normal or severely sub-normal 24 35 19 24 102 66 3. Initially admitted to hospital (i) Informally 40 52 28 35 155 122 (ii) Corapulsorily Section 25 (Observation) 30 45 44 37 156 110 Section 26 (Treatment) 11 9 6 3 29 29 Section 29 (Emergency) 25 26 36 38 125 139 Other 3 Nil Nil 2 5 16 TOTALS 109 132 114 115 470 416 4. Final Disposal (including patients initially admitted to hospital) (i) No further action 124 132 148 144 548 476 (ii) Hospital care 106 130 114 115 465 425 (iii) Community care 99 101 92 76 368 294 TOTALS 329 363 354 335 1,381 1,195 Under care 31.12.66 Referred during 1967 Withdrawn from care 1967 Under care 31.12.67 5. Community care 407 368 228 547 MENTAL HEALTH STATSTICS Mentally ILL Subnormal Severely Subnormal -16 16+ Elderly -16 16+ Elderly -16 16+ Elderly TOTALS M F M F M F M F M F M F M F M F M F Totals referred prior to 1.1.67 (i.e. individuals under L.H.A. care at 31/12/66). 1 73 108 8 46 12 21 40 42 1 1 10 22 60 12 457 Totals of referrals during year 5 5 484 623 22 206 20 16 27 19 5 5 5 2 3 1.447 First Referrals - Total during year 4 4 377 468 16 148 19 15 26 13 4 5 5 2 3 1.109 Total known in previous year(s) 101 125 6 48 1 4 8 1 2 1 1 298 No. of individuals referred once during year 3 3 302 368 10 104 18 14 25 9 3 5 5 2 3 874 Subseauent Referrals - Total during year 1 1 107 155 6 58 1 1 1 6 1 338 Total known in previous year(s) 49 72 3 27 4 155 Second Referrals - Total number of referrals 1 1 75 100 6 44 1 1 1 4 1 235 Total of patients known in previous year(s) 35 44 3 19 3 104 No. of individuals referred twice during year 1 1 50 70 6 35 1 1 1 3 1 170 Third Referrals - Total number of referrals 25 30 9 1 65 Total of patients known in previous year(s) 13 18 4 1 36 No. of individuals referred three times during year 20 11 6 37 Referrals four times Total number of referrals 5 19 3 1 28 Total of patients known in previous year(s) 1 10 3 14 No. of individuals referred four times or more during year 5 19 3 1 28 Referrals over four times 2 6 2 10 Referrals of patients known in previous year(s) 3 1 4 Section 6 ENVIRONMENTAL HEALTH SERVICES 59 SANITARY ADMINISTRATION OF THE BOROUGH Mr. H, Hoyland, Chief Public Health Inspector For the purpose of routine inspection of premises and the investigation of complaints, the borough is divided into three areas. The overall supervision of each area is the responsibility of a senior district inspector. The three areas are sub-divided to form twelve districts, each being the responsibility of one district inspector or one senior district inspector. Owing to staff shortages, this has not been possible, and it has been necessary for some inspectors to control two or more districts resulting in unavoidable curtailment of routine inspections. Six advertisements for public health inspectors were issued during the year but the response was disappointing, so that throughout the year, with an establishment of 29 inspectors, there continued to be eight vacancies. The establishment of assistants to the public health inspectors has been increased from two to six and student public health inspectors from eight to nine. In addition to district duties, there are inspectors and assistants engaged on the following specialised work:- (1) One senior housing inspector with a team of five inspectors engaged exclusively on duties in connection with houses in multiple occupation in specified areas which are being dealt with street by street. (2) One senior housing inspector dealing with slum clearance and underground rooms. (3) One senior inspector dealing with improvement grants, mortgage applications and overcrowding. (4) One senior inspector with one unqualified assistant engaged on duties under the Clean Air Act, 1956, in connection with Smoke Control Orders and atmospheric pollution recordings. (5) One senior inspector engaged on duties in connection with the Offices, Shops and Railway Premises Act, 1963. together with special duties for pilot schemes, research projects and exhibitions. This officer is supported in his work by two unqualified assistants, (6) One senior inspector dealing exclusively with the sampling of food and drugs, fertilisers, feeding stuffs and rag flock and other filling materials used in the upholstery trade, together with the investigation of all complaints in connection with these products. The inspectors are supported in their work by six unqualified assistants, including the three referred to above, two drainage assistants, together with a rodent officer with six assistant rodent officers, and the chief disinfector with six assistants. During the year, 2,361 complaints were received and 37,76l inspections and re-inspections were carried out. In only 141 cases was it necessary to resort to legal proceedings, nineteen of these proceedings being concerned with offences under the Food and Drugs Act, 1955. 60 WORK OF THE PUBLIC HEALTH INSPECTORS AND THEIR ASSISTANTS The following is a summary of the work carried out during the year by, or under the supervision of, the public health inspectors and their assistants- Inspections made Public Health Acts, 1936 and 1961 Complaints (number of premises) 2,361 Infectious disease 577 Smoke observations 84 Other inspections 2,253 Re—inspections 5,l54 Housing Acts, 1957 to 1964 Houses in multiple occupation (house-to-house) 214 Slum clearance (house-to-house) 242 Underground living rooms 559 Overcrowding 287 Other inspections (loans, grants,, etc,) 153 Re-inspections 8,425 Clean Air Act, 1956 Total number of visits 2,812 Factories Act, 1961 Premises inspected 92 Outworkers' premises inspected 22 Offices. Shops and Railway Premises Act. 1963 Total number of visits 4,104 Drainage Applications received (plans submitted) 444 House drains inspected 9,218 House drains tested 795 Notices Served Public Health Acts, and l96l Intimation notices 665 Statutory notices 216 Final notices 86 Housing Acts. 1957 and 1961 Section 9 Crepair) 189 Section 14 (deficiencies of management) 31 Section 15 (additional amenities) 176 Section 16 (means of escape from fire) 168 Various Offices, Shops and Railway Premises Actt 1963 52 Other notices 106 - 61 - Work Completed House drains, reconstructed or repaired 114 House drains cleansed 102 Water closets, reconstructed or repaired 108 Water closets, new provided 247 Soil pipes, vent pipes, repaired, etc. 49 Soil pipes, vent pipes, new provided 86 Baths, new provided 280 Sinks, new provided 285 Lavatory basins, new provided 119 Bidets, new provided 13 Waste pipes, new provided 223 Cisterns cleansed 24 Dustbins provided 91 Ac cumulations of filth, etc. removed 226 Roofs, gutters and rainwater pipes repaired 281 Dampness in dwellings remedied 273 Artificial lighting to staircases provided 79 Houses disinfected after infectious disease (including bedding,etc.) 96 Rooms in such houses disinfected after infectious disease 180 Verminous houses cleansed (including bedding, clothing- etc.) 364 Verminous rooms in such houses cleansed 818 Housing Individual Unfit Houses or Parts of Houses Houses made fit after informal action under the Housing or Public Health Acts 458 Houses repaired after service of formal notices under the Public Health Acts 220 Houses made fit after service of formal notices under Section 9 of the Housing Act, 1957 (a) by owners 101 (b) by local authority in default 3 Action under Sections 16, 17 and 23 of the Housing Act, 1957 (a) demolition orders made Nil (b) houses demolished in pursuance of demolition orders Nil (c) closing orders made in lieu of demolition orders 2 (6 dwellings) (d) undertakings accepted from owners to render houses fit for habitation Nil (e) houses rendered fit for habitation by owners and closing orders determined Nil 62 Action under Section 18 of the Housing Act, 1957 (a) closing orders made 14 (28 rooms) (b) closing orders determined 28 (54 rooms) (c) consent given to use of closed rooms for non-sleeping purposes 8 (9 rooms) (d) undertakings accepted from owners to render part of building fit for habitation Nil (e) part of building rendered fit and undertaking cancelled Nil Overcrowding Number of new cases of overcrowding reported during the year 106 (447½ units) Number of cases of overcrowding relieved during the year 121 (515½ units) Number of cases in which dwelling houses have again become overcrowded after the local authority have taken steps for the abatement of overcrowding Nil (NOTE: Units mean the number of equivalent persons in the families, obtained by regarding children betweeen 1 and 10 years of age as "half-persons" and disregarding infants under the age of twelve months). MEDICINAL BATHS - PERSONAL CLEANSING STATION The following table shows the work carried out during 1967:- Description Scabies Vermin Persons Cleansings Persons Cleansings Adults Kensington and Chelsea 120 192 131 133 Other boroughs - - - - Schoolchildren Kensington and Chelsea 60 109 106 107 Other boroughs 12 27 86 89 Children under five Kensington and Chelsea 31 45 10 10 Other boroughs - - - - TOTALS 223 373 333 339 In addition to the cleansing of persons referred to above, articles of personal clothing disinfested at the medicinal baths during the year numbered 396. 63 DISINFECTION AND DISINFESTATION A summary of the routine work carried out in 1967 by the disinfecting staff is shown in the following table:- Houses disinfected after infectious disease 96 (180 rooms) Houses disinfested after vermin 364 (818 rooms) Tons cwts. qtrs. lbs. Total weight of bedding, etc. dealt with 4 12 3 5 It is the practice of certain foreign countries to prohibit the import of parcels of clothing, unless accompanied with a certificate that the articles have been disinfected. The Council afford facilities to persons desirous of sending clothing abroad and, for this service, a standard charge is made of 10s.0d. per parcel. During the year, fifty-two parcels of clothing were disinfected and the income amounted to £26. 0. 0d. The following table indicates the destination of these parcels Destination No. of parcels Albania 1 Argentina 2 East Germany- 21 West Germany 1 Greece 1 Rumania 2 Spain 24 Total 52 PREVENTION OF DAMAGE BY PESTS The Prevention of Damage by Pests Act, 1949. imposes a duty on occupiers of premises to notify the Council of rodent infestation, and the Council are required to ensure that the borough is, as far as practicable, kept free from rats and mice. The Council deal with rat and mice infestation in dwelling houses without cost to the occupiers, but expenditure incurred in treating infestations on commercial and industrial premises is recovered from the owners. The Council are required to submit reports on (i) the extent of infestation; (ii) special circumstances to which any undue presence of rats and mice might be attributed; and (iii) the nature and extent of co-operative working with contiguous local authorities. The Minister of Agriculture, Fisheries and Food requested a report for the twelve months ended 31st December, 1967, as follows:- 64 Treatment of premises (rats and mice) Number of properties in the borough 74,309 Total number of properties inspected following notification 1,041 Number infested by rats 86 Number infested by mice 784 Number of treatments carried out 863 Total number of properties inspected for rats and/or mice for reasons other than notification 4 Number infested by rats Nil Number infested by mice Nil Destruction of Rats in the Council's Sewers The poison baiting (using Fluorakil 3) the 2,300 access points to the 125 miles of sewers is carried out as a continuous programme; the borough being divided into areas with the majority of points baited four times daring the year. Details of the work during 196? are given in the following table;- Period of Treatment Number of Test baits Poison baits 1. 2nd January to 6th April - 2,134 2. 4th April te 13th June - 2,111 3. 27th June to 29th September 1,072 (sausage rusk) - Complete takes 52 partial takes 7 No takes 1,013 4. 7th June to 29th September - 1,079 5. 2nd October to 29th November - 2,118 6. Every 9 weeks throughout year - 359 at selected manholes Generally The rodent staff, in addition, deal with infestations from pests other than rats and mice, and the following is a summary of action taken during the year in respect of all forms of infestation:- Premises inspected following complaints 1,222 Premises where rats were found 86 Premises where mice were found 784 Premises where other vermin were found 179 Number of visits made 5,562 Number of successful treatments 908 Cases in which advice only was given 138 Borough Council properties dealt with (excluding dwelling houses) 19 65 FERTILISERS AND FEEDING STUFFS ACT. 1926 On 1st April, 1965. duties under the above Act were transferred to the London Boroughs from the London County Council under the provisions of the London Government Act, 1963. During the year, twenty-two samples of fertilisers and two samples of feeding stuffs were obtained and submitted for analysis in accordance with the provisions of the Act, and in each case the result was satisfactory, DISEASES OF ANIMALS ACT. 1950. AND OTHER ASSOCIATED ACTS Generally As from 1st April, 1965. the Council assumed responsibility for administering the above Acts and, in July, 1965, authorised and appointed the Veterinary Officer and Inspectors of the City of London to act on their behalf for the purposes of the Diseases of Animals Act, 1950, and the following associated Acts:- Cruelty to Animals Act, 1876 Protection of Animals Acts, 1911 and 1934 Performing Animals (Regulation) Act, 1925 Cinematograph Films (Animals) Act, 1937 Docking and Nicking of Horses Act, 1949 Protection of Animals (Anaesthetics) Act, 1954 Riding Establishments Act, 1964 By agreement with the Council the City Corporation have undertaken to provide administrative, clerical, professional, scientific and technical services in connection with certain functions under these Acts, and have further agreed that they should report offences occurring in the borough and thereafter their officers should take such action as may be necessary, subject to prior consultation with the appropriate officers of the Council. Riding Establishments Act, 1964 This Act provides for the licensing and inspection of any establishment at which a business of keeping horses for hire, for riding or for providing riding instruction is carried on. Two riding establishments in the borough are licensed, and in each case, satisfactory reports were received from the Veterinary Officer during the year. PHARMACY AND POISONS ACT, 1933 At the end of the year the number of sellers of Part II poisons (other than registered pharmacists) on the list maintained by the Council was 112. There were no new registrations during the year. RAG FLOCK AND OTHER FILLING MATERIALS ACT. 1951 This Act regulates the use of clean filling materials in upholstered articles and other articles which are stuffed or lined. Subject to certain exceptions, the Act makes it unlawful to use prescribed filling materials except on premises registered by a local authority. The local authority are required, on the application of the occupier of premises, to register the premises on payment of a registration fee of One Pound. At the end of the year, there were twenty-one registered premises in the borough. - 66 - If on registered premises there are unclean filling materials, the occupier shall be guilty of an offence. It is also an offence to sell or offer for sale any article which is upholstered with unclean filling materials (second-hand articles are excepted). Inspections of the registered premises were made during the year and the eight under-mentioned samples of rag flock and other fillings were taken for analysis. The results were all satisfactory. Description No. of samples Grey Felt Mixture 1 Coir Fibre 1 Unused Cotton Felt 1 Feathers and Down 1 Hair and Fibre Mixture 4 1 Algerian Fibre 2 Grey Hair 1 PET ANIMALS ACT- 1951 This Act requires that no person shall keep a pet shop except under the authority of a licence issued by the Council and in compliance with any conditions specified in the licence. During the year, nine premises were licensed under the Act. No contraventions of the Act were found during regular inspections of the premises, and at all times the stock was well cared for and maintained in accordance with the conditions specified in the licence. CONSUMER PROTECTION ACT, 1961 This Act empowers the Secretary of State to make regulations imposing, in respect of any prescribed class of goods, requirements which are expedient to prevent or reduce risk of death or personal injury. The Heating Appliances (Fireguards) Regulations, 1953 Under the provisions of these Regulations it is an offence to sell any gas or electric fire, or oil heater, suitable for use in residential premises, unless it is fitted with an adequate guard. A careful watch is maintained on the sale of second-hand fires from stalls in public markets, and throughout the year no offences under these Regulations were observed. The Oil Heaters Regulations, 1962 and 1966 These Regulations prescribe certain standards of construction, design and performance with which both new and second-hand unflued domestic oil heaters must comply, and make it an offence for any person to sell, or let on hire, or hire purchase, or have in his possession for sale, any such heater or component part thereof not complying with the Regulations. Power is given in the Regulations to enable local authorities to test oil heaters to see that they comply with the requirements which are laid down. The Secretary of State has authorised two bodies, namely the British Standards Institution and Messrs. Ellis Research and Testing Laboratories Limited, to carry out the necessary tests. 67 The public health inspectors continue to keep strict observations during their daily routine duties regarding the sale of oil heaters, particularly second-hand models offered for sale by market traders and second-hand dealers. During the year no defective heaters were seen to be exposed for sale. In the event of a heater being found which appears to be defective, it will be purchased and sent for examination, and if an adverse report is received, it will be recommended that proceedings be taken against the offender. Any person who sells a heater not complying with the Regulations is guilty of an offence and is liable on summary conviction to a fine not exceeding £100 or, in the case of a second or subsequent offence, to a fine not exceeding £250, or to imprisonment for a term not exceeding three months, or to both. The Nightdresses (Safety) Regulations, 1967 These Regulations, which came into operation on 1st September, 1967, revoke the Children's Nightdresses Regulations, 1964. The Regulations impose requirements in relation to nightdresses and, among other things, require any fabric used in children's nightdresses to be a kind capable of satisfying the requirements of the British Standard for fabrics "described as of low flammability". The Regulations also require adults' nightdresses to bear a warning label unless they comply with the requirements imposed in relation to children's nightdresses, and, furthermore, labelling is required in the case of nightdresses made of fabrics which have been treated with chemicals to make them safer from fire. No person may sell or have in his possession for sale a nightdress not complying with the Regulations, and Regulation 5 provides that goods shall be subject to the Regulations notwithstanding that they were manufactured before the coming into operation of the Regulations. Under Regulation 4 certain garments were exempted until 1st December, 1967. No offences under these Regulations were observed during the year. The Stands for Carry-cots (Safety) Regulations, 1966 The Stands for Carry-cots (Safety) Regulations, 1966, which came into operation on 1st February, 1967, impose requirements in relation to stands for carry-cots. Regulation 1 requires a label stating the maximum dimensions of cot for which the stand is designed, and Regulation 2 relates to the size of the base. Regulation 3 requires a guard-rail or stop to keep the cot in position and prescribes a maximum height above the floor. The Regulations also relate to the cot being of a specified strength and to a prohibition on the sale of goods not complying with the Regulations. No contraventions of the Regulations were observed during the year. The Toys (Safety) Regulations, 1967 These Regulations came into operation on the 1st November, 1967, and prohibit, from that date, the use of celluloid in toys other than balls used for ping pong or table tennis. They will also regulate, after the 31st October, 1968, the proportion of lead, arsenic, soluble antimony, barium, cadium, chromium, or their compounds, which may be present in any substance used to paint toys. It was not found necessary to take any action under the Regulations during the two months of the year that they were operative. - 68 - ATMOSPHERIC POLLUTION Smoke Control Areas During the year, the Council decided to make a Smoke Control Order in respect of the Brompton/Queen's Gate area, (No.ll). The area is that part of the Brompton and Queen's Gate wards bounded on the north by the borough boundary, on the east by the centre of Hoopers Court, on the south by the centres of Fulham Road, Draycott Avenue, Walton Streets Walton Place and Basil Street, and on the west by the centres of Palace Gate, Gloucester Road, Cromwell Road, Queen's Gate, Onslow Gardens and Neville Terrace. It has an area of approximately 224 acres. The detailed survey showed that the total cost of adaptations will be approximately £14,766 of which, after deducting Exchequer Grant and the cost for which private owners will be responsible, the Council will be liable for £5,031. The Order was submitted to the Minister of Housing and Local Government for approval on 23rd August, 1967, and the date of operation will be 1st October, 1968. The Minister has asked local authorities to exempt, from Smoke Control Orders, buildings or separately-occupied parts of buildings, not supplied with town gas, subject to the condition that the exemption will apply only where authorised, fuels are used and kindling is by sticks and paper. Provision for this was also made in the Order. The following table gives details of Smoke Control Areas which were in operation at the end of 1967. See also map between pages 68/69. Smoke Control Area Map Ref. Boundaries Order operative Holland Ward (No. 1) 1 N. E. S. w. Holland Park Avenue Campden Hill Road Kensington High Street Abbotsbury Road 1.l0.l959 Holland Ward (No. 3) 3 N. E. S. W. Notting Hill Gate Borough boundary Kensington High Street Campden Hill Road 1.10.196O Church Ward Cl Church Ward boundaries 1.12.196O Holland Ward (No. 2) 2 N. E. S. W. Holland Park Avenue Abbotsbury Road Kensington High Street Borough boundary 1.10.1961 Pembridge Ward (No. 1) 4 N. E. S. W. Westbourne Grove Borough boundary Notting Hill Gate Ladbroke Grove 1.10.1961 Pembridge Ward (No. 2) 5 N. E. S. w. Lancaster Road Borough boundary Westbourne Grove Ladbroke Grove 1.10.1962 69 Smoke Control Area Map Ref. Boundaries Order operative Hans Town Ward C2 Hans Town Ward boundaries 1.11.1962 Norland Ward (No. 1) 6 N. Lancaster Road E. Ladbroke Grove S. Holland Park Avenue W. Walmer Road and Princedale Road 1.10.1963 Norland Ward (No. 2) 7 N. Lancaster Road E. Walmer Road and Princedale Road S. Holland Park Avenue W. Borough boundary 1.10.1964 Cheyne and Royal Hospital Wards C3 Cheyne Ward and Royal Hospital Ward boundaries 1. 7.1965 Earls Court and Queen's Gate Wards 8 N. Kensington High Street E. Palace Gate and Gloucester Road S. West Cromwell Road W. Borough boundary 1.10.1965 Earls Court, Redcliffe and Brompton Wards 9 N. Cromwell Road and West Cromwell Road E. Queen's Gate S. Old Brompton Road W. Borough boundary 1.10.1966 Redcliffe and Brompton Wards 10 N. Old Brompton Road E. Onslow Gardens and Neville Terrace S. Fulham Road W. Borough boundary 1.10.1967 Variation Order - Redcliffe and Brompton Smoke Control Area No. 10 During the year, it was decided to return to the owners forty-four properties in Evelyn Gardens which were held on lease by the Council. The owners agreed to accept the return of the properties prior to the expiry of the lease,, but at the same time they indicated that they would either carry out extensive alterations to the properties or demolish them. In the circumstances, and to avoid unnecessary expenditure on fireplace adaptations;, the Council agreed to make a Variation Order exempting all the properties from the provisions of the Smoke Control Order. This Variation Order comes into operation on the 1st July,, 1968. New Furnaces Section 3 requires that new furnaces,, not used mainly for domestic purposes and exceeding a specified capacity,, shall be so far as is practicable, smokeless. Any person installing such a furnace must give prior notice to the Council and may submit detailed plans and specifications for approval before the work of installation takes place. During the year, forty-three notifications were received. These applications were approved. - 70 - Smoke Nuisances During the year,, sixty-four complaints of smoke nuisance were received and thirty formal smoke observations were carried out. Remedial measures in all cases were secured without resorting to legal proceedings. Routine Measurement of Atmospheric Pollution There are four premises in the borough where apparatus has been installed for measuring atmospheric pollution. The readings obtained by the Council are forwarded to the Warren Spring Laboratory where they are converted by computer into the figures shown in the following table. The table covers the twelve-month period up to and including the latest figures obtained from the laboratory when this report was prepareds- Sites Smoke (Microgrammes per Cubic Metre) Sulphur Dioxide (Microgrammes per Cubic Metre) Monthly Average Highest Daily Reading Monthly Average Highest Daily Reading A B C D ABC D A B A B 1966 July 29 23 50 23 51 35 77 38 68 61 113 132 August 32 46 73 37 85 215 200 97 125 126 335 391 September 60 62 * 46 102 125 159 74 212 204 589 553 October 64 69 135 53 204 240 23O 103 265 249 570 431 November 95 102 I78 70 346 612 376 I78 278 312 775 867 December 73 74 157 70 297 341 334 116 285 280 670 783 1967 January 90 87 I69 95 199 203 3OI 161 339 337 625 612 February 58 69 131 76 172 240 291 169 280 316 557 674 March 39 27 63 52 74 52 99 114 211 194 336 281 April 43 36 106 35 72 78 166 55 239 225 588 494 May 62 * 97 * 128 152 194 93 190 * 573 504 June 44 ≠ 68 39 75 ≠ 118 56 124 ≠ 189 ≠ * Figures not available ≠ No results received Site address - A - Chenil Galleries, Kings Road„ S.W.3. B - The Red House0 Hornton Streets W.8.0 C - Public Library0 Lancaster Road„ W.10. D - Child Welfare Centre, Redcliffe Street, S.W.0. (Sites C & D have smoke measuring apparatus only) 71- Reduction in Pollution The 1966 Annual Report of the Scientific Adviser to the Greater London Council discussed air pollution and indicated that not only smoke, but now also sulphur dioxide, is diminishing. The Report showed that results for 1966 from seven representative sites in Inner London indicated a yearly average smoke concentration of 65 micrograms per cubic metre, representing a reduction of 14 per cent compared with the previous year. Measurements of sulphur dioxide by the daily volumetric method at these seven sites indicated a yearly average concentration in 1966 of 17 micrograms per cubic metre, showing a reduction of 11 per cent over the previous year. Following upon a reduction of 14 per cent a year earlier, this result suggests that a downward trend in the pollution of the air of London by the consumption of sulphur-containing fuels is at last in evidence. NOISE ABATEMENT ACT, 1960 One hundred and fifty-six complaints concerning alleged noise nuisances were received, an increase of sixty-five over the preceding year. 53% of the complaints related to noise caused by industrial works, road works (use of pneumatic drills and compressors), building operations and miscellaneous plant and machinery in commercial premises. Noise caused by neighbouring residents in private dwellings accounted for 27% of the total complaints received and the remaining 20% concerned clubs, dance halls, musical chimes from ice-cream vans, schools, barking dogs, etc. All complaints were thoroughly investigated and, in most cases, the fullest co-operation was given to implement suitable methods either to reduce the noise in intensity or to eliminate it completely. No cases were considered suitable for legal action by the Council and in cases where complainants were not satisfied with the power of action available to the Council's officers, their rights under private action were explained to them. With regard to industrial noise, it is a good defence in any proceedings to prove that the best practicable means have been used for preventing it or counteracting its effect. Apart from the Council having authority to take action, any three or more persons who are aggrieved by a noise nuisance may make complaint direct to a Magistrate. Section 2 of the Noise Abatement Act, 1960, deals with the use of loudspeakers on the highway. It prohibits their use (except for specified services) for any purpose between 9.00 p.m. and 8.00 a.m. and at any other time for advertising any trade, business or entertainment, provided that between noon and 7.00 p.m. a loudspeaker fixed to a vehicle used for the sale of perishable foodstuffs may be operated to announce that the commodities are on sale; the loudspeaker is, however, not to be so operated as to give reasonable cause for annoyance to persons in the vicinity. In view of the marked increase during the summer months of the use of musical chimes by ice cream traders after 7.00 p.m., the Health Committee directed that concerted action be taken against this nuisance, and during July and August the public health inspectors carried out nightly observations throughout the borough. Resulting from this action, 44 offenders were fined a total sum of £113 and £32 costs were awarded to the Council. SLUM CLEARANCE Action already taken The following table gives details of the clearance areas declared in the borough since 1950:- 72 Name of Area Date of Declaration No. of houses No. of persons displaced Elgin Mews 25.4.1950 28 86 Lionel Mews (Nos.1 and 2) 3.10.1950 13 38 Lonsdale Mews (Nos.1 and 2) 2.1.1951 19 14 Munro Mews 2.1.1951 24 55 South End Row and Gardens 3.4.1951 10 4 East Mews Road 3.4.1951 14 40 Powis Mews 13.11.1951 13 30 St. Luke's Mews 13.11.1951 20 41 Portobello Road 13.11.1951 4 3 Kensal New Town (No.1) 1l.l2.1956 34 309 Kensal New Town (No.2) 14.1.1958 62 441 Kensal New Town (No. 3) 14.1.1958 15 146 Portland Road (No.1) 11.3.1958 5 31 Portland Road (No.2) 11.3.1958 10 71 Kensal New Town (No.4) 8.3.1960 7 41 Kensal New Town (No.5) 8.3.1960 20 187 Kensal New Town (No.6) 8.3.1960 6 62 Railway Mews 10.5.1960 10 7 Portobello Road/Telford Road 17.l0.196l 18 127 Kensal New Town (No. 7) 12. 3.1963 49 350 Princedale Road 25.6.1963 7 30 Kensal New Town (No. 8) 23. 7.1963 24 182 Kensal New Town (No. 9) 15.10.1963 54 417 Lancaster Road (West) (No. 1) 28.10.1965 187 1,233 Lancaster Road (West) (No. 2) 1.11.1966 96 535 Lancaster Road (West) (No. 3) 31.10.1967 113 891 Kensal New Town Area This area, consisting of over 20 acres, is scheduled for clearance and lies in the north eastern part of the borough. Clearance and redevelopment of the first portion of the area, consisting of 8.1 acres, was completed during the year, and work was also commenced on Phase 3, a further portion of 3.1 acres, which will provide 189 flats and 157 hard standings for cars. This latter portion is scheduled for completion in 1969. The remaining residential portion, consisting of 7.2 acres and bounded by Golborne Road, Kensal Road and the railway, is being redeveloped by the Greater London Council and considerable demolition work was carried out by them during the year. Adjoining this area to the north, the Greater London Council are considering a scheme to provide an open space of approximately 3½ acres in the City of Westminster. Lancaster Road (West) Area This area lies on the western boundary of the borough, south of the metropolitan railway line from Latimer Road Station. It consists of 27 acres and contains approximately 455 houses, 15 factories, 140 shops, 6 licensed premises and 11 other business premises. It is the Council's intention that this scheme, which is to be redeveloped in five stages, should be regarded primarily as a venture in slum clearance. It is appreciated, however, that there may be many houses in the area which will not be representable as unfit for human habitation. PART OF KENSAL NEW TOWN BEFORE REDEVELOPMENT PART OF KENSAL NEW TOWN AFTER REDEVELOPMENT 73 During the year, the compulsory purchase order in respect of the first stage was confirmed by the Minister of Housing and Local Government. A compulsory purchase order was made and a public inquiry was held in respect of the second stage, and the Minister's decision is now awaited. The Council declared the compulsory purchase order in respect of the third stage and a public inquiry will be held during 1968. Linked with the Lancaster Road (West) redevelopment area is the Blechynden Street area, comprising 12 acres, situated north-west of the metropolitan railway line. This area is being redeveloped by the Greater London Council and, during the year, progress was made by that council on the provision of 342 flats. IMPROVEMENT OR CONVERSION OF EXISTING HOUSES Houses in Multiple Occupation The legislative powers for dealing with bad living conditions in houses let in lodgings or occupied by members of more than one family were described in my annual report for 1965. The implementation of these powers commenced in 1963 within the area bounded by Acklam Road, Portobello Road, Wornington Road and St. Ervans Road. The original area contained 1,463 houses, but inspections have now extended south of the Metropolitan Railway and into the Pembridge ward, so that the total number of houses involved is now 1,900. The procedure and some of the difficulties and problems encountered were mentioned in last year's annual report. Briefly, the Council's policy is to secure the repair and the provision of basic amenities-hot and cold water, gas and electricity supplies; washing, bathing and sanitary accommodation; facilities for the storage, preparation and cooking of food; the cleanliness and repair of parts used in common; fire precautions and avoidence of overcrowding and over-occupation. The Council's minimum requirements in these matters were given in detail in my annual report for the Royal Borough of Kensington for 1962. The following table summarises the action taken in 1967 and the total results since the operation commenced in 1963:- 1963/66 1967 TOTAL Houses inspected 1,032 258 1.290 Re-inspe ctions 17,685 6,071 23.756 No action required 107 61 168 Management Orders made 103 39 142 Notices served - Section 9 - Housing Act 1957 707 189 896 Section 14 - Housing Act 1961 71 31 102 Section 15 - Housing Act I961 727 176 903 Section 16 - Housing Act I961 238 168 406 Negotiations in progress 24 28 52 Work completed 492 122 614 Work in default authorised 207 43 250 To deal with this work on houses in multiple occupation, the Council have established a section consisting of a senior and five other public health inspectors. During the year under review, the section was maintained at full strength to deal with this very important aspect of the Council's housing work. This was done despite the serious shortage of public health inspectors which still exists in the Greater London area and in the Council's service. 74 Although this work is not without difficulties, many of the problems encountered in the earlier days of the project and which have been mentioned in earlier reports are now disappearing. The Council's policy of executing work in default is now more widely known among owners and has had a good effect in securing the execution of works by them. Improvement Grants The circumstances in which the Council may make discretionary or standard grants to owners for the improvement or conversion of private dwellings were given in detail in my Annual Report for 1965. Discretionary Grants Applications for discretionary grants received and dealt with increased from eighty-eight in 1966 to one hundred and fourteen in 1967 and are summarised as follows:- Applications received 114 Applications granted 113 Applications refused 1 Total amount of grants approved £48,49l Standard Grants During 1967, six applications for standard grants were received in respect of individual premises, compared with eleven in the previous year. All six applications were approved. HOUSE PURCHASE LOANS During the year, the basemants of twenty-four properties were inspected as a result of applications to the Council for house purchase loans. BYELAWS AS TO THE ARTIFICIAL LIGHTING OF COMMON STAIRCASES IN TENEMENT HOUSES AND FLATS The Council's Byelaws relating to artificial lighting of common staircases in tenement houses and flats were made on the 3rd May, 1967. under the provisions of Section 63 of the London County Council (General Powers) Act, 1956, as amended by Article 3 and the 1st Schedule to the Local Law (Greater London Council and Inner London Boroughs) Order, 1965, and came into operation on 1st August, 1967. These Byelaws revoked similar Byelaws made by the former Royal Borough of Kensington in 1958 (the former Metropolitan Borough of Chelsea did not take similar action) and they apply to the whole Borough of Kensington and Chelsea. The principal Byelaw reads as follows:- "The occupier of every tenement house to which these byelaws apply and the owner of every block of flats shall provide adequate artificial lighting for all common staircases:- (a) from half an hour before sunset until 12 o'clock midnight; (b) for one hour before sunrise during the months of October, November, December, January, February and March; (c) at other times as and when necessary if adequate means of natural lighting are not provided." 75 During 1967 formal notices were served in three cases requiring compliance with these Byelaws. CERTIFICATES OF DISREPAIR IN RELATION TO DWELLING HOUSES The Council's duty to issue certificates of disrepair in respect of "rent controlled" dwelling houses, not reasonably suitable for occupation is governed by the Rent Act, 1957. The following is a summary of the action taken during 1967:- Part I - Applications for Certificates of Disrepair Number of applications for certificates 2 Number of decisions not to issue certificates Nil Number of decisions to issue certificates - (a) in respect of some but not all defects 2 (b) in respect of all defects Nil Number of undertakings given by landlords 1 Number of undertakings refused by Council Nil Number of certificates issued 1 Part II - Applications for Cancellation of Certificates Nil OVERCROWDING All cases of overcrowding are dealt with on the strict interpretation of the standards laid down in the Housing Act, 1957, distinguishing between "penal" and "non-penal". The number of new cases of overcrowding reported to the Housing Committee during 1967 was 106 (37 penal and 69 non-penal), giving an equivalent number of persons of 447½.The total number of overcrowding cases recorded during the year as having been abated was 121, comprising a total of 5l5½units. Since October, 1945 2,681 cases have been reported, and the number of cases remaining on the register at the end of this year was 290 (35 penal and 255 non-penal). ASSESSMENT OF HOUSING PRIORITIES ON MEDICAL GROUNDS During the year, 244 applications for rehousing on medical grounds were examined, and recommendations for the award of additional points were made to the Chief Housing Officer. In each case, the precise medical condition and resultant disability were determined (frequently necessitating communication with the family doctor or with the hospital attended). The premises were inspected in detail to ascertain the extent and nature of the existing accommodation; the adequacy of day and sleeping space; sanitary and structural defects; and the existence of inconveniences, such as stairs, which might be prejudicial to the patient. On this information and that supplied by the Chief Housing Officer an assessment of points to be awarded on medical grounds was made in 236 cases. FACTORIES Section 153(1) of the Factories Act, 1961, requires the Medical Officer of Health to make an annual report in regard to the Council's functions under the Act. The following tables give the prescribed particulars in the form requested by the Ministry of Health in Circular No. 1/68:- 76 Part I of the Act 1. INSPECTIONS for the purposes of provisions as to health (including inspections made by Public Health Inspectors) Premises (1) No. on Register (2) Number of Inspections (3) Written Notices (4) Occupiers prosecuted (5) (i) Factories in which Sections 1, 2, 3, 4 and 6 are to be enforced by local authorities 129 17 - - (ii) Factories not included in (i) in which Section 7 is enforced by the local authority 726 40 - - (iii) Other premises in which Section 7 is enforced by the local authority (excluding outworkers' premises) 56 35 - - TOTAL 911 92 - - In no case was any defect found which necessitated formal action being taken. 77 Part VIII of the Act Outwork (Sections 133 and 134) Nature of Work Section 133 Section 134 No. of Outworkers in August lists required by Section 133(1)(c) No. of cases of default in sending lists to the Council No. of prosecutions for failure to supply lists No. of instances of work in unwholesome premises Notices served Prosecutions (1) (2) (3) (4) (5) (6) (7) Wearing apparel 120 - - - - - Curtains and furniture hangings 6 - - - - - Furniture and upholstery 3 - — — - • Brass manufacture 2 - - - - - Artificial flowers 1 - - - - - Paper bags 4 — - - - — Boxmaking 4 - - - - - Feather sorting 4 - - - - - Carding of buttons 1 — _ - - — Lampshades 2 - - - - - TOTALS 147 - - - - - During the year, 22 inspections of outworkers' premises were made, but in no case was action necessary to prevent work being carried out in unwholesome premises. No instance of infectious disease occurring in premises where home work is carried on was reported during the year. Basement Bakehouses The Factories Act, 1961, (Section 70) requires the Council to inspect in every fifth year all basement bakehouses in the borough for which certificates of suitability have been issued. The certificates continue to operate if the Council are satisfied that the bakehouses are still suitable. The last quinquennial review was made in 1963/4. At the present time there are nine basement bakehouses in use in the borough as follows:- 151 Earls Court Road 178 Fulham Road 134 King's Road 323 Fulham Road 517 King's Road 65 Golborne Road 139 Portland Road 79 Golborne 46 Walton Street Register of Factories The Factories Act, 196I. requires the Council to keep a list of all factories within the borough with respect to which the duty of enforcing the provisions of the Factories Act is imposed upon them. The following table gives a summary of the factories on the Council's register at the end of the year, indicating the types of business carried on, whether or not mechanical power is used, and where situated i.e. North Kensington, South Kensington or Chelsea:- 78 Factory-Business North Kensington South Kensington Chelsea Mech. N-M. Mech. N-M. Mech. N-M. Antique Restorers 1 - 1 — 1 1 Bakers and Confectioners 9 1 10 2 12 - Belt and Button Manufacturers - - - 1 - - Boat and Marine Repairs and Construction - - - _ 2 - Bottling Stores - - - - 2 - Builders and Decorators 2 - 5 10 3 - Building Construction 9 - - - 2 - Carton Making and Salvage 2 - - - - - Coffee Grinding and Roasting 1 1 2 - - - Dental Mechanics 3 - 5 - 2 - Display Works and Signwriting 4 1 3 1 - - Doll and Toy Manufacturers 2 1 _ - - — Dressmaking 10 - 21 7 24 8 Dyers and Cleaners 12 1 9 - 9 - Electrical Generating Stations 2 - 1 - 1 - Electro Platers 2 - _ _ — — Engineering (Electro.) 10 - 6 3 11 - Engineering (Mech.) 21 - 7 - 1 - Furriers 1 1 14 2 4 - Gas Works 1 - _ - - — Glass Cutting and Polishing 4 - - - - - Ice Cube and Cream Manufacturers 4 - _ - - - Jewellers and Watchmakers 2 1 5 1 — - Lampshade Manufacturers 1 1 1 1 — 1 Laundries 9 - 5 - 7 — Leather Goods 1 - 1 3 3 - Metal Merchants 9 — 3 1 5 - Milliners 1 — 1 4 - 2 Motor Car Accessories 4 _ - — - _ Motor Car Repairers and Garages 61 1 57 1 46 1 Musical Instruments — - 2 - 1 - Office Equipment - - 1 - 2 - Oil Blenders and Packers 1 — — 1 - - Paint Makers and Storers 1 _ 1 — — — Photographers 4 - 13 3 3 5 Picture Frame Makers 2 — 4 - 7 2 Plastics 6 1 _ - 1 _ Printers and Bookbinders 22 _ 1 - 5 - Radio and Television 10 - 6 2 2 3 Rag Merchants 1 1 — — — - Rubber Goods Manufacturers 1 _ 2 _ _ - Sausage Makers 13 - 2 - - - Scientific and Hospital Instruments 3 - 1 - - - Shoe Makers and Repairers 7 - 12 — 6 — Silk Screen Printing and Spraying 3 - 1 - — — Soft Furnishings and Upholstery 18 - 11 6 22 8 Stone Masons 1 — 1 — _ _ Sweet Making and Packing 5 1 — — - — Tailoring 15 1 1 8 - 1 Tool Making 5 - 2 - — - Undertakers 1 _ — 1 — - Wax Workers 2 _ - _ _ - Weaving 1 - 1 - - - Woodworkers (Joiners, etc.) 10 1 11 2 13 1 Miscellaneous 22 7 5 6 8 1 TOTAL 342 29 235 66 205 34 79 OFFICES SHOPS AND RAILWAY PREMISES ACT, 1963 The Offices, Shops and Railway Premises Act, 1963, makes provision for the safety, health and welfare of persons employed in such premises. The requirements of the Act follow closely those of the Factories Act and include provisions relating to cleanliness, overcrowding, temperature, ventilation, lighting, sanitary conveniences, washing facilities, drinking water, seats, safety of machinery, first aid and fire precautions. Enforcement of the provisions of the Act is in most premises the Council's responsibility, but H.M. Inspectors of Factories are responsible for the enforcement in premises which are associated with, or broadly similar in their conditions to, factories, i.e. railway premises, fuel storage depots on railway premises and offices in factories.. They are also responsible for inspecting premises owned or occupied by the Crown and those occupied by local authorities. Provisions relating to fire precautions are the responsibility of the Fire Authority. Registrations and General Inspections Class of premises Number of premises registered during year Total number of registered premises at end of year Number of registered premises receiving general inspections during the year Offices 44 1,098 171 Retail shops 43 1,476 318 Wholesale shops, warehouses 1 68 20 Catering establishments open to the public, canteens 18 450 63 Fuel storage depots — - 1 TOTALS: 106 3,092 573 Number of visits of all kinds (including general inspections) to registered premises 4,104 Analvsis by workplace of persons employed in registered premises at end of year Class of Workplace Number of persons employed Offices 16,327 Retail Shops 13,269 Wholesale departments, warehouses 1,129 Catering establishments open to the public 5,418 Canteens 370 Fuel storage depots - TOTAL 36,513 TOTAL MALES 17,332 TOTAL FEMALES 19,181 80 Summary of Contraventions Section of Act Contraventions found Total during general inspections during routine visits by the District Public Health Inspectors Section 4 Cleanliness 12 219 231 Section 5 Overcrowding 2 — 2 Section 6 Temperature 120 19 139 Section 7 Ventilation 8 158 166 Section 8 Lighting 2 2 4 Section 9 Sanitary conveniences 33 220 253 Section 10 Washing facilities 48 120 168 Section 11 Drinking water supply 3 - 3 Section 12 Accommodation for clothing 3 - 3 Section 16 Floors passages and stairs 19 28 47 Section 17 Fencing of exposed parts of machinery 2 7 9 Section 24 First aid 66 13 79 Section 49 Notification of fact persons are employed 19 83 102 Section 50 Information for employees 155 5 160 TOTALS 492 874 1.366 81 Accidents The following tables show the total number of accidents reported during the year, and their primary causes, together with a comparison of the figures for the borough and national statistics:- Workplace Number reported Total No. Investigated Action recommended Fatal Non Fatal Prosecution Formal warning Informal advice No action Offices - 25 6 - - 6 - Retail shops - 94 16 - — 16 - Wholesale shops and Warehouses - 14 2 - - 2 - Catering establishments open to the public, canteens - 32 3 - - 3 - Fuel storage depots - - - - - - - TOTALS - 165 27 - - 27 - Causes of accidents Offices Retail shops Wholesale shops, Warehouses Catering establishments open to the public, canteens Fuel storage depots Machinery 1 6 - 1 - Transport 2 5 - - - Falls of persons 8 20 2 9 - Stepping on or striking against object or person 4 9 3 4 - Handling goods 6 33 9 12 - Struck by falling object 1 2 - - - Fires and exlosions - - - 2 - Use of hand tools - 15 - 3 - Not otherwise specified 3 4 - 1 - 82 COMPARISON OF CAUSES OF ACCIDENTS Primary Cause 1965 1966 1967 RBK & C England RBK & C England RBK & C % % % % % Machinery 3.70 5.40 1.54 5.30 4.85 Transport 0.90 3.70 1.52 4.00 4.24 Falls of persons 38.80 40.00 33.05 39.70 23.60 Fires and explosions - 0.80 - 0.70 1.20 Due to electricity - 0.30 - 0.40 - Use of hand-tools 4.60 5.60 7.69 5.30 10.80 Stepping or striking against an object or person 15.00 9.70 13.84 10.30 12.10 Handling goods 25.00 21.40 32.30 20.70 36.30 Struck by falling object 1.90 5.10 6.90 6.00 1.80 Not otherwise specified 10.20 8.00 3.10 7.60 4.85 LAND CHARGES The number of land charge enquiries dealt with during the year was 5,684, compared with 4,889 in 1966. These concerned outstanding statutory or informal notices, closing orders, smoke control orders, certificates of disrepair, slum clearance, etc. TOWN PLANNING APPLICATIONS During the year, 1,266 applications were referred to the health department for observations, and the persons responsible for carrying out any accepted schemes were informed of the various requirements of the health department before any work was commenced. Close liaison was maintained between the officers of the Health, Town Clerk's and Borough Engineer and Surveyor's departments, and the public health inspectors ensured that any development which took place was in accordance with the relevant Acts and Byelaws relating to health. LICENSING ACT, 1964 Forty-six copies of applications to the Licensing Justices for restaurant or residential licences were received during the year, and inspections were made in each case to ensure that there were no breaches of the Food Hygiene (General) Regulations, 1960, and that there was sufficient and properly sited sanitary accommodation for the use of patrons. FOOD AND DRUGS ACT. 1955 - INSPECTION AND SUPERVISION OF FOOD This is the principal Act for controlling the composition, labelling, fitness and hygienic handling of food, and the Food Hygiene (General) Regulations, 1960, are the principal instruments for enforcing good food hygiene practice in foodshops. Inspection of food premises The district public health inspectors are responsible for the supervision of food premises, including food shops, catering establishments and stalls, etc., within their districts but, as a result of the serious shortage of public health inspectors, it was only possible to make 1,045 inspections during the year. 83 The following tables show the number of inspections made of the various types of food premises in the borough during the year:- Premises registered under Number of Premises Number of Inspections 1. Section 16, Food and Drugs Act, 1955 (a) for the sale, or the manufacture for the purpose of sale, of ice cream, or the storage of ice cream intended for sale 494 54* (b) for the preparation or manufacture of sausages or potted, pressed, pickled or preserved food intended for sale 171 63 2. Milk and Dairies (General) Regulations, 1959 as dairies or where the occupier is registered for the sale of milk in sealed containers only 241 208* * Additional inspections of these premises (not primarily in connection with the sale of ice cream or milk) are recorded under different headings in the following table which also gives details of the number of premises fitted to comply with the Regulations 16 and 19 of the Food Hygiene (General) Regulations, 196O:- Food Premises Number of Premises Number of Inspections Number provided with wash-hand basins (Reg.16) Number with facilities for washing food and equipment (Reg. 19) Bakehouses 11 15 11 11 Butchers 87 25 87 87 Bread and Cake shops 52 9 52 52 Food factories 22 14 22 22 Greengrocers 98 31 91 94 Confectioners 177 5 177 147 Cafes, restaurants, Public Houses and Off-licences 8O7 873 781 752 Fishmongers and fried fish shops 34 38 34 34 General provision shops 325 195 325 325 Street Markets - Stalls 101 348 *14 †12 Storage premises 40 85 15 31 *87 use nearby Public Conveniences +25 have sharing arrangements 84 Unsound Food Food sampling During the year, 11 formal samples were submitted for analysis by the Public Analyst, of which 5 (45.5% were either adulterated or otherwise unsatisfactory. 1,009 informal samples were also submitted for analysis, of which 73 (7.2%) were either adulterated or otherwise unsatisfactory. It is now the policy of the Council to take formal samples only in those cases where there is reason to believe a product is well below the required standards, usually following an adverse report on an informal sample. In the case of one of the formal samples legal proceedings were authorised, in one case a warning was given to the producer, and in the remaining three cases no further action was taken. The results of all unsatisfactory samples were brought to the notice of the producers, manufacturers or vendors as appropriate. Complaints During the year, eighty complaints were received from members of the public alleging the unsatisfactory condition of food purchased by them in the borough. The complaints generally related to the presence of foreign matter in foods, and the unsatisfactory condition of meat, fish, sausage, pies, butter, fruit, bread, cream, sweets, cakes, cooking oil, beer, minerals and frozen food. Of these complaints, thirteen cases resulted in the Health Committee instructing the Town Clerk to institute legal proceedings and in two other cases the Committee decided to send warning letters to the vendors or manufacturers concerned. The remaining sixty-five cases were dealt with informally, either owing to the lack of sufficient evidence or to the complaint not being substantiated. Surrender During the year, the following amounts of food were surrendered and condemned as unfit for human consumption:- Commodity Weight (in lbs.) Meat (raw) 455 Meat (other) 128 Ham and Pork 3,404 Sauerkraut 694 Cucumbers and Gherkins in brine 1,235 Butter and Cheese 4,484 Fish (wet and dry) 864 Sausage 97 TOTAL 11,361 Items Tins, jars, packets or cartons of fruit, vegetables and miscellaneous food stuffs 14,907 Frozen foods (packets) 10,185 TOTAL 25,092 All food condemned as unfit for human consumption is collected by the Council, taken to the refuse destructor in Fulham, and destroyed. 85 Seizure Under Part I of the Food and Drags Act, 1955, it, is an offence to sell,, offer, or expose for sale, or to be in possession for the purpose of sale or preparation for sale, food intended for human consumption which is in an unfit condition. Such food can be seized and taken before a Justice of the Peace, who can condemn it and order it to be destroyed or disposed of for purposes other than human consumption. Action was taken in one instance during the year, where seven packets of creamed coconut and nine packets of margarine were found to be on sale in a mouldy condition. Following seizure of the articles, legal proceedings were instituted in respect of the contravention. As a result, the defendants were fined £5 and costs of £2 were awarded to the Council. Milk (Special Designation) Regulations,, 1963 Milk Licences These Regulations, as amended by the Milk (Special Designation) (Amendment) Regulations, 1965, require that all milk sold by retail in England and Wales shall be specially designated, and that retailers must be licensed by the local authority to sell such milk. Licences are issued by the Council for a five-year period and all current licences are valid until the end of 1970. The number of licences granted by the Council during the year in respect of each designation, together with the total number in force at the end of the year, are shown in the following table:- Designation Licences issued in 1967 Total number in force at end of year Untreated milk - 107 Pasteurised milk 10 240 Sterilised milk 7 197 Ultra-heat Treated milk 11 151 Milk Examinations The following table shows the number of samples of Untreated milk and processed milks taken during the year for examination in accordance with the Regulations, together with the results obtained:- Designation No. of Samples Methylene blue test Phosphatase test Colony Count test Passed Failed Passed Failed Passed Failed Untreated - - - - - - - Pasteurised 104 95 2* 104 - - — Sterilised 1 1 - 1 - - - Ultra-heat Treated 4 - - - - 4 - * Seven samples of pasteurised milk were not submitted to the methylene blue test, in two instances because the atmospheric shade temperature exceeded 70°F. which is the limit specified in the Regulations, and in the remaining five instances because of failure of the test apparatus used. With regard to the two samples that failed the test, further samples were obtained from the same source and these were satisfactory. 86 Milk and Dairies (General) Regulations. 1959 Registrations The number of persons registered under these Regulations at the end of the year to sell milk from premises in the borough (including the sale of cream in sealed containers) was 241. Unclean milk containers It is an offence under these Regulations for any dairy farmer or distributor to use for holding milk any vessel that is not in a state of thorough cleanliness immediately before use. In the case of bottled milk, the time "immediately before use" is considered to mean at the time the bottle is first filled and, therefore, any offence would be committed at the time and place of bottling. Seven complaints were investigated during the year and each case was referred to the local authority in whose area the bottling plant was located, Composition of milk During the year, 119 samples of milk (all grades) were submitted to the Public Analyst for examination. Two samples of milk were found to be below the legal standards laid down and the respective packers were informed accordingly. Subsequent samples from the same source proved to be satisfactory. Channel Islands and South Devon milk The Milk and Dairies (Channel Islands and South Devon milk) Regulations, 1956, require that all milk for human consumption sold under the specific description of "Channel Islands milk", "Jersey milk", "Guernsey milk" or "South Devon milk" must contain not less than 4% by weight of milk fat. This compares with the presumptive milk fat standard of 3% specified for ordinary milk by the Sale of Milk Regulations, 1939. The following table shows the average percentages of milk fat and non-fat solids of the genuine samples taken during each month:- Month Number of samples taken Average Percentages Milk Fats Non-fat Solids January 6 4.52 8.91 February 5 4.35 8.85 March 6 4.33 8.85 April 9 4.01 8.85 May 7 4.19 9.07 June 6 4.20 9.05 July 4 4.25 8.95 August 2 4.42 8.95 September 3 4.48 9.06 October 6 4.54 9.03 November 4 4.47 8.96 December 12 4.48 8.83 Average for the whole year 4.35 8.94 Legal minimum standard 4.00 8.50 87 Other milk The following table shows the percentage of milk fat and non-fatty solids of the genuine samples of milk, other than Channel Islands and South Devon milks, taken during each month:- Month Number of samples taken Average Percentages Milk Fats Non-fat Solids January 2 3.65 8.50 February 9 4.15 8.56 March 7 3.55 8.45 April 4 3.52 8.57 May 2 3.57 8.56 June 6 3.48 8.74 July 1 3.55 80.55 August 2 3.70 8.60 September 1 3.55 8.75 October 1 3.85 8.80 November 5 3.74 8.69 December 7 3.74 8.60 Average for the whole year 3.67 8.61 Legal minimum standard 3.00 8.50 Ice Cream The Food Standards (Ice Cream) Regulations, 1959. prescribe standards for ice cream and introduce separate standards for "dairy ice cream" (or "dairy cream ice" or "cream ice") and for "milk ice". The Labelling of Food (Amendment) Regulations, 1959, prohibit the labelling, marking or advertising of ice cream in a manner suggestive of butter, cream, milk or anything connected with the dairy interest unless the ice cream contains no fat other than milk (except such as may be introduced by the use as an ingredient of any egg, flavouring substance, or emulsifying or stabilising agent), but permit the presence of skimmed milk solids to be declared. These Regulations also provide that it is an offence to sell under the description "ice-cream", any pre-packed ice cream which contains fat other than milk fat, unless it bears on the wrapper or container a declaration "Contains non-milk fat" or, if appropriate, "Contains vegetable fat" in type of a prescribed minimum size. The following table shows the number of samples of ice cream taken during 1967 for chemical analysis compared with those taken in the previous year:- 1966 1967 Number of samples 20 15 Variation of fat content per cent 5.0 to 12.5 6.0 to 12.7 Variation of non-fat content per cent 20.8 to 29.4 20.6 to 28.1 Average fat content per cent 8.4 7.86 Average non-fat content per cent 26.0 24.86 88 The Ice Cream (Heat Treatment, etc.) Regulations, 1959, require that ingredients used in the manufacture of ice cream be pasteurised or sterilised. There is still no legal bacteriological standard for ice cream. As in previous years, samples were taken and submitted for examination under the provisional methylene blue reduction test, which is a simple and practical means for the routine examination of ice cream. The test is not of sufficient precision to justify its use as a statutory test. The grading is determined by the length of time taken to decolourise the methylene blue, and it is suggested that, if samples consistently fail to reach grades 1 and 2, it would be reasonable to regard this as an indication of defects in manufacture or handling which warrant further investigation. During the year, forty samples of ice cream were taken and submitted to the methylene blue test. The results are as follows:- Grade Number of samples 1 13 2 6 3 14 4 7 Premises in the borough where ice cream is manufactured, stored or sold were frequently inspected during the year, and generally were found to be in a satisfactory condition. The Liquid Egg (Pasteurisation) Regulations, 1963 These Regulations require the pasteurisation of liquid egg to be used in food intended for sale for human consumption, other than egg broken out on the food manufacturers' premises and used within twentyfour hours. The Regulations prescribe the method of pasteurisation and the test to be satisfied. There are no egg pasteurisation plants in the borough and it was not found necessary during the year to take any samples of liquid egg in accordance with these Regulations. Pesticides Residues in Foodstuffs In January 1966, the Council agreed to participate in a scheme, proposed by the Association of Public Analysts, to enquire into the contamination of food by toxic chemicals. The enquiry was arranged to cover a two-year period commencing 1st August, 1966, and each local authority participating in the scheme was required to obtain and submit for analysis eighteen samples each year. The first eighteen samples in connection with this scheme were obtained during the year and the results of the analyses were all satisfactory. Generally There are no abattoirs or slaughterhouses in the borough, and no killing of animals for human consumption is carried out. There are no premises within the borough where poultry is processed. 89 LEGAL PROCEEDINGS Public Health Acts, 1936/1961 Nuisances During the year, forty-five summonses were issued for various nuisances under the Public Health Acts, 1936/1961. In nine cases Abatement Orders were secured, fines totalling £28. 0. 0d., and costs amounting to £21.10. Od. In twenty-one cases the summonses were withdrawn, the nuisances having been abated prior to the Court hearings, and in eleven cases the summonses were adjourned sine die as the necessary works were being carried out by the defendants. In three cases the summonses were not served and in the remaining case the defendant was granted an absolute discharge and the Magistrates ordered the Council to execute the necessary work in default. Contraventions of Drainage Byelaws Two summonses were issued in respect of contraventions of these Byelaws, which included failure to deposit plans and failure to give notice of intention to commence drainage works. In both cases the summonses were withdrawn as the plans were deposited prior to the Court hearing. Prevention of Nuisance from Demolition Byelaws Four summonses were issued against a demolition contractor for failing to take steps as required by the Byelaws to prevent nuisances arising from the demolition of properties. The Magistrates imposed fines in all cases totalling £20. 0. Od and the Council were awarded £7.10. 0d costs. Noise Abatement Act, 1960 Nuisances Legal proceedings were taken in forty-five cases against mobile ice cream vendors for operating loudspeakers or musical chimes after 7,00 p.m. In forty-four cases fines totalling £113. 0. 0d were imposed and costs amounting to £32. 0. Od were awarded to the Council. In the remaining case the summons was dismissed. Housing Act. 1957 Overcrowding Three summonses were issued for permitting dwelling houses to be overcrowded. Convictions were obtained in each case and fines amounting to £15. 0. Od were imposed, and the Council were awarded £17. 0. 0d costs. Illegal Occupation of Closed Unfit Rooms One summons was issued against a landlord in respect of the illegal occupation of closed basement rooms. The summons was withdrawn at the Court hearing as the rooms had become vacant. Housing Act, 1961 Housing (Management of Houses in Multiple Occupation) Regulations, 1962 Twenty-two summonses were issued against three landlords for various offences under these Regulations. A conviction was obtained in each case and the Magistrates imposed fines totalling £148. 0. Od and costs amounting to £15. 0. 0d were awarded to the Council. 90 Food and Drugs Act, 1955 Offences under Section 2 Ten summonses were issued in respect of the sale of food not of the nature, substance or quality demanded. In nine cases, convictions were obtained and fines totalling £108. 0. 0d were imposed, and the Council were awarded £46. 0. 0d costs. In the remaining case, which concerned the presence of a small cylindrical pad resembling a cigarette filter tip in hot chocolate sause served in a restaurant, the Magistrates felt that there was a reasonable doubt as to how this foreign object gained access to the food and dismissed the summons, awarding £10. 0. Od costs against the Council. Food Hygiene (General) Regulations, 1960 Proceedings were taken under these Regulations against a trader who failed to refrain from the use of tobacco whilst handling open food. The defendant was fined £5. 0. 0d and costs of £1. 0. 0d were awarded to the Council. Two further summonses were taken out against a restaurant owner for contraventions of these Regulations which included (a) failure to keep the floor of the kitchen in such a condition to enable it to be effectively cleaned, and (b) failure to supply suitable and sufficient ventilation to two female water closet apartments. The summons was withdrawn in case (a) as the necessary works had been completed prior to the Court hearing, and in regard to case (b) the summons was adjourned sine die as the necessary works were being carried out by the defendant. Food Hygiene (Markets, Stalls and Delivery Vehicles) Regulations. 1966 Six summonses were taken out against four defendants for contraventions of these Regulations. The contraventions included the failure to display on delivery vehicles the name and address of person carrying on the business, failure to wear over-clothing whilst handling open food, and failure to refrain from the use of tobacco whilst handling open food. In all cases convictions were obtained and fines totalling £28. 0. 0d were imposed. Costs amounting to £10. 0. 0d were awarded to the Council. Section 7 WELFARE SERVICES 91 WELFARE SERVICES Mr. S.A. Biddlecombe Chief Welfare Officer The duties and powers of the local welfare authority are contained in the National Assistance Act, 1948, as amended; the main provisions of which are as follows:- (a) Residential accommodation for persons in need of care and attention. (b) Temporary accommodation for the homeless. (c) Comprehensive services for the blind, partially sighted, deaf and other handicapped persons including special residential accommodation, workshops, occupational and rehabilitation centres, holidays and other amenities, and a full range of domiciliary services, including a casework service. (d) Domiciliary services for the aged, provided either directly or in co-operation with voluntary organisations. (e) Contributions to organisations engaged in promoting the welfare of handicapped and elderly persons. (f) Registration and inspection of homes for the disabled and elderly. (g) Removal to suitable premises of persons in need of care and attention. (h) Temporary protection of property of persons admitted to hospital, etc. (i) Burial or cremation of persons found dead when no suitable arrangements have been, or can be, made. 92 FORWARD PLANNING Residential Homes Former Public Assistance Institution King's Mead Last year it was reported that the Ministry of Health proposed to allocate to the Council sites at Springfields Hospital, Wandsworth, on which to build two homes each of 60 beds, as part replacement of King's Mead. The suggested year of occupation of the two new homes, as a result of the Ministry's study of the closure of all former P.A.I's in Inner London, was 1971. In the event, the planning authority of Wandsworth objected to the proposal of another authority developing homes for the elderly within their borough boundaries, and offered land at Merton as an alternative. The Council's Welfare Committee were unable to accept the alternative and the position would seem to be no nearer being resolved. Clearly the proposed year of closure of King's Mead, i.e. 1970/71, bears no relationship to the facts. Other Homes Progress in regard to the detailed planning of the proposed home at Edenham Street (61 beds) and the development of the site in Allen Street (34 beds) has been made, and it is to be hoped that the appropriate Ministries will grant loan sanction for the building works to commence during 1968/69. It is with pleasure that the Welfare Committee record their appreciation of the Housing Committee's co-operation in agreeing to allocate land within the Lancaster Road (West) development for a home for the elderly of 40 beds, a Day Care Centre for the elderly and, particularly, for the agreement to provide within the area Warden controlled flatlet accommodation for the elderly of up to 40 units. Temporary Accommodation Properties Good progress has been maintained in the replacement of short-stay accommodation. In 1966, it was anticipated that 144/148 Earls Court Road (18 family units) would be available for use only up to April, 1969. Consultations continued with the Greater London Council, however, and during the year it was learned that the properties would not have to be returned until later in 1970. Replacement has therefore been deferred until 1969. Schemes A joint Circular was issued in October, 1966, by the Ministries of Health and Housing and Local Government and the Home Office, in which emphasis was placed upon prevention of the break-up of families, and homelessness. The close liaison and co-operation which already existed with other departments and agencies was strengthened by the advent of this Circular. The Department's ability to deal with the social problems gained greater impetus in the Council's agreement to appoint three Social Caseworkers to this field of activity. GENERAL It has been thought helpful to place in parentheses where appropriate, figures for the previous year. 93 RESIDENTIAL ACCOMMODATION The number of persons in residential accommodation at 3lst December, 1967,was as follows:- Council accommodation 488 Other local authority homes 33 Voluntary homes 185 Total 706 The Council maintain four residential homes for aged and infirm persons under Section 21(1)(a) of the National Assistance Act, 1948. One of the homes is outside the borough boundary. The total number of beds is allocated as follows:- Dale Mead 56 men and women Ellesmere 122 " " " King's Mead 317 " " " 5 Holland Park 31 women Total 526 The number of beds at King's Mead was increased by 18 over the previous year, by the reduction of active male beds from 66 to 54, and the opening of a ward for infirm men for 30 residents. During the year, there were 265 new admissions and 154 discharges from the Council's homes. In the same period, 101 persons died in the homes. Vacancies are held for, short-term admissions to hospitals, residents who are away on holiday, and for major re-decoration programmes. The total number of re-admissions from hospital was 95 and discharges to hospital amounted to 107. Age Analysis at 31st December, 1967 Home Total King's Mead Ellesmere Dale Mead No. 5 Holland Park 50-64 years Male 3 - - - 3 Female 8 1 - 1 10 65-74 years Male 32 4 1 - 37 Female 46 18 6 8 78 75-84 years Male 19 17 11 - 47 Female 99 42 24 7 172 85 years and over Male 4 10 - — 14 Female 77 28 9 13 127 TOTALS Male 58 31 12 - 101 Female 230 89 39 29 387 Average Age 81.5 80 81.2 81 80.9 (Average Age 3l,12.66) (81.2) (80.7) (84.3) (80.6) (81.7) 94 Admissions and Discharges The following statistics show the admissionsand discharges at each residential home for the period, 1st January to 31st December, 1967:- Home Total King's Mead Ellesmere Dale Mead No. 5 Holland Park Resident on 1.1.67 Men 56 26 14 - 96 Women 226 83 42 31 382 Total 282 109 56 31 478 (483) Admissions (new) Men 52 12 2 - 66 Women 156 30 5 8 199 Total 208 42 7 8 265 Discharges (perm) Men 44 1 1 _ 46 Women 85 15 1 7 108 Total 129 16 2 7 154 Died Men 6 6 3 — 15 Women 67 9 7 3 86 Total 73 15 10 3 101 Remaining on 31.12.67 Men 58 31 12 — 101 Women 230 89 39 29 387 Total 288 120 51 29 488 (478) Normal accommodation 317 122 56 31 526 (508) - 95 - Other Local Authority Homes Section 21(1)(4) National Assistance Act, 1948 If suitable accommodation is not available from the borough's resources, or a resident seeks accommodation in a particular home or district belonging to another local authority, co-operation between the borough and other local authorities secures residential care for the applicant. The number of persons assisted in this way during the year is shown on the following table:- Name of Home Owning Borough Resident on 1.1.67 Admitted Discharged Remaining on 31.12.67 Women Men Total Women Men Total Women Men Total Women Men Total Fitzjohn's Avenue Camden 1 - 1 - _ - — — - 1 - 1 Somerville Hastings House Camden 1 - 1 - - - - - - 1 - 1 Hillside Islington 1 - 1 - 1 1 - - - 1 1 2 Southern Grove Lodge Tower Hamlets - 3 3 - 1 1 — 2 2 - 2 2 Lansbury Lodge Tower Hamlets - 1 1 - - - - 1 1 - - — Ladywell Lodge Lewisham - 18 18 - 6 6 - 13 13 - 11 11 Newington Lodge Southwark 1 - 1 2 _ 2 1 - 1 2 - 2 Brockle Bank Wandsworth - 1 1 - 8 12 2 3 5 2 6 8 St. Ann's, Redhill Sutton - - - - - - - - - - - - Saxoncroft Lambeth 2 1 3 - - - - - - 2 1 3 Yew Tree Lodge Wandsworth 1 - 1 - - - 1 - 1 - - - White Chester Hammersmith - - - 1 - 1 - - 1 - 1 Whitby Dene Hillingdon - - - 1 - 1 - - - 1 - 1 Western House Hertfordshire - - - - 1 1 - - - - 1 1 TOTAL 7 24 31 8 17 25 4 19 23 11 22 33 The comparatively large numbers of men accommodated was owing to the lack of infirm beds for elderly men in the borough. 96 Accommodation provided by Voluntary Organisations On 31st December, 1967, there were 185 persons in accommodation provided by voluntary organisations for whom the Council are responsible. They were classified as follows:- By major disability Under 65 65 and over Blind 4 ( 3) 9 ( 12) Deaf 1 ( 1) 2 ( 5) Epileptic 3 ( 5) 1 ( 2) Physically handicapped 18 (19) 40 ( 13) Others 2 ( 4) 105 (123) Total 28 (32) 157 (155) By age and sex Male Female Under 30 years 2 1 30-49 years 2 3 50-64 years 8 12 65-years 13 29 75-84 years 10 59 85 years and over 2 44 Total 37 (42) 148 (145) Average age 68 77 Seventy-two homes were used for this purpose. Waiting List for Admission to Homes for Aged Persons There were eighty-five persons on the waiting list for admission to residential accommodation at 3lst December, 1967, viz:- Urgent Applications for Admission Normal Applications for Admission Total Men 9 11 20 Women 17 48 65 TOTAL 26 59 85 Names were added to the waiting list at the rate of twenty-two persons per month. In cases of genuine emergency, thirty-five people had to be admitted within two or three days of application, but the greater number remained on the waiting list for varying periods up to sixteen months. TEMPORARY ACCOMMODATION Homeless Families The Council have a responsibility under Section 21(1)(b) of the National Assistance Act, 1948, to provide temporary accommodation for 97 persons in urgent need through circumstances which could not reasonably have been foreseen. Emergency provision is also made for victims of fire or flood, whilst they are temporarily homeless. The premises in use for homeless families are as follows:- 144/148 Earls Court Road, S.W.5. 18 family units available for use up to April, 1969 68 Holland Road, W.14. 8 family units 16/18 Wrights Lane, W.8. 17 family units + 68 Oxford Gardens, W.10. 3 family units + 228 Lancaster Road, Well. 5 family units + 84/90 Princedale Road, W.11. 11 family units + 32 Dawson Place, W.2. 7 family units Trenmar Lodge, Trenmar Gardens, N.W.10. 5 family units Owing to the closure of Lorrimore Square in October, 1966, the premises marked +were taken into use during 1967 and the following properties will be ready for occupation in 1968:- 201 Ladbroke Grove, W.10. 5 family units 210 Ladbroke Grove, W.10. 5 family units Family casework is maintained at an intensive level in order to ensure that families are not evicted or for those already in temporary accommodation that they should be more speedily rehabilitated in preparation for eventual re-housing. In this way a reasonable flow is maintained of families moving in and out of temporary accommodation. The following statistics show the number of families received into and discharged from temporary accommodation during the years - Number of families in temporary accommodation as at 1.1.67 45(56) Number of families admitted (comprising 30 men, 56 women and 136 children) 56(78) Number of families discharged 46 (89) Number of families remaining as at 31.12.67 55(45) The reasons for homelessness were as follows:- Rent arrears 10(16) Unauthorised occupants 15(23) Overcrowding 4(7) Family disputes 4(11) Fire victims 4(8) Essential repairs 2) Demolition 2)(4) Dangerous structures 2) Other reasons (including landlord wanted accommodation, service contract ended and from hotel accommodation) 13(9) Of the forty-six families discharged, seventeen were re-housed by nomination by the Greater London Council, nine were re-housed by the Council, eight were assisted to find accommodation and twelve found their own accommodation. Family caseworkers are engaged in supporting families who find themselves perhaps for the first time in the relatively close living conditions of temporary accommodation. - 98 - Their casework approach of the families is based principally on three main conditions (a) Acceptance by the families of their financial responsibility, regular payment of charges,, proper budgeting and the payment of any outstanding debts including rent arrears. (b) Training of the parents in good standards of child care, which includes correct feeding, adequate clothing, reasonable discipline and to assure their children of sincere parental regard. Appreciation of the value of regular attendance at school and a constant care of the health and well being of the family. (c) Acceptance by the husband of the necessity of retaining full employment. Encouragement and assistance is given when necessary. The response shown by families was encouraging and resulted in re-housing being effected within a period of twelve months in most cases. Examples of two such families are as follows:- (1) Family consisting of man, wife and four children, two of whom were in care in a special school for maladjusted children. The woman was apparently mentally unstable and prone to using excessive violence in the discipline of her children. The husband, although in full time employment, spent the greater part of his spare time with friends and did not share the family's responsibilities. The woman was trained to rectify her attitude to the children, the two in care were re-united with the family and have had good reports from their respective schools, where they have been completely accepted. The woman has prospered and is a good housewife, proud of her home and family. The husband has also accepted his responsibilities and now works overtime for the benefit of his family. (2) This family, consisting of man, woman and two children, had been repeatedly evicted for rent arrears. The husband was almost an alcoholic and did no work, living mainly on Ministry of Social Security grants and charity. The wife had a grandiose complex but was totally incapable of managing even a small household. The husband was persuaded to undertake a cure in a residential hostel for alcoholics run by a religious body. He was then encouraged to find employment and obtained two part-time jobs and freelance journalism. The woman was trained to keep a clean household, to budget properly and to have a more reasonable outlook on life. She was eventually found a part-time job, while the children were in a day nursery, and paid off her debts. This family are now re-housed and, with a little support, should progress favourably. Mothers and Babies Provision for unmarried mothers and their children is made under Section 21(1)(b) of the National Assistance Act, 1948. The majority are "first baby" cases. The practice is to arrange admission to one of the homes run by voluntary societies for a suitable period before and after confinement. The Council pay an agreed weekly charge. Others were admitted to the Council's mother and baby unit at King's Mead, but this unit was closed on 15th September, I967. The following tables show the numbers accommodated during the year:- 99 (a) Voluntary Homes Mothers Children Total Number in residence at 31st December, 1966 13 13 26 ( 32) Admitted 86 86 172 (180) Discharged 92 92 92 (186) Number remaining at 31st December, 1967 7 7 14 ( 26) Country of origin of mothers admitted: United Kingdom 40 France 1 Eire 23 South Africa 1 New Zealand 2 Malaya 1 Australia 5 Sweden 1 West Indies 3 Rio de Janiero 1 Spain 6 Maritius 1 Canada 1 Total 86 (90) 64 (72) domiciled in London 22 (18) domiciled outside London (b) King's Mead Mothers Children Total Number resident at 31st December, I966 1 1 2 Admitted 20 20 40 Discharged 21 21 42 Country of origin of mothers admitted: United Kingdom 10 Eire 5 Australia 1 Canada 1 France 2 West Indies 1 Total 20 (52) 15 (43) domiciled in London 5 (9) domiciled out of London Local Authority responsible:- Kensington and Chelsea 3 Camden 4 Islington 4 Lambeth 1 Hammersmith 4 Westminster 2 Wandsworth 1 Southwark 1 Total 20 100 (c) Other Homes "Ballantyne", Lewisham Mothers Children Total Number resident at 31st December, 1966 - - - Admitted 15 15 30 Discharged 14 14 28 Number remaining at 31st December, 1967 1 1 2 Country of origin of mothers admitted; United Kingdom 8 West Indies 1 Eire 5 Kenya 1 Total 15 (11) 8 domiciled in London 7 domiciled out of London "Carisbrooke", Lambeth Mothers Children Total Number resident at 31st December, 1966 - - - Admitted 3 3 6 Discharged 3 3 6 Number remaining at 31st December, 1967 - - - Country of origin of mothers admitted: United Kingdom 3 Total 3 (4) 1 (5) domiciled in London 2 (6) domiciled out of London DOMICILIARY WELFARE SERVICES FOR ALL CLASSES OF HANDICAPPED AND ELDERLY PERSONS Sections 29 and 30 of the National Assistance Act, 1948, empower the Council to make arrangements, both directly and in conjunction with voluntary organisations, for promoting the welfare of persons who are substantially and permanently handicapped by illness, injury or congenital deformity or such other disabilities as may be prescribed by the Minister. The Council are also required to maintain separate registers of (a) the blind, (b) the partially sighted, (c) the deaf and hard of hearing and (d) those with other disabilities. In addition, a register is kept of those elderly persons who apply for assistance, or on whose behalf such application is made. The following table shows the number of persons on the registers at 31st December, 1967:- Blind 420 (443) Partially sighted 134 (123) Physically handicapped 1,046 (739) Deaf/hard of hearing 52 ( 26) Elderly persons 2,591 (2,536) Total of all Registers 4,243 (3,867) 101 The services to all classes of handicapped and elderly people are based upon home visiting by social welfare officers supplemented by 'community care' in day time social and rehabilitation centres, provided by the Council and by voluntary organisations. The social welfare officers ensure that day-to-day needs are adequately met, and that the home conditions are satisfactory. To this end, a wide variety of services is made available, which includes the teaching of Braille and Moon type to blind people, homecraft instruction,, the provision of aids and appliances and adaptations in the home, holidays, home chiropody treatment, meals on wheels, mobile library services and a laundry service in certain cases of chronic illness. During the year, 11,384 (12,756) initial and follow-up visits were made in connection with the above services and in respect of applications for admissions to homes, voluntary visitors, clubs and centre membership and other miscellaneous services. It will be noted that 1,372 less initial and follow-up visits were made. This is due to the fact that the comprehensive review of the registers of the former authorities for elderly people was completed during 1966. The review visits were primarily to ascertain that the elderly person was still at the address given in the registers handed over by the former authorities and resulted in some 5,000 deletions. In addition, 1,070 persons were interviewed at head office. During the year the following grants by the Council were made to voluntary organisations who make a significant contribution in respect of specific services:- Blind Associations £. s. d. National Library for the Blind 100. 0. 0. Nuffield Talking Book ) Library for the Blind ) 260. 0. 0. Southern Regional Assoc. for the Blind 85. 0. 0. Handicapped Associations British Epilepsy Association 40. 0. 0. Information Services for the Disabled 45. 0. 0. Deaf and Dumb Royal Assoc. in Aid of the Deaf and Dumb 75. 0. 0. Voluntary Associations Cecil Homes 470. 0. 0. London Free Church Federal Council 75. 0. 0. Servite Houses (Hearth & Home Ltd.) 300. 0. 0. Task Force (1964) Ltd. 3,000. 0. 0. Voluntary Hostels Conference 100. 0. 0. Kensington and Chelsea Communal Services Committee 3,140. 0. 0. The Kensington Day Centre Ltd. 5,710. 0. 0. Kensington and Chelsea Old People's Welfare Committee 3,300. 0. 0. International Voluntary Service 50. 0. 0. The Irish Centre 100. 0. 0. Winged Fellowship Trust 2,000. 0. 0. In addition,, the Kensington and Chelsea Old People's Welfare Committee made the following grants from its funds:- 102  £. s. d. St. Luke's Club No. 1 20. 0. 0. Leisure Club for Disabled 25. 0. 0. West London Angling Club 5. 0. 0. Rugby Club 15. 0. 0. Six Bells Club 4. 6. 6. North Kensington O.A.P. Association 15. 0. 0. St. Thomas O.A.P. Club 10. 0. 0. Third Feathers Youth Club 15. 0. 0. Alexander & Seventh Feathers Club 15. 0. 0. Chelsea Housing Improvement Society 15. 0. 0. Chelsea Over Sixty Club 15. 0. 0. St. Luke's Club - Ifield Road 10. 0. 0. Home from Home Club 31. 1. 0. National Old People's Welfare Council 5. 5. 0. Greater London Conference on Old People's Welfare 5. 5. 0. WELFARE OF THE BLIND The statutory definition for the purpose of registration as a blind person under the National Assistance Act, 1948, is that the person is "so blind as to be unable to perform any work for which eyesight is essential". The number of persons newly registered as blind during 1967 was 54, twelve being men and forty-two women. Table I showing the distribution in age groups of the 420 registered blind persons ordinarily resident in the borough. The majority of new registrations are in the age groups of sixty-five and over, which is consistent with figures produced for national statistics. The analysis of causes of blindness in newly registered persons is shown in Table II. An analysis of the register showing the education, training and employment position is given in Tables III and IV. It will be seen that a total of 303 persons are over sixty-five years of age, leaving a total of 113 adults, of whom 46 are either not available for, or not capable of, work. At the Council's Rehabilitation Centre, Gertrude Street, a social club for the blind is held every Tuesday. A social welfare officer, who is a qualified home teacher, organises the club which has 19 members, Games equipment is provided and other activities includeda Christmas party and an outing. Close liaison is maintained with voluntary organisations; viz. the Royal National Institute for the Blind; the London Association for the Blind, the Southern Regional Association for the Blind; St. Dunstan's and the National Library for the Blind. Referrals for employment and training are made to the Disablement Resettlement Officer of the Ministry of Labour, with whom consultation is arranged in cases of special difficulty. The number of home visits made to blind persons during the year was 1,646 (1,641). A brief summary of the special facilities available to registered blind persons is given below;- Free wireless on loan from the Wireless for the Blind Fund Free wireless licence Free dog licence (for guide dogs) Special postal rates for Braille literature 103 Free issue of white walking sticks Loan of special equipment in approved instances (i.e. talking books) Free bus passes for escorts Free railway fares for guide for special purposes Braille literature Library books in Braille or Moon type Fireguards on loan Specially designed aids and gadgets TABLE I -BLIND PERSONS (REGISTERED) FOR THE YEAR ENDED 31ST DECEMBER, 1967, SHOWING THE DISTRIBUTION BY AGE GROUP OF THE BLIND POPULATION New cases in 1967 All cases (old and new) Male Female Total Male Female Total Under 1 year - 1 1 - - - (1) 1 year - 1 1 - 1 1 (-) 2 years - - - - — - (-) 3 years - - - — — -(-) 4 years - - - - — - (1) 5 - 10 years - - - 2 - 2 (1) 11-15 years - 2 2 - 1 1 (-) 16 - 20 years - 1 1 3 2 5(4) 21 - 29 years - — - 17 7 24 (22) 30 - 39 years 1 - 1 9 6 15 (22) 40-49 years - - - 11 10 21 (30) 50 - 59 years 2 1 3 20 16 36 (32) 60 - 64 years - - - 7 5 12 (16) 65 - 69 years 1 3 4 9 18 27 ( 38) 70 - 79 years 5 17 22 24 81 105 (98) 80-84 years 2 7 9 15 52 67 (68) 85 - 89 years 1 6 7 15 53 68 (74) 90 years and over - 3 3 2 34 36 ( 36) Unknown - - - - - - 12 42 54 134 286 420 (443) TABLE II - ANALYSIS OF CAUSE OF BLINDNESS OF PERSONS NEWLY REGISTERED DURING 1967 Cause Male Female Total Senile Macular Degeneration 3 15 18 Disciform degeneration of the Macular - 3 3 Cataract 1 9 10 Retinal Dysgenesis - 1 1 Optic Atrophy 1 3 4 Myopia 1 1 2 Glaucoma 2 4 6 Amblyopia 1 - 1 Retinopathy 1 1 2 Myopic Degeneration of Retina - 1 1 Cortical Blindness - 1 1 Iridocyclitis - 1 1 Retrolental Fibroplasia - 2 2 Aphakia 1 - 1 Choris Retinal Scarring 1 - 1 TOTAL 12 42 54 104 TABLE III - SUMMARY OF OCCUPATIONS OF BLIND PERSONS AT 31ST DECEMBER, 1967 Male Female Total Children Aged under 2 years - 1 1 Aged 5 - 15 years (educable) attending special schools 1 - 1 attending other schools - 1 1 (ineducable) at home 1 - 1 Adults aged 16 years and upwards At school 1 — 1 Employed in sheltered workshops 3 1 4 Employed in open employment 39 19 58 Trainee for open employment 3 1 4 Unemployed but capable and available for work - - - Subject to training in open employment 3 - 3 Without training in open employment 1 - 1 Not available for work, aged 16 - 64 18 21 39 Not capable of work, aged 16 - 64 1 6 7 Not employed, aged over 65 63 236 299 TOTAL 134 286 420 TABLE IV - ANALYSIS OF THE OCCUPATION OF EMPLOYED BLIND PERSONS SHOWN IN TABLE III Sheltered Workshops Home Workers Schemes Open Industry Total Masseurs and Physiotherapists - - 1 1 Lecturers, Teachers — _ 3 3 Barristers, Solicitors - - 3 3 Musicians — - 1 1 Proprietors, Managers - - 4 4 Typists, Secretaries - - 21 21 Braille copyists - - 1 1 Clerical workers - — 3 3 Telephone operators — - 9 9 Shop Managers - - 1 1 Boxers, fillers, packers - - 1 1 Machine knitters 1 - - 1 Basket makers 2 - - 2 Brush makers 1 - - 1 Piano Tuners -, — 1 1 Domestic Workers - — 4 4 Other open employment - - 5 5 TOTAL 4 - 58 62 105 PARTIALLY SIGHTED PERSONS There is no statutory definition in the National Assistance Act, 1948, of partial sight, but the Ministry of Health has advised that a person who is not blind within the meaning of the Act of 1948 but who is, nevertheless, substantially and permanently handicapped by congenitally defective vision or in whose case illness or injury has caused defective vision of a substantial and permanently handicapping character is within the scope of the Welfare Services which the local authority are empowered to provide for blind persons, This does not apply to other benefits specially enjoyed by the registered blind. The register of partially sighted persons (Table I) shows a total of 134 (123) of whom 39 (36) were newly registered during the year (Table II). An analysis of the causes of partial sight of the newly registered is shown in Table IV. Training and Employment Severely handicapped There are sixty-one persons near and prospectively blind who require the full range of Welfare Services. Their circumstances are as follows:- Male Female Total Employed 2 3 5 Undergoing training 2 1 3 Awaiting suitable placement 2 - 2 Not available for employment or not capable of work 5 46 51 11 50 61 (50) Requiring observation only - 15 15 (20) Industrially handicapped The remaining persons registered are classified thus:- Children aged 16 years and over still at school - 1 1 Employed 8 3 11 Available for and capable of training for work 2 - 2 Not available for work 10 33 43 20 37 57 (50) Education One child under 15 years is attending a special day school 1 - 1 (3) TOTAL 32 102 134 (123) 106 TABLE I - PARTIALLY SIGHTED PERSONS (REGISTERED) FOR THE YEAR ENDED 31ST DECEMBER, 1967. SHOWING THE DISTRIBUTION BY AGE GROUPS OF THE PARTIALLY SIGHTED POPULATION 0-1 2-4 5-15 16-20 21-49 50-64 65 and over Total Males - - 1 - 15 1 15 32 Females — - - 2 5 13 82 102 TOTAL - - 1 2 20 14 97 134 (123) TABLE II - PARTIALLY SIGHTED PERSONS REGISTERED AS NEW CASES 0-1 2-4 5-15 16-20 21-49 50-64 65 and over Total Males - - - - - 1 9 10 Females - - - - - 3 26 29 TOTAL - - - - - 4 35 39 ( 36) TABLE III- REMOVALS FROM REGISTER DURING THE YEAR FOR REASON SET OUT BELOW (i) On admission to Blind Register 0-1 2-4 5-15 16-20 21-49 50-64 65 and over Total Males - - - - - 1 1 2 Females - - 1 - - - 2 3 TOTAL - - 1 - - 1 3 5 (ii) No cases were decertified due to improved visual acuity TABLE IV - ANALYSIS OF CAUSES OF PARTIAL SIGHT OF PERSONS NEWLY REGISTERED DURING 1967 Cause Male Female Total Cataract 2 11 13 Myopia 2 5 7 Arteriosclerosis 1 3 4 Heminaopia 1 - 1 Macular Degeneration 2 2 4 Bilateral detachments 1 - 1 Cerebral Lesion 1 1 2 Haemorrhage - 1 1 Glaucoma - 4 4 Cerebral Artery Occlusion - 1 1 Keratitis - 1 1 TOTALS 10 29 39 107 HANDICAPPED PERSONS - GENERAL CLASSES The main objectives in promoting the welfare of handicapped persons are as follows:- (a) To assist them to overcome the effects of their disability and to obtain any available general, preventive or remedial treatment. (b) To give advice and guidance on personal problems and in connection with any service, whether provided under any enactment or rendered by any voluntary organisation, which appears to be available to them and of which they wish to take advantage. (c) To encourage them to take part in the activities of social centres and clubs. (d) To use the best endeavours to arrange for voluntary workers to visit handicapped persons with a view to affording them comfort and encouragement and assistance in the solution of domestic and other problems confronting them. (e) To provide practical assistance in adaptations to the homes of handicapped persons. (f) To facilitate the taking of holidays. (g) To provide facilities and assistance to handicapped persons travelling to and from their homes to participate in any of the services. (h) To take such steps as are practical in consultation with the Ministry of Labour to assist a handicapped person to secure any work for which he appears to be fitted and which he is desirous of obtaining. (i) To take such steps as are practicable to assist a handicapped person who appears to be capable of benefiting from training under the Education Act, 1944, or the Disabled Persons (Employment) Acts, 1944 and 1958, and is desirous of taking advantage of such training. The Register of Handicapped Persons at 31st December, 1967, showed a total of 1,046. During the year, 416 (347) persons were added to the register. The grouping of disabilities is in accordance with the Medical Research Council code of diseases and disabilities as used by the Ministry of Labour. Relevant statistics are produced in Table I. An analysis of the disabilities of the newly registered cases is shown in Table II. Notifications concerning handicapped persons are received from a variety of sources and the circumstances of each case are investigated at the earliest opportunity. The number of home visits carried out by the social welfare officers was 4,009 (2,915). Arising from these visits, many needs have been brought to notice resulting in 210 (108) items being supplied, such as bath safety rails, bed rests, bath mats, bath seats, long-handled dustpans and brushes, a Hoyer Lifter, lazy tongs, long-handled shoe horns, raised toilet seats, stocking aids, tap turners, writing frames, walking aids, white folding sticks for the blind and adapted cutlery. The cost of these totalled £373.18.8d (£176.14. 0d). In addition, 219 articles of medical loan equipment were issued. The sum of £638.9.2d (£391.6. 5d) has been spent on special grants for handicapped persons on the following items:- 108 Grab-rails in toilets and bathrooms Handrails by steps Erection of ramp General flat adaptations in three cases Two examples can be quoted of extensive help given to very severely disabled residents of the borough. A professional man, almost completely incapacitated, has been assisted in his appeal to be helped to continue in self-employment and with the running of his home. This has been achieved by making him a long-term interest-free loan so that adaptations to his house could be effected to make it possible for him to be cared for at home. The only alternative to this would have been life in hospital or special institution where he could not have continued to carry out his work and would have eventually succumbed to institutional dependence. The second example concerns a lady with a crippling neurological disease which makes communication and mobility difficult. The hospital service has supplied this lady with a "Possum" and the Council have been financially responsible for the electrical and other installation required. The "Possum" (trade name for the device Patient Operated Selector Mechanisms for the Severely Disabled) enables her to manage her home from a wheel-chair and perform a range of activities including use of telephone, control of heating and radio, admission of callers to her home and the operation of an alarm system. This makes it possible for her husband to leave her alone for some hours at a time, which he had previously been unable to do. In both cases the disabled residents are now able to experience a dimension of living from which their severe handicaps would normally have excluded them. Table I - Analysis of Persons on the General Classes Register according to Age and Handicap Code Major Handicaps Age Groups Total Under 16 16-29 30-49 50-64 65 and over A/E Amputation _ 3 5 9 25 42 F Arthritis or Rheumatism - 1 6 56 253 316 GG Congenital malformations or deformities - - 2 4 12 18 H/L Diseases of the digestive, genito-urinary, heart, circulatory and respiratory systems. 1 2 10 43 134 190 Q/T Injuries of head, face, neck, abdomen, pelvis, trunk, limbs and spine 3 4 12 20 97 136 V Organic nervous diseases, epilepsy, poliomyelitis, multiple sclerosis, etc. 5 20 47 83 111 266 U/W Neuroses, psychoses other than in 'V' above - 1 1 3 9 14 X.Y. Tuberculosis, respiratory and non-respiratory - - 2 3 2 7 Z Diseases and injuries not specified - - 2 9 46 57 TOTAL 9 (7) 31 (28) 87 (73) 230 (196) 689 (435) 1,046 (739) 109 Table II - New Registrations during 1967. Analysis of disabilities Disability No. of Persons Abdominal operation 1 Amputation of leg (one double amputee) 14 Anaemia 1 Angina 5 Arteriosclerosis 6 Arthritis 124 Asthma 5 Brain Haemorrhage 1 Bronchitis, chronic 10 Cancer 13 Cardial and Vascular Disease 44 Cerebral Ataxia 1 Cerebral Lesion 4 Colostomy 3 Congenital Deformity of Hip 3 Congenital Deformity of Leg 4 Congenital Deformity of Spine 2 Coronary Thrombosis 5 Diabetes 6 Dropsy 2 Duodenal Ulcer 3 Epilepsy 6 Hemiplegia 36 Hernia 8 Hypertension 6 Ileostomy 1 Injuries or Diseases of Legs 19 Injuries or Diseases of Hips 7 Injuries or Diseases of Spine 6 Injuries, War (shoulder, skull, leg) 15 Multiple Sclerosis 8 Muscular Dystrophy 3 Neurosis 2 Paralysis 10 Paraplegia 5 Parkinson's Disease 9 Rheumatism 3 Spacticity 6 Spondilitis 2 Syringomyelia 1 Throat, Diseases of 1 Tuberculosis in Joints 1 Ex-tuberculosis 1 Tumours and Growths 5 Ulcerated Legs 3 Vertigo 5 TOTAL 416 110 TRANSPORT The Council have four vehicles, (two coaches with a hydraulic tail-lift and two utilabuses) for taking handicapped persons between their homes and social centres, transporting elderly persons to residential accommodation, homeless families and unmarried mothers to temporary accommodation. In addition, they were used for delivering aids and gadgets to the blind and handicapped, for taking residents of welfare homes on regular outings and to the shops. During the old people's organised holidays, they transported the blind and handicapped and their baggage from their homes to the pick-up points and in some cases took severely handicapped persons direct to the holiday homes. Two of the vehicles were stationed at the holiday camp in Berkshire to enable the elderly to be taken on outings, to the shops and church services. Voluntary organisations are granted use of the transport for approved purposes in the evenings and at weekends. They have availed themselves of this service on over five hundred occasions. The total mileage travelled in covering all these commitments amounted to over 48,000 (40,000) miles. For operational purposes, the Council's schedule of transport needs is at present grouped with that of Westminster and Camden Councils in order to meet each borough's commitments. WELFARE OF THE ELDERLY At 1st January, 1967, the number of elderly persons shown on the register was 2,536. During the year 463 persons were removed from the register having either moved from the borough, or died or been re-registered under some other category, i.e. blind, handicapped, etc.; 518 new cases were added and the number of persons remaining on the register at 31st December, 1967, totalled 2,591. Many received assistance from statutory and voluntary sources to ensure their continued welfare. In addition to those on the register, 1,840 other persons were afforded advice and/or assistance by statutory and voluntary sources. A specially appointed officer co-operates with voluntary organisations interested in the welfare of elderly people and in consequence much additional benefit has been derived by the old persons in the borough. Close liaison was maintained with the Old People's Welfare Committee, of which the Chief Welfare Officer is the Honorary Secretary. Meals Service The preparation and supply of meals for old people in Kensington has been carried out by the Kensington and Chelsea Communal Services Committee at St. George's Hall, Kensington Place, where approximately 1,270 meals a week are prepared, including those supplied to luncheon clubs. The preparation of meals for delivery in Chelsea is undertaken from the kitchen at 'King's Mead' old people's home where an average of 300 meals a week are prepared. Deliveries in both areas have been effected by volunteer drivers and attendants of the Women's Royal Voluntary Service. The meals are delivered in a fleet of eight vans, seven of which are fitted with equipment for keeping the food hot. During 1967, the Kensington and Chelsea Communal Services Committee resolved to wind up and hand over to the Council all its assets. In consequence, the Welfare Committee assumed full responsibility for the service on 1st August, 1967, the Women's Royal Voluntary Service still being responsible for delivering the meals. 111 The total number of meals supplied was 80,994 (79,568). Of these 48,212 (47,322) were delivered by the Meals-on-Wheels service to elderly people in their own homes, the balance were delivered to luncheon clubs. Chiropody In conjunction with the Old People's Welfare Committee and the British Red Cross Society, a domiciliary chiropody service was provided for home-bound elderly persons,, The three chiropodists employed carried out 1,965 visits to 457 individual persons. A clinic operates at the Chelsea Community Centre in co-operation with the School of Chiropody, the Old People's Welfare Committee and the British Red Cross Society, and 1,346 treatments were given to 347 elderly persons. Laundry No direct authority exists at the moment for the Council to provide a laundry service. The Council are empowered under Section 84 of the Public Health Act, 1936, to cause any article in a house to be cleansed, disinfected or destroyed if it is in such a condition as to be a danger to health. Fouled bed linen in cases of incontinence may be cleansed under this section. To comply with legal requirements, the Council have given a general authority to the Medical Officer of Health to take whatever action appears to him to be necessary under the terms of the section. Action was taken in 62 (53) cases. The bedding was marked, collected and laundered at the Council's disinfecting station and returned to the persons' homes. The scheme undoubtedly fulfils a much felt need. During the year 2,438 (2,330) separate collections of laundry were made and the number of articles cleansed totalled 30,128 (30,414). Holidays A comprehensive holiday scheme for blind, handicapped and elderly people. Including residents of the borough's homes was arranged; 180 bookings were made at the California Lakeside Holiday Camp in Berkshire, and 143 bookings were made at guest houses at Ramsgate, Worthing and Bognor. Special holidays were arranged at estalishments catering for the severely disabled. The staff on duty throughout the camp holiday included members of the department from head office, residential homes, coach drivers and attendants and members of the International Voluntary Service. Two State Registered Nurses were engaged and valuable assistance was given by the camp staff and the Wokingham branch of the Women's Institute. The total number of people for whom two weeks' holiday was arranged was 363 (307), of whom the majority were elderly, but included some who were blind and physically handicapped. The gross cost to the Council for all holidays was £4,565 (£4,383). Library Facilities The Libraries Committee authorise the provision of suitable books, including large print, for old people confined to their homes. The books were distributed by the Women's Royal Voluntary Service in the Kensington area and by the British Red Cross Society in the Chelsea area. The number of persons benefiting from the service was 135 (148). 112 Advice Leaflets The publication and distribution of pamphlets giving information on the services available to old people was arranged by the Old People's Welfare Committee. Approximately 2,000 were distributed. In addition, and by arrangement with the Ministry of Social Security, cards giving general information on how to obtain services are sent to persons reaching retirement age. Social Activities There are twenty-six social clubs, for the elderly, organised by various associations, etc. In addition, Old Time Dancing and Arts and Crafts classes held at the Chelsea and North Kensington Community Centre. The main object of the clubs is to provide facilities where the elderly of both sexes can meet in a friendly and convivial atmosphere. Concerts and outings are also arranged by the clubs. A small subscription which generally provides for a cup of tea and biscuits is collected weekly and any balance is directed towards the costs of outings and a Christmas party. Most clubs hold a weekly raffle and other games, for which a small charge is made; any profits help to offset club expenses. The Old People's Welfare Committee arranged Christmas concerts at Kensington and Chelsea Town Halls, which were attended by 750 elderly persons. In addition, 1,714 Christmas parcels were distributed to those in need through the Old People's Welfare Committee, assisted by various organisations and schools in the borough. Arrangements were made with the management of a local store for late Christmas shopping facilities. The store remained open until 8.00 p.m. and 250 people from the borough and adjoining boroughs took advantage of this facility, which was greatly appreciated. Nine elderly people were sent on holiday for a fortnight to Bognor late in the year. Social and Rehabilitation Centre The Centre, which is situated in Gertrude Street, S.W.10., was opened in November, 1965. Since then it has provided a daily service to the blind, physically handicapped and elderly. At the 31st December, 1967, the total membership was 123. The staff at the Centre consists of the Supervisor and Assistant Supervisor, kitchen and cleaning staff and a porter. The main activity is handicraft work, for which qualified instructors of the Inner London Education Authority are engaged. One class which is thoroughly enjoyed by the members is "Music and Movement". A summer outing to Worthing took place in July and an enjoyable day was spent by all. Parties were arranged at Christmas for the members and those who attend the Blind Club. A very successful Open Day and Sale of Work was held in November, which made it possible to display the high standard of work carried out. The total sum of £113. 1. 3d (£79.1. 6d) was raised from the sale of articles. Transport is provided for handicapped persons to and from their own homes. Mid-day meals, and morning and afternoon teas, are provided. Task Force During the year, Task Force continued to operate in the borough. Some 835 volunteers were involved in providing help to the elderly. The volunteers being enlisted from schools, youth clubs and groups, and individuals. The approximate number of visits made to elderly persons each month was 1,389, 463 persons being visited regularly. In addition. 113 Task Force volunteers carried out 137 decorating jobs and 560 other jobs, such as window cleaning and gardening and escort duties were undertaken. Much of the work performed by Task Force is carried out during the weekends, when the recognised statutory and voluntary services are not available. From 11th June, 1967, when detailed records were first kept, 172 emergency jobs were carried out by Task Force,, The number of volunteers recruited is encouraging as is the widening variety of tasks being undertaken. Consequently more elderly persons are benefiting. Many letters of appreciation have been received, especially for the arrangements which were made for the well-being of lonely elderly persons over the Christmas holidays. Relations with other voluntary organisations have been consolidated and an interchange of services and information is now working satisfactorily. Voluntary Services Some forty to forty-five 'freelance' voluntary visitors have been engaged during the year in visiting regularly one elderly person each. Also, the very active Good Neighbours scheme which was started in the Chelsea area has expanded to cover most of the borough. Over 100 voluntary visitors from churches in the borough, of all denominations, as well as individuals, are providing a very valuable contribution to this work. An essential feature of a voluntary visiting service, particularly where more than one scheme is functioning is good co-ordination. This has been materially assisted by the special appointment agreed by the Council of a Liaison Officer whose help and advice has been warmly welcomed by many voluntary organisations. It is of interest to note that during the past year some twenty talks have been given to organisations and groups of people regarding the welfare services available to the handicapped and elderly of the borough. The Kensington Day Centre Limited Close liaison was maintained with the Centre, which has a membership of 350 elderly and handicapped persons. It is open each weekday and provides recreational facilities and occupational therapy, a chiropody service, hairdressing and bathing facilities, library service and midday meals. Attendances average sixty per day. A hydraulic tail-lift coach, with driver, is provided by the Council to transport the handicapped to and from the Centre. The work of the Kensington Day Centre makes a significant contribution to the services provided by the Council and is greatly appreciated. OTHER FEATURES OF THE WORK OF THE DEPARTMENT Determination of Liability of Local Authority Section 32 of the National Assistance Act, 1948, provides that the local authority in whose area a person is "ordinarily resident" shall be responsible for the cost of assistance provided by any other local authority. Cases of disagreement are determined by the Minister of Health. It has not been necessary to date to refer any cases for arbitration to the Minister, and all cases in doubt have been amicably resolved. Registration and Inspection of Voluntary and Private Homes for the Aged and Infirm The National Assistance Act, 1948 Section 26, enables local authorities to make use of accommodation for aged and infirm persons 114 in homes established and maintained by voluntary organisations. Section 37 provides for the inspection and registration of such homes including those establishments run in a private capacity. The main requirements are that the homes shall be satisfactory in regard to situation, construction, repair, cleanliness, equipment and staffing. There should be adequate rooms, toilets and bathroom facilities for the numbers accommodated,, and the homes should be conducted to provide such services and facilities as may be considered reasonable for the people using them. At the beginning of the year, the Council had on their register, sixteen voluntary homes providing 753 beds and two privately run homes providing 35 beds. There were no changes during the year. Additionally, however, one home in the borough is registered as a nursing home, and by virtue of an agreement between this home and the former London County Council that a maximum of eight beds would be available for Part III cases, this Council is currently using three beds. Care and Protection of Property Section 48 of the National Assistance Act, 1948, requires the Council to undertake responsibility for the care and protection of movable property of persons admitted to hospital, residential accommodation or place of safety under an order of the Court where it appears there is danger of loss or damage, and where no other suitable arrangements are being or can be made. At 1st January, 1967, the property of twenty people was being stored and in twelve instances, houses and flats had been secured against unauthorised entry. During the year 148 (104) cases were dealt with. It was possible to trace relatives in twenty-nine cases and arrange for them to accept responsibility. The property of ten people was sent to the hospitals in which they were patients. Of the remainder, 75 patients' belongings were taken into store, and 34 premises were secured. Altogether 83 cases were satisfactorily resolved and at 31st December, 1967, there remained 15 homes under surveillance and the property of 43 people still remained under care and protection in store. Burials and Cremations Section 50 of the National Assistance Act, 1948, imposes on the Council the duty to arrange for the burial or cremation of the body of any person who has died or been found dead within the borough where no suitable arrangements have been, or are being, made for disposal. During the year under review, the Council became responsible for the burial of thirty-one (40) persons. The following is a summary of the action takens:- Cases where funeral expenses have been fully recovered 16 (20) Cases where part only of the expenses have been recovered 5 (8) Cases where the full cost has been borne by the Council 10 (12) Cost of burials £820. 3. Od (£885. 0. 6d) Amount recovered £564. 4. Od (£602. 0. 6d) Net cost to the Council £255.19.0d (£283. 0. 0d) 115 In addition6 28 burials and cremations were arranged for persons resident in the Council's homes at the time of deaths which are summarised as follows:- Cases where funeral expenses have been fully recovered 16 (16) Cases where part only of the costs have been recovered 4 (8) Cases where the full cost has been borne by the Council 8 (5) Cost of burials £712. 11. 4d (£738. 5. 6d) Amount recovered £466. 18. 7d (£494. 9. 6d) Net cost to the Council £245. 12. 9d (£243. 16. 0d) Settlement of Estates If a person dies intestate, the local authority is required to arrange the settlement of the estate, provided they have been actively engaged in the provision of services arising from the National Assistance Act, 1948. Such work is carried out in consultation with the Treasury Solicitor. On 1st January, 1967, there were seventy-six estates outstanding. During the year 118 estates were referred for settlement. 103 estates were wound up involving receipts and payments of £3,578, and at 31st December, 1967, a total of 91 estates were still in hand. Receiverships The Chief Welfare Officer is the designated person to act as Receiver, by order of the Court of Protection, on behalf of persons who are deemed to be mentally incapable of managing their own affairs. The duties of the Receiver are defined by the terms of the Court's order and vary in each case. They are usually connected with the day to day administration of the patients' income and welfare, making lodgment into Court of capital monies, the purchase of investment bonds, paying outstanding debts, and arranging for the safe custody of securities. The Receiver has to account annually to the Court of Protection for his action on behalf of the patients. He is also required to take a personal interest in the welfare of patients, to advise and assist them where possible, to be restored to the management of their own affairs, and to submit to the Chief Clerk of the Court any proposals within the patients' means which are likely to ameliorate their condition or add to their comfort. At 1st January, 1967, there were eight persons for whom the Chief Welfare Officer was appointed as Receiver. During the year one person died, leaving a total of seven Receivership cases with a gross estimated value of £14,707.12, 2d and for whom a total sum of £2,802. 6. 6d was disbursed during the year. Application for Receivership Orders have been made to the Court of Protection in two further instances, and one case has been referred to the Official Solicitor. Removal to Suitable Premises of Persons in Need of Care and Attention Under Section 47 of the National Assistance Act, 1948, and the National Assistance (Amendment) Act, 1951, powers are given to the local authority for the compulsory removal of persons suffering from grave chronic disease, or who are aged, infirm or physically handicapped and who are living in insanitary conditions and unable to devote to themselves, or are not receiving from other persons, proper care and attention. 116 Several cases were visited during the year but it was only necessary to take action in four (3) cases,, Two women suffering from a grave chronic disease and aged 81 and 88 years respectively, were removed to hospital. One woman aged 91 years and a man aged 97 years being in need of care and attention were removed to King's Mead„ All four persons eventually died. Training of Social Work Staff The trainee social welfare officers who commenced training in the Autumn of 1966, continued with their programme of visits of observation to other departments and agencies, and during the year were given selected caseloads of their own under close supervision. In September two social welfare officers were seconded to full-time two-year courses, which lead to the nationally recognised Certificate in Social Work. Many of the social welfare officers attended courses and seminars arranged by the London Boroughs' Training Committee and other bodies. Monthly discussion groups were held within the department on different aspects of social work. Arrangements were made for a team of workers from a Geriatric Unit of a London hospital to visit the department and discuss their work with an audience which included members of other sections of the department in addition to the Welfare Section. Participation in Social Surveys The social welfare officers took part in surveys arranged within the department to establish whether there was an unmet need both for accommodation specially, adapted for disabled-persons, and for warden supervised accommodation for elderly persons in which independent living could be maintained. The conclusions drawn from the results will be very valuable in forward planning. The staff also co-operated with the Department of Nutrition of the Queen Elizabeth College of the University of London in a survey of the milk consumption of elderly people in the borough. The results of this survey will be available to the Ministry of Health's panel on Nutrition of the Elderly. Students from other Organisations Six social work students from universities were received into the department for periods of time varying from six days to two months. Visits of observation to homes for the elderly and day centres were arranged, and advanced students were given experience of practical work closely supervised by senior social welfare officers. It is now customary to include in syllabus of training of related professions, aspects of the social services. The department has co-operated in giving trainee nurses and students from other disciplines some insight into the Council's welfare services. Section 8 MISCELLANEOUS SERVICES 117 EMERGENCY CALL SERVICE. This service covers local authority health, welfare and children's emergencies on a twenty-four hour, seven days a week, basis. The scheme is shared between this Council and the City of Westminster and the cost of running the service is divided between the two authorities. It is staffed by four rota duty officers based at Westminster City Hall, who call into action appropriate departmental emergency services when offices are closed, i.e., at night and during week-ends and public holidays. During 1967, 1,207 calls were received for this Council's services necessitating the calling into action of services by the duty officers. The comparable figure for 1966 was 1,549. HEALTH EDUCATION. Health education is a continuing and, to a large extent, a repetitive process and, inevitably, many of the Council's activities follow well-marked paths. This is particularly the case with mothers and children of whom the population is constantly being renewed. The Council have maintained links with the national organisations active in this field - the Royal Society for the Prevention of Accidents, the Central Council for Health Education, the National Association for Mental Health and the National Association for Maternal and Child Welfare, whose publicity and information material is widely used. The panel of senior officers has continued its responsibility for devising and carrying out policy, and the working team of health visitors again undertook detailed planning and preparation. Dr. W.T.D. Ray, Principal Medical Officer with responsibility for the school health service, continued his membership of the ILEA'S Advisory Committee on Health Education. The plan for the year, phased in a similar pattern to that of the previous year, was as follows:- Early months of the year Spread of infection Spring Nutrition and relative matters Summer months Summer health Autumn and winter Accidents in the home, with special reference to fire risks Much of this work attracts little publicity and is not designed to do so since it is carried out by fieldworkers-principally, the health visitors-in the day-to-day course of their work. Special projects, mounted from time to time and emphasising particularly important facets of the plan, are given more publicity and their effect thereby strengthened. The year's pattern was, therefore, of continued daily contact on the one hand and, on the other, the mounting of a number of special projects for which departmental resources were augmented by assistance from other quarters-a campaign in the Spring on nutrition, a campaign at the approach of winter, which included an exhibition on safety in the home, and a careers exhibition which was also designed to give the public a clear idea of the health and welfare service available to them. 118 Nutritional Exhibition at St. Quintin Welfare Centre. From 12th to 19th April, 1967, an exhibition was arranged at St. Quintin Welfare Centre, Kingsbridge Road, W.10., under the theme of "Your Food and You". The aim was to help mothers in the neighbourhood in the preparation of wholesome meals and in the proper use of cooking appliances. Emphasis was laid on the need for food cleanliness and the personal hygiene of all involved in its preparation. Food safety, storage, the keeping qualities of food, adequacy of diets and housekeeping were also dealt with. Valuable assistance was rendered by bodies outside the Council's service, who provided speakers and demonstrations supplementing the stands prepared departmentally. Demonstrations were given by the London Electricity Board and North Thames Gas Board, and students from the Department of Home Economics at Isleworth Polytechnic gave talks on nutritional matters. Voluntary organisations in the borough were approached and asked to inform their members of the exhibition and encourage them to visit it. A particularly interesting part of the exhibition was a display provided by the public health inspectors dealing with means of preserving food apart from the refrigerator and, as a warning, showing samples of blown food in cans. The exhibition was publicised by posters in the vicinity of the Centre, but the attendance was not as good as could have been wished. Health education on this subject was carried out throughout the borough at the same time, and some of the individual display stands were subsequently shown at other welfare centres. Home Safety Campaign. In support of the continuing effort of the department, an intensive campaign was held at the outset of winter and was given particular emphasis in North Kensington, where much old property in multiple occupation by an immigrant and transitory population makes a campaign of this type an annual necessity because of the ever present risk of fire and other accidents in the home. This campaign dealt comprehensively with home risks, e.g., those from poison, the misuse of electricity, gas and oil heaters, falls, etc. An exhibition van toured the borough with a programme of short films and a health visitor to talk to audiences, deal with points raised and distribute suitable leaflets. All fieldworkers in the department, when entering homes in the course of their duty, look for obvious dangers and discuss them with the householders, laying emphasis on the fact that the majority of accidents are due to falls, either off chairs or over obstructions or through defective floor covering. An exhibition, presented at Lancaster Road Welfare Centre, was well attended, particularly by parents living in the locality and by parties of school children. "Kiss of Life" resuscitation demonstrations arranged by the British Red Cross Society formed part of it, and proved extremely popular. It is impossible to assess any direct effect, but there is no doubt that the campaign brought home to many people, especially to those living in North Kensington, the ever present danger of accidents in the home. CAREERS EXHIBITION, APRIL, 1967 - HEALTH AND WELFARE SECTION 119 Careers Exhibition. A Careers Exhibition organised by the Council and held at Kensington Town Hall from 25th - 27th April, 1967, had as its aim, showing to the public the services provided for them and for school children, and particularly those about to leave school, the many activities of modern local government and the careers that can be made in these diverse fields. The Health and Welfare Department participated fully and the departmental contribution, which was a considerable part of the exhibition, was located in the Small Hall of the Town Hall. A photograph taken from the entrance to the Small Hall is reproduced opposite. The work of the personal and environmental health and of the welfare services was illustrated. Environmental health displays covered such matters as atmospheric pollution, defective housing and food hygiene. Examples were shown of infestation in food, blown tins, etc., and hygienic methods of food handling were demonstrated. The work of the Rodent Officers was also represented. Personal health displays portrayed the work of the health visiting, school health, district nursing, nursery nursing, mental health, domiciliary midwifery and home help services. The welfare services shown included residential accommodation for the elderly and services and aids provided for elderly, blind and physically handicapped persons. Officers responsible for the work were in attendance to answer questions put to them about their work. An information stand was set up and gave information about the various careers available in the local authority health and welfare services. A total of 14,000 persons attended the exhibition, included among them seventeen parties from local schools. Talks to Youth Clubs. Following discussions with representatives of the Inner London Education Authority Youth Service, a series of fortnightly evening talks was arranged at the mixed Youth Club at Cardinal Manning School in North Kensington. These talks given by health visitors and a medical officer, under the title "Healthy Living and Loving", covered topics of interest to young people. Health Education in Schools. In November, 1966, an agreement was reached with representative heads of schools that talks given by health and welfare department staff might have a place in the. school curriculum. As a result, five health visitors were making regular visits to schools in the borough to give health education talks, which, during the year, were heard by 4,353 children. The Inner London Education Authority itself has two mobile units, each with a qualified Health Educator. The units consist of a film projector, tape recorder and public address equipment available to take part in school programmes. The units visited eight schools in the borough during the year and illustrated talks on sex education and on smoking were given for an equivalent of twenty-seven sessions. Organised groups of pupils from schools in the borough attended the exhibitions mounted by the Council at St. Quintin and Lancaster Road Welfare Centres already mentioned. In addition, a home safety poster competition for school children produced a number of excellent 120 entries. The winners received prizes made at the Council's Day Centre for the mentally ill, and certificates of merit awarded by His Worship the Mayor. During the week commencing 27th November, 1967, Pierre the Clown, well known for his activities in support of road and other safety campaigns, visited infant and junior schools in the borough and spoke to the children on the care of their teeth. Mental Health Week. 1967. The Council's Mental Health Services featured prominently in the Careers Exhibition held during the year at the Town Hall. Extensive local arrangements were not made, therefore, in connection with the National Mental Health Week, but a display was mounted at the Central Library and Open Days were arranged at the Training Centres for interested members of the public. Home Accidents. Statistics relating to persons admitted to hospital by the London Ambulance Service following accidents in the home are supplied by the Greater London Council. 750 persons (255 males and 495 females) were removed to hospital, as compared with 717 in 1966. The number of children (0-14 years) involved increased from 87 to 114, but there were fewer removals of elderly persons (65 years and over) - 279 compared with 299. Health Education. Talks and Lectures. Details of the talks given by departmental staff and other persons to specialised audience groups follow. Mention should be made of the Mothers' Clubs organised by the health visitors at the Lancaster Road, Walmer Road and St. Quintin welfare centres, at which mothers are encouraged to extend their knowledge of home-making, food preparation, child care and the means to ensure physical fitness. The talks given by the health visitors were supplemented by practical demonstrations. In addition, groups of mothers from these Clubs attended the exhibitions at St. Quintin and Lancaster Road welfare centres described earlier in this Report. TABLE 1 - SPEAKERS Health visitors 1,003 Instructors (ILEA) 50 Domiciliary midwives 5 Other 95 1,153 121 TABLE 2 - SUBJECTS Talks Attendances Care of Mothers and Young Children 706 6,101 Prevention of Accidents 33 561 General Family Health 168 2,886 Infectious Diseases 5 69 First Aid 3 23 Care of Older Children 12 103 Dental Health 4 100 Other 222 2,192 1,153 12,035 TABLE 3 - AUDIENCES Groups Totals Expectant Mothers 576 4,295 Schools 273 4,353 Mothers 271 2,740 Student Nurses 24 423 Pupil Midwives 1 2 Parents 6 182 Clinic Nurses 1 30 Teachers 1 10 1,153 12,035 WATER SUPPLY. The water supply in Kensington and Chelsea is almost entirely provided by the Metropolitan Water Board, but there are four premises which obtain water, used for domestic purposes, from artesian wells. Samples of water were taken both by the Council and the owners for bacteriological and chemical examination, and the results were in all cases satisfactory. Swimming Baths. There are five swimming pools in the borough, two at the Public Baths in SilChester Road, two at the Public Baths in Chelsea Manor Street and one private pool, used by school children, situated in the Kensington Close Hotel. The water used in the pools at Silchester Road and the Kensington Close Hotel is taken from the main supply of the Metropolitan Water Board, and the pools at Chelsea Manor Street are supplied from a deep well situated beneath the baths. In all establishments the water is treated by chlorination and continuous filtration. During the year, samples of water were taken from the pools and from their sources of supply, for bacteriological examination, and all were satisfactory. Regular examinations of the bath waters were carried out by the department, and full chemical analyses were carried out periodically by the Public Analyst. 122 Fluoridation. Fluoridation of water supplies to a level of 1.0 part per million has been shown to be both harmless to health and most suited for the purpose of dental protection. This concentration of fluoride occurs naturally in many parts of the country, and artificial fluoridation in London is intended to make generally available the protection which is enjoyed by these other areas. The Council have agreed to support the general policy regarding fluoridation of water supplies, but no action has yet been taken by the Metropolitan Water Board to introduce the fluoridation of water in the London area. BACTERIOLOGICAL AND ANALYTICAL WORK. During the year, arrangements were continued whereby specimens of milk, water and ice-cream for bacteriological examination were dealt with by the laboratory at County Hall, and all other specimens were sent to the laboratory at St. Stephen's Hospital. The following table shows the total number of specimens examined by the two laboratories:- Nature of sample Number examined Nose and throat swabs 64 Faeces and rectal swabs 458 Urine 66 Milk (bacteriological) 110 Water (drinking) 27 Water (swimming) 44 Ice cream 41 Miscellaneous 43 PUBLIC MORTUARY FACILITIES AND CORONER'S COURT. Since 1st April, 1965, the Council have had an arrangement with the City of Westminster whereby all Kensington and Chelsea bodies are accommodated in the Westminster Mortuary at Horseferry Road, S.W.1., which had been enlarged in order to deal with the extra requirements. The total number of Kensington and Chelsea cases admitted during the year was 487, which included 143 cases in which there were inquests. MEDICAL EXAMINATIONS. During the year, the Council's policy was continued, namely, of no longer requiring prospective employees to undergo a full medical examination before being admitted to the Superannuation Funds, but asking each one to complete a comprehensive questionnaire. Only where an element of doubt existed was the applicant actually asked to attend for medical examination. Number of questionnaires received 513 Number referred for medical examination 13 Number failing to pass 5 Number referred for further opinion 8 Number required to be re-examined within twelve months 11 In addition, thirteen members of the staff who had been on prolonged sick leave were medically examined. Three medical examinations were also carried out at the request of other local authorities. INDEX Page Abattoirs 88 Accidents in the Home 120 Adoptions 29 Adulteration of Food 84-85 Advice Leaflets 112 Area of Borough 7 Artificial Lighting of Common Staircases 74-75 Atmospheric Pollution - Clean Air 68-71 "At Risk" Register 30 Bacteriological and Analytical Work 122 Basement Bakehouses 77 Bathing Centre 48 BCG Vaccinations 24, 49 Births 7 Blindness 37-38, 102-104 Boarding-Out of Children 30 Borough Co-ordinating Committee 42-43 Burials and Cremations 114-115 Cancer 8 Care and Protection of Property 114 Care of Mothers and their Young 27-29 Careers Exhibition 119 Causes of Deaths 8-10 Certificates of Disrepair 75 Cervical Cytology 38 Child Minders 28-29 Children "At Risk" 30-31 Chiropody 39,111 Clean Air Act 68-71 Clearance Areas 71-73 Clinics and Treatment Centres: Ante-natal 27 Child Welfare 27 Dental 51-54 Diphtheria Immunisation 23 E.N.T. 47 Hearing 46-47 Minor Ailments 47 Special Investigation 47 Speech 47 Vision 46 Community Care 56 Composition of Milk 86-87 Compulsory Removals 115-116 Congenital Malformations 30-31 Consumer Protection Act 66 Coroner's Court 122 Creches 28 Cruelty to Animals Act 65 Cytological Diagnosis of Early Uterine Carcinoma 38 Page Day Nurseries 28-29 Deaths 7—10 Dental Health Education 54 Dental Service51-54 Dental Treatment 51-52 Diphtheria 18 Diphtheria Immunisation 23, 48 Discretionary Grants 74 Disease (Notification) 15-18 Diseases of Animals Act 65 Disinfection and Disinfestation 63 Domiciliary Midwifery 31-33 Dysentery 18 Emergency Call Service 55,117 Encephalitis 18 Enteric Fever 18 Environmental Health Services 59-90 Exhibitions 117 Factories and Workshops 75-78 Family Planning 40-41 Fertilisers and Feeding Stuffs Act 65 Fireguards - Loan of 42 Fireguards 66 Fluoridation 122 Food and Drugs Act 82-90 Food Hygiene 82-90 Food Poisoning 18 Food Premises - Inspection and Registration 82-83 Food Surrendered 84 Foreign Bodies in Food 84 General Practitioner Maternity Unit 32 Grants and Loans 74 Handicapped and Elderly Persons 100-109 Handicapped Children 30-31, 46 Health Committee 3 Health Education 117 Health Visiting 33-35 Holidays for Old People 111 Home Accidents 120 Home Help Service 40 Home Nursing 35-37 Home Safety 118 Homeless Families 96-98 Homes for Old People 93-100 Hospital Admissions (Mentally Sub-normal) 56 House Purchase Loans 74 Houses in Multiple Occupation 73 Housing 61-62 Housing Priority on Medical Grounds 75 Ice Cream 87—88 Illegitimate Births 7 Illegitimacy 11-14 Page Immunisation and Vaccination 20-24, 48 Improvement and Conversion of Existing Houses 73-74 Improvement Grants 74 Infant Mortality 7-10 Infectious Diseases 15-18 Infectious Illness in Schools 49 In-Service Training 35 Inspections and Supervision of Food Premises 82-90 International Certificates 20 Introduction 1-2 Kensington Day Centre Limited 113 King's Mead 92 Land Charges 82 Laundry Service for the Aged Incontinent 1ll Legal Proceedings 89-90 Legal Proceedings in relation to Food Hygiene 90 Library Facilities for Old People 11l Licensing Act 82 Liquid Egg (Pasteurisation) Regulations 88 Loan of Home Nursing Equipment 42 Loans and Grants 74 Malaria 18 Marriage Guidance 42 Mass Radiography 24 Maternal Deaths 8 Maternity and Child Welfare 27-29 Meals-on-Wheels 110 Medical Examination of Staff 122 Medical Inspection at Schools 45 Medicinal Baths 62 Mental Health Service 55 Mental Health Week 120 Midwifery 31-33 Midwives Act 33 Milk 85-87 Miscellaneous Services 117 Mortuary Facilities 122 Neonatal Deaths 8 Nightdresses (Safety) Regulations 67 Noise Abatement Act 71 Notification of Congenital Malformations 30-31 Notification of Diseases 15-18 Nurseries 28-29 Nursery Nurse Training 28 Nursing Homes 37 Obstetric Nurse Training 33 Occasional Creches 28 Officers of the Health and Welfare Services4-5 Offices, Shops and Railway Premises Act 79-82 Oil Heaters 66-67 Ophthalmia Neonatorum 18 Old People's Welfare 110-113 Page Outworkers 77 Overcrowding 62, 75 Partially Sighted Persons 37-38, 105 Performing Animals (Regulation) Act 65 Personal Cleansing 62 Personal Health Services 27-43 Personal Hygiene in Schools 47 Pesticide Residues in Foodstuffs 88 Pet Animals Act 66 Pharmacy and Poisons Act 65 Flay Group 29 Poliomyelitis 18 Poliomyelitis Immunisation 22, 48 Population 7 Preface 1—2 Prevention of Damage by Pests Act 63-64 Protection of Animals Acts 65 Psychiatric Day Centre 55 Rag Flock and Other Filling Materials Act 65-66 Rateable Value 7 Rats and Mice 63-64 Receiverships 115 Recuperative Holidays 39 Registration of Food Premises 83 Remedial Foot Classes 48 Residential Accommodation for the Elderly 92-96 Riding Establishments Act 65 Rodent Control 63-64 Safety in the Home 118-120 Sanitary Inspection 60-62 School Health Service 45-49 Screening Tests of Vision and Hearing 46 Seizure of Unsound Food 85 Settlement of Estates 115 Slaughterhouses 88 Slum Clearance 71-73 Smallpox 18—19 Smallpox Vaccination 24,48 Smoke Control Areas 68-69 Social and Rehabilitation Centre 112 Staff 4—5 Standard Grants 74 Stands for Carry-Cots (Safety) Regulations 67 Statistics - Dental Health 51-54 Environmental Health 60-88 Mental Health 58 Personal Health 27-43 School Health 45-49 Vital and Social 7-10 Welfare 91-116 Stillbirths 7 Sub-normal Children 56-57 Suicide 8,10 Surrender of Unfit Food 84 Swimming Baths 121 Page Task Force 112-113 Temporary Accommodation 92,96 Tetanus Immunisation 23,48 Town Planning Applications 82 Toys (Safety) Regulations 67 Training Centres for the Mentally Ill 56-57 Training of Nursery Nurses 28 Training of Pupil Midwives 33 Training of Welfare Workers 116 Tuberculosis - Care and After-Care 19-20 Notifications, deaths, etc. 19-20 Vaccination 24 Visiting 19 Unclean Milk Containers 86 Unmarried Mother and her Child 98-100 Unsound Food 84 Vaccination and Immunisation 20-24,48 Vital Statistics 7-10 Voluntary Child Minders 28-29 Voluntary Visiting of the Elderly 113 Voluntary Homes for the Aged and Infirm 96-100 Water Supply 121-122 Welfare Services 91-116 Welfare Committee 3 Whooping Cough Immunisation 23 X-ray Units 24